SitRep

#6 Government of Ministry of Health and Population Health Emergency and Disaster Management Unit (HEDMU) Health Emergency Operation Center (HEOC) Ram Shah Path, Contact: 014250845

Situation Update Report #6 28 Chaitra 2075/ 11 April 2019 0

Health Sector Response to Bara, Parsa Storm 2019

Situation Update Report

Thursday 11 April 2019 28 Chaitra 2075 SitRep #6

Date of the Incident: 31 March 2019 (20:00 hours Sunday)

Situation Update:

28 1110 Deaths Injured as of 11 April 2019

Injured are treated in the following hospitals & other hospitals (as of 11 April 2019, 5:00 PM):

Admitted in ward Documented Undocumented Total S.N Name of the Hospitals Death (a) (undertreatment) Referred (c ) Discharged (d) Remarks e=(a+b+c+d) (f ) (e+f) (b) Narayani Sub Regional 1 9 12 6 106 133 202 335 Hospital 2 National Medical College 1 18 0 206 225 175 400 Undocumented 3 Hospital 18 1 10 183 212 0 212 cases are as per 4 Tarai Hospital, 0 0 0 6 6 6 12 verbal 5 Gandak Hospital 0 3 1 55 59 0 59 communication 6 Birgunj Health Care Unit 0 6 1 49 56 0 56 with focal point 7 LS Neuro Hospital 0 3 0 17 20 0 20 of respective 8 Apollo Ortho 0 1 1 4 6 0 6 health 9 TUTH 0 6 0 3 3 0 9 institutions 10 Bhawani Hospital 0 0 0 1 1 0 1 Total 28 43 19 627 727 383 1110 Death (28) *One child died in hospital

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MAJOR HIGHLIGHTS ON HEALTH SECTOR RESPONSE TO BARA, PARSA STORM 2019

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Key activities undertaken by HEOC, MoHP: S.N Date Activities 31 March 2019 1. (17 Chaitra 2075), Incident Occurs (20:00 hours) Sunday - First information received from NEOC (6:13 AM) - Information communicated to: Dr Pushpa Chaudhary, Secretary, Mr Chandra Kumar Ghimire, Secretary, Dr Sushil Nath Pyakurel- Chief Specialist, Dr Guna Raj Lohani - DG, Dr Dipendra Raman Singh - Chief, Quality Standards Regulations, Chuda Mani Bhandari - Chief, HEDMU/HEOC (through viber), Mr Mahendra Prasad Shrestha - Chief, Health Coordination Division and Dr Bibek Kumar Lal - Director, Epidemiology and Diseases Control Division and WHO Health Emergencies Programme. - Incident Management System was activated at 7:30 AM at HEOC - Information recording template sent to hospitals for line listing of cases. - Kathmandu valley hub hospitals were alerted for deployment of Emergency Medical Deployment Team (EMDT) and requested them 01 April 2019 (along with satellite hospitals) to be ready for casualties from Bara 2. (18 Chaitra 2075), and Parsa. Monday - Field update communicated to National Emergency Operation Center (NEOC) - MOHP requested for activation of Nutrition and Water Sanitation and Hygiene (WASH) response immediately. Requested DG, DWSS for further support as lead for WASH. - Hon State Minister of Health and Population chaired emergency coordination meeting at HEOC (10:00 am) with highly technical health experts. - Hon. Deputy Prime Minister and Minister for Health and Population, State Minister for Health and Population, Secretary, MoHP, DG, Department of Health Services went to incident site to support the response coordination and response monitoring. - MoHP established a central coordination team for response coordination including information management. - Press Releases from MoHP on situation updates - Health Sector Coordination Meeting on the chairmanship of Dr Sushil Nath Pyakuryal, Chief Specialist, MoHP at HEOC at 11:00 AM. HEOC collected data on immediate health sector support partners agency can and suggestions. 02 April 2019 - Temporary Information Management Center established at Narayani 3. (1 9 Chaitra 2075), Sub Regional Hospital to support data collection in support from Tuesday WHO - Six Emergency Medical Deployment Team (EMDT) mobilized to support response. o One team from Nepal Army

