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Situation report 18

While the focus remains on life-saving relief, rehabilitation and reconstruction are gaining momentum in most areas. WHO continues the helicopter-assisted rapid health assessments along the western coast of the Indonesian province of Aceh. The information gained by these assessments is helping to formulate public health action in the region.

Summary

• Based on today's helicopter-assisted rapid health assessments of four sub-districts in the otherwise unreachable western coast of Aceh, it is apparent that health delivery services need to be better coordinated as some areas have too many NGOs providing services while others have too little. In almost all areas, sanitation and safe water needs to be improved. Malaria treatment programs appear to be a priority.
• No disease outbreaks have been reported anywhere in the region.
• WHO reaffirms that corpses from people killed by the tsunami pose no health risk to the living. A WHO / FAO study reports no increase in fish-borne or seafood-borne illnesses as a result of the tsunami.

Situational Updates

Health Priorities

Communicable Diseases

• India: No outbreaks or epidemics have been reported. There are reports of isolated cases of chicken pox in Tamil Nadu but they have not been confirmed.
• Indonesia: There are no reports of epidemics or outbreaks but information suggesting cases of diarrhoea and malaria are being investigated. WHO, the Global Outbreak Alert and Response Network (GOARN) and the Ministry of Health (MoH) are strengthening surveillance with a more comprehensive Health Information System, including mapping and a surveillance & alert database.
• Maldives: There are no reports of epidemics or outbreaks. The MoH has put in place a disease surveillance system and reports a slight increase in the incidence of diarrhea, acute respiratory infections and viral fever. According to MoH and WHO epidemiologists, the numbers are likely to still be within a normal range. The increase may possibly be due to better reporting and increased access to health facilities. However the situation will be closely monitored and assessed. Following a probable interruption in vaccinations due to a breakdown in cold chain and loss of vaccines, the government plans to resume its routine immunization programme (including for measles) by the end of January 2005. WHO is prepared to provide technical assistance for the measles campaign.
• Sri Lanka: No disease outbreaks have been reported. An entire camp in Galle district was vaccinated in response to one confirmed measles case reported ten days ago. WHO epidemiologists in Galle District say that with increasing numbers of people leaving camps it will become more difficult to sustain disease surveillance in a more dispersed population.
• Thailand: No outbreaks have been reported. Daily disease surveillance being carried out.

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

• India: 1260 metric tons of water have been airlifted to Andoman and Nicobar Islands since December 26th.
• Maldives: 10-12 islands are still reporting water shortages but all islands have at least three to four days' supply. There are conflicting reports regarding critical emergency needs such as safe drinking water, food, and supply of essential medicines being in place.
• Sri Lanka: WHO assisted a community movement in Kalmuni for a city-wide cleaning campaign today. In Kalmuni, Galle, Matara, and Hambatota, public health inspectors report that camp-site water and sanitation has improved. However, optimism is tempered by a survey of the Galle, Batticoaloa and Ampara districts completed by WHO water and sanitation experts. Although water provision and quality in the Galle camps was found to be satisfactory, they did find problems for camp sanitation. In the Batticaloa and Ampara districts, the problems include 3000 contaminated shallow wells which people returning from camps are using, almost non-existent water-testing facilities, and unsafe hygiene practices. For instance, open defecation, when combined with lashing rains, may contaminate ground water. Pools of floodwater serve as breeding grounds for mosquitoes. The experts have recommended chlorination, water testing, sanitation training and hygiene education to be included in a work plan.

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

• India: The central government has requested regional authorities to remain vigilant towards the trafficking of women and children.
• Sri Lanka: On January 15, 2005 the National Child Protection Agency (NCPA), supported by Probation and Child Care Services, UNICEF, Save the Children, and the ILO, released provisional data collected from camps on the number of unaccompanied children (38), separated children (836), and children who have lost one parent (3,203). It is important to stress that these figures are provisional and are likely to rise once a thorough registration of children has been completed at the community level.

Health system and infrastructure (functioning health facilities, access)

• Maldives: In many health facilities it will be necessary to replenish all equipment and medical supplies.
• Sri Lanka: The President of Sri Lanka has established several task forces to coordinate reconstruction work. The "Task Force to Rebuild the Nation (TAFRER)" will start work on January 15, 2005 and is expected to complete all work, including the rebuilding of hospitals, water and sanitation services, homes, schools, roads and other infrastructure within one year.

WHO Country Information

Indonesia: The inter-agency rapid health assessment team, accompanied by officials from the United Nations, Indonesian military, the Indonesian Ministry of Health and the US Marine Corps conducted a second day of assessments along the west coast of Aceh, this time deploying four teams to four separate areas. After these surveys, WHO recommends that the following actions be taken in the next seven days:

• In Lam Teungoh: national health staff or an NGO should be recruited to work in the area; a mass measles containment campaign should be initiated; and the US military should maintain this area on its ongoing distribution list.
• In Lamno: a measles vaccination campaign, including Vitamin A supplements should be carried out for children under 15 years of age; the disease surveillance system should be strengthened (especially for malaria); the local health department should take the lead and develop communication and coordination between the various NGOs and medical groups; and hygiene should be improved by constructing latrines, giving education, and distributing soap or hygiene kits.
• In Calang: water stations should be established to ensure adequate quality and quantity of drinking water from local sources; hygiene should be improved with training, the provision of shovels for digging proper pit latrines and the provision of soap, detergent, and buckets; a measles vaccination campaign should be enacted and this requires the setup of a cold chain; and clinical and support staff, along with medical equipment and supplies should be provided.
• In Drien Rampak: a measles vaccination campaign for children 6 months to 15 years in the affected community should be organized; well water should be chlorinated; latrine should be constructed; a partner for the provision of essential health services to this community should be identified; and the area should be included in a disease surveillance system.

In the medium term WHO recommends that safe water and sanitation facilities are strengthened in all four areas. In Lam Teungoh and Calang, health services also need to be strengthened with a special focus on malaria treatment and control. In Lam Teungoh this should also include surveillance systems. In Calang this should include a measles vaccination campaign.

Sri Lanka: WHO logistics experts are receiving donations of drugs and channeling supplies to MoH. A consignment arrived on January 15, 2005 from UK-based International Health Partners and another large consignment is expected to arrive from donors in Canada on January 16, 2005. The central government chaired a review meeting to develop malaria and DHF prevention plans. WHO, after receiving a request for bed nets, is arranging for a local purchase for immediate delivery to the affected areas.

MAP: Sri Lanka - affected districs and healthcare facilities

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Dead bodies in water no risk for disease
There is no added communicable disease risk from dead bodies lying in the sea water for more than 2 weeks. The physical health risk from corpses of otherwise healthy people who have died is negligible. Corpses only pose a health risk when they are from people who have died as a result of an outbreak or epidemic of communicable disease.

No dangers of eating fish
WHO and the Food and Agriculture Organization (FAO) report that there is no evidence that fish- and seafood-borne illnesses have increased in Asian countries affected by the tsunami. Conversely, eliminating fish from the diet could have adverse nutritional impacts, especially for weakened tsunami survivors.

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.