Haiti• Cholera Situation Report #4 25 October 2010 This Report Was Issued by OCHA Haiti. the Next Report Will Be Issued on Or

Haiti• Cholera Situation Report #4 25 October 2010

This report was issued by OCHA Haiti. The next report will be issued on or around 26 October.

I. HIGHLIGHTS/KEY PRIORITIES

• The Ministry of Health reports the total of 259 deaths and 3,342 confirmed cases. • Artibonite: at the epicentre of the outbreak more than 20 organisations including DINEPA, the Red Cross Movement, UNICEF, Partners in Health/Zanmi Lasante, ACTED, IOM, MSF, Oxfam and WFP continue to reach affected areas with WASH, health, and communication assistance. • In North and West departments preparations are being made for cholera treatment centres with support from MINUSTAH, Oxfam and MSF. • Humanitarian partners continue to support the public information campaign on cholera prevention and hygiene, in particular in the West department, particularly in Port-au-Prince.

II. Situation Overview

The response continues to focus on stopping the spread of the outbreak by ensuring clean water and food, promoting good personal hygiene practices including hand washing and waste management. The Haitian Ministry of Health (MSPP) report 6 deaths and 327 new cases. The total number of dead now numbers 259 while there are 3,342 cases confirmed. Although the origin of the outbreak is in the departments of Artibonite and Centre, suspected cases of cholera have been reported in the North and West departments.

According to UNICEF, MSPP reports show that there is no significant difference in attack case-fatality rates by gender. The Ministry has reported no fatalities among children under one year. All these suspected cases have origins in either Artibonite or Central departments, where the supposed source where cholera first emerged is the Artibonite River.

Assessments show the majority of cases involve people from rural areas where rice growing is prevalent. Health authorities report that many cases in Artibonite involve daily workers involved in seasonal labour.

Dominican authorities have mobilised a contingency plan in the border area and have reports of partially- closed borders at Ounaminte, Balladere, Malpasse and Anse-à-Pitre to anyone not holding a passport.

The government of Haiti, the UN and humanitarian partners continue their efforts to reach affected populations in Artibonite where the overall population is estimated at 435,540. Medical assistance, supplies and equipment for water purification and cholera transmission prevention are being distributed. The WASH cluster reports that they have reached 40 per cent of the people in the 17 most affected communal sections with such distributions. Relief efforts continue in St Marc, where the logistics cluster made available a Mobile Storage Unit for the storage of medical equipment in St Marc for the World Health Organisation (WHO). Partners in Health/Zanmi Lasante received from the International Organisation for Migration (IOM) 70 beds, 140 wash basins, 7,200 litres of bottled water and a 10,000 litre capacity water bladder. In Gonaives IOM distributed to 206 hygiene kits and is distributing 360 jerry cans from prepositioned stock.

Humanitarian Coordinator Nigel Fisher today visited St Marc at the epicentre of the outbreak where he highlighted the need to prepare for a wider outbreak of cholera. “This is an extremely serious situation and based on experience with epidemics elsewhere it would be irresponsible to plan for anything but a considerably wider outbreak,” he said.

Today the MSPP along with WHO/PAHO agreed to classify three steps to treat cholera, each stage of treatment represents a more serious case of the illness: stage one is to administer oral rehydration salts, stage two is IV administered rehydration treatment, stage three is to send patients to a Cholera Treatment Centre (CTC). The Government reports its plan to establish distribution centres for oral rehydration salts

The mission of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors. throughout Port-au-Prince with up to 30,000 volunteers to ensure distributions with a plan of one distribution centre for every 2,500 households. The second stage of intervention will be the establishment of intermediary/transitory centres for intake of patients and where IV and oral rehydration will be available for those with suspected cases. These centres will require additional health personnel and are planned to be set- up in existing health facilities or in spaces identified by the local authorities. The final step is the establishment of CTCs for more acute cases and patients requiring hospitalisation.

III. Humanitarian Needs and Response

Health

The MSPP, UN and humanitarian partners continue to respond to the cholera epidemic in a growing number of locations. In the West department distributions of prevention materials such as chlorine tablets and soap and a public information campaign are ongoing. In camps and vulnerable areas humanitarian partners continue to pass on messages approved by the Ministry of Health on cholera prevention, treatment and detection. For example, ACT Alliance reports reaching 5,000 people with informational material on how to use the water purification tablets in five camps in Port-au-Prince and in neighbourhoods in Bel Air and Cite Soleil.