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S.N Date Activities o Two teams from Nepal Police o One team from Hospital o One team from Chitwan Medical College o One team from Zonal Hospital - 3 Consultants from NAMS Dr Neelam Khadka, Dr Subash Karna, Dr Rabiram Shrestha deployed to the hospital of the incident site for additional support. - Dr Pushpa Chaudhary, Health Secretary and Mr Mahendra Prasad Shrestha, Division Chief, MoHP visited TUTH for situation updates and monitoring of patients status. - A team lead by Dr Dipendra Raman Singh visited the affected sites and noted that crowd control is utmost need to restrict the movement of the visitors. Similarly team led by Dr Bibek Kumar Lal visited the Kalaiya Hospital and interacted with health coordinators to observe the field level issues and gaps for necessary support from government and partners. - On the lead of Dr Hemant Chandra Ojha Nepal Ambulance Service (NAS) deployed ambulance at Tribhuvan International Airport (TIA) to respond the patients. - Government officials and WEDS officer has been deployed to collect data as per template shared by HEOC and to update incident site - Media Briefing to update the situation by Mr Mahendra Prasad Shrestha, Spokesperson, MoHP - The State Minister for Health and Population convened a meeting among key government officials and partners to receive an update on the ongoing interventions and provide instructions to address the gaps and issues observed in the field. He also visited hospitals to ensure healthcare services provided to the victims are optimum - Health Secretary also visited the affected sites, observed and interacted with key officials to ensure the ongoing medical and public health interventions in the field reaches the victims. - The Chief Minister of Province 2 was briefed on Health Emergency Operation Center (HEOC) and inaugurated information management support center in Narayani Hospital with support from WHO. - Team led by Dr Ramesh Kharel with WEDS officer visited Narayani Sub Regional Hospital, National Medical College, Gandak Hospital, Birgunj Health Care Unit, Apollo Ortho Trauma Hospital to validate the cases, discussed the challenges and emphasized on recording & reporting to the Information Management Center. - Video Conferencing (VC) was successfully tested with temporary Information Management Support Center at Narayani Sub Regional Hospital at 11:30 AM 03 April 2019 A total of 3 meetings were held at Bara as follows:- 4. (20 Chaitra 2075), - Led by Dr Ramesh Kumar Kharel, MoHP a meeting with the Wednesday representatives of DoHS (FWD, EDCD, CSD, NHEICC, NPHL &

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S.N Date Activities NHTC) Centre for Mental Health & Counseling Nepal (CMC) and WHO-WHE carried out at Narayani Hospital - A meeting with District Public Health Officer (DPHO), . - The team also met with Mr. Narayan Prasad Bhattarai, Chief District Officer, , Mr Rajesh Poudel, Chief District Officer, Bara District. 04 April 2019 - Health Sector Coordination Meeting on the chairmanship of Dr 5. (21 Chaitra 2075), Dipendra Raman Singh, Chief, Quality Standard and Monitoring Thursday Division, MoHP at HEOC at 11:00 AM .

05 April 2019 - Video Conferencing with Field Coordinator Dr Madhab Prasad 6. (22 Chaitra 2075), Lamsal on ongoing response and situation updates Friday - Template shared to field coordinators to identify health sector needs.

06 April 2019 7. (23 Chaitra 2075), - HEOC coordinate with field coordinators for situation updates Saturday - Brief meeting with Dr Dipendra Raman Singh, Division Chief, Quality Standard and Regulation Division, MoHP, Dr Ramesh Kumar Kharel, field coordinator, Dr Hemant Chandra Ojha, DoHS 07 April 2019 and HEDMU/HEOC Team with Chief, HEDMU/HEOC on ongoing 8. (24 Chaitra 2075), activities and situation updates. Sunday - Video Conferencing with Provincial Health Director, Coordinators, Health offices, Hospital and health partners on ongoing response and situation updates chaired by Chuda Mani Bhandari, Chief, HEDMU/ HEOC - Health Sector Coordination Meeting on the chairmanship of Dr 08 April 2019 Sushil Nath Pyakuryal, Chief Specialist at HEOC. 9. (25 Chaitra 2075), - Partners attending the meeting are: WHO, UNICEF, Americares, Monday Humanity and Inclusion, NDF, ADRA Nepal - HEOC coordinate with field coordinators and team for situation 09 April 2019 updates 10. (26 Chaitra 2075), - Video Conferencing with field coordinator Dr Madhab Prasad lamsal Tuesday on health sector needs and situation updates 10 April 2019 - Progress Report Collection 11. (27 Chaitra 2075), - HEOC coordinate with field coordinators and team for situation Wednesday updates 11 April 2019 - Progress Report Collection 12. (28 Chaitra 2075), - HEOC coordinate with field coordinators and team for situation Thursday updates

Ongoing Response

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Team Deployment:

- Hon. Deputy Prime Minister and Minister for Health and Population, State Minister for Health and Population, Secretary, MoHP, DG, Department of Health Services went to incident site to support the response coordination and response monitoring. - Two teams; one team led by Dr Dipendra Raman Singh and another team on the lead Dr Ramesh Kumar Kharel of were sent from MoHP to the incident sites for response coordination, temporary information Management Support, epidemiological management and information management: o Team Members were Dr Bibek Kumar Lal, Dr Madhab Kumar Lamsal and Mr Shrawan Kumar Mishra from MoHP and Dr. Rajan Bikram Rayamajhi and Mr Deepesh Sthapit from WHO. - Six Emergency Medical Deployment Team (EMDT) mobilized to support response. o One team from Nepal Army o Two teams from Nepal Police o One team from Hetauda Hospital o One team from Chitwan Medical College

o One team from Janakpur Zonal Hospital Meeting with health coordinators at Bara DPHO, 02 April 2019 (1:00 PM) - On the lead of Dr Hemant Chandra Ojha Nepal Ambulance Service (NAS) deployed ambulance at Tribhuvan International Airport (TIA) to respond the patients. - Dr Pushpa Chaudhary, Health Secretary and Mr Mahendra Prasad Shrestha, Division Chief, MoHP visited TUTH for situation updates and monitoring of patients status. - 3 Consultants from NAMS Dr Neelam Khadka, Dr Subash Karna, Dr Rabiram Shrestha deployed to the hospital of the incident site for additional support on 2 April 2019 - 4 psychosocial counselors are mobilized to the incident sites from TPO Nepal for coordination and assessment on 3 April 2019. - 6 teams mobilized to their respective field sites on 8 April 2019 at 6:00 AM- 1: 00 PM to conduct the rapid assessment and post- emergency syndromic disease surveillance.

