Humanitarian Health Action

Situation report 23

21 January 2005

No disease outbreaks have been reported. However, the risk of outbreaks has not passed. Given the damaged infrastructure in Aceh there is a precarious situation and the public health system is straining to stay ahead of a wide range of threats to a severely weakened and still disoriented population. However, the hard work of local people in responding to this disaster, the local capacity that governments have built up over the past couple of years, and the strength of the international response has so far kept this threat at bay.


  • No disease outbreaks have been reported.
  • Disease surveillance systems have been strengthened in Sri Lanka, Thailand, and India. The early warning system that has been put in place in Aceh is working well. Cases and rumours of cases have been investigated.
  • Mark Malloch Brown, Chair of the United Nations Development Group and Jan Egeland, the UN Emergency Relief Coordinator will co-chair a meeting in New York on 28 January to maintain the momentum of the international community's focus on the response requirements. They will stress that pledges need to be converted into contributions and highlight the importance of also funding immediate recovery activities.

Health Priorities

Communicable Diseases
  • India: There are no reports of disease outbreaks.
  • Indonesia: A reported measles case led to an immunization campaign of children aged 6 months to 14 years of age in Aceh Besar. Médecins Sans Frontières (MSF) investigated acute watery diahorrea cases from south of Meulaboh and ruled out cholera.
    Additional shigellosis dysentery cases were identified in Secata Internally Displaced Persons (IDP) camp. Daily surveillance has been activated. Reports of tetanus cases are being analysed; this analysis will assist in better targeting prevention measures. The strengthening of surveillance and reporting from four major hospitals in Banda Aceh is required.
    A generous outpouring of donations targeting malaria control efforts have been made available. These include some 100 000 insecticide-treated mosquito nets, 20 000 rapid diagnostic tests for malaria and 150 000 treatment courses of artemisinin-based combination therapy.
  • Maldives: There are no reports of disease outbreaks.
  • Sri Lanka: There are no reports of disease outbreaks. The Ministry Of Health Epidemiology Unit reports immunizations taking place in most camps. Three cases of chicken pox have been detected in Galle City and have been isolated and treated. Laboratory assessment has been provided by WHO. WHO continues to work with the Ministry of Health in strengthening disease surveillance. Surveillance data, including the number of cases of watery diarrhoea, is now being collected from all hospital outpatient departments. The Ministry of Health currently has no way to collect laboratory specimens in the field and so has expressed the need to address this issue.
  • Thailand: There are no reports of disease outbreaks. The Ministry of Health continues to strengthen disease surveillance for vector borne diseases. The Ministry of Public Health is gradually handing over disease surveillance activities to the provincial health authorities.
Environmental Health (access to safe water and hygiene, sanitation situation)
  • India: Progress has been made in restoring water supplies in the Andaman and Nicobar Islands: 83% of the public supply has been restored on Car Nicobar, 45% on Teressa, 60% on Nancowary and almost full supply on Kamorta. Furthermore, contaminated water has been pumped from wells and bottled water has been supplied to relief camps on Katchal.
  • Maldives: WHO continues to provide technical support for water and sanitation issues. The United Nations Environment Program (UNEP) has raised concerns over risks posed by asbestos contained in the debris of destroyed buildings. The issue is being investigated.
  • Myanmar: The UN estimates that approximately 10 000 affected people in the Irrawaddy delta area and several thousand more in Tanintharyi may be in urgent need of food, water, basic health assistance and shelter. Food security needs to be ensured, basic sanitation facilities (latrines) need to be installed, and clothing for displaced people is needed.
  • Sri Lanka: Ongoing assessments have identified work needed on water tanks, wells and water pipes to supply schools. Forty water tanks will be installed and repairs will be made to pipe lines from 21 to 24 January. Although latrine construction work in Batticaloa has been hampered by heavy rains, this still remains a priority in all affected districts. WHO and UNICEF are developing materials to improve hygiene practices in camps and schools.
  • Thailand: The Ministry of Health and the CDC are conducting rapid environmental health assessments.
Other health issues (Mother and child health, mental health)
  • India: WHO, UNICEF and UNDP have developed a framework for the training and provision of psycho-social services and have identified agencies to provide training to teachers, local community workers and community level volunteers using standard manuals. WHO and its partners will also work with the community in the affected areas. The Jawaharlal Institute of Postgraduate Medical Education & Research in Pondicherry, a WHO collaborating center, will provide a range of psycho-social support activities for disaster relief workers including: training programs; field visits to assist relief workers; assistance in recognizing emotional disorders in affected communities; and treatments for victims.
  • Indonesia: WHO finalized a comprehensive strategic plan to address psychosocial needs and emerging psychiatric disorders in the population affected by the tsunami in the Aceh region. The plan will be discussed with the Ministry of Health on 24 January and presented to other UN agencies and major NGOs on 26 January. It addresses several issues including: assessment of mental health needs, mapping of mental health activities in Aceh, provision of guidelines, training of community leaders and strengthening of the mental health care system including the Aceh Psychiatric Hospital. The plan provides a detailed description of necessary actions during the emergency, rehabilitation and reconstruction phases.
  • Myanmar: The Tsunami Liaison Group has begun a second round of assessments of longer term needs of the affected population. The group is evaluating clean water sources, damage to soil and crops and destruction or damage to houses, fishing boats and nets. WHO is focusing its support on reducing the risk of disease outbreaks and morbidity by supporting disease surveillance and providing emergency medical supplies as requested by the Ministry of Health.
  • Sri Lanka: Communication materials addressing pre-natal and child health issues are currently being developed. Mahamodara Maternity Hospital, which had 1200 deliveries per month before the disaster, has been severely damaged, leaving the city of Galle with a serious shortfall of delivery services. WHO and local officials have recommended that the Ministry Of Health support home visits until the capacity of inpatient delivery services in Galle can be improved. WHO continues to work with national authorities, other UN organizations and NGOs to develop and implement a psycho-social support strategy for affected populations. In Galle, the Psychiatric Department and the Pediatric department of the Medical Faculty of Karapitiya is trainung 150 pre-intern Doctors on psychosocial support for the affected families.
  • Thailand: The Mental Health Department has set up a command center for psycho-social services at their regional center in Surat Thani (about 2 hours drive from Phuket and Phang Nga). Mobile teams of psychologists and counselors are visiting villages affected by the disaster. They are rotating every six days in order to avoid burn out among staff.
Health system and infrastructure (functioning health facilities, access)
  • India: The government is planning an assessment of the health infrastructure, human resources, health information and referral system, provision of medicines and drugs and medical equipment and resource availability in affected areas. In Car Nicobar there are currently 19 doctors and 38 residents. Seventy outpatients are being treated and 324 people are receiving medical attention at the camps. There is one doctor on Teressa treating patients in all the camps. On Katchal, Nancowary and Kamorta there are five doctors and a Community Health Centre at Kamorta is now functional. WHO continues to work with the Ministry of Health and UN Agencies through the UN Disaster Management Team (UNDMT) to provide assistance with identified public health needs such as communicable disease surveillance, environmental health, and mental health.
  • Myanmar: Basic public health services, already precarious prior to the tsunami, need to be restored. Public health education is also required. WHO has provided medical supplies to provide basic care to more than 50,000 people for a period of three months, as well as more than 20,000 anti-malarial drug treatment courses. The Ministry of Health is preparing a proposal to request WHO assistance in improving disaster preparedness and management for the future. This includes technical assistance to strengthen Ministry of Health disease surveillance and to detect outbreaks of communicable diseases, including measles, diarrhoeal disease and vector-borne diseases in a timely manner.
  • Sri Lanka: Overall, the situation continues to improve. The number of displacement camps continues to reduce, from 161 to 53. Damaged health clinics have been replaced by temporary health centres. The WHO sub-office in Galle has reported that all camps have either easy access to fixed health facilities or are visited regularly by mobile clinics. The Government of Sri Lanka has announced that financial support (in the amount of Rs 5,000) will be made available to each family affected by the tsunami, as start-up grants following the disaster. Additionally, the government announced a temporary shelter strategy, making various options available to families including returning to their own land, re-location to a new plot, living with relatives, living in temporary settlements, and a food coupon system.

