WHO P.O. Box: 63565 - Nairobi, Kenya - [email protected] - T: +254 20 7623197/8/9 and +254 20 7622840

Emergency Humanitarian Action Weekly Highlights 6 –12 November 2010

BULLETIN HIGHLIGHTS

• In week 431 and 443, health facilities in region reported an increase in the number of acute watery diarrhoea (AWD) cases. WHO and partners are monitoring the ob- served increase especially in reported AWD cases from district.

• WHO conducted a training for 49 health workers on outbreak investigation and response from 7 till 10 November in Galkayo. This is part of the ongoing outbreak preparedness ac- tivities in South and Central Somalia.

Update on major public health concern:

• Cholera/Acute watery diarrhoea (AWD)

Cases Graph 1. Banadir hospital AWD and cholera In light of the current cholera transmission 180 trends (Red - Cholera; Blue - AWD) season, WHO and partners continue to 160 Cases: 3327{2739 <5 yrs}; Deaths: 94{78 < 5yrs} monitor acute watery diarrhea (AWD) 140 trends all over Somalia. The high risk re- 120 gions are Lower and , 100 Lower and , Hiraan, Banadir 80 and in South and Central Somalia 60 zone (see map on page 3) 40 20 2 Since week 1 , 3327 AWD/cholera cases 0 (2739 under 5 years) and 94 related deaths 1 3 5 7 9 1113151719212325272931333537394143 have been reported from Banadir Hospital week in Mogadishu alone (see Graph 1). Graph 2. Reported AWD trends Lower In week 44, a total of 77 AWD cases were Cases Shabelle reported form Lower Shabelle region in- 90 Cases: 2272 (Afgooye 36%; Merka 43%) cluding 62% children under 5 years and 80 Other districts 70 one related death. Afgooye district alone Afgooye district 60 accounted for over 71% of all cases re- Merka district ported from 33 health facilities in the region 50 40 during the reporting week. 30 Afgooye and Merka districts account for 20 36% and 43% respectively of the aggregate 10 cases reported from week 1 to 44 (see 0 Graph 2) 1 3 5 7 9 1113151719212325272931333537394143 week

1Week 43: 25-31 October 2010 2Week 1: 4-10 January 2010 3Week 44: 1-7 November 2010 [email protected] www.emro.who.int/somalia/healthcluster.htm www.emro.who.int/somalia/CollaborativeProgrammes-eha.htm

WHO is calling on health partners to continue Cases Graph 3. Low er Shabelle region w eekly AWD cases ongoing AWD prevention and outbreak pre- w eek 21 (2008) - w eek 44 (2010) paredness activities during the current chol- 400 era transmission period (see Graph 3). An 350 AWD response matrix was distributed to all 300 health cluster partners to determine the cur- 250 2008 2009 2010 rent available response capacity and supplies 200 by region. 150 100 WHO remains concerned that the observed 50 suspension, withdrawal and scaling down of 0 aid activities in parts of Somalia will nega- 1 4 7 101316192225283134374043464952 tively impact on the health situation of the week population. Movement restrictions in outbreak prone areas is another challenge.

Conflict and displacement

• From 4 January to 7 November 2010, 3888 weapon-related casualties, including 18% (707) un- der five years of age and 104 related deaths, including 22% (23) children under 5 years, have been reported from two major hospitals in Mogadishu. The deaths on site of injury unknown. In the same period, a third hospital reported 2892 weapons-related injuries.

Somali children receive immediate medical attention following continued skirmishes in Mogadishu . Photos by SOYDA

• UNHCR4 estimates that 53 600 people have been displaced from Mogadishu since 23 August. Of the displaced, 32 100 have left Mogadishu while an estimated 21 500 people have relocated to rela- tively safer areas in Mogadishu.

4OOCHA Weekly Hunmanitarian Bulletin Issue # 43 [email protected] www.emro.who.int/somalia/healthcluster.htm www.emro.who.int/somalia/CollaborativeProgrammes-eha.htm

Health Events in Somalia

Epidemiological surveillance during week 44 Map of high risk regions of seasonal AWD

• 12 health facilities in Lower and Middle Juba regions reported a total of 906 consultations, including 53% (477) children under 5 years. 377 consultations for influ- enza-like illness (ILI), 59% (222) children under 5 years. Suspected malaria cases accounted for 270 consulta- tions, including 43% (116) children under 5 years. Acute watery diarrhea accounted for 138 consultations, includ- ing 83% (111) children under 5 years. This compares to week 43.

• 33 health facilities in Lower Shabelle region reported 4758 consultations including 44% (2119) children under 5 years. Acute respiratory infections (ARI) accounted for 869 consultations of which 61% (534) were children under 5 years. Malaria accounted for 138 cases includ- ing 47% (65) children under 5 years and no related death. 60% (83) were confirmed by rapid diagnostic test or microscopy. Acute watery diarrhea accounted for 77 consultations including 62% (48) children under 5 years and one related death under 5 years - this signifies a 51% increase in reported cases compared to week 43. Afgooye district alone accounted for 71% of all reported AWD cases.

• Banadir Hospital in Mogadishu reported 34 cases of AWD including 82% (28) children under 5 years with one related death .

• Habeeb Hospital cholera treatment centre in Heliwa district, Mogadishu reported 25 AWD admis- sions including 56% (14) children under 5 years and one death above 5 years.

[email protected] www.emro.who.int/somalia/healthcluster.htm www.emro.who.int/somalia/CollaborativeProgrammes-eha.htm

WHO’s response

WHO and partners continue to monitor health events and respond to the ongoing situation in South Central Somalia, through the following activities:

• Following an observed increase in reported AWD cases in Afgooye district, Lower Shabelle region, WHO and partners are closely monitoring the AWD trends in the district.

• WHO and partners carried out rumor verification of suspected bloody diarrhoea in Hagar dis- trict in Middle Jubba region. Retrospective data revealed 73 suspected cases including 33% (24) children under 5 years were reported in the villages of Bulo Golol, Bullo Dabadheer and Shabeeley in October. Treatment administered included antibiotics. The situation has normal- ized. District Percentage • During the current cholera transmission season, WHO and partners continue to implement prevention activities Kismayo 21 including monitoring the quality of water in Lower and Afmadow 13 Middle Jubba regions. The low levels of chlorination at drinking water points in the regions pose a risk of out- Jamaame 5 breaks of water-borne diseases. During monitoring of Hagar 3 water source quality in various districts in the reporting Jilib 3 week, data collected revealed the proportions of chlorin- ated wells by location (see table 1). Badhaade 2

Gadudey 2

Dobley 1 Table 1: Proportion of chlorination of water sources in Lower and Middle Jubba districts

• From 7 till 10 November, WHO conducted a training in Galkayo for health workers, local health authorities and the community on outbreak investigation and response. The training aims to improve the detection and coordination of all outbreak related activities while creating ownership of the same by district. This is expected to mitigate observed delays in response to outbreaks. 49 participants nominated from all the districts in and Galgaduud regions attended the training which serves as a milestone for the development of district based out- break response teams.

Practical and theoretical sessions during the outbreak investigation and response training, 7 - 10 November, Galkayo, Somalia. Photos by WHO/Somalia

[email protected] www.emro.who.int/somalia/healthcluster.htm www.emro.who.int/somalia/CollaborativeProgrammes-eha.htm