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Group Division for Field Surveillance (Bara and Parsa) Members Group 1 Group 2 Group 3 Group 4 Group 5 Group 6 / Group Palika Subarna Prawanipur Mahagadimai Bahadurmai Feta(Remaining) Kalaiya N.P Prasauni Devtal Birgunj M.P Bhali,Bharwaliya Dr Madhab Prasad Mr Raj Kishor Leader Dr Bijaya Jha Lamsal Binod Yadav Pandit/Amaleshor Mishra Dr. Mukti Narayan Shah Prem Jaiswal/Shankar Shankar Gupta DoHS Mr Ganesh Srivastav Mr Ram Avatar Gupta Kanchan Ojha Hari Narayan Laxmi Marasini Mr Amar Dawadi Mr Pramod Shah HC Mr Nawal kishor Yadav Mr Suresh K. Shah Jagannath/Bishwnath Bidur Uprety Lal Babu Prasad Ajay K.Jaiswal HI Mr Sunil Pokhrel Mr Prabin K. Yadav Mr Nabin K. Jaiswal Mr Ram Bahadur Thapa Ms Rati Kumari Gurung Nabin Jaiswal WHO - Dr Soniya EDPs CMC - Mr Manish Prasad Ray WHO-Dr Irana Joshi WOREC- Sabina Rimal NRCS-Sailendra Ku. Bhagat SIRC- Bishnu Prasad Ghimire

Central Coordination Team at HEOC

- MoHP has established a central coordination team for response coordination including information management on 1 April 2019. Team comprises the following members from MoHP, DoHS & WHO. # Name Designation Organization 1 Dr Pushpa Chaudhary Secretary MoHP 2 Mr Chandra Kumar Ghimire Secretary MoHP 3 Dr Sushil Nath Pyakuryal Chief Specialist MoHP 4 Dr Guna Raj Lohani DG DoHS 5 Dr Dipendra Raman Singh Division Chief, Quality Standard and Regulation MoHP 6 Mr Mahendra Prasad Shrestha Division Chief, Health Coordination Division MoHP 7 Dr Bibek Kumar Lal Director EDCD 8 Mr Chuda Mani Bhandari Chief, HEDMU/HEOC MoHP 9 Mr Ram Kumar Mahato PHI MoHP 10 Mr Damodar Adhikari NPO WHO 11 Dr Subash Neupane WEDS officer WHO 12 Mr Sanjib Gautam Information Management Assistant WHO

Information Management Team - MoHP response update is prepared based on the information receives from NEOC, NRCS, health sector partners, Team deployed for response, health facilities, Provincial Health authority, District Health Offices. # Name Designation Organization 1 Mr Mahendra Prasad Shrestha Division Chief, Health Coordination Division MoHP 2 Mr Chuda Mani Bhandari Chief, HEDMU/HEOC MoHP 3 Dr Hemant Chandra Ojha Senior MS DoHS/CSD 4 Mr Damodar Adhikari NPO WHO 5 Dr Subash Neupane WEDS Officer WHO 6 Mr Sanjib Gautam Information Management Assistant WHO

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Annex 1: Brief Meeting with field coordinator and MoHP delegates 07 March 2019 (24 Chaitra 2075) Participants:

1. Dr Dipendra Raman Singh, Division Chief, Quality Standard and Regulation Division, MoHP 2. Dr Ramesh Kharel, Sr MS, MoHP 3. Mr Chuda Mani Bhandari, Chief, HEDMU/HEOC 4. Dr Hemant Chandra Ojha, Sr. M.S, DoHS/ CSD 5. Mr Ram Kumar Mahato, PHI, MoHP 6. Dr Subash Neupane, WEDS, HEOC 7. Mr Bimal Bista, Consultant, WHO 8. Mr Sanjib Gautam, IMA, HEOC

Dr Dipendra Raman Singh

- Thankful to WHO & other key partners for untimely & remarkable response coordination. - Viber group should be effective, alternative & home phone number to be in listed for emergencies. - Incident site to be marked as red-hot iron zone and need to establish PHEOC in province-2 as per previous decision so the provincial government can take the significant move. - Regular budget, strategic places for stockpiling, EMDT, plans, regular activities like ICS activation, mock drills, & orientation should be included in annual plan. - Communication to temporary information management center of Narayani Sub Regional Hospital and treatment of injured to be ensured.

