Emergency and Humanitarian Action, WHO Nepal Floods and Landslides Health Update

SITUATION REPORT 3 – 5 August 2007

1. Situation Update • Over the past days the rainfall has abated and the water level is receding in most (lowland) districts • As of 4 August, (NRCS) reported 94 people dead, 1 missing, 51 injured, 20,771 displaced families, and 313,150 people (52,904 families) affected • According to media reports, 27,500 families have been displaced as follows: Saptari 10,000 families, Siraha 6,000 families, Mahottari 3,700 families, Bardiya 2,500 families, Parsa 2,000 families, Sunsari 1,000 families, Rupendeshi 1,0000 families, Banke 750 families and Dhanusha 550 families (www.nepaldisaster.org as of 5 August) • Home Ministry statistics show that 268,000 people have been affected by the floods and the landslides since July 10 • The UN Humanitarian Coordinator assesses that emergency needs can be covered by existing resources available in the country • Emergency response at present focuses on relief operations and field assessments to target humanitarian interventions

The map below summarises the current emergency situation correlated with rumoured, confirmed and controlled outbreaks in the country:

FLOODS & LANDSLIDES NEPAL 2007

Public health monitoring based on NRCS, Epidemiology and Disease Control Division, WHO and media reports, 05.08.07 HUMLA

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BAJHANG MUGU BAITADI BAJURA

DADEL- JUMLA BHAK DHURA KALIKOT ACHHAM DOLPA China MUSTANG KANCHAN- LALIT PUR DAILEKH JAJARKOT KAILALI RUKUM MANANG

SURKHET MYAGDI BARDIYA SALYAN GORKHA ROLPA B KASKI A G LU LAMJUNG NG PARBAT RASUWA BANKE PYUT- HAN GULMI DANG ARGHAK SYANGJA TANAHU SINDHU- HACHI NUWAKOT PALCHOK PALPA DOLAKHA DHADING KATHM KAPIL- NAWAL BHAK SULUK- BASTU RUPAN- PARASI HUMBU DEHI P SANKHUWA- A TAPLEJUNG MAKAWAN- LALIT KAVRE H SABA CHITWAN H PUR C E M A R OKHAL- DHUNGA PARSA SINDHULI KHOTANG TERHA- R India BARA A BHOJ- THUM TH E RAUT- H PUR C AHAT SARLAHI UDAYAPUR DHAN- PA MAHO- KUTA TtARI DHA ILAM Flood & landslide affected district: 33 districts NUSA SIRAHA SUNSARI MORANG No. of displaced families (NRCS) SAPTARI JHAA 1 - 100 Unconfirmed outbreak 100 - 999 Confirmed outbreak 1000 - Controlled outbreak

WHO NEPAL – Flood & Landslide Sitrep 2

2. Health Impact • No major or unexpected outbreaks have been reported from any of the flood or landslide affected areas during the past ten days • Common illnesses such water-, food- and vector-borne diseases are observed in the majority of the affected districts. Whether the main cause of these disease incidents are the floods, the season, or more vigilant surveillance remains to be analysed in order to identify emergency-related excess morbidity • Provision of clean water, basic sanitation and health promotion are key measures to prevent outbreaks • A detailed summary of reported health findings are presented in the table below:

No. District & VDC Health Impact Health Response Source 1 - No outbreaks detected - Health team EDCD team - VDC at Koshi Zonal Hospital dispatched to affected (5 August) - Ithara VDC - JE and malaria cases VDCs to collect slides - Urlabari VDC increasing confirming malaria (6 Health Directorate, - Pathari VDC - One person died due to PF and 36 PV cases) Dhankuta, Eastern - Rajghat VDC JE - EDCD field Region (3 August) - Sanishare VDC inspection (flood-affected) 2 - No outbreaks detected - EDCD field EDCD team at Sunsari District inspection (5 August) (flood-affected) Hospital 3 - Diarrhoeal cases - Rapid response Health Directorate, - Kaisagarpur VDC team dispatched Dhankuta, Eastern (flood-affected) Region (2 August) 4 Dhanusa District - No outbreaks detected - Rapid health NRCS (4 August) - Busara VDC at Zonal assessment Hospital conducted WHO IPD (1 August) - Sporadic cases of viral - DPHO and NRCS fever and diarrhoea provided medical assistance to 35 fever (flood-affected) affected families 5 - Viral influenza outbreak - Treatment provided Kathmandu Post - 12 VDCs affected among women and to 39 viral fever (August 4) children rumoured patients at the District - People reportedly Hospital suffering from cold, fever, (flood-affected) headache and dizziness 6 - No outbreaks detected - Health teams ready DHO Sarlarhi - Khairawa VDC - Cases of viral fever to be dispatched to (30 July – 3 August) - Balara VDC observed affected VDCs - Ramnagar VDC - Sufficient medicine - Bawharawa VDC available - Manpur VDC - Health team treated 265 viral fever and 25 (flood-affected) diarrhoea cases 7 - Unconfirmed reports of - A health team has Disaster Watch - Karuniya VDC five deaths due to been sent to the field (5 August) - Dewahmi VDC dysentery and viral fever (flood-affected) over the last week NRCS (4 August) WHO NEPAL – Flood & Landslide Sitrep 3

