Afghanistan Health Cluster Floods in Afghanistan Bulletin No. 1 10 September 2010 Highlights Flooding and heavy rains have affected 16 provinces, with the 9 provinces in central and south-east Afghanistan being the most affected. Twelve health facilities in Kunar, Khost, Bamyan, Ghazni, and Paktia provinces have been damaged but remain functional. Assessments and assistance are ongoing in affected areas. The main health priorities are to ensure access to essential health care; treatment of casualties; and prevention and control of waterborne and vector borne diseases. Major threats to public health include water and vector borne diseases: diarrhea, typhoid fever, hepatitis A and E, malaria, acute respiratory infections (ARI), skin infections, and measles. These threats are due to the lack of access to safe drinking water, standing water, and the lack of shelter and interruption of EPI services. Also, on medium term as the communities living in affected areas lost crops, food stocks and livestock, there is a risk of increased acute malnutrition amongst vulnerable groups Fourteen affected provinces are sharing daily diseases surveillance data. The most common reported diseases are (ARI) and acute watery diarrhea (AWD) in Kunar, Nangarhar, and Ghazni provinces. The outbreaks and alerts have been investigated and control measures are underway. Emergency medical supplies have been prepositioned and distributed to health NGOs. Nineteen mobile clinics have been established by health NGOs to serve the affected communities. A measles campaign has been completed in the eastern provinces of Kunar and Nangarhar.
Situation overview and current scope of disaster Since the beginning of July, heavy rains and subsequent floods have hit parts of Afghanistan, with more rains expected. Around 17 provinces have been affected, with the 9 provinces in central and More than 8 000 houses have been damaged or destroyed Around 60 000 people are without shelter Tens of thousands of acres of agricultural land and orchards have been destroyed Thousands of water sources contaminated south-east Afghanistan being the most affected. Kapisa province Assessments are ongoing as flooding continues (see box) and initial information was gathered by Afghanistan National Disaster Management Authority (ANDMA), MoPH, DEWS, Departments of Rural Rehabilitation and Development (DoRRD), NGOs, UNAMA, and OCHA. Health concerns According to initial data, 12 health facilities in Kunar, Khost, Ghazni, Bamyan, and Paktia provinces have been damaged by the floods; except for Dahan Yakshin BHC (Ghazni province) that sustained severe structural damage, all of them remain functional. The main issues in terms of population access to essential health services in flood affected areas are: Dahan Yakshi BHU (Ghazni province) Insufficient capacity to deal with increased patient caseload Lack of or difficult physical access o by the affected population to reach health facilities o by mobile teams to reach affected communities, and to transport supplies o blocked roads and security issues in Laghman, Paktia, Khost, Sari Pul and Zabul impede transport of supplies and access to functioning health facilities Difficult referral of severe cases, especially for women and children Major threats to public health include outbreaks of water and vector borne diseases: diarrhea, typhoid fever, hepatitis A and E, malaria, acute respiratory infections (ARI), skin infections, and measles. These threats are due to the lack of access to safe drinking water, standing water, and the lack of shelter.
