World Health Organization – WHO Pakistan Floods Situation Report # 12 Monday 27 August 2007

Highlights

• A seven years old male child has died from Malaria in Tharpakar, Sindh as reported by the District Officer. Moreover, an alert of suspected Measles case has been reported from Bin Qasim Town, Peri Shadi Kot (Karachi). A five year female child with fever, rashes and runny nose had come to the dispensary. The Dispensary staff has been requested by the provincial DEWS Team to note the proper and complete address of the patient for follow up etc.

• Jhal Magsi district has experienced large number of gastroenteritis cases, of

which 5351 are AWD cases from 5th July–20th August. Seven deaths were reported from Kotara (04), and Kari (03) villages of district Jhal Magsi due to acute watery diarrhea. AWD is now reported to be under control, and severity of the disease is decreasing. The WHO team has assessed the need to provide Neroxfilters and educate public on personal hygiene in the district.

• Disease Early Warning System (DEWS) has been established in district

Dadu with Surveillance Officers at the EDO Health office from where the data is forwarded to the DEWS office in Karachi.

• WHO DEWS team in Islamabad is preparing the rain/floods recovery plan and would share the updates on the same with other partners.

• UNICEF office in NWFP has jointly developed the 3 months EPRP, based

on the needs identified by the Health Department. The plan has been submitted to the UNICEF Country Office for approval.

Update on Floods/Rains Situation Sindh

• Recent rains in Karachi, Thatta and Badin and other parts of Sindh during August 21-22 have reportedly caused 3 deaths in Karachi city in addition to some loss of valuable property, traffic jams and other difficulties

• Weather conditions in districts Kambar and Dadu are reported to be improving day by day. However, the water level is still rising in some areas of the district Dadu and those affected areas are still inaccessible.

• Three out of the four talukas in District Dadu have been affected as summarized in the following table:

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Name of Taluka

UC’s Affected Total Population

Area in acres

Affected area(acres)

Affected villages

Population Affected

Mehar Faridabad, Khan jo Goth Mangwani

318053 265641 56474 63 61472

K.N. Shah

Chore, Ghozo, Burera Kandochukhi

253309 280324 7840 110 141400

Johi Kamal khan Chinni Pat G. Mohd

207383 899839 8315 62 50712

Total 778745 1445804 72629 235 253584 Source: WHO Surveillance Officer, Dadu

Flood affectees along the Flood Protection Band in Dadu

• In district Kambar Shahdadkot, Sindh, 318750 acres (75%) of agricultural land

has been affected. The following table shows the details of damage in district Kambar:

Tehsil UCs Damage/Loss

1. Qubo 80%

2. Bago Daro 10 %

Qubo Saeed Khan

3. Hazar Wah 60 %

Shahdadkot 1. Silra 40%

Miro Khan 1. Khabar 70%

1. Ghaibi Dero 90%

2. Dost Ali 70%

3. Bohar 20%

Qamber

4. Kalar 20%

Warah 1. Mirpur 100%

Khandoo 70%

Gaji Khuhawar 40% Source: WHO Surveillance Officer, Kambar

IDPs and flooded areas - Kambar

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North West Frontier Province

• Two injuries have been reported by the District Coordination Officer, Kohistan due to thunder storm/rains in Ranolya.

• On August 24, 09 persons have been injured due to collapse of Veranda at

village Ambar in district Swabi.

• Following is the update on the loss and damages reported for health facilities and other public/private infrastructure in the NWFP province as per the report of the NWFP Relief Commissioner, of August 24, 2007.

Person Buildings

Government Private

DISTRICT

Died

Injured

Missing Damaged Washed

away

Damaged Washed

away

Total 132 138 - 29 10 2530 1001

Balochistan No assessments received as yet Health impact

Sindh

• Our of the 78 health facilities in Dadu (1 DHQ, 3 THQ, 3 RHC, 3 MCH centres, 44 BHU, 15 Govt dispensaries and 10 Experimental dispensaries) many of them have been affected by the floods and still under water. The district has 173 Doctors including specialist, 21 female doctors, 17 staff nurses, 36 health technician and 69 EPI vaccinators.

