EMERGENCY AND HUMANITARIAN ACTION (EHA) WEEKLY UPDATE – WHO COUNTRY OFFICE : (Week 29, 13 – 19 July 2009) HIGH LIGHTS:

• Preliminary findings of the needs assessment indicate that the overall Belg performance was well below normal in many crop producing areas, as well as in pastoral areas that receive rains at the same period (February-May 2008). • reported 143 cases and 18 deaths due to an unidentified illness from district in of Amhara Region by the Regional Health Bureau. • According to official reports from the Federal Ministry of Health (FMOH), 2 new cases of Influenza A H1N1have been reported this week. The total confirmed cases reported in the country are 6. • According to official reports from the Federal Ministry of Health (FMOH), 579 new cases of AWD and 11 deaths (CFR of 1.9%) have been reported from Addis Ababa, Somali, Oromiya, Harari and SNNP Regions last week.

I. 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.)

Food security and malnutrition

• The Disaster Management and Food Security Sector presented to donors revised beneficiary food aid needs for the period June to December 2009. The needs are based on projections and estimations that the population in need of relief assistance will increase from 4.9 million to 6.2 million people. Consequently, there is an expected increase of approximately 460,500 mt of relief food, of which there is a current shortfall of over 390,000 mt. The increase in needs is attributed to the following: (a) poor performance of the Belg rains ( short rains) in 2009 that resulted in below-normal crop production in most areas; (b) the poor Gu/Sugum rains in the pastoral areas of Borena zone of Oromiya , Afar and Somali regions resulting in low milk production and animal productivity; (c) the poor 2008 Meher (long rain season) production in the eastern areas of Amhara and Oromiya regions and; (d) the poor coffee and root crop production in Southern Nations, Nationalities and People’s Region (SNNPR).

• Food requirements for the period June to December 2009 will be revised in August when the Government-led multi-agency needs assessment results become available. Preliminary findings of the needs assessment indicate that the overall Belg performance was well below normal in many crop producing areas, as well as in pastoral areas that receive rains at the same period (February-May). In Amhara region, for instance, the zone and woreda assessments reveal that only 30 per cent of the planned Belg production is expected to be harvested. Crop production in the six Belg benefiting woredas in Tigray have failed with only about 1 per cent of normal harvest expected.

• The nutrition situation in Abaya woreda of Borena zone is reportedly critical. This woreda has no history of similar high levels of severe malnutrition. The woreda Health Office undertook a mass nutrition screening using MUAC measurement and identified 5,372 malnourished people, including 222 oedema and 1,676 severe cases. Consequently, the regional FSDPPC requested for an ad-hoc targeted

supplementary food (TSF) intervention. Dispatch of TSF food to eight final distribution centers in the worede has already started since the first week of July, while food distribution has started in four of the centre as of 9th.July 2009. The situation in the remaining parts of Borena zone of Region is expected to become clearer following the completion of the final report of the join needs assessment team, currently in the area. In Gode woreda of Somali Region, the number of malnourished children less than five years admitted to Gode hospital this week has increased. As of 23rd June 2009, the total number of admissions was 25 children, mainly from Gode town and the surrounding woredas of Gode zone. A WFP monitoring team facilitated the transfer of 11 severely malnourished children from a distribution site in Gode town to the hospital. Following reports on the worsening food security and the critical nutritional situation in Gode, WFP and UNICEF will hold a meeting to discuss, among other issues, the general food response in the town as it is the underlying contributor to the deteriorating situation.

• As of 15 July, the number of newly-arrived refugees from Somalia registered in Dolo Ado stands at 10,346, of which 6,903 have been moved to the newly opened Boqolomayo camp. However, additional relocations to the camp have been temporarily suspended due to the insufficient quantity of shelter. The Administration for Refugees and Returnees Affairs (ARRA) has asked UNHCR to look into opening a second camp, as the refugee caseload is expected to exceed the maximum capacity of 20,000, before the end of the year. Meanwhile, WFP completed the distribution of the July allocation to refugees at full ration. Oxfam is providing emergency water tankering services. In total, there are approximately 100,000 refugees throughout the country, with new influxes continuing to arrive in Afar and Somali regions from Eritrea and Somalia respectively. UNHCR, with US government assistance, is working to resettle Somali and Eritrean refugees.

