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Situation report 20

In some places - particularly in Aceh - access to the basic needs of water, sanitation, and hygiene is still not adequate. In other places, such as southern India, Sri Lanka and Thailand, the focus has moved more to planning for rehabilitation and reconstruction. Disease surveillance continues to be strengthened across the region in order to rapidly identify potential outbreaks. Experts are standing by in the case of an outbreak.

Summary

• Helicopter-based rapid health assessments continue in previously inaccessible areas of Aceh. Identification of local needs allows for increasingly targeted public health action. Supply chains must be reinforced as vital systems and lifelines remain broken.
• No disease outbreaks have been confirmed in any of the affected areas throughout Southeast Asia. As the risk of outbreaks remains high, control and preparedness measures are being augmented to rapidly respond. Surveillance is key to an effective response as this allows the rapid identification of an outbreak, the first step in responding.
• WHO recommends that mental health and psychosocial care have a high profile in the relief and reconstruction work

Situational Updates

* Please note that this information has been corrected and updated as additional information became available.

Health Priorities

Communicable Diseases

Across the region, WHO has put in place or strengthened surveillance systems and has prepared stockpiles and teams of experts to respond in the case of an outbreak.

• India: No disease outbreaks have been reported. The daily surveillance for Acute Diarrhoeal diseases (ADDs), Acute Respiratory Infections (ARIs), measles, fever, skin diseases and chicken pox has been strengthened. WHO continues to provide technical assistance for laboratory surveillance for Shigella and Cholera and technical assistance for communicable disease surveillance. WHO will support HIV awareness campaigns in the Tsunami affected areas of Tamil Nadu, Pondicherry, Kerala and Andhra Pradesh. The deteriorated living conditions and increased vulnerability of the affected populations makes this a priority. This campaign will take place in conjunction with psycho-social activities already underway.
• Indonesia: No outbreaks have been reported. In the past four days more than 16,000 children have been vaccinated for measles in a campaign coordinated by the Ministry of Health (MoH) in cooperation with WHO, UNICEF, Medicins Sans Frontiers (MSF) and Medicins du Monde (MDM). Disease surveillance continues to be strengthened with daily telephone data collection. A rapid deployment team investigated reports of suspected cholera cases in an area south of Meulaboh. However, no cases of illness suggestive of cholera were identified.
• Maldives: No disease outbreaks have been reported.
• Sri Lanka: No disease outbreaks have been reported.
• Thailand: No significant outbreaks were detected. 111 new cases seeking care were reported on 16 January 2005. 85 diarrhoeal syndrome cases were reported with 1 death (a 9 month old girl in Phang Nga). One more case of mumps was reported in Phang Nga.

Environmental Health (access to safe water and hygiene, sanitation situation)

Clean water and sanitation saves lives and protects health.

• India: WHO is providing technical assistance for monitoring the microbiological contamination of water.
• Indonesia: While the availabilty of food and water is improving in the affected areas, sanitation and waste disposal continue to be a problem.
• Maldives: A WHO team visiting Thilafushi, a reclaimed island used for disposal of municipal waste,warns that the slow burning of plastics on the island could lead to dioxins entering the food and water chain. The environmental effect of large quantities of plastic containers used to distribute water to affected populations needs also to be examined.
• Sri Lanka: Sanitation is a major challenge in temporary camps due to the high water table in coastal areas which reduces the effectiveness of latrines. UNDAC's rapid environmental impact assessment team recommends setting up a program to manage the considerable amount of debris and waste deposited by the tsunami. UNDAC also provided useful technical solution to address the problem of digging latrines in areas of high water tables. The numbers of camps and of displaced people are decreasing in Ampara and Kalmunai.

Other health issues (Mother and child health, mental health)

The tsunami and earthquake affected vulnerable populations such as women, children, elderly, poor more than most

• India: After identifying the need for psycho-social support for the affected population, WHO has worked with the Collaborating Centres, Medical Schools and other partners to identify priority needs and strategies to meet them. Psychosocial support services will be integrated with other health activities. Various providers have been identified in the affected districts and they will be trained using standardized manuals from the WHO Collaborating Centres.
• Indonesia: The inter-agency rapid health assessment team working on the western coast of Aceh report that women and children were disproportionally affected by the tsunami. In some villages, there are no surviving children under the age of five and only small numbers of women.
• Sri Lanka: WHO reported a shortage of formula supplies for infants. The World Food Programme (WFP) has supplied Corn Soya Blend (2600 metric tones for all children aged 6 months to 10 years) to be distributed with the assistance of district health staff.

