Humanitarian Health Action

Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010

Highlights

  • In Khyber Pakhtunkhwa, acute diarrhoea (AD) accounted for 3 807 (17%) of the total patient visits in all age groups and is the leading cause of morbidity in the flood affected districts. Acute respiratory tract infections (both upper and lower) were recorded in 3 255 (15%) patient visits. Skin infections were reported in 4 122 (19%) of the patients.
  • In Punjab, skin diseases were reported in 6% of total patient visits and were the leading cause of morbidity among affected communities while acute diarrhoea accounted for 6% of patient consultations.
  • In Baluchistan, the leading causes of morbidity are diarrhoea, and scabies. In Sindh, Acute Respiratory Infection (ARI) was the leading cause of consultations followed by skin infection and acute diarrhoea. Suspected cases treated for malaria are rising as more areas with stagnant waters emerge.
  • Rumors of confirmed cholera cases are pouring in. In accordance with Article 9 and 10 of International Health Regulations (2005), WHO has requested the Ministry of Health for a verification of the news item reported in the international media regarding the cholera case from Mingora town of Swat district; and WHO has requested for a notification if any risk assessment has been carried out using the decision instrument and the result, as stipulated in the Annex-2 of IHR (2005).
  • Medical Emergency Relief International (Merlin) and Malteser International are conducting health interventions in response to reported cases of diarrhoea in Mingora town in Swat District.
  • International support has started to build-up through the deployment of medical teams and donations of essential medicines. Indonesia has deployed 5 medical doctors and 10 paramedics in Nowshera. On 15 August, Sri Lanka will send 7 medical doctors, 6 nurses and 2 pharmacists to Sukkur and Jordan will deploy 25 medical doctors and pharmacists in Multan. Hungary, USA and Italy are also sending medical teams to support the humanitarian work in flood affected areas.
  • The National Health Emergency Preparedness and Response Network (NHEPRN) of the Federal Ministry of Health is leading the health interventions in all affected districts. All health activities are coordinated with provincial/district departments, WHO (Health Cluster lead), UN agencies, national and international agencies.

Situation overview and current scope of disaster

Based on the latest data from the National Disaster Management Authority (NDMA), the affected population is over 14 million. The number of deaths has reached 1 392 while the number of injuries has reached 1 985.

Health situation/ alerts and outbreak

  • The leading causes of morbidity in flood affected communities are: skin diseases, acute watery diarrhoea, and acute respiratory infections.
  • Rumors of confirmed cholera cases are pouring in. In accordance with Article 9 and 10 of International Health Regulations (2005), WHO has requested the Ministry of Health for a verification of the news item reported in the international media regarding the cholera case from Mingora town of Swat district; and WHO has requested for a notification if any risk assessment has been carried out using the decision instrument and the result, as stipulated in the Annex-2 of IHR (2005).
  • As response to cases of diarrhoea in Mingora, Medical Emergency Relief International (Merlin) and Malteser International are conducting health interventions in affected areas.
  • Fifty-six (56) out of 62 flood affected districts from the provinces of KPK, Punjab, Sindh and Baluchistan shared daily disease surveillance data for 11 August. One new alert (false) of suspected hemorrhagic fever was reported from CH Nawagai, district Buner in Khyber Pakhtunkhwa.
  • Cholera is endemic in Pakistan and in the current emergency situation it is anticipated that cholera cases will occur sporadically amongst the susceptible population in the affected areas. Therefore the threat of cholera in the flood affected communities remains high. In order to avoid excess mortality, it is important that all acute watery diarrhoea cases with severe dehydration have easy and rapid access to standardized treatment.
Sindh situation
  • Sindh’s situation is getting critical. By 14 August, 300 000 people have evacuated using the road and railway. Based on reports from the ground, water is entering Shahdadkot Qamber and likely to also flood Larkana. In Karachi, 4 areas (Toll Plaza, Kimari Town, Bin Qasim and Gaddab Town) have been dedicated by city administration to host the affectees.
  • The Government is planning to establish big camps in 3 locations: Hyderabad, Jamshoro and Karachi. Furthermore, 35% of the Sindh is under water. Upper Sindh districts which where hosting the affectees from Sukkur, Khairpur, Dadu, Ghotki and Shikarpur do not have the capacity to host any more affectees.
  • Kashmore and Jacobabad are totally under water while Ghotki, Sukkur, Larkana and Qamabar Shahdadkot, Dadu, Nausehro Feroz and many others are partially flooded. In Southern Sindh only a few districts have dry land and some capacity to host the affectees.
  • The Sindh affected population has reached 2.25 million and figures and is expected to reach 3 million easily in the coming days. According to PDMA 4 Army and 2 Navy helicopters are evacuating people and thousands are still stuck in flooded districts. Around 900 000 people are on the move in the last few days. There are 200 boats currently evacuating the population.
Khyber Pakhtunkhwa (KPK)
  • From Khyber Pakhtunkhwa, 122 health teams and static health facilities from 8 flood affected districts shared daily reports. A total of 21 813 patient consultations were reported. Acute diarrhoea (AD) accounted for 3 807 (17%) of the total patient visits in all age groups and is the leading cause of morbidity in the flood affected districts of Khyber Pakhtunkhwa. Acute respiratory tract infections (both upper and lower) were recorded in 3 255 (15%) patient visits. Skin infections were reported in 4 122 (19%) of the patients.