MAP: Medical supply distribution in Sri Lanka

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:

Donor Contributions received (USD) Firm Pledges (USD) Soft Pledged (USD) Location/comments
WHO Director General Office 100,000 Region
Australia 774,593 Indonesia
Canada 1,229,508 Region
Denmark 2,313,058 Indonesia
EC/ECHO 678,426 Indonesia
Finland 2,035,278 Region
France 5,427,408 Region
Japan 6,000,000 Indonesia, Sri Lanka, Maldives
Luxembourg 1,017,639 Region
Republic of Korea 1,000,000 Region
Netherlands 2,442,334  Indonesia
Norway 6,000,000 Region
Poland 100,000 Region
Portugal 542,741 Region
Saudi Arabia 500,000 Region
Sweden 5,295,008 Region
Switzerland 884,956 Region
UK/DFID 100,000 Region
UK/DFID 3,831,418 Region
UK/DFID 1,149,425 Indonesia
UK/DFID 1,149,425 Indonesia
USA/USAID 291,500 Indonesia
TOTAL 7,840,466 26,862,178 5,717,739
Vienna Philharmonic 156,038 Region
Online donations 90,588 Region
SMS donations, South Africa 206,157 Somalia
Other private donations 150,549 Region
TOTAL 603,332
Grand total: 41,023,715

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.