WORLD HEALTH ORGANIZATION LIBERIA HEALTH UPDATE 5 September 2003 WHO/OMS
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WORLD HEALTH ORGANIZATION LIBERIA HEALTH UPDATE 5 September 2003 WHO/OMS I. Humanitarian situation in Monrovia: Water and sanitation in general Water and sanitation problems are massive in Liberia, only 32% of Liberia’s population has access to clean drinking water and less than 30% of the people have access to latrines. A large amount of the population depends on wells and many of these wells are not protected. The city of Monrovia has had no regular garbage collection since 1996. Refuse collection has been carried out on an occasional basis by NGOs and the municipality of Monrovia. In March this year, garbage collection collapsed completely. UNICEF and its partners under the Water and Sanitation Committee are taking the lead in solving the garbage problem. New population movements underway Over 90 camps in Monrovia provide shelter to at least 250,000 displaced people. According to latest information, a new population wave is on the move towards Monrovia. Over 50,000 people are fleeing from fighting in Totota in Bomi County toward Salala and a few have been reported to trickle into Monrovia to escape the rebels. UN agencies and NGOs are working on contingency plans to avoid the arrival of more internally displaced people in the already overcrowded camps in the capital. Humanitarian aid agencies hope to halt the population movement to Salala, Bomi County. Situation in the camps in Monrovia About 45,000 displaced people live in the SKD Stadium which is the biggest camp in Monrovia. Daily heavy rainfall makes living conditions in the camp even more difficult. IDPs cook and sleep in any sheltered spot they can find, in hallways and in tiny slots under the stadium seats. Humanitarian aid agencies and NGOs work around the clock to improve water and sanitation in the SKD camp. But progress takes time. Each day, MSF France pumps 120,000 litres of water into the camp water outlets, providing each person with about three litres. Outside the stadium, in little plastic huts, 22 latrines have been built, certainly not enough to serve the needs of the entire camp population. The health centre at the SKD stadium is completely overwhelmed. Up to 400 patients visit the centre each day to see the six nurses. Most common health problems include malaria, diarrhoea, skin infections due to poor hygiene, and acute respiratory infections. The health centre also provides antenatal care to an average of 40 to 50 mothers per day. Last week, twelve babies were born in the camp. A cholera treatment centre is attached to the health centre. 174 suspected cases were admitted last week, 62 of them with severe diarrhoea. The situation in other camps is similar. The Masonic Temple, for example, provides shelter to about 10,000 displaced people. MERLIN provides water to the camp and runs the health clinic. People receive about two litres of water per day for drinking, cooking and washing. There is one latrine per 1,000 IDPs. The health clinic there has identified malaria, diarrhea and skin infections as the main health concerns. Disease outbreaks Cholera: WHO has now established a disease surveillance system and can provide more accurate figures on the cholera outbreak in Monrovia, with information from all NGOs working on health in the city. Due to the prevailing humanitarian situation in the camps with a very high population density, the cholera outbreak is still not under control. During the week from 25 to 31 August, 2035 new cases were reported of which 213 suffer from severe diarrhoea. Four people are reported to have died of cholera last week. Compared to September last year when there were 25 new cases per week, the figure is alarming. Measles: Measles cases have been reported in the Grey Stone camp that currently provides shelter to more than 5,000 displaced people. So far, two children are infected. However, measles is a highly contagious disease and WHO is coordinating with NGOs working in the camps to carry out immunization as soon as possible. II. Outside Monrovia Although the security situation outside the capital is volatile WHO has undertaken several field trips to start assessing the health status of the population in the counties surrounding Monrovia. As soon as Liberia becomes more peaceful and accessible, WHO will carry out thorough assessments of the population’s health situation and the state of the health facilities in order to identify the potential for establishing essential personal and public health services. In all towns visited, the local population contains displaced people living in camps or in homes of other displaced who have fled to other counties and to Monrovia. In Tubmanburg, about 60 km northeast of Monrovia, 80% of the population are displaced people. In other areas the situation is similar. Buchanan Buchanan is located about 100 km south-east of Monrovia in