TYPHOON YOLANDA HEALTH CLUSTER BULLETIN

Transcription

1 Photo: WHO/Francisco Guerrero TYPHOON YOLANDA HEALTH CLUSTER BULLETIN ISSUE #2 NOVEMBER 22, 2013 HIGHGLIGHTS As of 22 November 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 4,015 deaths,18567 injured, and 1,602 missing. A total of 10,023,075 have been affected with 4,330,502 displaced. Of the displaced, 381,022 are currently living in 1,529 evacuation centres. Top health conditions reported from selected sites are acute respiratory infections, wounds, fever, diarrhoea, asthma and hypertension. Furthermore, there have been reports of tetanus deaths and suspected leptospirosis in Tacloban. In Capiz and Iloilo, there have been rumours of chicken pox. Rumours of typhoid in Ormoc were not substantiated. A total number of 61 Foreign Medical Teams (FMTs) are operational in the affected areas, composed of more than 918 medical staff as of 22 November Fifty-one of the field hospitals established are type 1 and three additional type 1 teams are under deployment. There are six teams with type 2 hospitals and one team with a type 3 hospital. Seventy-two national and local medical teams have also been deployed to the affected areas. Additional FMTs are requested to remain on standby as the health priorities are shifting away from immediate trauma care to essential public health care service to address the broader public health concerns. The four health cluster coordination mechanisms established in Manila, Tacloban city, Cebu and Roxas are fully functional. Additional health cluster coordination mechanisms are planned for Ormoc, Borongan and Guiuan following request for additional support in coordinating international teams in support of the local health authorities. Inside this bulletin: Affected population and areas Context Main public health concerns Morbidity data Health cluster priorities Health needs, gaps and constraints Health cluster action Funding status of flash appeal Health cluster meeting participants 1

2 AFFECTED POPULATION AND AREAS Forty-four provinces out of a total of 81 have been affected in regions IV -A, IV-B, V, VI, VII, VIII, X, XI, and Caraga (Map). As the typhoon moved from east to west, the eastern regions were the hardest hit. Preliminary assessments of the affected areas show that regions VI, VII and VIII were the most affected, currently accounting for around 90% of the total affected population (Table 1). As of 22 November 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 4,015 deaths, 18,567 injured, and 1,602 missing. A total of 10,023,075 have been affected with 4,330,502 displaced. Of the displaced, 381,022 are currently living in 1,529 evacuation centres. Table 1: Affected Population (NDRRMC, 22 November 2013) Number of affected population % of total population of the area Number of Displaced Population % of internally displaced Region IV A Region IV B Region V Region VI Region VII Region VIII Region X Region XI Caraga Total Humanitarian Case Load according to Flash Appeal % 2