Dr Ramesh Kumar Kharel

- Awareness rising and information dissemination through mike. - About fogging need to be discussed. - Shelter should be prioritized followed by food. - Data (Injured, Death, Health facilities damaged status, partners working there, camps, Palika covered, medical stock, logistic supply, blood) should be symmetrical. - There are chances of abuse, epidemics and rise in snake bites cases so, health, WASH, Protection and Nutrition Sectorial lead and co leads to be alert. - HUB and Satellite Mechanism to be strengthened through preparation of disaster plan and identification of focal point. Medical logistics and medicines that are in stock piles need to have timely review and should adopt proper replenish mechanism. - PHEOC need to be established in other 4 remaining provinces. Should prioritize LHEOC concept. At least a well-equipped safe room could be identified in each local level and district level for health information collection and dissemination. - Analysis on real scenario is observed in the local community. Early morning and evening evaluation reflects that people life is being normal. - Continuous follow up and re-supervision from HEDMU/HEOC required.

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Dr Hemant Chandra Ojha

- Issues related to health should be totally handled by MoHP in any Disaster. - There should be a representative from health, representing in any sites that may be related to disaster e.g. one health FP at TIA handling ambulances & coordinating with hospitals. - Referral forms to be filled by hospital after they refer the cases for proper follow up. - As per MoHA now cast along with forecast should be prioritized. Now cast radar system will be installed in three different for piloting. - Local ICS should be established in affected areas for effectiveness of the response coordination. - Situation analysis of health sectors and sectorial ministry (Immunization, Reproductive Health dignity kits and other components of health) to be identified for proper response coordination. - PSS, PTSD should be activated urgently on need basis.

(via video conferencing) Mr Bijay Kumar Jha

- Meeting with Health coordinators of affected municipalities and rural municipalities, Focal points of government and private hospitals (as a part of HUB and Satellite hospital) and partners meeting has been conducted at local level. - Open defecation is a major issues, Sanitation and renovation need to be promoted. - Media management and unnecessary crowd has been major distracting factor for getting the things into normal situation so one door policy (integrated system-Health,WAHS, Protection, Nutrition) need to be established. - Maintaining strong coordination in local level along with mobilization of social sector, FCHV and team for response & refer prioritizing on awareness and renovation also through the mikes. - Health facilities of the affected area are functional. Now need to focus on medical logistics, medicines for epidemiological management. - Some medicines are necessary for Bara/ Kalaiya Hospital.

Dr Madhav Prasad Lamsal

- Sectorial meeting is being conducted in every alternative day. Early morning and late evening analysis of local community shows that people life of affected areas has been normal. - Regularly participating in DDMC meetings. - Kalaiya Hospital is in collapsing situation. - There is a risk of household and wildfires; Need of toilets renovation and construction. - Some medicines need to be procured through the center. - Consultants are needed in hospitals only in case of necessity. - Representative from SIRC has proposed a 3 days training to the local health workers to be mobilized in local affected areas.

Health coordinator of Parauta HP - 12 people working in a brickkiln were injured in the incident. - There are few OPD based cases of diarrhea; overall situation is normal.

Remarks from Mr Chuda Mani Bhandari:

- Team mobilized from MOHP, DOHS at incident site need to visit the affected area (10- Municipalities and Rural Municipalities) dividing into groups including partners then report the situation to the ICS at local level (Dr Madhav Kumar Lamsal and Mr Bijay Kumar Jha) and HEOC by tomorrow 3 pm.

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- Specialist team should be identified from incident site if necessary. - Logistic review need to be conducted and prepositioning up to ward and family level. - Updated on individual sectorial report and RRT mobilization for investigation, surveillance and preparedness. - Human resources may be replaced on the need basis. - Detail of ward number 7 (Parautara and Belauri) to be updated by tomorrow. - Health facilities monitoring and damage status along with picture. - Duty roster of daily deployed team in the field need to be provided. Recording of activity of mobilized health workers should be recorded for this keep need to keep the exact record and should be reported to HEOC. - Health sectorial coordination meeting to be conducted at HEOC, a 1 PM. - Preparedness for Surveillance and Outbreak response to be done with coordination through EDCD and on the leadership of EDCD. - Integrated information, Counseling and emergency care skills to be provided with in short period of time (Not as a long and single training, the information to be provided in advance to HEOC and also for approval from HEOC.)

Some glimpse of [1] Brief meeting with Dr Dipendra Raman Singh, Dr Ramesh K Kharel, Dr Hemant Chandra Ojha with Chuda Mani Bhandari, Chief, HEDMU/HEOC [2] Video Conferencing with PHD, Hospital, Health Offices, Health Coordinators and partners with Chief, HEDMU/HEOC [3], [4] *Health Sector coordination meeting on the chairmanship of Dr Sushil Nath Pyakuryal, Chief Specialist, MoHP

*Health Sector coordination meeting on the chairmanship of Dr Sushil Nath Pyakuryal, Chief Specialist, MoHP

Key Remarks by Dr Sushil Nath Pyakuryal, Chief Specialist, MoHP - Continue coordination on field more in WASH - EDCD should mobilize RRT - Monitoring from HEOC

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Annex 2:

Ministry of Health and Population

Health Emergency and Disaster Management Unit Health Emergency Operation Centre (HEOC)

Health Sector Coordination Meeting

4th April 2019

Agenda

 Update from the field  Priority interventions  AOB The meeting was chaired by Dr Dipendra Raman Singh, Division Chief, Quality Standard and Monitoring; attended by Mr. Mahendra Shrestha, Chief Health Coordination Division; Dr.; Dr. Hemant Chandra Ojha, Senior Medical Superintendent, Curative Service Division, DOHS. There were 25 participants participated the meeting from 20 health sector partner agencies.