The trend of diarrhoeal disease shows an increasing number of patients expected in the period 7 – 15 days after contamination of water sources. A high number of diarrhoea cases in the districts of Charsadda, Swat, Peshawar and Nowshera are being reported. WASH interventions underway but further expansion is needed in these districts as more areas become accessible. If the clean drinking water supply is not supplied and environmental hazards are not addressed in time, it is expected that waterborne disease outbreaks will occur more frequently in the affected community.

Punjab province
  • In Punjab province, 28 flood affected districts shared the daily disease report. From these districts, 535 health facilities including 368 mobile teams and 167 static facilities are providing health services to the affected communities in Punjab. On 11 August, a total of 143 983 patient consultations were reported. Skin diseases were reported in 6% of total patient visits as the leading cause of morbidity. Acute diarrhoea accounted for 6% of patient consultations and a high number of diarrhoea cases were reported from Muzafargarh.
Baluchistan Province
  • In Baluchistan, 4 flood affected districts shared daily disease reports on 11August. A total of 2 238 patient visits were reported with 514 (23%) cases of diarrhea, 285 (13%) upper respiratory tract infections and 409 (18%) cases of scabies. Since 29 July, a total of 10 629 patient visits were reported from 20 health facilities in flood affected areas. Diarrhea was recorded in 2 386 (22%) patients, malaria in 2 187 (21%) patients and scabies in 2 070 (19%) patients.
  • Between 29 July and 11 August, 61 snake bites have been reported from district Naseerabad and Jaffarabad.
  • A high proportion of acute diarrhoea also has been reported in districts Jaffarabad and Naseerabad. The diarrhea cases visiting the health facilities/mobile teams are presenting with mild symptoms of diarrhea. Health hygiene education sessions are being conducted involving lady health workers (LHW) and water purification tablets have been distributed in the affected community.
Sindh Province
  • In Sindh, daily disease surveillance reports were received from 342 health facilities (99 mobile teams and 243 fixed facilities) in 16 flood affected districts. A total of 21 493 patient visits were reported from the fixed facilities and mobile medical camps were established in the districts.
  • In Sindh, ARI was the leading cause of consultation and accounted for 17% of total visits followed by skin infection (17%) and acute diarrhoea (14%). A high numbers of diarrhoea cases are also being reported from districts Kashmor, Sukkur, Ghotki, Khairpur and Dadu. Health education in these districts is being conducted by LHWs. Strong WASH interventions are highly required in these districts.

  • Results of initial rapid assessments in flood areas show that out of 1 167 health facilities, 189 facilities have been damaged or destroyed in 4 flood affected provinces. Table below shows the damaged or destroyed facilities by district.

Health cluster response

Care International is supporting 4 basic health units (BHUs) in Upper Swat (Bahrain, Tirat, Miadem & Chail). It is also providing primary healthcare services through 2 mobile clinics in Upper Swat which cover the union councils of Bahrain, Bishigram, Tirat and Miadem. Since the onset of floods, Care International’s mobile teams have attended to 5 026 consultations.

One mobile clinic of the Church World Service is providing essential medicine and consultations for patients with a special focus on women and children in Tehsil Balakot, Mansehra. On 12 August, 1 401 consultations were made and patients were given free essential medicine by the mobile health unit.

International Medical Corps teams have provided health services to 613 people and psychosocial services to 32 people in Charsadda, Nowshera and Peshawar. Psychosocial services were provided to people with psychosomatic, psychological distress, anxiety, phobic anxiety, and depression. IMC’s medical officers and lady health volunteers are also conducting regular health education sessions and provide preventive information through health messages to individuals and families for behavior change. In addition, IMC distributed 120 hygiene kits at the Government Higher Secondary School City -1 in KPK.

Medical Emergency Relief International (MERLIN) is continuing its provision of health services to flood affected communities in Swat, Buner and Nowshera districts. On 12 August, a total of 5 034 consultations were conducted. Merlin is providing primary health care services to flood affected communities in 3 districts through 26 static clinics located in Swat (11), in Buner (9), and in Jalozai (7) and 14 mobile teams located in Swat (6), Buner (3), and Nowshera (5). Merlin mobile teams were increased from 6 to 9 in Swat but these additional 3 teams could not be airlifted to target areas in Upper Swat due to bad weather conditions. Five of Merlin's mobile teams are now operating in Upper Swat.

International support has started to build-up through the deployment of medical teams and donations of essential medicines. Indonesia has deployed 5 medical doctors and 10 paramedics in Nowshera. On 15 August, Sri Lanka will send 7 medical doctors, 6 nurses, 2 pharmacists to Sukkur and Jordan will deploy 25 medical doctors and pharmacists in Multan. Hungary, USA and Italy are also sending medical teams to support the humanitarian work in flood affected areas.

Mercy Corps will run a static clinic at Thrik-E-Islamic - Pakistan Islamic Centre near the town cemetery surrounded by schools occupied by IDP; and a mobile clinic team will serve other schools or camps nearby in Charsadda. In addition, a static clinic will be functional Pabbi Government High School which is occupied by 200 IDP families; and a mobile clinic team will serve other schools or camps nearby.

Hygiene kits will be distributed in affected areas with partners PATTAN and Pakistan Islamic Medical Association (PIMA). Mercy Corps is also looking into the expansion of its health services to Punjab.

The National Health Emergency Preparedness and Response Network (NHEPRN) of the Federal Ministry of Health is leading the health interventions in all affected districts. All health activities are coordinated with provincial/district departments, WHO (Health Cluster lead), UN agencies, national and international agencies.

UNICEF is providing oral rehydration salts (ORS) and Zinc to the Lady Health Workers for community based management of diarrhoea among under-five children by LHWs in the flood affected areas of Khyber Paktoonkhwa, Punjab, Sindh, Baluchistan, AJK and Gilgit Baltistan. A total of 4.2 million sachets of ORS and 2.1 million doses of zinc are being sent through the Provincial Units of National Programme on Family Planning and Primary Health Care to the Lady Health Workers.

As of 15 August, WHO has distributed 1521 cholera kits, 179 emergency health kits, 3 surgical kits, 700 anti-snake vials which will cover the needs of 1.8 million people in one month in flood affected areas in Balochistan, Gilgit-Biltistan, KPK, Punjab, Sindh.

In Nowshera, 12 water tankers are supplying 1.6 million liters of chlorinated water daily to 100 000 people. In addition, 14 out of 15 tube wells of Tehsil Municipal Authority (TMA) and 57 out of 60 Public Health Engineering Department (PHED) tube wells were made functional and are currently supplying 14 million liters of water in flood affected areas of Nowshera. WHO provided 180 kilograms of chlorine disinfection to TMAs and PHEDs. In Charsadda, 25 water tankers and trucks are providing water to affected communities daily. Around 270 000 liters of chlorinated water per day are being distributed to affected communities.

So far, 1 500 health promotion sessions were conducted by WHO and the National Program (DoH) in hosting schools.

In Swat, 37 out of 53 water quality tests from tube wells, boreholes and hand pumps were found unfit for drinking. In response, water disinfection through regular chlorination is being carried out by MSF-B. In addition, 130 residual chlorine tests were conducted. In the camps, no residual chlorine was found in drinking water sources.

For further information contact

Dr Hendrikus Raaijmakers
Emergency Preparedness and Humanitarian Action Coordinator
e-mail: raaijmakersh@pak.emro.who.int

Alfred Dube
Health Cluster Coordinator
e-mail: dubeal@pak.emro.who.int

Syed Haider Ali
Communications Officer
mobile: 0092 3004005944
e-mail:alisy@pak.emro.who.int
focus_ali@yahoo.com

Christina Banluta
Communications and Advocacy Officer
mobile: 0092 3085559639
e-mail: christinabanluta@gmail.com
banlutac@pak.emro.who.int

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