3 CONTEXT Current event Haiyan, a category 5 typhoon locally named Yolanda, made landfall on 8 November 2013 at 0440 am in the Guiuan municipality, Eastern Samar province, moving steadily north into the province of Northern Cebu, with maximum winds of 235 km/hr and severe gusts of 275 km/hr. The typhoon made subsequent landfalls in Tolosa municipality south of Tacloban City, Leyte province, Daanbantayan and Bantayan Island, Cebu province, and Conception, Iloilo province. The typhoon also affected the city of Roxas in Capiz province and the tourism centre of Borocay in Aklan province. Subsequent storm surges caused widespread flooding in coastal areas. MAIN PUBLIC HEALTH CONCERNS Lack of access to safe water and sanitation, overcrowding and displacement, and suboptimal vaccination coverage pose a serious risk of outbreaks of diarrhoeal diseases as well as measles. None of the affected regions had sufficient coverage of measles vaccination to prevent a measles outbreak. Coverage of MCV2 (Measles Containing Vaccine 2nd dose) is especially low in regions IVb and VIII. In regions VI and VII a large measles outbreak occurred in 2012(Table 2). No case of polio have been reported since 1993, and the country was declared poliofree in However polio vaccination coverage is low in some provinces which increases the risk of a potential re-introduction of polio into the country. There is also an increased likelihood of leptospirosis throughout all potentially affected regions. Region V had a cholera outbreak in 2011 and a higher incidence of cholera than the national average in Region IV-A and IV-B had a higher incidence of typhoid compared with the national average in Region IV-B and VI had a higher incidence of tetanus compared with national average in Tetanus vaccination among pregnant women is low, especially in region VII. There is also a risk of increase in acute malnutrition among children due to food shortage. In view of the public health profile of the Philippines as well as the risks associated with typhoons and flooding, the main public health concerns are as follows: Injuries as a direct result of the storm, or associated with post-event flooding Lack of food, water, sanitation and hygiene facilities, and related food and waterborne illnesses Reproductive health especially safe deliveries for pregnant women Respiratory infections associated with overcrowding, especially acute respiratory infections in children Measles, and potentially polio due to importation Malnutrition among infants and young children Mental health and psychosocial problems Leptospirosis from direct exposure to rodent excreta or contaminated water Vector-borne diseases, especially dengue, chikungunya Sexually transmitted diseases MORBIDITY DATA The disease surveillance system in the affected areas has been disrupted by the typhoon as many of the reporting sites. As a consequence the morbidity data remains sparse. Some parts of Cebu have reinstated the routine reporting system while other areas are still relying on an event based surveillance system. The five main causes of morbidity include wound, acute respiratory infection, fever, diarrhea and hypertension. In region VIII there have been two deaths from leptospirosis and two deaths from tetanus with an additional 20 cases of tetanus. In Capiz and Iloilo, rumours of chickenpox is being verified by the DoH. Rumours of typhoid in Ormoc were not substantiated. 3

4 Table 2 Routine Vaccination Coverage 1 in affected areas Pre-Disaster DTP1 2 DTP3 3 OPV3 4 MCV1 5 MCV2 6 TT2+ 7 Pregnant Women Region 4b Marinduque Occidental Mindoro Oriental Mindoro Palawan * Romblon Puerto Princesa Region Negros Occidental Iloilo Capiz Aklan Antique Guimaras Region Bohol Cebu Negros Oriental Siquijor Region Leyte Southern Leyte Biliran Eastern Samar Northern Samar Samar Official country estimates reported to WHO, 2012; 2 Diphteria-tetanus-pertussis first dose; 3 Diphteria-tetanus-pertussis third dose; 4 Oral Polio Vaccine third dose; 5 Measles-containing vaccine first dose; 6 Measles-containing vaccine second dose; 7 Tetanus-toxoid second dose data 4

5 HEALTH CLUSTER PRIORITIES The immediate priorities for the cluster currently remain management of the direct effects of the disaster including trauma care for the wounded, increasing the scope and coverage of services to essential primary and secondary health care services, including referral for medical, surgical and obstetric emergencies, and management of dead bodies. Prevention and detection of outbreaks such as measles and diarrhoeal disease is also a priority especially in view of the disrupted surveillance system and difficult living conditions, compounded by the lack of safe drinking water and sanitation which needs to be addressed urgently. As the emergency approaches the end of its second week, the main needs are changing from acute trauma-related issues to primary health care including mental health and psychosocial support and treatment of chronic conditions such as hypertension and diabetes. Sexual violence against children and malnutrition are also emerging areas of concern. Rehabilitation and re-surgery needs will arise, as well as a more robust surgical capacity that can provide emergency obstetric care (e.g. caesarean sections). In addition, the increased burden on the health care services in the host communities following mass internal migration needs to be addressed especially in Cebu which is currently the main receiving area for the displaced population from the affected areas. Management of dead bodies including identification of victims Measles and polio vaccinations in the affected areas Strengthening the early warning system for early detection and response to outbreaks Infection control in healthcare units including safe blood transfusion and medical waste management, as well as sufficient water supply and sanitation Management of acute malnutrition including cases Immediate priorities with medical complications On-going trauma care for Continuity of treatment for the wounded including prevention for tetanus chronic diseases and chronic infections such as Provision of medicines and tuberculosis medical supplies Re-establishment of essential health care services Short term priorities include: Mental health and psychosocial support (primary, secondary and tertiary care including referral) including in host com- Waste management Vector control munities of the migrating population Risk communication for the public HEALTH NEEDS, GAPS AND CONSTRAINTS Functionality of health facilities The government s three main areas of focus are structural safety of hospitals, appropriate medical waste management and infection control in both the acute and recovery phases. Due to difficulties in accessing some of the affected areas, data on the functionality of health services remains largely incomplete. The Department of Health (DoH) and health cluster partners have conducted damage assessment of health facilities and the results are currently being analysed. The analysis will be overlaid with a mapping of needs for basic health care services which will guide the action of health cluster partners in the short to mid term. The rehabilitation of Ormoc Hospital, which was more than 80% destroyed, has been identified as a main priority. The lack of health workers, 50% of whom have been lost due to death, displacement or injuries, has created a large gap in terms of delivery of health care services. In Cebu, the continued influx of migrants to the area has started to put a strain on the existing health system in the region. The northern part of Cebu was also affected by the typhoon and due to the recent earthquake one of the rural hospitals has closed. Additional support is needed to enhance the capacity of the health system in the region. 5