Health system and infrastructure (functioning health facilities, access)

Relief work must support the reconstruction of a sustainable health system.

• The World Bank in collaboration with the national authorities, the Asian Development Bank and the UN is conducting a first assessment of recovery and reconstruction needs for the Maldives, Indonesia and Sri Lanka, which will be completed in January 2005. A more comprehensive needs assessment exercise for Indonesia and Sri Lanka, which could take approximately 6-8 weeks will start thereafter.
• Indonesia: In the town of Banda Aceh at least ten field hospitals and four local hospitals are operational on a limited basis due to reduced local medical staff (from 700 to 30) and the need for substantial cleaning and repair work. Remote locations along the west coast still lack adequate medical facilities as the existing ones are not fully operational due to extensive damage and lack of staff. NGOs running mobile clinics and visiting camps have not been able to provide enough coverage. Public health laboratories capable of bacteriological testing and virology have been established in Banda Aceh and in Meulaboh. The MoH and WHO will deploy a permanent mission in Meulaboh, consisting of a coordinator, an epidemiologist, a logistician and a laboratory technician.
• Maldives: The MoH has said that 80 portable oxygen tanks are urgently required and a formal request will be made to WHO. In addition, WHO will assist with procuring equipment for primary health care, obstetrics and gynecology and minor surgery. The German Red Cross will reconstruct and repair equipment in four partially functioning health centres and provide first aid kits for all health facilities.
• Sri Lanka: The government of Sri Lanka estimates that it will need US$1.5 billion to carry out immediate rehabilitation and reconstruction to be focused on 13 areas including the development of roads, railways, telecommunications, water supply and sanitation.

WHO Country Information

India: 17,680 tents have been dispatched to the affected States of which 15,612 tents go to Andaman & Nicobar (A&N) Islands. All Relief camps have been closed in Andhra Pradesh and Pondicherry. People from relief camps in Kerala and Tamil Nadu have started going back to their villages. However, relief camps in A&N Islands have increased and more people are being accommodated.

Indonesia: The rapid health assessments by helicopter continued for a fourth day, along the west coast of Aceh. Assessments indicate that while food aid, consisting largely of cereals, is reaching the displaced populations. While water supply is available at most displacement camps, quality testing must be continuous, as some of the temporary water wells may have been contaminated. Lack of sanitation in the displacement camps is a major concern, with insufficient numbers of latrines. In one camp, no latrines are available for more than 700 displaced people. Urgent needs also include water storage containers, soap and personal hygiene education programmes. UN agencies, NGOs, military forces, government bodies and other agencies involved in health activities have worked together to form sub-groups for: hospital care and field hospitals; primary care and mobile clinics; communicable diseases; logistics and medical supplies; psycho social assistance; and water and sanitation. Each group is responsible for coordinating the large number of organizations working in that sector. WHO has organized a workshop for January 18, 2005 to plan operations over the coming six months and for the longer term. WHO is supporting the Provincial hospital and providing a warehouse to accommodate supplies from other agencies and assist them with distribution.

Maldives: WHO has responded to government concerns regarding the fear of contamination of fish and seafood by corpses. According to FAO/ WHO, there is no evidence that fish and seafood borne illnesses have increased in Asian countries hit by the tsunami and no evidence, epidemiological or otherwise of any increased risk.

Sri Lanka: The government has initiated action to establish a data bank on relief organizations (NGOs, government, private sector), assistance (requests for help, offer of help) people data (missing, dead, separated), and monitoring of relief items. The government also issued a press statement today saying it will launch a housing scheme for the homeless.

MAP: Sri Lanka - humanitarian agencies providing medical supplies and medicine

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Through the Emergency Health Action Programme for South-East Asia, the financial requirements for WHO’s health response over the forthcoming six-months period is assessed at US$67 million. WHO thanks the Vienna Philharmonic Orchestra (cash) and the governments of Australia (cash), Canada (in kind), Denmark (in kind), Finland (cash), France (cash), Germany (in kind), Italy (in kind), Japan (cash), the Netherlands (cash), Norway (in kind), Poland (cash), Portugal (cash), Kingdom of Saudi Arabia (in cash), Sweden (in cash), Switzerland (in kind and in cash), the United Kingdom (DFID in cash and in kind), and the United States (USAID in cash) for recent and early contributions. Expressions of support from individuals around the world are overwhelming.