High risk of outbreaks and epidemics of water and vector borne diseases: diarrhea, typhoid fever, hepatitis A and E, malaria, ARI, skin infections, and measles due to lack of access to safe drinking water, standing water, and lack of shelter. The main health priorities are to ensure access to essential health care; treatment of casualties; and prevention and control of waterborne and vector borne disease outbreaks. Health Cluster response WHO is working closely with MoPH, NGOs, ANDMA, and other related sectors/clusters (food, shelter, and WASH) to assess health needs and coordinate response. Ensuring adequate supplies of medicines and medical supplies Health NGOs working in affected provinces are covering the immediate health needs with support from MoPH, WHO, UNICEF and UNFPA. In an effort to support health NGOs in dealing with the additional caseload and health risks, the MoPH, WHO and UNICEF provided necessary medical supplies and prepositioned more supplies in central, eastern, and southern Afghanistan. WHO distributed emergency medical supplies to MoPH/PPHD, Aid Medical International (AMI), International Medical Corps (IMC), Swedish Committee for Afghanistan (SCA), Health Net International TPO, Ibn Sina, Sanayee Development Organization (SDO), BRAC, Peace Medical Services (PMS), and AADA, namely: 18 Diarrheal Diseases Kits (DDK), 38 IEH kits, 1 Trauma kit, 10 Pneumonia kits and other miscellaneous medicines and medical supplies. Four Cholera kits were distributed in Wardak district by the EPR department of MoPH. These supplies are sufficient to cover the immediate health needs of more than 100 000 people for the period of 1 month. In addition, 26 Diarrhea kits (cover the treatment of 26,000 cases of AWD/cholera), 6 Trauma kits and 115 IEHKs (cover the basic health needs of 115,000 people for 3 months) were prepositioned by WHO in affected regions. UNICEF dispatched 6 New Emergency Health kits and 3000 ORS sachets to Kapisa province. With UNICEF support, the distribution of around 1500 cartons of High Energy Biscuits by NGO implementing partners to children less than 5 years of age and pregnant and lactating mothers is ongoing. Nutrition education was strengthened in all affected areas and nutrition screening initiated in Nangarhar. UNFPA will procure 2000 Hygiene kits and package of RH kits including PEP kits that meet the needs of 20,000 populations for 3 months for the distribution to health facilities in the worst-affected communities. The kits will be distributed in coordination with WHO. Disease outbreak and response Public health interventions focusing on prevention of serious disease outbreaks that can significantly increase postflooding morbidity and loss of life were planned and are being implemented: The MoPH and WHO with the support of health NGOs immediately strengthened the Diseases Early Warning System (DEWS) in all flood-affected districts. DEWS is now reporting the trend of communicable diseases on a daily basis instead of weekly. So far, daily reports are being received from 14 affected provinces.
The most commonly reported diseases are acute respiratory infections (ARI) and acute watery diarrhea (AWD). Alerts and outbreaks of AWD have been reported from Kunar, Nangarhar, Kabul, Kandahar, and Ghazni provinces. These have been investigated by DEWS, health NGOs, and provincial health departments: On 8 August, the Ghanikhail District Hospital in Shinwar district (Mohmandara, not affected by the recent floods) of Nangarhar province reported an outbreak alert of AWD with 10 patients from the tribal mountainous area near Torkham border (Khawray, Mhomandra). Within 28 hours, on 9 August, an investigation team of DEWS, CDC and Health Net (BPHS NGO) visited the affected villages: six samples were taken for laboratory tests. The Cholera outbreak has been confirmed by the Central Public Health Laboratory (CPHL). The source of the outbreak turned out to be an unprotected open spring contaminated with animal dung, and an unsafe water tanker. Starting from 16 August, more patients were reported from Goroko,, Abdulkhil, Achim, Ghamikhil, Canals, Barkot, Nazian, Qalae Shahe, Deh Sarak, Dorbaba, Amla, Skakialay, and Pekha Achin flood affected areas of the Shinwar and Darinoor districts. More than 600 patients reported and around 200 have been hospitalized; so far, no reported death. Sufficient medical stock is available with MOPH and partners (WHO has provided four cholera kits; enough for treating4000 patients) and preventive and control measures are being implemented by the PPHD, DEWS, HN-TPO, ARCS, and PMS with WHO and UNICEF support. Chlorine in tablet and liquid form has been made available by UNICEF for water chlorination. Follow-up on new cases investigation and implementation of control measures is ongoing. More cases were reported by Afghan National Army (ANA) hospital in Jalalabad amongst the Afghan military. The alarm was investigated by DEWS, CDC and PPHD: the laboratory results are pending. On 9 August, in Ghazni Province, Sanayee Development Organization (SDO) reported 60 cases of severe AWD from Nowa District. An outbreak response was initiated the same day. Due to insecurity for MoPH and UN staff, three health workers of SDO from the same area were trained on outbreak investigation, including sample collection, and case management. In addition, necessary supplies donated by WHO including, one DDK and two IEHKs were sent. In total, 1530 severe AWD cases have been reported, including 1 death (a 70-year-old patient). Laboratory results confirmed cholera. The outbreak was controlled, no new cases reported.. On 24 August, an alarm of cholera was investigated and responded by district DEWS team and BRAC in Sorobi district (Kabul Province); 49 cases (6 with severe dehydration) were registered. The laboratory results confirmed cholera; WHO had supplied BRAC with one cholera kit, and health education and WASH intervention are being implemented by BRAC and MoRRD. Kandahar province; two cholera alerts were reported and responded: on 21st August 53 cases of AWD (no death) from Maroof district, and on 25th August in Arghistan District, from the remote, insecure villages of Lora and Wam. Three patients died home before the response team (District Health Officer and AHDS) reached the area on 26 August. Active case finding, immediate treatment of cases and health education are implemented by AHDS; the WHO supplied one cholera kit to AHDS to support the response.