6 HEALTH CLUSTER ACTION Health Cluster coordination The Department of Health is the lead of the Health Cluster, with WHO as co-lead. In addition to the national Health Cluster in Manila, subnational Health Cluster Coordination teams have been established in the following areas: Tacloban City for coordinating in region VIII Cebu city for coordinating in region VII Roxas City for coordinating in region VI Additional sub-national Health Cluster Coordination teams will be deployed to Ormoc, Borongan and Guiuan. Health cluster partners at each site are listed at the end of the bulletin. Daily Health Cluster meetings are being held to coordinate response actions through establishment of common priorities and goals, identification of needs and gaps and avoiding duplication in geographical coverage of assessments and services. At national level, 6 technical sub-working groups for reproductive health, mental health, vaccination and cold chain, health care services, planning, and surveillance and epidemiology, have been formed under the health cluster for more detailed discussions and targeted Essential health services Transport of patients to referral hospitals is still an issue due to lack of ambulances and fuel. Supply distribution is improving as more roads are cleared. Basic/essential health care services need to be scaled up, and gaps filled when foreign medical teams leave, especially routine surgical capacity (e.g. caesareans). There is a reported need of support for the provision of urgent temporary repairs to key facilities and temporary mobiles services to ensure access to care at the peripheral level. Essential drugs, vaccines and supplies The DoH has identified basic medical supplies as the main priority including cold chain for vaccines. In remote areas in Tacloban region antibiotics are in high demand to prevent post -surgical infection. Equipment such as self-powered refrigerators, freezers, ice packs and action. The sub-national level health clusters have also established working groups according to the key areas of interest and need in the area. Information on the activities of health cluster partners is being collected through the 4Ws (Who is doing What Where and When) matrix and supplies and logistical capacity of the partners is being compiled through a logistics tracking system. A packet of relevant global and national guidelines in specific public health areas has been put together and distributed to partners on a memory stick. The packet can also be accessed via the health cluster website. Needs assessment Needs assessments by health cluster partners are on-going. As of 22 November, initial health assessments have been conducted in all major landfall sites and further in depth assessments are going on. Health facility assessments have been completed in 11 of 66 municipalities in Leyte and Samar A Multi-Cluster Initial Rapid Assessment, is planned. The health cluster will participate and the analysis of the collected information will include other cold boxes are also needed. In Tacloban, supply and equipment for general waste management and medical waste disposal are needed in large quantity, including those to be used in the vaccination campaigns. information collected by individual agencies and that of DoH. Response Health services A total number of 61 Foreign Medical Teams (FMTs) in the affected areas composed of more than 918 medical staff as of 22 November 2013 (map). Fifty-one of the field hospitals established are type 1and three additional type 1 teams are under deployment. There are six teams with type 2 hospitals and one team with a type 3 hospital. An additional 72 national and local medical teams have also been deployed to the affected areas. All FMTs are required to be completely self-sufficient for the duration of their stay as resources are limited. Provision of fuel remains the main challenge. A guidance note has been issued by DoH on the entry and exit strategy of FMTs in light of the evolving situation and the subsequent shifting of priorities from immediate trauma care to primary and surgical care as well as public health issues. 6