Dr Dipendra Raman Singh, Division Chief, Quality Standard and Monitoring presented the presentation on MOHP response for recent incident.

Discussion:

Transcultural Psychosocial Organization Nepal (TPO):

- Team has already been deployed to the incident site. Team will closely observe the situation and will imply on immediate interventions. - Psychosocial First Aid (PFA) has been provided and from tomorrow (5 April 2019) onwards they will focus more on adolescent and child psychosocial council. More counselors can be mobilized as per need. Suggestions: - Language barrier: Local language should be preferred while giving psychosocial counseling. - Psychosocial counseling should be conducted on the basis of need assessment. - The psychosocial team should prioritize the intervention in community level with low visibility. - United Nations Population Fund (UNFPA): Additional manpower for psychosocial counseling is ready in case of need. This team also includes local experts.

Nepal Physiotherapy Association (NEPTA): - They emphasized on the issues related to the proper mechanism for the coordination to provide the service in the new federal structure.

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- Stockpiles and Human Resources are ready. - Need to coordinate with Dr Ramesh Kumar Kharel in field level for further coordination sharing the information with HEOC. Suggestions - Humanity and Inclusion (HI): There should be more focus on community based rehabilitation. - Physiotherapists need to be deployed on the need basis.

UNFPA: Two pregnancy cases with bleeding are being treated at Narayani Sub Regional Hospital. Additional 500 dignity kits have been dispatched.

Suggestions - Any medicine and medical logistics dispatched to the incident site should be documented in HEOC. (NRCS): - 206 NFRIs full set distributed - 612 rope distributed - 612 Tarpaulin distributed - 100 Mattress, 75 people reached with first aid service, 40 Blankets - 5 NDRT deployed, 99 NRCS volunteer mobilized, 2 ACT members deployed - If needed additional volunteers can be mobilized through NRCS World Vision International:

- 1000 plus NFRIs avaible; if needed it can be dispatched to temporary shelter management. UNICEF:

- Can dispatch 15 Medical Tents, Zinc Tablets (Sufficient to 10,000 Families), “Nyano Jhola”, Bed Nets (20,000)

ADRA: Can dispatch Tarpaulin and resources to support health in need basis.

Trauma Center: On the basis of need assessment provided by the consultant dispatched from the NAMS additional support will be provided for physiotherapy.

Other suggestions:

- Press Release to the general public regarding the ongoing response and situation report - Outbreak Surveillance should be prioritized by MoHP - Details name listing and tracking of the discharged patients should be documented. - Official Letter from MoHP to the hospitals on patient treatment.

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Annex 3:

Meeting of the Rapid Assessment carried out in all the affected municipalities of Bara & Parsa District: 8 April 2019 3 PM-7 PM:

All the team members shared their observation along with the findings from each affected municipality and following gaps and key recommendations were made by the team led by Dr Madhab Prasad Lamsal Senior Health Administrator DoHS, MoHP/ Dr Anamul Haque, MeSu, Narayani Hospital.

Gaps:

 Inadequate awareness regarding sanitation and hygiene, health promotion activities.  Open defecation observed due to damage of toilets in the affected sites. (Open defecation was prevalent before the incident in some sites)  Poor waste disposal and drainage system.  Inadequate counselling done to the discharged patients (fracture, trauma) thus, mobilization nor physiotherapy has been initiated; this may result in deformity.  Increased risk of wound infection. (Dressing set inadequate, autoclaving not carried out due to power cut off in some sites)

Recommendations:  As the situation in the affected sites is gradually returning to normal, health camps to be replaced with health promotion center and health services to be continued through the health facilities. Emphasis on hand washing techniques, safe drinking water and sanitation through the health promotion center.  Specialized medical team not required.  Door to door campaign for health promotion activities: risk communication, health awareness message, local video, Street Play (Sadak Natak), miking in all sites.  Post-disaster syndromic surveillance to be carried out for additional 1 week.  Community awareness regarding their role in waste disposal and management.  Water quality surveillance to be carried out by the municipality level coordinating with the WASH stakeholder.  Medical community-based rehabilitation, physiotherapy for the discharged patients to be carried out.  Regular follow up of all the hospital-discharged patients as well as injured patients. Proper wound care to prevent wound infection.  Psychosocial awareness & counseling needed at household level.  Health package as reward to be provided to the health workers who are actively providing health services to the victims during the disaster.  Orientation/training to the health workers/FCHV on psychosocial and spinal injury cases to be done.  Orientation to the ward chief/ward members/leaders on health problems resulting due to disaster need to be emphasized (health in all policies, programs and activities approach).

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Annex 4:

Health Partners coordinating and reporting at field level as of 10 April 2019.

