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Somali Health response update Weekly Highlights 24 – 30 Sept 2011

BULLETIN HIGHLIGHTS

• Since the beginning of September 2011, over 300 casualties from weapon-related injuries have been treated in the three main hospitals in Mogadishu.

• During the reporting week, over 60 measles cases among children that are internally dis- placed and currently in the district of Qansadheere in Bay region have been reported by the WHO and SAMA health mobile teams (see more on health responses on page 4)

• In Focus: WHO field hospital installed in district, along the Somali- Ethiopian border

Update on major public health concerns:

• Trends of acute watery diarrhoea (AWD)/cholera

Poor sanitation conditions, a shortage of safe water, overcrowding and high malnutrition rates are the perfect combination for infectious diseases, such as cholera, to spread and increase death rates. The cholera transmission season is ongoing. Some areas have received sporadic rains, posing a high risk for transmission of waterborne diseases, such as AWD. Communities tend to use contaminated water for domestic use, hence the high risk for sporadic outbreaks.

WHO and partners continue to implement various training sessions for health workers in most affected areas to improve case management. Multiple rumors are currently Graph 1. Trend of AWD and cholera Cases case at Banadir hospital, being investigated. Confirmed cholera outbreak is ongoing 500 Mogadishu in Mogadishu (Banadir region). Meanwhile in the Afgooye 450 corridor, Baidoa (Bay region), Xarardere, Bursalah, Trends for 2011 Godldogob, and ( region), Awdhegle 400 Trends for 2010 and Wanlaweyne district ( region) are 350 under control. Confirmed measles and dengue fever cases have been identified in Mogadishu (Banadir region). 300 Dengue fever is confirmed in Galbeed region of Somali- 250 land. 200

Since week 11, 6474 AWD/cholera cases including 4592 150 (71%) cases under the age of five with 261 related deaths 100 have been reported from Banadir Hospital in Mogadishu 50 (see graph 1 on trends). Children under the age of two bear 0 the greatest burden of AWD accounting for 49% of all 3 reported cases and 45% of all reported deaths. Based on 21 2 25 27 29 31 33 35 37 data collected, women and girls account for 47% of all Weeks AWD reported cases at the hospital.

1Week 1: 3-9 January 2011 2Week 38: 19 - 25 Sept 2011

Graph 2. Lower Shabelle region weekly AWD Cases cases The number of AWD cases reported in Lower 400 w eek 21 (2008) - w eek 38 (2011) 2 Shabelle region tends to increase in week 38 300 2008 2009 2010 2011 compared to the previous week (see graph 2). 200 100

0 1 4 7 101316192225283134374043464952 Weeks Mogadishu conflict Graph 3. Weapon injuries admitted to three From 1-25 September 2011, 359 casualties from Cases hospitals in Mogadishu week 1 - 38, 2011 weapon-related injuries were treated in the three 1400 hospitals in Mogadishu. Three related death were 1200 reported. The number of weapon-related casualties 1000 reported from these hospitals has remained stable 800 over the month (see graph 3). 600 The deaths on site of injury remain unknown. 400 200 0 1 5 9 7 5 9 3 Health Events in Somalia 13 1 21 2 2 3 37 Week

Epidemiological surveillance during week 38

• In Lower and regions, 16 health facilities reported 1609 consultations including 696 (43%) children under the age of five. Women and girls accounted for 772 (48%) of all consultations. Influenza like illness (ILI) accounted for 696 Graph 4. Kismayo General Hospital AWD Cases consultations of which 444 (64%) were children trends as during w eek 1 - 38 2011 200 under the age of five. Suspected malaria 180 accounted for 379 cases including 184 (49%) 160 children below the age of five. Only 1.5% were 140 Case above 5 years 120 confirmed by rapid diagnostic test or microscopy. 100 Case under 5 years AWD accounted for 336 cases including 270 (80%) 80 60 children under the age of five and no death. Kismayo 40 accounted for 31% of all reported AWD cases. The 20 overall number of AWD cases reported from Lower 0 and Middle Juba including those admitted to the diar- 1 4 7 10 13 16 19 22 25 28 31 34 37 Weeks rhea disease unit at Kismayo hospital has drastically reduced (see graph 4). On 20 September, health partners operating in the district of Afmadow reported an isolated incidence of four AWD cases with one related death. WHO has pre-positioned medical supplies in Buaale to distribute to targeted areas. The situation will be closely monitored.

