EMERGENCY AND HUMANITARIAN ACTION (EHA) WEEKLY UPDATE WHO COUNTRY OFFICE ETHIOPIA: (Week 35, 24 30 August 2009) HIGH LIGHTS: I. According to official reports from the Federal Ministry of Health (FMOH), AWD epidemic has been reported from all ten sub-cities in Addis Ababa. The food security situation in the country remains poor as a projected figure of 6.2 million beneficiaries would require food assistance from July to December 2009. Malnutrition continued to be a serious concern in several woredas of Southern Nations, Nationalities and Peoples Region (SNNPR) in the first half of the year. GENERAL SITUATION: a) Political, social, security overview for the week The overall security situation in the country remained stable during this week. No major security incidents involving humanitarian staff members have been reported. b) Main events of interest/ concern for health (displacements, conflicts, disease outbreaks, etc.) Acute watery Diarrhoea (AWD) According to official reports from the Federal Ministry of Health (FMOH), AWD epidemic has been reported from all ten sub-cities in Addis Ababa. A total of 3089 cases with 4 deaths (CFR=0.12%) were reported from Addis Ababa Health Bureau since Aug 16, 2009. Cases started to build up starting from 20th August 2009 and continue with increasing trend with a report of 783 cases with 1 death today, 27th August 2009. It was observed that cases are being reported from all sub cities with the highest case load being reported from: Akaki/Kaliti, Addis Ketema, Arada and Kolfe sub citities.
Note: More AWD cases are from Akaki Kaliti, it is due to high wider geographical areas that the cases are scattered. According to official reports from the Federal Ministry of Health (FMOH), 2,460 new cases of AWD and 22 deaths (CFR of 0.9%) have been reported from six Regions (Addis Ababa, Afar, Amhara, Somali, Oromiya and SNNPR) from 17 to 23 August 2009. A total of 61 districts and 10 sub-cities have been affected by AWD in the country. National Trend analysis Shows AWD Cases and Deaths as of 23 August 2009, Ethiopia AWD Cases 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0 300 280 260 240 220 200 180 160 140 120 100 80 60 40 20 0 AWD Deaths 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Analysis: WHO - Ethiopia EHA/DPC - Units Data Source: FMOH - Ethiopia Date of Production: 31 August 2009 Epidemic Week 1-34 Cases Deaths Food security and malnutrition The food security situation in the country remains poor as a projected figure of 6.2 million beneficiaries would require food assistance from July to December 2009. The Belg needs assessment figures are being finalized. The revised Humanitarian Needs document is expected to be released by the Government by the end August 2009. On 25 th August, a delegation of senior UN staff, including the Humanitarian Coordinator a.i., donors and NGOs, travelled to Jijiga to meet with the Regional President of the Somali Region and a number of key figures in the regional government. The regional authorities briefed partners on the latest developments in the humanitarian situation in the region and highlighted the urgency of water tankering interventions to counter the threat posed by severe water shortages to health and livelihoods. Donors and humanitarian partners signalled their commitment to provide continued support to the Region and urged regional authorities to work closely with their counterparts at the Federal level to resolve outstanding issues relating to access. In addition to the high-level meeting, operational partners on the ground met in Jijiga to develop a multi-sectoral response plan on the basis of the findings of the seven standard nutrition surveys, conducted between June and July 2009. Water problems are particularly serious in the Somali region where many of the affected areas 2
require urgent water relief interventions. In Oromiya region, recent reports indicate a serious deterioration in the food security situation in Kurfachele woreda of East Harerghe, Abaya woreda in Borena and several woredas in West Shewa Zone. Consequently, malnutrition rates remain high in these areas. Increased occurrences of weather-related shocks such as heavy rains, hailstorms and flash floods have been reported in some woredas in SNNPR, Oromiya and Amhara regions, especially in August. These events have resulted in crop damages of various magnitudes. The impact of these natural hazards is of concern especially in Alaba Special woreda and Shashego in Hadiya Zone. The overall performance of the Kiremt rains showed a general improvement in amount and geographic coverage over the last two weeks in most parts of the country. Nevertheless, rainfall continued to be poor in many low-lying areas of eastern and south-eastern Oromiya, lowland parts of southern SNNPR, most of Gambella, a few woredas in Eastern and Southern Tigray and some woredas in eastern Amhara. In the Somali region and parts of eastern and south-eastern Oromiya and southern SNNPR, the condition of livestock is below normal and declining while in the remaining parts of the country livestock condition is gradually but steadily recovering. Influenza A H1N1update According to official reports from the Federal Ministry of Health (FMOH), no new cases of Influenza A H1N1have been reported this week. The total confirmed cases in the country is still six II. ANALYSIS & HEALTH CONSEQUENCES: Health problems & Needs of affected populations. Acute Watery Diarrhoea (AWD) The AWD outbreak has been reported from six Regions (Addis Ababa, Afar, Amhara, Somali, Oromiya and SNNPR) from 10 to 16 August 2009. A total of 47 districts and nine sub-cities have been affected by AWD in the country. The