IOM, at the request of MPSS, has deployed five teams including GPS experts and site planners to assist the MPSS staff in identifying, assessing and mapping possible sites to establish CTCs in five communes across the Port-au-Prince metropolitan area. Camp coordination and camp management (CCCM) has additionally engaged in direct non-food-item distribution, contributing 100 cots to Médecins Sans Frontières (MSF) towards the establishment of the CTCs.

UNICEF and partners distributed oral rehydration salts for 6,000 people in Grande Saline where many of the population of 30,000 is isolated due to high water levels of the river. UNICEF tents have been distributed and will be used for three CTCs in St Marc, L’Esterre and Gonaives; MINUSTAH peacekeepers have provided site preparation assistance.

In Artibonite, the Government has identified six locations for the establishment of CTCs in Saint Marc, Petite Rivière, Verettes, L’Estere, Marchand Dessalines, and Grande Saline. MSF-Spain has taken over operations at St. Marc Hospital, and MSF-Belgium is positioned to run operations at Mirebalais and Petite Rivière de l’Artibonite.

In the commune of Tabarre in Port-au-Prince, Médecines sans Frontiers (MSF)-France opened yesterday a CTC that has the capacity for 235 beds though only 20 beds are being used at present. The CTC director has stated that MSF are urgently recruiting nurses, nurses’ assistants and doctors to assist in the CTC. WFP has made available 20 large tents, 300 beds, plastic sheeting and two generators for CTCs in St Marc. IOM distributed to Partners in Health in St Marc today 70 cots, 140 wash basins 7,200 litres of water and a water bladder with the capacity for 100,000 litres of water. A cargo plane is bringing 100 metric tonnes of medical, water and sanitation supplies to Médecines sans Frontiers medical teams in the affected areas this weekend.

A joint assessment by MINUSTAH, World Food Programme (WFP) and Oxfam GB to Pilboro today, on the border of the North and Artibonite departments has recommended that a CTC be established there. A police checkpoint and cholera treatment clinic were set up in Pilboro by the Haitian Police (HNP) and MSPP, although reports suggest the facilities are only adequate to administer emergency treatment to stabilise a patients condition before transport to a health facility.

In coordination with MSPP and UNICEF, a total of 2,500 sachets of oral rehydration salts and 20 large boxes of personal protection equipment (PPE) are being distributed to communal health centres and hospitals in the region in the coming days.

Assessments in Artibonite and Central departments of health centres and rural communities are ongoing by the MSPP, UNICEF, IOM and other partners. Reports show urgent needs to scale up disinfection efforts at health facilities.

Gaps & Challenges

There is a lack of Ringer’s lactate intravenous solution used to treat dehydration. UNICEF reports that challenges remain with intake and management of patients in Artibonite. Health centres are overwhelmed by the caseload.

Many health staff are not trained in best practices regarding the isolation of patients, proper disposal of bodily fluids and bodies of the diseased. The main challenge in the West department is identification of locations for CTCs in congested neighbourhoods in Port-au-Prince.

Water, Sanitation and Hygiene (WASH)

The Haitian water and sanitation directorate DINEPA distributed 2,000,000 water purification tablets today to local authorities, reaching almost all of southern Artibonite. This will cover some families for a short period of time while other agencies and organisations move in with additional support. DINEPA also distributed 715 kilograms by helicopter today to water network operators in 12 major cities. This operation will continue for the next two days to cover all major cities across the country, in both affected and non-affected regions.

The WASH cluster reports that humanitarian partners are still scaling up their distributions in the Artibonite and Central departments, with Samaritan’s Purse and ACTED partnering to install two chlorination stations in Villars and Boudette. Oxfam has reached 40,000 people in the commune of Petite Rivière in Artibonite with distributions of soap, water purification tablets and oral rehydration salts. World Vision has sent teams to assess water points, sanitation facilities and latrines while distributing water purification tablets, soap and oral rehydration sachets.