Following rumors of AWD in Bullo Gudud in , WHO, partners and the local authority conducted a joint investigation. Three deaths are said to have occurred over the previous 3 weeks. Seven cases including 5 under the age of five were identified and were administered oral-rehydration salts (ORS)- see page 4 on more information on response.

• In Lower Shabelle region, 56 health facilities reported a total of 10 218 consultations of whom 4582 (45%) are children younger than 2 under the age of five. Women and girls accounted for 5766 (56%) of all consultations. Acute respiratory infections (ARI) accounted for 1642 consultations of which 834 (51%) were children under five years. Suspected malaria cases accounted for 312 cases including 123 (39%) children under five years. Around 256 (82%) were confirmed by rapid diagnostic test or microscopy. AWD accounted for 175 consultations including 177 (67%) children under five years. During the same period, 277 suspected measles cases were reported from the region. Around 44 suspected whooping cough cases were reported. The number of measles cases continues to increase. The lack of access to conduct vaccination activities in the region continues to impact negatively on the health of children especially measles cases.

• At the Merka Hospital cholera treatment centre in Cases Graph 6. Merka cholera treatment the region reported 17 AWD cases including 14 (74%) 100 centre admission trends children under the age of five. The number of 80 admissions reported continues to decrease (see graph 6). Of all the cases 7 (37%) were women and girls. 60 WHO and partners are monitoring the situation and 40 facilitating preventive activities. Adequate case 20 management supplies are been distributed to partners on the ground. Mobile clinics supported by WHO and 0 implemented by partners in Lower Shabelle region 1 4 7 10 13 16 19 22 25 28 31 34 37 Weeks provide access to basic services targeting over 5000 people per month.

• During the reporting week, Jowhar Regional Hospital reported a total of 170 consultations. The majority were the pneumonia cases - 38 cases - of which 45% are under the age of five. Following the successful implementation of the measles-mumps-rubella vaccination programme within the hospital, the measles cases tend to decrease. There are only two cases reported during the week. A number of serious tetanus cases have been referred to the hospital. In response, tetanus–toxoid vaccination for women of child bearing age has been implemented. In coming weeks the vaccination programmes will be implemented at mother and child health centre (MCH) level, once training of local staff has been carried out and a cold chain system set-up.

• Banadir Hospital in Mogadishu reported 201 cases of AWD including 143 (71%) children under five years, with 9 related deaths (5 under the age of five). Of these cases 50% are women and girls. The number of reported cases continues to reduce steadily in the past weeks. WHO and partners continue to monitor the trends and undertaking AWD preventive activities. Case management supplies have been pre-positioned in Mogadishu, ready for dispatch. The increased influx of internal displaced people and the precarious living conditions are high risk for outbreaks and the number of AWD cases is expected to rise significantly between now and October.

• The SOS Hospital in Huruwaa district, Mogadishu, reported 37 AWD cases under the age of five. Of these cases 16 (43%) were girls.

Health response © WHO

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

• In response to AWD cases reported in Bullo Gudud in Kismayo district (Lower Jubba region), local authorities in the area have constructed a makeshift oral rehydration therapy to treat cases. The team provided 120 litres of ringer lactate and accessories, 1500 ORS sachets and 2000 aqua tabs to be used for pre-referral patient stabiliza- tion by the village community health workers. Health Mothers access services at Kismayo hospital education was also provided to the community.