outbreak is rapidly spreading with the ongoing kiremt rains. In addition the continuous movement of pilgrims and migrant labourers to Holy water sites and Private farms continues to facilitate spread of the disease to other parts of the country. WHO and partners are addressing these issues at federal and regional level through increase supervision, monitoring and advocacy. The ongoing kiremt rains are expected to further exacerbate the spread of the disease as number of community unprotected water sources increase; already a significant rise in the number of new cases has been recorded since the beginning of June. Critical gaps in the response include lack of CTC materials and drugs, lack of funds for operational budgets, inadequate protection of water sources, poor hygiene practices and trained health staff. Case detection and management is still a challenge in CTCs located remote community where health workers have little experience in AWD treatment, preventative measures in communities also needs to be further strengthened. The absence of clean safe water supply, proper sanitation facilities, medical care and very poor and overcrowded living conditions in the state farms and holy water sites serves as an appropriate foci of infection for AWD transmission within the regions and other areas of the country. WHO and partners are addressing this issue at federal and regional level through increase supervision and monitoring. Food insecurity and malnutrition Malnutrition continued to be a serious concern in several woredas of Southern Nations, Nationalities 3
and Peoples Region (SNNPR) in the first half of the year. Currently, the situation is showing a considerable improvement as a result of the ongoing distribution of food assistance and the start of the green harvest. However, there are still a few areas where admission rate to therapeutic centres remain high and steadily increasing. These areas include Wonoago and Kochere (Gedeo Zone), Tembaro (KT Zone), Soro in Hadiya and Kindo Didaye in Wolayita Zone. Despite a general improvement in water availability and pasture regeneration in the areas benefiting from the Kiremt rain, water and pasture scarcity continued to intensify in many parts of the Somali region including lowlands of East and West Harerghe, Bale, Borena, and Guji zones in Oromiya, and parts of South Omo in SNNPR which are currently undergoing the dry season. The situation has forced pastoralists and agro-pastoralists to make unusual migrations and to concentrate in a few areas with relatively better resources. III. ACTIONS (in relation or response to the issues mentioned above): a) WHO activities (field trips, assessments, gap filling, coordination, information sharing, training, etc.) & needs (Human resources, material, and infrastructure) and other partners support. Acute watery Diarrhoea (AWD) At the federal level, government and humanitarian partners have set up a central command centre to scale up efforts to contain the outbreak and ensure that resources are in place so that cases are treated as quickly as possible. Partners meet twice daily and the Minister for Health receives regular updates on the situation and provides guidance on the response. UNICEF has seconded consultants to the Emergency Preparedness and Response Unit at the Ministry of Water Resources and the EHNRI to support government counterparts in their efforts to plan and respond to the outbreak. A team that is deployed to Kality (composed of RHB, WHO and FETP residents) where most cases have been reported due the location of one of the contaminated Holy water site, is currently conducting field investigation and so far identified that most people are using drinking water from public tap and use river water for most of their household activities. The city waste and other products from animal husbandry get in to this river which crosses kebeles where most cases were reported. The existing National humanitarian requirement which was finalized first week of August has now been revised considering the Addis Ababa situation (which was not considered at all in the Appeal) and possible spread of the outbreak. With respect to this, the team came up with additional USD2.3 mil requirement (expected national cases 132,000 in the coming 5 months). The requirement focuses on Drugs, medical supplies, CTC supplies, Strengthening surveillance (Epi and lab), public communication and training. The WASH aspect is expected to be prepared by MoWR. In response to Addis Ababa financial request of USD500, 000, WHO committed USD30, 000 (Surveillance /Case management/training) and UNICEF committed USD100, 000 (Training and operational cost). Support will be updated based on additional commitment. Food insecurity and malnutrition This week WHO has continued its technical support to regions in responding to food and nutrition crisis in Ethiopia. WHO is technically supporting the roll out of OTP and monitoring and on-job trainines of health workers for mangement of severe acue malnutrition. V. COORDINATION: This week, WHO actively participated in the technical officers/unocha, WASH cluster/mowr, Nutrition cluster and Ethiopian Humanitarian Country Team (EHCT)/UNDP meetings held in Addis 4
Ababa. WHO is supporting and facilitating the coordination for the preparedness and response of influenza A by the UN country team and AWD by the FMOH and the regional health bureaus. VI. COMMENTS: WHO is working effectively in partnership with the FMOH, RHBs and partners in strengthening capacity of the federal and regions for better health and nutrition response. Currently funds provided by the Finish Government is supporting WHO emergency response activities. 5