Gran Bassa County. It is still difficult to access the town from Monrovia, having to manoeuvre and negotiate through 19 rebel-controlled checkpoints. The streets are full of armed militiamen. MODEL, the Movement for Democracy in Liberia, holds the town and imposes curfew from 4 p.m. to 7 a.m. At nightfall, harassment gunfire is common and houses are broken into. The population fears the armed men and reports being harassed. WHO along with UNHCR and WFP participated in discussions with the local rebel commander and reminded him of his duty to discipline his forces. WHO stressed that harassment incidents will only delay access of the humanitarian community and the recovery of the public health system. Although food can be found on the local markets, 90% of the population does not have the money to buy anything. Children in the streets show early, but obvious, signs of malnourishment. Access to basic health services is very limited. One of the three health facilities in town, the Catholic Clinic, has power problems. The Liberian Government Hospital was looted and subsists on drug donations from MERLIN, which also opened a mobile clinic. The hospital staff has been energised by MERLIN’s commitment and is eager to re-open the hospital doors to the population of Buchanan. The third hospital in Buchanan, the Oriental Timber Company hospital, is not functioning. There is a significant shortage of pharmaceuticals. Antibiotics, antimalarials, analgesics and anti-epilepsy medication in particular are lacking. The Liberian National Red Cross (LNRC) found corpses in at least four of the town’s wells. LNRC reported that corpses were buried directly above wells that provide drinking water and recommends to exhume the bodies and bury them properly to avoid public health threats. A mass chlorination of the wells will be carried out by the LNRC. Salala More than 23,104 internally displaced people live currently in Salala, Bong County. Salala is a small village, about 97 km north-east of Monrovia. Phebe, the major referral hospital in Bong County, was relocated to Salala during the crisis and now does surgery for war wounded and obstetric emergencies. According to Dr Emmanuel M. Sandoe, Country Health Officer of Bong County, most of the patients who come to Phebe suffer from malaria, acute respiratory infections and diarrhoea. He also reports an increasing incidence of sexually transmitted infections, especially gonorrhoea and syphilis, and three patients were diagnosed with AIDS during the last three months. Another clinic in Salala is run by the Bong County Health Team which is part of the Ministry of Health. MSF France also opened a clinic in a camp for internally displaced people in Salala. Kakata Kakata, 60 km north-east of Monrovia, has a large camp for displaced people. 11,000 people shelter in this camp. Four hand pumps provide the displaced people with drinking water. Save the Children UK supports a Red Cross health centre that serves the camp population and receives about 90 patients per day. The main diseases found in this camp include malaria, acute respiratory infections, worms and a few cases of schistosomiasis and filariasis. Two midwives in the health centre provide antenatal care. An average of five babies are born here per week. III. WHO’s actions in this crisis To improve the health security of Liberia’s people, WHO currently focuses on six main emergency activities in and around Monrovia: (1) Access to safe water to reduce the risk of further outbreaks of water-borne diseases, such as cholera and dysentery, through regular chlorination of all accessible water supplies. The first chlorination round is being carried out. WHO, in collaboration with UNICEF and other health partners, is chlorinating the capital’s 5,000 wells. The wells will be re-chlorinated every four days to guarantee that water remains clean. (2) Strengthening and expanding the recently-established disease surveillance system in order to obtain exact data on trends of epidemic prone diseases. (3) Improving emergency immunization coverage. The national immunization programs have collapsed and coverage in Liberia is very low. WHO and health partners have carried out the first life-saving measles vaccination campaign in Tubmanburg. Measles is a highly contagious disease and one of the biggest child killers in Africa. To avert death from measles requires vaccination and Vitamin A, a protective micronutrient, that is often lacking in chronically malnourished children. During the one-week campaign the health workers vaccinated over 3,000 children, aged from six months to up to fifteen years and administered over 1,400 Vitamin A doses to children below five years of age. (4) Where there is disease and trauma, supplying essential medication and medical supplies to camps, hospitals and clinics. (5) WHO facilitates coordination of all the NGOs working in the health sector to ensure rapid response and avoid duplication of services.