1. World Health Organization 2. UNICEF 3. UNFPA 4. ADRA Nepal 5. Centre for Mental health and Counseling -Nepal (CMC) 6. Transcultural Psychosocial Organization Nepal (TPO) 7. Humanity Inclusion (HI) 8. Spinal Injury Rehabilitation Center (SIRC) 9. National Disabled Fund

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Annex 5: Emergency Contact Numbers

# Name Designation Organization Contact 1 Dr Pushpa Chaudhary Secretary MoHP Mr Chandra Kumar 2 Secretary MoHP Ghimire 3 Dr Sushil Nath Pyakurel Chief Specialist MoHP

4 Dr Guna Raj Lohani DG DoHS 9851079356 Chief, Quality Standard and 5 Dr Dipendra Raman Singh MoHP 9851124441 Monitoring Mr Mahendra Prasad Chief, Health Coordination 6 MoHP 9841404378 Shrestha Division Chief, Policy, Planning and 7 Dr Bikash Devkota MoHP 9847826400 Monitoring 8 Mr Chuda Mani Bhandari Chief, HEDMU/HEOC MoHP 9851129255

9 Dr Bhim Singh Tinkari Director NTC 9841046901

10 Dr Ramesh Kumar Kharel Senior MS MoHP 9851219410

11 Mr Sunil Raj Sharma Director NHEICC 9851181100

12 Dr Bibek Kumar Lal Director, EDCD EDCD 9851172572

13 Dr Kedar Prasad Century Director Bir Hospital 9851151955 Birendra Army 14 Dr Arun Neopane Focal Point 9851061071 Hospital 15 Dr Prem Khadka Director TU Teaching Hospital 9841255740

16 Dr Bishnu Prasad Sharma Director Patan Hospital 9841336289

17 Dr Dirga Raj RC Director Civil Service Hospital 9851076675

18 Dr Sudha Devkota Director Bhaktapur Hospital 9801077026 Dr Sameer Kumar 19 Section Chief, DHA EDCD 9851054699 Adhikari 20 Dr Hemanta Chandra Ojha Sr. MS DoHS/CSD 9849361593

21 Dr Madhab Prasad Lamsal Section Chief Social Security Section 9851234229 Mr Shrawan Kumar 22 NPHL 9851168220 Mishra Health Education Training 23 Ms Sheela Shrestha MoHP 9841360689 Administrator 24 Mr Ram Kumar Mahato PHI MoHP 9819704376

25 Dr Reuben Samuel Team Lead WHO-WHE 26 Dr Hyon Chol Pak Admin WHO 9801010009

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27 Mr Damodar Adhikari NPO WHO 9801010022

28 Dr Rajan Raymajhi NPO WHO 9801010039

29 Dr Subash Neupane WEDS Officer WHO 9801123154 30 Mr Deepesh Sthapit Information Manager WHO 9801123108

31 Mr Prahlad Dahal Programme Support WHO 9801010025 Information Management WHO 32 Mr Sanjib Gautam 9813207816 Assistant Outside Kathmandu Valley Mr Narayan Prasad 1 CDO CDO, Parsa 9855077777 Bhattarai 2 Mr Rajesh Poudel CDO CDO, Bara 2 Mr Nabal Kishor Jha Provincial Health Coordinator Province 2 9842037477 Narayani Sub Regional 3 Dr Anamul Haque Medical Superintendent 9803264250 Hospital Narayani Sub Regional 4 Dr Uday Singh MDGP 9852056858 Hospital 5 Mr Prem Chandra Jaiswal DPHO DPHO, Bara 9855028120 6 Mr Bijay Jha Bara 9854030161

Coordination Team at Field/ Incident Sites

# Name Designation Organization Contact 1 Dr Ramesh Kumar Kharel Chief, Medical Superintendent MoHP 9851219410 2 Dr Madhab Prasad Lamsal Section Chief DoHS 9851234229 Narayani Sub Regional 3 Dr Uday Singh MDGP Hospital 4 Mr Vijay Kumar Jha Senior PHA Health Directorate-2 9854030161 5 Mr Shrawan Kumar Jha NPHL 6 Ms Laxmi Marasini Nursing Officer DoHS/ FWD 9841460089 7 Mr Amar Dawadi Public Health Inspection EDCD 9855063985 8 Mr Ganesh Shriwastab Senior Health Education Officer NHTC 9847150367 9 Mr Hari Narayan Shah Public Health Inspection NTC 10 Mr Ram Awatar Gupta Public Health Officer NHEICC 9851139508 11 Mr Amrit Jung Basnet Health Assistant DoHS/ CSD 9849681355 12 Mr Kanchan Kumar Ojan Microbiologist NPHL 9844534841 13 Mr Himal Gaire Programme Officer DoHS/ CMC 14 Mr Lallan Shah Public Health Inspection DoHS/ MD 15 Dr Rajan Bikram Raymajhi NPO WHO 9801010039 16 Dr Soniya Bhagat WEDS Officer WHO 9801195813 17 Dr Irana Joshi WEDS Officer WHO 9801123151 18 Mr Deepesh Sthapit Information Manager WHO 9801123108

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Annex 6: Data Collection forms

Form V.1 for general information on death, injured, referred and discharged status on

Bara, Parsa storm 2019

Hospital wise details on Death, admitted, referred and discharged status on Bara, Parsa Storm, 2019 Death Admitted Referred Discharged S.N Name of the Hospital Male Female Male Female Male Female Male Female 1 2 3 4 5 6 7 8 9 10 11

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Form V.2 for Emergency Trauma Management Emergency Trauma Management Head to Toe Examinations Form

Name:-…………………………………………………………………………………………………………………………………………

Age:-…………………………. Sex:-…......