Acute watery Diarrhoea (AWD)

• According to official reports from the Federal Ministry of Health (FMOH), 579 new cases of AWD and 11 deaths (CFR of 1.9%) have been reported from 5 regions (Addis Ababa, Somali, Oromiya, Harari and SNNP) Regions.. A total of 29 districts have reported active cases from the 5 regions in epidemic week 28. • A cumulative total of 2,041 AWD cases and 34 deaths (CFR 1.7%) have been reported from Addis Ababa, Afar, Somali, Oromiya, Harari and SNNP Regions from 15th June to 12th July 2009. A total of 29 districts have reported active cases. Two cases and no death from Addis Ababa, 27 cases and no death from five Woredas of Afar Region, 226 cases and 19 deaths from four Woredas of Somali Region, 1,607 cases and 15 deaths from 15 Woredas of Oromiya Region, 27 cases and no death from Harari Region and 152 cases and no death from Konso special Woreda of SNNPR. See table 1 below.

Table 1. Distribution AWD cases and death by epidemic week by region Ethiopia July 2009 Week 25 Week 26 Week 27 Week 28 Week 24 - 27 # # CF # # TOT_ TOT Regions Dist C D CFR Dist C D R Dist C D CFR Dist C D CFR C _D CFR Addis Ababa 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 0.0 2 0 0.0 Afar 3 5 0 0.0 3 5 0 0.0 5 17 0 0.0 5 - - - 27 0 0.0 Somali 3 61 6 9.8 4 15 4 26.7 4 10 0 0.0 4 140 9 6.4 226 19 8.4 Oromiya 16 204 3 1.5 14 519 5 1.0 12 490 5 1.0 15 394 2 0.5 1607 15 0.9 SNNPR 1 27 0 0.0 1 55 0 0.0 1 38 0 0.0 3 32 0 0.0 152 0 0.0 Harari 1 2 0 0.0 1 2 0 0.0 1 12 0 0.0 1 11 0 0.0 27 0 0.0 National Total 24 299 9 3.0 23 596 9 1.5 23 567 5 0.9 29 579 11 1.9 2041 34 1.7 Source: Federal Ministry of Health July 2009.

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AWD patient in a CTC In East Zoa Zone. July 09 Ethiopian Red Cross Volunteers Supporting CTC establishment in Tulu Woreda, Bulbula Health Centre Oromia Region. July 09

Influenza A H1N1update • According to official reports from the Federal Ministry of Health (FMOH), no new cases of Influenza A H1N1have been reported last week. The UN clinic reported 2 suspected cases to the FMOH which were later confirmed and the total confirmed cases in the country is now 6 . The national technical working group is updating the National Influenza Pandemic Preparedness and response plan in view of the current pandemic phase. WHO supported the orientation of health workers on case management protocols. Daily coordination meetings continue at the FMoH chaired by the Minister with support from WHO.

Outbreak of an unknown illness.

• Rumour of unknown illness was reported on week 28th epidemic week by RHB from Kelela woreda of South Wollo zone, Amhara Region. From 4th to 18th July 2009, a total of 143 cases and 18 deaths have been reported. Signs and symptoms are head ache, fever, neck stiffness, diarrhoea and vomiting. Cases were reported from 2 villages and rresponses including investigations are in progress supported by WHO, and NGOs partners. SC/UK Wollo area office provided emergency drug kits to neighboring woreda • WHO EHA focal person with RHB experts are already in the filed to assess the situation.