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8 Whilst medical teams provide health care in Cebu city, additional resources are needed due to large migration of population from Tacloban and other affected areas to Cebu city. As FMTs start phasing out, DoH has established a website ( where partners are requested to provide exit strategies to ensure consistency and continuation of programs already started. To further support this, the DoH is promoting a campaign on Adopt a Hospital. This campaign requests all incoming medical teams, including from the local private sector, to set up their facilities on or close to a site of a destroyed health facility as a means ensure the operations can be transferred to rehabilitate the health facilities in the recovery phase. DoH has also requested for support to be given to areas outside of region VIII as much of the response is still concentrated in and around Tacloban. WHO is working with IOM on identifying location and needs of migrating populations. ICRC has commenced work to support the health services in affected prisons including provision of medical supplies to the prisons health units. An ambulance has been put in place by WHO in Tacloban for use by the local health authorities. Essential drugs and supplies The DoH has established hubs for medical supplies and personnel in Tacloban, Cebu, and Catbalogan Cities, with Cebu as the main hub for medical supplies. A One Stop Shop has been activated in Tacloban and Cebu ports to expedite and release donated relief items. Two thousand doses of Tetanus immunoglobulin have been deployed to Tacloban and Cebu (1000 doses in each location) for use in treatment of contaminated wounds. The health cluster in support of DoH is developing a logistics tracking and monitoring mechanism to identify available supplies and gaps. Vaccination and cold chain Vaccination against measles (6-59 months) and polio (0-59 months) has already been initiated in evacuation centers in region VIII along with Vitamin A distribution. A mass vaccination campaign for the same diseases will 8

9 start in Tacloban next week. An EPI specialist is being deployed to receive equipment and coordinate the campaign. Twenty nurse volunteers will also be deployed to vaccinate children. The regional cold chain is fully functional in region VIII. Sufficient measles and OPV vaccines, vitamin A and vaccination supplies are available to start the planned measles vaccination campaign in region VIII but additional needs are expected when scaling up the vaccination campaign to other regions. Surveillance The Surveillance in Post Extreme Emergencies and Disasters (SPEED) system has been activated by the Department of Health in evacuation centres and through mobile clinics but its implementation has been limited in several areas due to interruption of communication systems as the system is primarily based on SMS reporting. All health cluster partners have been requested to input disease information into this system in order to ensure proper verification of rumours of diseases in a timely manner. In regions VI and VII the routine surveillance system, the Philippines Integrated Disease Surveillance and Response (PIDSR), is functional as of 21 November Other areas are slowly recovering means to reinstate the PIDSR; however, in region VIII as the entire health system was destroyed, the PIDSR is not functioning and ad hoc measures are being put in place to facilitate reporting and response Protocols for treating tetanus and other health conditions from both global and national guidelines will be shared with all partners. Maternal, Newborn and Child Health The Philippines Food and Drug Authority (FDA) will distribute a circular to promote breastfeeding of new-born babies. This will include a guideline on breast milk substitute powder distribution. The guideline specifies that the powder bought from retail stores cannot be donated or distributed to the affected population. The circular is currently awaiting the signature of the Secretary of Health. In Cebu maternal and child health programmes are being scaled up in the evacuation centers. Breastfeeding promotion is being conducted at the vaccination posts. Dead Body Management Dead body management has been consolidated under the leadership of the Department of Health of the Philippines. The government of Philippines has developed a guidance note for dead body management based on the WHO guideline. The process is designed to manage the dead respectfully in a way that optimises the chances of identification. The government has mobilized resources to manage 10,000 bodies in region VIII. A further 2,800 body bags have been mobilized to regions VI and VII. In view of the daily increasing number of bodies being retrieved owing to improved access to the affected areas, there may be a need for further resources. Partners, including WHO, ICRC and governments of Australia and Germany have deployed forensic experts to assist the government in this endeavour. Additional support is en route from the Republic of Korea, New Zealand and Switzerland. Water, Sanitation and Hygiene (WASH) and Environmental Health The health cluster in Tacloban has started distributing 3,000 hygiene kits to evacuation centres in Tacloban City since 16 November The cluster has also supported in establishing a health care waste management system and at the EVRMCA transfer site for waste has been built and collection of waste will commence as of 22 November A donation of disinfectant and larvicide for control of dengue has been received and sanitation activities will begin in the affected areas. A large oil spill has been reported in Estancia, Iloilo. An interagency team including health cluster partners has been deployed to assess the extent of the damage. Planning Support has been provided to DoH to put together a response plan for the health sector. The plan is currently with the government for further approval. The health cluster is developing a response and recovery plan covering a period of 6 months and 12 months respectively in line with the DoH plan. All partners are encouraged to provide information on the organizational capacity to provide support in both areas, with special em- 9