Outside of Artibonite WASH cluster partners are also stepping up their activities. ACF is supplying HTH, buckets, sprayers and training to health facilities in their zone of operation and are monitoring the situation in the North of Artibonite. IOM is dispatching hygiene promotion teams to Artibonite to conduct trainings and disseminate prevention and treatment information. Training for community health workers and local authorities took place at Desdunes and L'Estere; training of trainers took place among IOM staff in Gonaives, where 15 nurses were trained in cholera hygiene promotion. IOM also trained 60 staff in community mobilisation who will then teach prevention methods in rural communities, travelling by motorbike.

MINUSTAH peacekeepers continue distributions of thousands of litres of water on a daily basis. Argentinean peacekeepers recovered from Port-au-Prince a water treatment plant and installed it in St Marc.

DINEPA and UNICEF met on 24 October to define the strategy for water treatment and chlorination in Port- au-Prince. Chlorination will be increased two to three-fold to water that is currently distributed in IDP camps. With two companies representing close to 80 per cent of all private water kiosks, an agreement was made to distribute water purification tablets through these private companies in addition to the Haitian public water provider for the next two months.

Gaps & Constraints

According to the St Marc WASH cluster situation report, further gaps include a reported shortage of organisations to support the installation of WASH facilities in hospitals and health facilities, including CTCs. The WASH cluster also reports a shortage of buckets and jerry-cans in rural areas. Prepositioned stocks in St Marc have been depleted and demand remains high. People covered by the first round of distributions in affected areas will soon require a second round as their soap and water purification supplies are used.

Logistics

In the past three days the logistics cluster has facilitated the transport of both personnel and live-saving assistance in the effort to stop the spread of cholera They have supported the French Red Cross by transporting 6,000 hygine kits and 6 large tents to St Marc as well as providing MSF-Spain with 10 large tents, 100 beds, 10 rolls of plastic sheeting for mattresses and two generators for the CTCs and St Nicolas Hospital. For Port-au-Prince the cluster transported for Médecins du Monde (MdM)-France 5,000 pocket ringer’s lactate IVs in case of a cholera outbreak in the capitol. On 23 and 25 October UNICEF delivered five Land Cruisers to DINEPA for immediate dispatch to Artibonite to support assessment and distribution efforts.

The logistics cluster remains mobilised to support the relief effort.

MINUSTAH peacekeepers also continue to provide significant logistical support to government and humanitarian partners engaged in the response. IOM also assisted in the organizing of the distribution of non- food-items like jerry cans and buckets.

Food

On the request of the Departmental Committee for Risk and Disaster Management in the North department, the WFP sub-office in Cap Haitian provided 250 boxes of meals-ready-to-eat (MREs) and has organized dispatch to transport, MREs, water and sanitation material to support local authorities in the establishment of a medical post at Poulboro on the North-Artibonite border.

While supporting immediate response, WFP is also putting in place preparedness measures to respond to a potential increase in numbers and to other parts of the country, including the capital Port-au-Prince. Meanwhile, regular WFP activities in the area are ongoing to ensure the most vulnerable continue to receive food assistance.

A longer-term food assistance strategy, including defining appropriate food rations for cholera affected people, is being developed by the food cluster in collaboration with health and WASH partners. WFP will assess cooking facilities in hospitals to ensure that there is access to clean water and to appropriate cooking equipment. They will further assess the school feeding programme as potential emergency platform for distribution of hygiene kits to families and for public information campaigns.

Communication The MSPP has developed a comprehensive communication strategy aimed at Artibonite and Centre departments with the objective to disseminate and reinforce cholera awareness, prevention and treatment messages. The strategy will also be implemented in the West and other departments as needed. The government, UN and humanitarian partners are carrying out sensitization through community mobilization, media campaigns on television and radio, and through the transmission of informational literature in affected and at-risk areas. The public information campaign has a strong personal hygiene component with a focus on promoting washing hands. Using radio, Oxfam reports an audience of 100,000 people in Artibonite and Centre departments has been reached with hygiene promotion broadcasting messages. The IFRC has mobilised nearly 300 volunteers have been mobilised to support the hygiene promotion campaign.

UNOPS, IOM and the Haitian Red Cross have 80 community mobilization staff communicating cholera sensitization messages and cholera risk reduction strategies on a face-to-face basis in an initiative targeting over 60 priority camps in Port-au-Prince. Save the Children is sending the same message in 109 schools and is planning to train the Education mobilization staff to provide hygiene promotion to 15,000 children. The IFRC reports having 300 volunteers available to pass on hygiene messages at the community level.