The Health Cluster, led by the WHO and MoPH, is prepared to answer the existing health threats posed by increased risk of water borne diseases (cholera, typhoid fever, dysentery, salmonellosis, amoebic diarrhea, etc.) through distribution and pre-positioning of DDK and IEHK, which include supplies necessary for the treatment of these diseases. Filling gaps in service delivery To respond to the immediate health needs of most affected communities, 19 temporary mobile teams were established by AMI, HNI-TPO, Ibn Sina, SDO, IMC, and SCA in Kunar, Nanagarhar, Zabul, Ghazni, Nuristan, and Wardak provinces. IMC, AMI, HNI, SCA, AADA, Ibn Sina, ACTD, and ARCS strengthened hygiene promotion activities in affected areas. Immunization: Starting 8 August, a measles campaign vaccinated 4200 children between 6 months to 14 years of age in the affected districts of Nangarhar and Kunar province (4600 children were targeted). Another measles vaccination campaign is being planned for the central region. Access to safe water The floods destroyed and/or contaminated thousands of water sources in affected districts. Ensuring access as soon as possible to safe water and appropriate sanitation for affected families is vital for the prevention and control of water borne diseases. UNICEF in close collaboration with MOPH, MRRD and health cluster is supporting health partners on implementation of emergency water and sanitation measures including health education. The distribution of water purification tablets, jerry cans, high capacity collapsible water tanks and well chlorination are ongoing. So far, 830 KG drums, 12 000 jerry cans, 3 water tanks, and 3800 NFI have been distributed by UNICEF, IOM, Oxfam, and ARCS. Also, 280 wells have been chlorinated. Coordination The Emergency Health Committees were activated in all affected provinces. Weekly and ad hoc meetings are held with the participation of health stakeholders to ensure synchronization of efforts in filling in the prioritized needs and gaps. Active participation of the communities living in affected areas is ensured. At national level, the health and nutrition clusters meeting held on 8th August on flood response was chaired by Her Excellency, Dr Suraya Dalil, the acting Minister of Public Health. The strategic priorities were jointly defined, responsibilities defined, and actions planned towards filling the identified gaps. Regular contacts are maintained by the cluster lead (WHO) and MoPH and implementing partners at central and field level. On 13 August a coordination meeting with ISAF was held for the Central region to limit the military involvement in health sector response and avoid duplication. For further information, please contact: Dr. Maria Luiza Galer
Health Cluster Coordinator World Health Organization - Afghanistan E-Mail: galerm@afg.emro.who.int Mobile phone: +93 (0) 796 726 276 Aanchal Khurana Communications Officer World Health Organization - Afghanistan E-Mail: khuranaa@afg.emro.who.int Mobile: +93 79 533 9211 Paul Garwood Communications Officer World Health Organization Geneva E-Mail: garwoodp@who.int