II. ANALYSIS & HEALTH CONSEQUENCES: Health problems & Needs of affected populations.

Food insecurity and malnutrition

• Admissions to Therapeutic Feeding Units (TFUs) continue to increase in SNNPR, Oromiya (Guji, West and East Hararghe zones), southern parts of Somali Region and some hotspot woredas in Amhara Region. In response, Oromiya, SNNPR and Amhara RHBs have started implementing the national Therapeutic Feeding Programme (TFP) roll-out plan, with support from NGOs. The aim is to achieve full coverage of hotspot woredas with Out-patient Therapeutic Programmes (OTPs) and TFUs. In priority 1 woredas, 28 TFUs and 457 OTPs will need to be opened in Oromiya, 15 TFUs and 502 OTPs in SNNPR, and 35 TFUs and 555 OTPs in Amhara to achieve full coverage. The Regional and Zonal monitoring groups, together with the RHBs and NGOs, are working to implement an evaluation plan as soon as possible. Meanwhile, the Somali Regional authorities postponed the multi-sectoral response planning activities in order to consider the findings of the ongoing needs assessments. In the meantime, partners are requested to initiate and/or strengthen nutrition interventions in the region. 3

Acute Watery Diarrhoea (AWD)

• The prevalent rate shows 68 per cent of cases are reported from Oromia, 24 per cent from Somali and 8 per cent from other 4 regions combined. • It has been observed that Somali Region has recorded a CFR ranging from 26.7% in epidemic week 26 to 6.4% in week 28 and zero per cent in week 27. This is attributed to late interventions at the district level, security and access problems, inadequate logistics and trained human resources. • At national level the CFR is above 1% showing the need for improvement in case management and prevention. Currently WHO and partners are addressing training of health personnel community awareness creation, supportive supervision, multi sectoral coordination and team deployment (Health, Water and Agriculture) at kebele level and immediate need for improvement of hygiene and sanitation at all level, in particular in investment farms and Holy water sites.. • 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 management in CTCs. Preventative measures in communities also need 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.

National Trend Analysis Shows AWD Cases and Deaths as of 12 July 2009

650 150

579 600 589 140 550 567 130 120 500 110 450

s 100 400 90 350 353 324 80 300 70 AWD DeathsAWD AWD CaseAWD 250 60 222 19 9 50 200 17 8 15 1 40 150 13 4 12 9 115 30 10 3 93 100 86 90 20 53 50 36 41 38 38 11 11 30 28 33 9 8 7 99 10 5 14 20 5 4 6 5 0 2 0004 7 111000 2 110 0 3 0 1 3 5 7 9 111315171921232527

Analysis: WHO - Ethiopia EHA /IDSR/DPC Units Data Source: FMOH - Ethiopia Epidemic Week Cases Date of Production: July 20, 2009 Deaths

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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.

Food insecurity and malnutrition

• This week WHO has continued its technical support to regions in responding to food and nutrition crisis in Ethiopia. WHO in collaboration with EHNRI and UNICEF is preparing the second half of 2009 health and nutrition requirement.

Acute watery Diarrhoea (AWD)

• WHO continues to provide technical support to the affected regions of Somali, Oromia, SNNPR, Afar and Harari through provisions of emergency drug kits to government and NGO partners, supporting assessment, assist in monitoring and supervision and strengthening surveillance activities. In addition support for emergency health response coordination activities are being supported through information sharing, working together and sharing plans and resources. WHO continues to provide technical and financial assistance to both federal and regional health bureaus through funds from the Finish Government in AWD preparedness and response including nutrition response. • The technical committee of the Emergency Health and Nutrition Task Force continues to meet with secretariat support from WHO. Reports from Oromiya, SNNPR, Afar and Harari indicated that AWD infection is spreading to new districts. • In view of the enormous challenges posed by the disease, a joint multi-sectoral response plan integrating health and WASH components based on lessons learnt from Gambella in 2006, Kenya and South Africa has been introduced in Oromiya, Afar, SNNPR and Somali Regions. • Influenza • WHO supported training on influenza A H1N1 awareness for 40 UN field staff in 3 sites in Amhara and Afar Regions

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 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.

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