Address:-……………………………………………………………………………………………………………………………………..

Contact number:-…………………………………………………………………………………………………......

Alternative Contact number:-………………………………………………………………………………………………………

Parts Examination  Remarks Head Injuries over scalp Face Injuries over eyes, ears, nose, mouth. CSF leakage over nose, ears, mouth Odema of tongue and pharynx Neck Cervical spine-any pain? Circumferential burn? Check x-ray-lateral view Chest Front and back of the chest Any fractures of ribs/clavicles/sternum? Circumferential burn? Soot cough/altered voice? Abdomen Any swelling/bruises? Examination of all quadrants Perineal & Any bleeding /bruises from rectal rectum/vagina/penis? Limbs Open fracture /contusions / crepitus / tenderness Pain/parasthesia/pulselessness/paralysis Any circumferential burn? Pelvis Stability/external wounds?

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Form V3 Hospital Referral Form

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Government of Nepal Ministry of Health & Population - Department of Health Services WHO MoHP Epidemiology & Disease Control Division POST-EMERGENCY SYNDROMIC DISEASE SURVEILLANCE FORMAT

District:……………………………………….. Reporting Date: ……………………… Reporting period: ......

Type of disaster: ……………………………...... Date and time of occurrence: .…………..……….………………….

1. Reporting unit (list specific location, camp or health facility): ......

No of the Total Population Name of VDCs/ Municipalities Wards < 5 years old => 5 years old

Diagnostic Events Under Surveillance < 5 years old = > 5 years old (only one diagnosis per patient) Cases Deaths Cases Deaths A. Diarrhoea 1 Diarrhoea with pain 2 Diarrhoea without pain 3 Bloody diarrhea B. Fever 4 Fever of unknown origin 5 Fever and jaundice

6 Fever and impaired consciousness 7 Fever and rash 8 Fever with chills and rigor 9 Fever and sub acute hemorrhage C. Others 10 Acute respiratory infection (ARI) 11 Acute flaccid paralysis (AFP) 12 Heat stroke 13 Eye infections 14 Ear infections 15 Skin diseases 16 Other

TOTAL 4. Mortality data: Name of Date of Name of Sex/ Cause of Place of household Address death person Age death death head

Prepared by: ……………………...... …………… Name of DHO: ...………………………...... Contact no: ...... …………………………...... … Contact no: ...... ……………………………...... Signature: ….………………………………...... Signature: ……………………………………...... Date: ..…………………………………………...... Date: …………………………………………......

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Government of Nepal Ministry of Health & Population - Department of Health Services

Epidemiology & Disease Control Division

MoHP WHO POST-EMERGENCY SYNDROMIC DISEASE SURVEILLANCE GUIDELINES A post-emergency syndromic disease surveillance form needs to be filled out by DHO / DPHO, the Rapid Response Team or available health staff every day after a public health emergency occurs. It should be faxed or in other ways communicated to the DHO/DPHO by 3 p.m. everyday. DHO/DPHO will compile the information and fax the form to EDCD daily by 5 p.m. WHEN TO USE THE SURVEILLANCE FORMAT: o Syndromic disease surveillance is NOT a replacement of regular surveillance systems o It is an active reporting system to enhance surveillance and ensure quick flow of information in periods of increased health risks during or shortly after emergencies o Decisions of when and where to implement syndromic disease surveillance should be taken by DHO / DPHO in consultation with the Rapid Response Team and the Director of EDCD o In post-emergencies a rapid health assessment needs to be implemented not later than 24 hours after a public health emergency occurs and reported on a separate format o Complete one new form each day as well as for each health facility (or location, i.e camp, village etc) and submit to DHO / DPHO o Continue to complete and submit one form each day until otherwise directed by the DHO / DPHO

HOW TO USE THE SURVEILLANCE FORMAT: 1. Reporting Period:  Indicate period of surveillance (clearly specify time and duration) 2. Type of Disaster:  Categorize the type of disaster (e.g. floods or Landslides) and the date and time of occurrence 2. Reporting unit:  List name of health facility or camp or any other location where the surveillance form is being completed and use a new form for each new location/facility. 2. Population:  Indicate total population size and population under 5 years which would be the catchment population of the reported VDC the reporting unit serves Surveillance data:  Report based on symptoms rather than case definitions  Record only one diagnosis per patient (for example, do not record one patient as having both watery diarrhea and fever and hemorrhage).  Do not forget zero reporting (when no cases, insert a “0” on the form)  If any unusual disease incident is expected, consider active surveillance (house-to-house visits) under the direction of DHO / DPHO  Send the completed form to DHO / DPHO at 3 pm every day 4. Mortality data:  In case of mortalities indicate date of death, name, name of household head, age, sex, cause of death, place of death and residence in the separate table  In the address include, VDC name and ward number and name of locality  When cause of death in unknown, indicate symptoms  Place of death should indicate if person died at a health facility (HP, SHP, PHC or Hospital) or at home Director / Disaster Focal Point Epidemiology and Diseases Control Division Department of Health Services Ministry of Health and Population Tel: 977-1-4255796 Fax: 977-1-4262268

