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Situation report 22

Although no outbreaks have been reported, the risk of outbreaks has not passed. Given the damaged infrastructure, increases in isolated cases of water-borne, respiratory and vector-borne diseases are to be expected. However, the strength of the international response - and in particular, the focus on delivering water purification tablets, getting water and sanitation systems in place as far as possible, and getting water and sanitation experts on the ground, has helped to prevent more cases of water-borne illness from occurring.

Summary

• No disease outbreaks reported.
• Strengthened disease surveillance systems in Sri Lanka, Thailand and India and the early warning system that has been put in place in Aceh are working well. Cases and rumours of cases have been reported and investigated. So far, no outbreaks of disease have been identified, despite reports of a number of isolated cases.
• The U.N. General Assembly discussed the tsunami disaster in a special plenary session on the 18-19 January. During this session, Member States adopted, by consensus, a resolution on Strengthening Emergency Relief, Rehabilitation, Reconstruction and Prevention on the Aftermath of the Indian Ocean Tsunami Disaster.

Health Priorities

Communicable Diseases

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

• India: There are no reports of disease outbreaks.
• Indonesia: There are no reports of disease outbreaks. Cases of diarrhoea have been confirmed as shigellosis in Bandeh Aceh. Active case-finding revealed no further cases. Other rumours of acute watery diarrrhoa have been investigated but found to be unsubstantiated. Malaria control programmes are currently being planned on the Nias Islands as there are concerns that the environment there is highly conducive to mosquito breeding.
• Maldives: There are no reports of disease outbreaks.
• Sri Lanka: There are no reports of disease outbreaks. Spraying for mosquito and fly control and a stagnant water drainage program are underway; more vector control equipment including chemicals and bed nets is needed.
• Thailand: There are no reports of disease outbreaks.

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

Clean water and sanitation saves lives and protects health.

• India: WHO continues to provide technical assistance for monitoring microbiological contamination of water.
• Indonesia: In Pante Kuyen, one of the areas visited by the rapid health assessment teams, drinking water is supplied from the river and from hand-dug wells, which have significant amounts of waste water nearby. This can encourage mosquito breeding. In Alue Bilie, hand-dug wells with a water table ranging from 1 to 1.75 meter and sometimes muddy and contaminated water are used for bathing and cooking. Bottled water, rainwater and newly constructed open wells are used for drinking. There were no latrines.
• Sri Lanka: A WHO water and sanitation rapid assessment in nine camps in Batticoloa reports problems with both clean water and sanitation. For water, it was discovered that people are using contaminated wells and there are problems with water quality surveillance and chlorination. For sanitation, they reported on inadequate latrine cleaning, poor hygiene practices, and inadequate waste collection. The team recommends training materials on hygiene standards to be distributed. Water and sanitation experts, after evaluating wells around the camps, suggest that pumping out contaminated water may do more damage to the water table than sealing wells and allowing natural cleaning to take place.

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: WHO continues to provide psychosocial support.
• Indonesia: A team from Hellen Keller International coordinating with other NGOs conducted a rapid nutrition assessment and anaemia testing on Nias Island. As a result, they are providing nutritional supplements to mothers and children under five.
• Sri Lanka: WHO has assisted the government in developing a plan for psychosocial and mental health for people affected by the disaster. The plan includes training of health professionals, developing guidelines to help avoid harmful practices and coordinating the work of different agencies. A Canadian NGO is providing training on post-traumatic stress in Ampara.

Health system and infrastructure (functioning health facilities, access)

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

• Indonesia: Public health infrastructure is almost totally destroyed in the northwest of Simeulue Island, off the coast of Aceh. There is a lack of adequate shelter. Family sized long life impregnated mosquito nets are urgently needed. A mobile clinic in North Aceh has been established and is distributing impregnated mosquito nets, soap, and food and water supplies. In Pante Kuyen, one of the areas visited by the rapid health assessment teams, there are 875 local people and 156 Internally Displaced People (most of whom preferred to stay as they have relatives in the villages). Currently there are no health services and no disease surveillance in the village as the health facility closed three years ago for security reasons. The closest facility was destroyed. However, the population is reported to have reasonably good health and no moderate or severe malnutrition was observed. There are currently 12 pregnant women in the community. 12 births (and no resulting deaths) have taken place since January 1. In Alue Bilie, another area visited by the rapid health assessment teams, Internally Displaced Peoples (IDPs) wish to rebuild their homes as soon as possible. The Indonesian government is constructing a semi-permanent settlement for around 250 people that could become overcrowded. There is no sustained NGO presence. Food insecurity is a considerable problem.
• Sri Lanka: A WHO rapid assessment report has suggested the testing of Ministry of Health Mass Casualty Management plans through training and simulated drills. Many districts lack a health sector emergency preparedness and disaster response plan.

WHO Country Information

India: WHO has provided emergency supplies to support health services, including surgical and emergency health kits, 1 000 chloroscopes, 10 000 impregnated bednets, insecticide for bednets, and 100 000 oral rehydration salts. Additionally, WHO has deployed technical experts to support disease surveillance, immunization activities, mental health work, and water and sanitation / environmental health programmes. A WHO team of technical experts and the Joint Director (Epidemiology) from the National Institute of Communicable Diseases and representatives from the Indian goverment have visited the States of Tamil Nadu and Kerala and the Union Territory of Pondicherry to make an assessment on progress made for disease surveillance and other public health needs. Sirombu, a coastal town on Nias Island, has become a centre for displaced people.

Indonesia: WHO has established an Integrated Disaster Management Information Office in the Ministry of Health which works with the Ministry of Coordination. The inter-agency rapid health assessment team conducted its final day of assessments along the west coast of Aceh, deploying two teams by helicopter to two areas, Pante Kuyuen and Alue Bilie. Based on information gained in these assessments, WHO and the Ministry of Health will in the next 30 days, support the local health sector until critical gaps can be addressed, assess the IDP situation, focusing on health services, water/sanitation, camp planning, food distribution, and protection and work to include these areas into its disease surveillance and outbreak early detection system. Also based on the conclusions of the off-shore assessments, the Integrated Disaster Management Information Office has identified the following gaps: 1). Although NGOs continue to arrive in Banda Aceh (two more field hospitals from Turkey Red Crescent, a Japanese emergency team (Jica) and 7 other NGOs have arrived) there are some areas where no one yet is willing to work for security reasons. 2). Vaccination campaigns against measles and needed. 3). Improved water and sanitation in Banda Aceh and the west coast is needed. 4). There is a shortage of local human resources including drivers, translators and people to dig latrines. WHO continues to strengthen its presence in Meulaboh and Medan.

MAP: Number of deaths in the Aceh province

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Sri Lanka: Proposals have been received under the flash appeal fund and will be grouped under these headings: Coordination of health sector response; Epidemiological surveillance; Prevention and control of communicable and vector borne diseases; restoration of basic health facilities; psycho-social and mental health support; and Water and Sanitation.

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 following: