Vidyya Medical News Service
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Volume 7 Issue 29 Published - 14:00 UTC 08:00 EST 30-Jan-2005 Next Update - 14:00 UTC 08:00 EST 30-Jan-2005
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Update #8: South Asia earthquake and tsunamis - 29-January-2005

(29 January 2005: VIDYYA MEDICAL NEWS SERVICE) -- No major outbreaks of communicable diseases have occurred in tsunami-affected areas. However, the region continues to be vulnerable. This is a densely populated area and is endemic for dengue fever and malaria. With the rainy season now starting, a rise in cases should be expected. The early warning and rapid response systems set in place by Ministries of Health supported by WHO and a wide network of international health experts have been performing well. Mental health experts are providing guidance to properly help people cope with the impact of the tsuanami. Malnutrition is a growing concern.

Summary

  • The scale of international goodwill and solidarity poses a unique challenge to coordination, in all sectors: in Aceh alone, there are at least 59 international NGOs that need to be brought together around cohesive and effective strategies and programmes.
  • In Myanmar, approximately 10 000 people in the Irawaddy delta area are still in need of food, water, basic health care and shelter.
  • In Indonesia, WHO has developed an action plan in cooperation with the Ministry of Health to provide emergency support for reproductive health. The Ministry of Health has sent 300 midwives to Banda Aceh.
  • Malnutrition is an emerging concern. Those who are malnourished are more susceptible to infections and at higher risk of dying. In Sri Lanka, initial studies are showing increased underweight prevelance rates. A recent rapid assessment of 600 children found that approximately 13% are acutely malnourished.
  • In India, WHO assisted with vaccination campaigns for measles and polio in several states as well as the Union Territories of Pondicherry and the Andaman and Nicobar islands.

Health Priorities

Communicable Diseases

  • India: In the State of Kerala and the Union Territories of Pondicherry and Andaman & Nicobar islands, disease surveillance systems are being strengthened. WHO recently held several disease surveillance sensitization meetings in Tamil Nadu. Medical staff were trained in integrated and post-disaster disease surveillance, laboratory support for confirmatory diagnosis, and epidemic preparedness and response.
  • Indonesia: In Meulaboh, the majority of reported fever cases have tested positive for malaria. Both vivax malaria and mixed infection with falciparum malaria were detected in these patients. Future planned initiatives include the distribution of bednets and the implementation of environmental control measures. Measles vaccine supplies and cold chain equipment have been sent to sub-districts of Aceh Besar for a vaccination campaign scheduled to start on 28 January 2005 in the district.
  • Maldives: No outbreaks have been reported.
  • Myanmar: No outbreaks have been reported. WHO is supporting the Ministry of Health with disease surveillance as well as the provision of emergency medical supplies, including more than 20 000 treatment courses of anti-malarial drugs.
  • Sri Lanka: No outbreaks have been reported.
  • Thailand: The Bureau of Epidemiology is investigating dengue hemorrhagic fever cases in Phuket following increased case reports.

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

  • India: Environmental sanitation projects for 14 villages (with support from Gandhigram Rural Institute) are ongoing. Insecticide-treated bed nets have been provided to tsunami-affected districts of Tamil Nadu. On the Indian mainland, water supply systems have been restored in most of the affected areas. Sanitation services still need improvement in the camps. In the Andaman and Nicobar islands, however, not all regions have had their water systems restored and in some areas, only 43% of the supply is adequate.
  • Myanmar: WHO Myanmar has reported that about 10,000 people in the Irrawaddy delta area and several thousand more in Tanintharyi are still in urgent need of food, water, basic health care and shelter. An assessment of the Ayeyawaddy division revealed that the lack of safe water supplies is the biggest threat to public health. There is also a potential threat of vector-borne diseases in the coming months.
  • Somalia: A second WHO field visit to the tsunami-affected villages of Forham and Haffun reveal that access to clean water is precarious. The only way to ensure this is to dig new water wells to replace the ones that were destroyed by Tsunami disaster. At the moment UNICEF is supplying clean water to the town from wells situated about eight kilometers from the town. Sanitation is also very poor.
  • Sri Lanka: To date, 715 contaminated wells have been cleaned out of a total of 2000 wells in the Jaffna District. WHO has provided dewatering pumps, chlorinometers, water purifying tablets and training for village level operators and supervisors.