© UNFPA • UNFPA has so far, pre-positioned medical supplies including emergency reproductive health (RH) kits in Galkaayo (Mudug region) to cover a period of six months. In addition, training for eight medical doctors on emergency obstetric care (EmOC), 28 midwives on basic emergency obstetric care (BEmOC) and, 20 RH emergency focal point s on the minimum integrated service package has been carried out. Supplies distributed include 3600 delivery kits to midwives and non-governmental or- ganizations (NGO) for distribution to expectant mothers, hospitals kits for six hospitals and 11 mother and child health centres. Ongoing is the dis- tribution of locally assembled dignity or nutrition kits Clean delivery kits distribution to pregnant mothers in Badbaado, to benefit 8000 pregnant women. Gender-based Beledweyne in Hiraan region violence coordination activities through a local NGOs supported by UNFPA is also underway.

• With the support of WHO and OCHA, health partners SOYDA and Intersos are running one health center each in Lower Shabelle region meanwhile health partner SOYDA does also run two mobile teams. In Banadir region, SOYDA manages a health centre and has four mobile teams. In the reporting week about 2092 beneficiaries in the districts in Lower Shabelle and 1636 in districts in Banadir were attended by the medical teams. There were more than 1200 reported consultations of children under the age of five in both regions.

• WHO, in collaboration with SAMA, is providing health services to the newly relocated IDPs through mobile clinics, following the relocation of thousands of IDPs from Baidoa to Qansadheere (Bay region). A number of children among the displaced have been clinically diagnosed with measles. Over 60 cases have been reported by mobile teams. Low vaccination coverage coupled with high malnutrition rates among the IDPs has exacerbated the measles situation across Somalia. WHO is urging all local authorities to allow for mass vaccination activities to avoid preventable deaths associated with measles and other vaccine-preventable diseases.

© SAMA • Mulrany International is undertaking primary health care activities including operating a trauma clinic. In the reporting week the Wardhiigleey clinic in Lower A clinical measles case Shabelle region reported 357 consultations including 127 under the age of five.

In Focus © WHO

Field hospital installed in Dolow Somalia district, along the Somali-Ethiopian border

A new field hospital was installed last week in Dolow Somalia, nearby the Ethiopian border to provide medical aid to thousands of Somali refugees fleeing towards the border areas. The hospital will be operated and managed by WHO. The world health body is providing medical profes- Together with the installation of the field hospital also needed sionals to staff the facility as well as all the needed medical supplies and equipment got delivered. medical supplies and equipment.

The main reason for setting up a field hospital is part of WHO’s strategy to decentralize health care, especially in an emergency setting. Many internally displaced people are seeking health assistance and therefore flee to bigger cities, including Mogadishu. In order to stop some of the huge influx of IDPs to the Somali capital, the newly installed field hospital will treat patients mainly from the and regions. However, also people from the Ethiopian and Kenyan border areas might benefit from this newly established hospital.

“In an emergency situation like Somalia, a field hospital may be the only way to improve the availabil- ity of health care services for communities when existing hospitals are not sufficient, says Dr Marthe Everard, WHO’s representative for Somalia. “A field hospital is an enormous relief for the population by bringing health services to them while lessening the burden on existing overstretched health facili- ties,” she continued. The Dolow Somalia area previously never had secondary health care, therefore the best way to reach the people in need and make best use of the resources is by setting up a field hospital.

The Dolow district commissioner, Mr © WHO Abdulrashid Hassan Abdi, expressed his appreciation and support for this newly established field hospital. Last week, more than 400 patients were treated – an average of 75 patients per day - and more than 30 surgical operations were performed success- fully by a WHO medical team. Even a case with a neck swelling looking for medical assistance all the way from Gaalkacyo diagnosed and treated at the field hospital.

The newly installed field hospital in Dolow, Somalia

The major consultations included malaria, acute watery diarrhea, acute respiratory infections and provision of emergency surgical treatments for patients suffering from tumors, shrapnel, foreign bod- ies and birth defects. The installed field hospital is a mobile self-contained and self-sufficient facility, which includes a tent with 8 beds, one operating theatre, and a basic laboratory. The field hospital is meant to run for the next coming months. Financial support has been provided by the Norwegian government, and security support was provided by UNDSS.