Internally Displaced Persons ( IDP ) District of Vavuniya - June 2009 to January 2010 Background Total number of persons displaced was around 230,000. They were housed in welfare camps and majority were in Cheddikulam, Vavuniya which was under the purview of Cheddikulam MOH office. Few camps were scattered in other MOH areas in the district of Vavuniya occupying mainly in existing government buildings. The relief camps in Menik Farm, Cheddikulam were initially organized as Zones starting from 0 4 with following populations; Zone 0 : Kadiragarmar village 21,602 Zone 1 : Ananda Kumaraswamy village 37,102 Zone 2 : Ramanadan village 75,564 Zone 3 : Arunachalam village 39,434 Zone 4 : 52,175 The organization structure was consistent with the district health administrative structure. Later zones were expanded up to seven with more dispersion of population and established as relief villages/welfare centres. Health coordination centre was established and total administration was carried out by the Directorate and the administrative staff appointed at the Coordination centre.
Activities carried out by the Epidemiology Unit Disease surveillance activities Common epidemic prone diseases were under the disease surveillance activities initially. Viral hepatitis, Dysentery, Watery diarrhoea, Chicken pox, Typhoid fever and Malaria were considered at initial stages and later extended to other communicable diseases. The staff of the Epidemiology unit assisted the regional health staff in establishing the surveillance activities. Notifications were actively collected ( 1. Notification format ) by the volunteers involved in duties at welfare camps and by the health staff temporary recruited from other districts on a roster basis. Overall supervision and coordination activities of epidemiological aspects of disease surveillance and prevention activities were carried out directly by the Epidemiology Unit up to mid August. We were able to recruit a staff of Public Health Inspectors (13) since mid August and routine disease surveillance activities were efficiently carried out by them. Communicable disease pattern in the month of June, Cheddikulam IDP camps, Vavuniya Number of cases 440 420 400 380 360 340 320 300 280 260 240 220 200 180 160 140 120 100 80 60 40 20 0 Dysentery Chicken pox Malaria Viral Hepatitis Watery diarrhoea enteric fever Viral hepatitis 6/1/2009 6/2/2009 6/3/2009 6/4/2009 6/5/2009 6/6/2009 6/7/2009 6/8/2009 6/9/2009 6/10/2009 6/11/2009 6/12/2009 6/13/2009 6/14/2009 6/15/2009 6/16/2009 6/17/2009 6/18/2009 6/19/2009 6/20/2009 6/21/2009 6/22/2009 6/23/2009 6/24/2009 6/25/2009 6/26/2009 6/27/2009 6/28/2009 6/29/2009 6/30/2009 Dysentery Enteric Fever Watery diarrhoea Date Chicken pox Malaria PHII Recruitment and disease surveillance Strengthening of Public Health Services to Control the Spread of Communicable Diseases in IDP Camps, Cheddikuam, Vavuniya, 13 PHII were recruited with the support from WHO. They were distributed in zones and all responsibilities of Epidemiological duties were handed over under the guidance and supervision of Epidemiology Unit.
Vaccination procedure carried out according to the Interim guideline issued for IDP camps Vavuniya ( 2. Interim guidelines of vaccination ) in addition to the routine immunization Catch up measles immunization ( 3. Catch up measles immunization format ) Suspected measles cases were reported and early catch up programme was carried out according to the guidelines. Groundwork for the Immunization Catch up Programme which was started on 12 th July 2009 was organized with the assistance of the regional health staff at Cheddikulam, Vavuniya and Anuradhapura. This included preparing the immunizing ground plans & maps, organizing the supportive staff etc. Chicken pox outbreak: investigation and management guidelines of Chicken pox was issued ( 4. Chickenpox guidelines ) and possible effort done to control the outbreak. Outbreak of chickenpox reported since initial establishment of welfare camps and spread in almost all zones. But isolation was difficult within the prevailing situation. The closest hospital Puvarasakulam was identified as the isolation hospital for urgent requirements even though the facilities were inadequate. Typhoid vaccination programme and guidelines ( 5. Typhoid guidelines ) Awareness on basic measures in typhoid prevention was carried out and typhoid prevention guideline was issued. Vaccination of high risk categories were carried out according to the guideline. Guideline issued in prevention of Hepatitis A ( 6. Hepatitis guidelines ) & activities carried out were supervised. Water quality issues
Poor quality of drinking water was a problem at the beginning and coordination activities on adequate chlorination was done with National Water Board. Monitoring of chlorine levels at camp entry points/ delivery points were organized. These checking points were manned by water quality monitors trained in chlorine level measurements who checked chlorine levels of all bouser s entering the camp site and they had the authority to turn back the bouser s with sub optimum ( < 2 ppm ) chlorine levels. PHII were assisted and supervised the procedure. The trend of using water from tube wells were identified as an important reason for increasing frequency of water borne communicable diseases. Health education measures were carried out to make people aware of the quality of drinking water.
Food sanitation, fly control and other activities related to PHII were included in PHI duty list. They were expected to submit a daily report ( 7. Daily status report format ) to coordinating PHI at Coordinating PHI had to compile weekly data and forward to Epidemiology Unit. Coordinating PHI also expected to carry out routine disease surveillance activities since September. Supervision visit of resettlement areas Resettlements started at identified areas in Killinochchi and Mullativu districts. The regional health staffs recruited in district were carried out public health services with minimum facilities. Supervision visit to identify requirement of facilities in carrying out Epidemiological activities was done by the Epidemiology Unit at the initial stages of resettlement. Temporary MOH office Poonakari Supervision of vaccination clinic
Reconstruction MOH office Malavi