• In districts Dadu and Kambar of Sindh, skin diseases are more common in

children than in adults in the aftermath of the floods.

Skin disease seen in a girl of 4- 5 years Girl with a skin disease on the FP Band

• The total number of health facilities in district Kambar is 67 of which 3 BHUs and 1 RHC have been affected by the floods and are water.

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• Flood water is being used for washing, bathing and in some places even for drinking in districts Dadu and Kambar and safe drinking water is available to about only 20 – 30 % of the affected population.

• Following are the trends of diseases in districts Kambar and Badin in Sindh

Kambar Data Aug 17 through Aug 24

05

1015202530

17.08

.2007

18.08

.2007

19.08

.2007

20.08

.2007

21.08

.2007

22.08

.2007

23.08

.2007

24.08

.2007

Days

# of

Con

sulta

tions

AWD

ARI

UF

Snake Bites

Skin

Badin Data Aug 17 through Aug 24

0102030405060

17.08

.2007

18.08

.2007

19.08

.2007

20.08

.2007

21.08

.2007

22.08

.2007

23.08

.2007

24.08

.2007

Days

# of

Con

sulta

tions

AWDARIUFSkin Diseases

• The above two graphs reflect that ARI is on decline but AWD cases have started to increase especially in the fourth week of August in both districts Kambar and Badin in Sindh, though the latter shows a higher ratio of AWD cases. Skin diseases have been reported in both the areas however very few snake bite cases have been reported only from Kambar.

Balochistan

• The WHO Surveillance Officer visiting Jhal Magsi has informed that acute watery diarrhea cases have been reported from Karri, Peerchatta, Kumbi and Pach near to Kotra villages in Tehsil Gandawa of the district.

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• People are using surface raw water from irrigation canal and unprotected spring and water tests conducted by the WHO and PCRWR teams have shown high level of bacterial contamination in water sources. Open defecation is also common due to the absence of latrines in the houses. The source of contaminated water is unhygienic habits of the local people as they use the water collection points for multi purposes: bathing, washing cloths and besides that animal also drink water from the same sources.

Water Sources for washing, bathing and drinking Water in Jhal Magsi, Balochistan

NWFP

No assessments received as yet

Health response

1. Assessment and monitoring

Sindh

• In the Health Partners Meeting held on August 22 in Karachi, all agencies have agreed that tasks such as filling data entry forms for DEWS reporting at facility level and submitting the same at district level, data entry at district level, interpretation of the data, response (if any), follow-up, and feedback would be done by using available resources in the district with little adjustment (if needed).

• WHO Database Manager from Islamabad is visiting Dadu and Kambar to

monitor data entry at the district level and send a backup to Provincial DEWS Office on weekly basis.

• As per the assessment of the WHO surveillance team in Dadu and Kambar in the two districts, there are few female medical staff available hence reproductive health has not become a major focus in the districts.

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Balochistan • WHO team visited district Jhal Magsi to assess/monitor the acute diarrhea

situation, coordinate appropriate control measures taken and provide technical assistance to EDO Health and other organizations working in the area. Around 50 houses were visited for information on AWD. Other than that the team also visited DHQ Hospital Gandawa, RHC Jalmagsi, Civil Dispensary Saifabad and CD/DTC Kotara and also went to see the MSF (Holland) DTC center at Kotara and Pakistan Red Crescent society working in RHC Jhal Magsi.

• During their visit to the Civil Dispensary, Jhal Magsi, the WHO team has

found that the building was totally damaged by floods. However, the EDO Health has made alternate arrangements, and Civil Dispensary was made functional in a private building with equipments, medicines, and medical staff available.

