Ministry of National Health Services, Regulations & Coordination National Institute of Health, Islamabad Pakistan *****

Transcription

1 Ministry of National Health Services, Regulations & Coordination National Institute of Health, Islamabad Pakistan ***** Tackling Pubic Health Challenges Associated with Population Displacements from the Federally Administered Tribal Areas (FATA) Background: With the launch of operation Zarb-e-Azb in the troubled North Waziristan agency of Federally Administered Tribal Areas (FATA) on Sunday 15 th June 2014, temporary migration /relocation of population to safer locations has started. As per NDMA report, by 25 th June 2014, a total of 36,831 families crossing over from areas of operation have been registered as per following details: Male: 120,110 Female: 143,996 Children: 192,442 Total: 456,508 Whereas the population influx is likely to increase in coming days, as per initial information from the field, after availing the registration facility, the dislocated families are mainly opting to live in host areas rather than staying in Main camps established for the purpose. Public Health Risk: The massive displacement of population with limited access to basic amenities poses special threats to the health of both displaced individuals as well as the people residing in areas where the IDPs are opting to settle temporarily. Preemptive measures and coordinated efforts on part of all Government and non-government stakeholders are therefore required to avert the occurrence of any untoward situation including communicable disease outbreaks. Purpose of the Advisory: The purpose of this advisory is to alert the local health departments as well as public health personnel of various departments and agencies about the possible health risks and the readily implantable mitigation measures to protect the health of displaced as well as the settled populations across Pakistan. Anticipated Diseases: Considering the prevalent seasonal and environmental factors, there is an impending threat of the eruption of communicable disease outbreaks of water and vector-borne diseases such as Gastroenteritis/Acute Watery Diarrhoea, Measles, Polio, Tetanus and other vaccine preventable diseases, Dengue, Malaria, Leishmaniasis, Typhoid, Hepatitis A & E, etc. Moreover, the extreme weather conditions and vulnerabilities also significantly enhance the risk of non-communicable ailments such as Injuries, sunstroke and health exhaustion, cardio-vascular accidents, animal & Snake Bites etc. Besides this, because of prevalent uncertainty and sense of deprivation, the displaced population is also vulnerable to psychological stress.

2 Mitigation Measures: For an effective response relevant to the IDPs needs, the Health Cluster platform should be immediately activated at national, provincial and district levels to guide various partners involved in response efforts. Non-health sectors such as district administration, police and other law enforcement agencies, public health engineering, water and sanitation agencies should be invariably on board. In the light of the above narrated health challenges, it is extremely important for health departments to establish and maintain a close liaison with relevant departments to monitor demographic characteristics of the displaced population at the registration points and their subsequent settlement sites so as to timely identify and effectively address their needs. An overview of the possible mitigation measures is as follows: S. # Intervention Specific Mitigation Measures 1. Management of IDP camps: The concerned District health department must designate, notify and logistically facilitate a senior Public Health Officer to supervise all health related operations for IDPs in close coordination with camp management as well as the teams involved in relief work from line departments, NGOs, international agencies etc. The officer be made responsible to keep updated record of IDPs, and the particularly vulnerable groups i.e Children under five, pregnant mothers, Old individuals with chronic diseases etc. Besides having close linkage with health facilities in the vicinity, he/she may also keep a close check on medicine stocks as well as the daily surveillance data to timely detect and respond to any communicable disease outbreak in the area. 2. Providing basic amenities to protect health: The following facilities must be essentially provided and regularly monitored in close coordination with the local administration and relevant departments: Access, safety and security of the camp Quantity and quality of the water supply Sanitation facilities including dedicated male and female latrines and safe waste disposal Sufficient quantities of soaps / detergents Distribution of chlorine tablets coupled with a vigorous health education campaign to instruct people how to use them Vector control in breeding sites in the vicinity Recommended checklist to monitor camp facilities is attached at Annex-I. 3. Assistance for the off-camp IDPs: Majority of displaced families may not enter designated camps, but take shelter off-camp amongst host communities, with family or friends or in rented accommodation. They need to be simultaneously tracked and supported as per their requirements.