In the Centre department World Vision deployed a team of 12 nurses, a doctor and 50 community health workers to Mirebalais, where they conducted a rapid awareness-raising campaign on cholera aimed at 3,000 students at seven schools.

IOM communication teams has engaged in a variety of activities in IDP sites, both to promote hygiene awareness and to educate the public on how to react in the event of a cholera infection. The Communication team has also worked closely to support the operational activities of CCCM, Health and the WASH units- both helping to create the right messages and disseminate said messages through effective channels.

The CCCM cluster has engaged IDP camps in preparedness activities, central to which is the public information strategy on cholera. IOM has been sending cholera prevention messages via SMS text to all IDPs registered with IOM via the Digicel phone network SMS system. The messages have been approved and developed with the Government as well as with the IFRC and Haitian Red Cross, who have a similar program with the Voila network.

IOM is recording and broadcasting a radio show on the subject of emergency health and hygiene on national radio and another Port-au-Prince based radio station. Internews is also disseminating public information messages through their radio show (ENDK) which focuses on humanitarian issues. UNICEF representatives met today with the Minister of Education to discuss a strategy for preventing the spread of cholera in schools. The government has developed the overall public information strategy to be tailored for schools. During the coming weeks, UNICEF will also support training of teachers on prevention The mission of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors.

and hygiene, disinfection and chlorination in affected schools. The education cluster is working with UNICEF, WFP and other partners to develop a hygiene promotion campaign in schools.

Coordination

Partners engaged in responding to the cholera outbreak can request logistical support from MINUSTAH through the Joint Operations and Tasking Centre. Request forms can be picked up at the Crisis information Centre in OCHA's office at the UN logistics in Port au Prince, or at MINUSTAH Regional Offices. Forms can be submitted by email to [email protected].

A crisis information centre was established to facilitate the transmission of information for this response. A website has been developed at http://haiti.humanitarianresponse.info/ . Please send your information requests and other queries to [email protected].

Contact Information

Head of OCHA Haiti, Kazimiro Rudolph Jocondo Email: [email protected], Tel: (509) 3485 8140

Head of Communications, Imogen Wall Email: [email protected] , Tel: (509) 3491 2244

Public Information Officer, Rachelle Elien Email: [email protected], Tel. (509) 3482 5785

Public Information and Reports Officer, Jessica DuPlessis Email: [email protected], Tel: (509) 3485 7964

United Nations Office for the Coordination of Humanitarian Affairs, (OCHA Haiti), Boulevard Toussaint Louverture et Clercine 18, Port-au-Prince, Haiti.

If you would like to be added or deleted from OCHA’s global sitrep/humanitarian bulletin mailing list, please subscribe/unsubscribe at http://www.rpcvinctest.com/dadamail/

HAITI - Cholera Situation: Affected communes in Artibonite and Centre 25 October 2010, 19:30

Répartition des cas de choléra Evolution des cas de choléra, Patients hospitalisés et décédés, (Patients Hospitalisés et décédés par Age et par Sexe selon l'Institution) du 20 au 24 octobre 2010

R dans le Bas d'Artibonite et le Bas Plateau (Département du Centre)

i v

r R e iv Legend i d é re Total décès e Période de collecte allant du 20 au 25 Octobre 20 d 10 e Total cas # de décès Toal décès # de décès Total décès D S

i a s rte DATE # de cas Hospitalisés communautaire p s u Hospitalisés Institutionnels Institutionnels communautaires communautaires t

e M G R R d s Total des décès o e i i v v C/S R s

i i J q é é Age&Sexe a

e r u b r e a e l i e n t y e Inconnu

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é Institutionnels CommDE VERuNEUIL nautaires Total deces i CS LA v i G FOSSETTE G DISPENSAIRE R 20/10/2010 13 22 213 211 226 233 0 0 4 10 4 10 0 0 0 0 0 0 35 49 G DE TREUIL HOP L'ACUL G re 21/10/2010 20 17 577 453 597 470 0 1 19 12 19 13 0 0 0 0 0 0 36 68 vié Artibonite 2981 128 Ri el 117 245 orc M d 22/10/2010 20 22 416 380 436 402 0 1 29 18 29 19 0 0 0 0 0 0 21 69 G

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