10 phasis on the need for long term support during the recovery process. An estimated cost of damage has been put together by the DoH. The operational cost for dealing with the damage is still under development, including costing for reconstruction of destroyed health facilities. Once the costing and the gap analysis are finalized DoH will circulate for identification of available resources. NEXT STEPS Assessments, tracking and mapping will be continue to: Estimate amount of infrastructure damage and health service availability Better define affected populations and needs, including for pregnant and lactating women and patients with chronic disease, evacuee locations and needs of displaced people including migrants. Evaluate resources currently available and what will be required in the short to mid term Refine understanding of health partners current location and activities including availability of logistics and supplies to match population needs. Better understand the needs for longer term relief and recovery in the next 6 to 12 months FUNDING STATUS OF FLASH APPEAL As of 22 November 2013, the action plan is 31% funded for the health sector (table). FUNDING STATUS OF FLASH APPEALFOR HEALTH (Million US$) Project Appealing Agency Amount Required Funding % covered Saving Pregnant Women and Newborn lives and support to Super Typhoon Haiyan affected provinces of Leyte, Capiz, Iloilo and Aklan Adolescent and Sexual Reproductive Health in Emergency Services and Support to typhoon Haiyan affected provinces of Leyte, Samar, Iloilo, Aklan and Capiz Ensuring Access to Reproductive Health Services for IDPS affected by Typhoon Haiyan Provision of emergency health services to Typhoon affected populations Emergency Health for Children and Families Affected by Super Typhoon Haiyan in the Philippines Source: 18_November_2013_(03_01).pdf As of 22 November WHO received firm commitments from Australia, Canada, Norway and the UN Central Emergency Response Fund (CERF) for a total of US$5.8 million. Japan has also pledged support. Rapid Save the Children Save the Children deployment of staff and medical supplies has been made possible thanks to contributions made earlier in 2013 to enhance WHO s surge capacity for acute emergencies from the governments of the Russian % % UNFPA % WHO % Save the Children % TOTAL % Federation, Sweden and the United States of America, and from the European Commission Humanitarian Aid and Civil Protection (ECHO). 10

11 Health Cluster Meeting Participants National- Manila: AECID, Americares, Australian Aid, CDNDART, CFSI, ChildFund, DFID, DOH, FPOP, Handicap International, HuMa, IFRC, IHP-UK, ILO, IMC, IOM, IRC, ISARGermany, JICA,MERLIN, MDM, MSF, National Bureau of Investigation, PHE, Philippines Red Cross, Relief International, Plan International, Project Hope, PU-AMI, SCI, UNFPA, UNICEF, USAid, US Forces, WHO, World Vision. Sub-national- Tacloban: AECID, ACF, AUs, BomberosUnidos SP, DOH, HUMEDICA, JICA, KOICA, MSF/F, SC, RTR hospital, UNICEF, WHO. Sub-national- Cebu: AmeriCares, ASB Germany, Canadian Emergency Response Unit, Canadian Medical Assistance Teams, CFSI, ChildFund, DOH, Embassy of Israel, Eversly Child Sanitarium, GOAL, IFRC, International Medical Corps, JICA, MDM, Med Japan, Merlin, MSF, NYC Medics, PNA, Samaritan Purse, SC, SCI, Spanish Red Cross, Saint Anthony Mother and Child Hospital, Talisay District Hospital, UNICEF; Vicente Sotto Memorial Medical Center, WHO. Health Cluster Contacts National- Manila: Sub-national- Tacloban: Sub-national- Cebu: Health Cluster Website: Please send any information on potential disease outbreaks to: 11