• WHO Surveillance team visited the DHQ Hospital Gandawa, district Jhal

Magsi and has informed that the sanitary practices are very poor there. According to the OPD register from 1st -18th August a total of 121 cases of acute diarrhea were treated at the hospital with mild, moderate and severe dehydration and amongst them 33 patients were given I/V treatment.

DHQ Hospital Tehsil Gandawa, district Jhal Magsi, Balochistan

Health Coordination

Sindh

• DEWS data is being utilized well in Sindh and even some EDOs in flood affected districts have reviewed their earlier demands. There are 23 districts in Sindh out of which DEWS team are receiving data from 6 out of 18 Towns in Karachi (Gadap, Bin Qasim, Lyari, Shah Faisal, Kemari and Saddar) and 8 out of other 22 districts (Kambar, Badin, Dadu, Larkana, Umarkot, Matiaari, Tarpakar and Hyderabad). District health department Karachi and DEWS team have decided to emphasize first on the present six towns reporting to DEWS, to make sure that all reporting sites of these towns are covered.

• Capacity building of the DEWS team for the DEWS software has been completed and training has now started for the alert response. Moreover, data entry has been completed in Sindh DEWS software and the DEWS team is now converting the daily forms into weekly forms. The Backup from Dadu

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has been received and merged into the software and backup of data will be received from Kambar this week.

Aug 22, DEWS meeting Chaired by Special Secretary Health Sindh in Karachi

• At the Health Emergency Preparedness Core Group Meeting held on August 27 in Peshawar, it has been discussed that subject to the provision of the Provincial Disaster Management Authority Acts, a provincial commission shall have the responsibility to form policies and plans for the disaster management in the province in accordance with the guidelines laid down by the National Commission. It will approve the disaster management plans prepared by the departments of the Provincial Government; oversee the provision of funds for mitigation and preparedness measures and coordinate/monitor the implementation of the plan, examine the vulnerability of different parts of the province to different disasters and specify provision or mitigation measures. WHO has agreed to extend technical support in all emergencies as per their mandate.

Filling Health Gaps

Sindh

• WHO’s EPI campaigns are going on and have covered vast areas especially

with the ongoing Polio campaign.

• WHO has provided 22 Basic boxes of the New Emergency Health Kit covering need for 22,000 people for 3 months, 5 Trauma kits (covering for 100 severely injured, 500 moderate, 1000 mild injured), 109,000 chlorine tablets and 10 tents to the EDO Health, Dadu.

• The Department of Health, Sindh has so far set up 14 medical camps in Dadu with 14 doctors, 2 LHVs and 03 midwives. Health services have been provided by permanent, temporary and mobile teams in the areas where the health facilities are under water.

• In district Dadu, safe drinking water is being provided by Mercy Corps. The agency is refilling bladders using tankers. There is a high risk for epidemics and outbreaks especially of water borne and vector borne diseases. In Kambar, safe drinking water is being provided by different NGOs who are using the

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water treated by the Finnish Emergency Response Unit (ERU) of IFRC and they have set up three treatment plants in Kamber district. Due to risks of epidemics and water borne diseases spraying has been done by the Department of Health in Talukas Kamber, Warah and Shahdadkot of Kambar.

• WHO has sent 2 trauma kits, 1 basic health kits, 100,000 chlorine tablets and 75 ASV vials provided to the EDO Health Kamber – Shahdadkot.

Balochistan

• The Diarrhoea Treatment Centre set up by MSF is still functional and providing preventive and curative services to the community. MSF-Holland has pitched tents to setup a proper Cholera Treatment Centre in the village. MSF-Holland has reported AWD positive with SMART (Rapid) test. Two Stool samples collected to be sent to NIH for confirmation of AWD. (Previously one sample was confirmed positive by NIH).