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

  • India: 766 people in Tamil Nadu, 100 teachers in Pondicherry, and 57 community-level workers in Nagapattinam have been trained to provide psychosocial support. There are plans to expand the training of NGO volunteers to provide psychosocial support to affected areas of Kerala, Andhra Pradesh and Pondicherry via medical colleges.
  • Indonesia: There are an estimated 800 pregnant women in relief camps. The Ministry of Health has sent 300 midwives to Banda Aceh to provide support. WHO has developed an action plan together with the Ministry of Health to support reproductive health. A recent rapid assessment of 600 children found that approximately 13% are acutely malnourished. Additional surveys (joint UN and Government) are planned, as well as the establishment of a nutrition surveillance system including the host communities. To address potential micronutrient deficiencies, WFP is planning on distributing fortified products (fortified biscuits/noodles) in the ration. The Nutrition Director from the Ministry Of Health chaired a meeting in Jakarta on the 26th January attended by WFP, UNICEF, WHO and many NGOs. The aim was to encourage better coordination by ministry authorities of assessments and action in nutrition. Concern was raised by the MOH about the large quantities of milk powder coming in to Aceh. WHO and UNICEF have issued a joint statement on appropriate infant and young child feeding, and caution about unnecessary use of milk products
  • Myanmar: Following an assessment in Ayeyawaddy division, WHO has recommended that psychosocial support be provided for those affected by the tsunami.
  • Somalia: The psychological trauma of the event was still evident in Hafun, since there was a significant loss of life, and buildings were severely damaged. The community have erected a low height barrier across a channel where the wave entered. While hardly adequate against the force of the sea, it symbolizes a need to protect themselves, and a resolve to overcome their inadequacy.
  • Sri Lanka: the Medical Research Council in Sri Lanka together with UNICEF and WFP conducted a rapid nutrition suvey. Although more complete data will be available at the end of January, preliminary results from clinic-based data (growth monitoring) show that all affected areas had underweight prevalence rates which were higher that the national average prior to the tsunami. Causes of malnutrition are likely to be linked to disease, as well as caring and feeding practices. In camps, infants and young children do not have access to appropriate complementary foods. There is concern about a potential rise in micronutrient deficiencies among the affected population, especially children and pregnant women (vitamin A deficiency, anaemia). Besides the distribution of vitamin A capsules and iron/folate tablets (guidelines issued by the Family Health Bureau), WFP is planning on distributing commodities fortified with multi-micronutrients in the food ration.
  • Thailand: WHO is working with the Department of Mental Health on a proposal for long-term activities addressing mental health issues in the tsunami-affected regions.

Health system and infrastructure (functioning health facilities, access)

  • India: Surgical and emergency health kits were provided to Kerala, Andhra Pradesh and Tamil Nadu. Insecticide-treated bednets, co-trimoxazole doses and oral rehydration salt sachets were also provided to Tamil Nadu.
  • Indonesia: WHO is working with the Provincial Public Health Laboratory (PPHL) and other partners to plan the rebuilding of local public health laboratory capabilities. PPHL is expected to take over lab services from a foreign agency in the near future.
  • Myanmar: Basic public health services, already precarious before the tsunami, are still in need of rehabilitation. Last week WHO provided five sets of new emergency health kits, and donations for treatment courses of anti-malarial drugs (approximately 22,000) were also facilitated.
  • Somalia: In Internally Displaced Person (IDP) camps in Bosasso, people affected by the tsunami only have access to tertiary level health facilities.

WHO Action & Country Information

India: WHO assisted authorities in Tamil Nadu, Kerala, Andhra Pradesh, Pondicherry, and the Andaman & Nicobar islands in vaccination campaigns for measles and polio. Vitamin A supplements were also combined into these efforts. To date, 71 388 children have been vaccinated.

Myanmar: The MOH has requested WHO support with a number of issues related to their disaster preparedness and response including: technical assistance to strengthen disease surveillance and psychosocial support; procurement of essential supplies and equipment; and training to improve overall response capacity.



Contributions/pledges to WHO for the Indian Ocean Tsunami response 29 January 2005

Governments


Donor Contributions received (USD) Firm Pledges (USD) Soft Pledges (USD) Location
WHO Director General Office 100,000 Region
Australia 774,593   Indonesia
Canada 1,229,508   Region
China 1,000,000
Denmark 2,313,058 Indonesia
EC/ECHO 678,426   Indonesia
Finland 2,035,278 Region
France 5,305,040 Region
Ireland 678,426 Region
Japan 6,000,000   Indonesia, Sri Lanka, Maldives
Luxembourg 1,017,639 Region
Republic of Korea 1,000,000 Region
Netherlands 2,394,844 Indonesia
Netherlands 1,000,000 Sri Lanka
Norway 6,000,000 Region
Poland 108,548   Region
Portugal 542,741 Region
Saudi Arabia 500,000 Region
Sweden 5,295,008 Region
Switzerland 884,955   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 15,377,646 24,915,176 5,087,010  

Private donations/individuals


Donor Contributions received (USD) Firm Pledges (USD) Soft Pledges (USD) Location
Vienna Philharmonic 156,038     Region
Online donations www.who.int 90,588     Region
SMS donations, South Africa 206,157     Somalia
Other private donations 200,549     Region
TOTAL 653,332      
Grand total contributions, firm & soft pledges: 46,033,164
WHO's financial requirements in the Flash Appeal: 67,060,220
Shortfall: 21,027,056

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