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Situation update Sheet, Storm Response 2019 ACT, BARA Storm Response 2019 Covering period: 31 March-04 April 2019 ACT, Situation Report, Storm Response 2019 SN District Disaster type Date of Affected VDCs/ People Affected Displaced Houses destroyed Source Occurrence Municipalities families families

Dead Missing Injured Fully Partially 1 Bara Windstorm 31st March 2019 Pheta RM ward 6 0 250 345 237 202 64 NRCS Bara, Nepal number 1, Police , DEOC, NID 2 Bara Windstorm 31st March 2019 Pheta RM ward 0 0 5 46 40 40 10 NRCS Bara, Nepal number 2, Police , DEOC, NID 3 Bara Windstorm 31 st march 2019 Pheta RA ward 0 46 38 22 22 13 NRCS Bara, Nepal number 3 Police , DEOC, NID 4 Bara Windstorm 31st March 2019 Pheta RM ward 0 36 15 15 19 NRCS Bara, Nepal number 4 Police , DEOC, NID 5 Bara Windstorm 31st March 2019 Pheta RM wards 12 0 200 213 76 76 93 NRCS Bara, Nepal number 6 Police , DEOC, NID 6 Bara Windstorm 31st March 2019 Pheta RM wards 0 0 7 98 24 24 59 NRCS Bara, Nepal number 7 Police , DEOC, NID 7 Bara Windstorm 31st March 2019 Parwanipur RM 0 0 200 612 327 284 291 NRCS Bara, Nepal wards number 4 Police , DEOC, NID 8 Bara Windstorm 31st March 2019 Prasauni RM wards 4 1 41 25 18 18 2 NRCS Bara, Nepal Police , DEOC, NID 9 Bara Windstorm 31st March 2019 Pacharauta Piparpati 0 3 127 56 56 48 NRCS Bara, Nepal Municipality wards 7 Police , DEOC, NID 10 Bara Windstorm 31st March 2019 Pacharauta Piparpati 0 0 0 54 19 19 27 NRCS Bara, Nepal Municipality wards 2 Police , DEOC, NID 11 Bara Windstorm 31st March 2019 Subarna RM 8 1 0 50 287 143 94 133 NRCS Bara, Nepal Police , DEOC, NID 12 Bara Windstorm 31st March 2019 Subarna RM 4 1 60 45 1 1 33 NRCS Bara, Nepal Police , DEOC, NID 13 Bara Windstorm 31st March 2019 Subarna RM 1 0 0 6 89 69 62 19 NRCS Bara, Nepal Police , DEOC, NID 14 Bara Windstorm 31st March 2019 Kalaiya Sub 4 0 70 98 6 6 15 NRCS Bara, Nepal Metropolitian City Police , DEOC, NID

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ward 12

15 Bara Windstorm 31st March 2019 Kalaiya Sub 1 0 180 198 146 134 12 NRCS Bara, Nepal Metropolitian City Police , DEOC, NID ward 18 16 Bara Windstorm 31st March 2019 Dev Tal RM 7 0 0 4 296 92 89 124 NRCS Bara, Nepal Police , DEOC, NID 17 Bara Windstorm 31st March 2019 Mhagadimai RM-7 1 175 41 41 80 NRCS Bara, Nepal Police , DEOC, NID Total 27 0 1122 2782 1332 1183 1042

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Abbreviations:

ADRA Adventist Development and Relief Agency CDO Chief District Officer CMC Centre for Mental Health & Counseling Nepal CSD Curative Service Division DDRC District Disaster Relief Committee DG Director General DoHS Department of Health Services DPHO District Public Health Office EDCD Epidemiology and Disease Control Division EMDT Emergency Medical Deployment Team FWD Family Welfare Division HEDMU Health Emergency and Disaster Management Unit HEOC Health Emergency Operation Center MoHP Ministry of Health and Population NAMS National Academy of Medical Sciences NAS Nepal Ambulance Services NCASC National Centre for AIDS and STD Control NEOC National Emergency Operation Center NHEICC National Health Information Education and Communication Centre NHTC National Health Training Center NPHL National Public Health Laboratory NPO National Professional Officer NRCS Nepal Red Cross Society NTC National Tuberculosis Center RRT Rapid Response Team TIA Tribhuvan International Airport TPO Transcultural Psychosocial Organization Nepal UNFPA United Nations Population Fund UNICEF United Nations Children's Fund VC Video Conference WEDS WHO Emergency District Support Officer WHE WHO Health Emergency WHO World Health Organization

Phone: 01-4250845, Fax: 01-4250842 Toll Free: 16600133444 E-mail: [email protected] Web: heoc.mohp.gov.np, fb: fb.com/HEOC

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