Civil Dispensary Kotara MSF (Holland) DTC Kotara Updates from Partners

• JORDAN (Johi Organisation for Rural Development and Natural Disaster), a participatory social organization has set up free medical camps at Razi Roadnani and Noor Mohammad Roadnani in Union Council Sawro, Chhapar Jamali and Fareed Roadnani in U.C Kamal Khan, and village chakar Khan Shanni U.C Chinni in district Dadu, Sindh. Jordan distributed food items in village Noor Mohammad Roadnani, Razi Roadnani, Peer Lakho, Pat Kanhri and Lakhmeer Brohi for 250 families.

• Department of Health Sindh’s mobile teams are working in the areas of district Kambar and providing primary health care services while also coordinating with other health partners.

• Mercy Corps is providing safe drinking water for 3 months in district Dadu, Sindh.

• Kachho Foundation, a local NGO working mainly in Taluka Johi, distrit Dadu, is facilitating in provision of safe drinking water through partners.

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• Catholic Relief Services (CRS) has provided water purifying tablets worth 60, OOO Pak Rupees in Taluka Johi, district Dadu, Sindh. It is undertaking assessment of villages Kando Babar and Ghayani laghari aiming at the socio –economic and health status of the flood affectees.

• Care International is working in Dadu, Kambar, Badin and other flood affected areas.

• Pirbhat Women Development Society has saved 700 people from floods in Sindh. It has provided mineral water provided to 1500 families and milk packs and biscuits to 2000 children. It has also provided water purification tablets to 3000 families and 900 Latrine slabs (supported by MC/AAH&LHDP) and distributed hygiene kits to 1700 families.

• IFRC has set up water treatment plants in Kachi Pul and Qubo Saeed Khan in district Kambar, Sindh.

Contaminated water in Sindh A Medical Camp in Sindh

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Latrine put up by SRSO and UNICEF Provision of water by Pirbhat

• IRC (Indus Resource Centre) with the assistance of Kachho Foundation has conducted assessment in District Dadu, taluka Johi in UCs Pat Gul Muhammad, Tando Raheem, Sawaro, Chinni and Drigh, to evaluate flood catastrophe in which most vulnerable and affected one thousand families were identified in 60 flood affected villages. IRC has funds to run mobile Clinics in K.N.Shah (GOZO) and other areas. It has distributed food and non-food items in 1650 families in Johi, K.N.Shah and Kamber. It has arranged 5 free medical camps and consulted 1200 patients in affected areas.

• In Jhal Magsi the Pakistan Red Crescent Society is supporting the health facilities with the collaboration of Health department.

• GTZ will train Doctors, Nurses and Paramedical staff on Disaster Management in NWFP.

• The Emergency Trauma and Accidents Centre LRH informed that 120

heath providers have already been trained as master trainers on UK Advance Life Support Group (ALSG) techniques in NWFP with the support of Provincial Government.

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2. Preserving and supporting local health systems

Urgent Needs

• Training of the DEWS software at the districts level is needed as requested by many EDOs in Sindh. Moreover, EDO Health Sukkur has requested for the new DEWS software as the on currently installed is creating problems

• People living with minimal shelter in districts Dadu and Kambar await provision of tents. Moreover it is also important to conduct sampling of the water and provide safe drinking water, water purification tablets and educating people on how to use them. It is also essential to build latrines in the affected areas and insecticide-treated mosquito nets and sprays to prevent Malaria and Dengue fever in the two districts.

• Deployment of female staff is essential for the affected areas in Sindh to improve reproductive health services.

• In district Dadu, the following priorities have been identified for early recovery

1. Water supply, safe latrines, water testing and health hygiene promotion.

2. Support for health facilities (building and equipment) 3. Reproductive health 4. DEWS and disease prevention (cholera plans, water testing, malaria sets) 5. Community disaster preparedness 6. Immunization and Nutrition (possible malnutrition risk in future due to crop

destruction)

• In district Jhal Magsi of Balochistan, the following needs have been identified: 1. Water bladder/tanks to be installed in different places of village Kotara, Kari,

Pach, Peerchatta and Kumbi on emergency basis for the provision of safe drinking water.