3 4. Specific interventions for public health risks: Mass awareness campaigns in local language particularly among ladies utilizing LHWs and other female volunteers to promote: a. Safe use of safe drinking water b. Hygienic food preparation and storage c. Frequent hand washing especially before food preparation and after using latrine d. Use of bed nets e. Early healthcare seeking for illness among family Vaccination of <5 children against all nine EPI target diseases and of <10 children against Measles Maternal and child health facilities for pregnant ladies Regular sprays of high risk areas through residual insecticide along with provision of impregnated nets to prevent Dengue, Malaria and Leishmaniasis. Measures to stop selling of unhygienic food items in and around camps by the street vendors Stock piling and regular supply of essential medicines including I/V fluids, ORS, bandages, antiseptics as well as Anti Snake Venom Serum and Anti Rabies vaccine Appropriate facilities for the management of diseased persons on 24/7 basis Referral / transportation arrangements for serious cases to major hospitals Implementation of Disease Early Warning System (DEWS) for early detection, investigation and response to outbreaks 5. Immunization: Considering the fact that children have been deprived of vaccination facilitation since quite some time, it is extremely important to do carpet coverage of all vulnerable children through the establishment of Vaccination points at every Permanent Transit Points (PTPs) and fixed clinics. Mass Measles and Polio immunization with Vit.-A supplementation should be implemented as soon as possible. The priority age groups are 6 months to 5-10 years 6. Surveillance/early warning system: For rapid detectio of cases of epide ic pro e diseases, a surveillance/early warning system should be quickly established covering priority diseases like Acute Gastro enteritis, Malaria, Dengue, CCHF, scabies, Viral Hepatitis (A&E), Measles, Tetanus, Meningitis etc.

4 Note: 1. The following documents available at NIH website may additionally be helpful for the implementation of above suggested measures: i. 30 th Issue of Seasonal Awareness and Alert Letter for Epidemic-prone Infectious Diseases in Pakistan ii. Surveillance Case Definitions, Sample Collection and Transportation and Prevention & Control of Priority Communicable Diseases iii. National Guidelines for Prevention and Control of: a. Gastroenteritis (GE) and Acute Watery Diarrhoea (AWD) b. Dengue Fever c. Crimean Congo Hemorrhagic Fever (CCHF) d. Control of vectors of public health importance 2. The suspected samples of communicable diseases may be transported to the National Institute of Health strictly observing the standard precautions for sample collection and transportation. 3. The Epidemic Investigation Cell NIH may please be kept updated about the health situation and mitigation measures being undertaken therein. 4. For any further guidance/queries, please contact the National Institute of Health at: Tel: , Fax:

5 Typical Services and Infrastructure Requirements for IDPs Camps Items Requirements Yes No Present condition 1 Latrine 1 family (6-10 persons) 1 Water tap 1 community ( persons) 1 Water point 1 water point/250 people (WHO) Water point distance From shelter to the nearest water point 500 meters (WHO) 2 Refuse drums 1 community ( persons) Approximate staffing level for refugee health and sanitation (Services for a population of 10-20,000) Community Health Workers Sanitarians 2-4 Sanitation Assistants 20 Site Planning Figures for Emergencies Environmental sanitation Water 1 latrine seat per 20 people or ideally1 per family sited not farther than 50 m from user accommodations and not nearer than 6m. 1x100 liter refuse bin per 50 people 1 wheelbarrow per 500 people 1 communal refuse pit (2m x 5m x 2m) per 500 people liters per person per day of clean water Health centre: liters/patient/day Feeding centers: liters/patient/day Tap stands Other needs Schools Mosques 1 per 200 persons, sited not farther than 100 m from user accommodations 2 liters/student (WHO) 5 liters per visitor (WHO)