2. WHO should distribute more Neroxfilters at Pach, Peerchatta, and Kumbi before the situation gets worse.

3. PHED water supply scheme in Kotra village to be restored immediately and disinfection of water to be done on regular basis.

4. Health education sessions should be conducted at community level.

Acknowledgments:

All photographs of districts Kambar and Dadu (Sindh) were taken by Dr. Shelina Kiyani, WHO and for Jhal Magsi, Balochistan by Dr. Jaffer of WHO and other members of the WHO Surveillance team in Balochistan.

SUMMARY OF DISTRIBUTION - KARACHI (August 30, 2007) Items Supplied By WHO

S/# Date Province District ASV NEHK Cholera

kit D Trauma

Kit

NEHK Basic Box

Chlorine Tablets Tents

PHC Drugs & Others

Status Remarks

TOTAL STOCK HELD AT KARACHI 1000 1 *7 16 41 450,000 10 Delivered * 2 Italian Diarrhoeal Kits

1 Sindh Karachi 20 119,184 Delivered

2 July 2007 Bal Lasbela 1 1 30,000 Delivered 3 July 2007 Bal Jhal Magsi 1 1 20,000 Delivered

4 July 2007 Bal JafFarabad 2 1 20,000 Delivered

5 July 2007 Bal Naseer Abad 1 1 10,000 Delivered

6 July 2007 Sindh Kamber 50 1 3 10,000 Delivered

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July Bal Turbat 3 2 2 30,000

400 bed sheets and

1500 Ringer

Lactates with

infusions Delivered 9 July Sindh Thatta 100 4 Delivered

10 July Sindh

Hyderabad DG Health 200 1 100, 000 Delivered

11 July Sindh

Hyderabad CH 40 Delivered

15 Sindh Badin 50 Delivered

16 Sindh Kashmore 25 Delivered July 20077 Dadu 100 2 5 22 109, 000 10

TOTAL

DELIVERED 585 1 3 13 35 491, 0004 10 Delivered

BALANCE 415 *2 3 6 15,000 Balance left in stock at Karachi

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SUMMARY OF DISTRIBUTION - QUETTA (August 30, 2007) Items Supplied By WHO

S/# Date Province District ASV NEHK

Modified

Ringer Lactate with I/V

sets

Trauma Kit

NEHK Basic Box

Chlorine Tablets Tents

PHC & Other Drugs

Status Remarks

TOTAL STOCK HELD AT QUETTA 200 5 3000 200,000

1 July 2007 Balochistan DG Health 200 3000 200, 000 Delivered

2 Balochistan 5 Delivered Bolan, Kuuzdar, Lasbela,Sibbi,Washuk.

3 4

Distributed 200 5 3000 200,000 Distributed

BALANCE LEFT Balance left in stock

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SUMMARY OF DISTRIBUTION - PESHAWAR August 30, 2007)

Items Supplied By WHO

S/# Date Province District ASV NEHK Cholera

kit D Trauma

Kit

NEHK Basic Box

Chlorine Tablets Tents

PHC & Other Drugs

Status Remarks

TOTAL STOCK HELD AT PESHAWAR 8 100,000 Delivered

1 July 2007 NWFP 1 2

2 Aug 16, 2007 NWFP

Dassu, Pattan, Banna, Battagram DHQ Battagram, Thakot, RHC Alpuri, RHC Puran, BHU Pashto, BHU Gantar, RHC Kuza bandi,

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25, 000 Pathedine injections

3

8

BALANCE LEFT 8 1 2 100,000

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SUMMARY OF DISTRIBUTION - ISLAMABAD August 30, 2007) Items Supplied By WHO

S/# Date Province District ASV NEHK Cholera

kit D Trauma

Kit

NEHK Basic Box

Chlorine Tablets Tents

PHC & Other Drugs

Status Remarks

100,000 Delivered

1 July 2007 Merlin 50 5,000 ORS

2 ARC 1

3 MSF- Belgium

IFRC 1

TOTAL DISTRIBUTED 50 2 100,000 5, 000 1