8 - No outbreaks reported - Two health workers Health Directorate, mobilized to assess Hetauda, Central health impacts of Region (2 August) (flood-affected) recent floods 9 - Number of viral fever - Narayani Hospital Kathmandu Post cases increasing treats 25 viral fever (5 August) (flood-affected) cases daily 10 Ramechap District - Diarrhoeal outbreak Media Report - Tilpung VDC reported causing six (5 August) - Gothgaun VDC deaths (landslide-affected) 11 - Diarrhoeal outbreak - Health response Dhading health officer - Dhusha VDC rumoured team dispatched to (3 August) - One dead reported affected VDCs with (landslide-affected) medicine 12 Rupendehi District - No outbreaks reported - Health teams Health Directorate, conducting rapid Pokhara, Western (flood-affected) assessments Region (3 August) 13 - Diarrhoea outbreak - Two health camps Kathmandu Post -Gwalichaur VDC rumoured provided health (5 August) - Jaljala VDC check-up to more (landslide-affected) than 1,000 people 14 Dang District - No outbreaks reported NRCS (4 August) (flood-affected) 15 Salyan District - Diarrhoeal outbreak - 141 cases treated Health Directorate, - Marmaparikanda for diarrhoea Surkhet, Mid-western VDC - Rapid response Region (2 August) - Kalagawan VDC team dispatched, outbreak controlled, and health education (landslide-affected) strengthened 16 - Diarrhoeal outbreak - Rapid response Health Directorate, - several VDCs rumoured by FM radio team being mobilized Surkhet, Mid-western (landslide-affected) to affected VDCs Region (3 August) 17 - Drainage is a problem in - Treatment provided DPHO Banke Nepalgunj municipality by health teams (5 August) - Widespread flooding - Medicine pre- and water-loggings raises positioned WHO IPD concern of water quality - Coordination (2 August) and related outbreaks meetings ongoing - No significant outbreaks - MOHP response detected team introduced - Flood-victims suffering preventive steps from diarrhoea, typhoid - Health messages fever, bronchitis, viral aired by FM radio fever and fungal (flood-affected) infections 18 Bardia District - People suffering from - NRCS and DHO NRCS (4 August) - Gulariya diarrhoea, fever, eye jointly organized a Municipality infections and head ache health camp Kathmandu Post - Bhadapur VDC - 93 people received (3 August) - Surygauda VDC medical treatment (flood-affected) WHO NEPAL – Flood & Landslide Sitrep 4

19 - Outbreaks rumoured NRCS (4 August) - Pavera VDC due to contaminated - Khailar VDC water - 80 people suffering from diarrhoeal diseases (flood-affected) - Eye infections reported 20 - Cases of diarrhoea - Treatment provided Health Directorate, - VDC observed by local health Surkhet, Mid-western officials and MSF- Region (2 August) (landslide-affected) Holland 21 - Diarrhoea and - Outbreaks controlled Health Directorate, - Kanda VDC pneumonia outbreak by health teams Dipayal, Far-western reported Region (2 August) - 10 deaths caused by pneumonia and 2 deaths (landslide-affected) caused by diarrhoea

3. Immediate Priorities • The immediate needs of the affected population remain shelter, food, water, sanitation and access to health care • Emergency medical services and supplies have been deployed to respond to the anticipated increase in caseload of people suffering from communicable diseases • Public health messages focussing on prevention of water-, food- and vector-borne diseases are being disseminated to the population at risk • In view of endemic diseases it is essential to strengthen disease surveillance and outbreak control, particularly of diarrhoeal and vector-borne diseases

4. Health Sector Response

MOHP / DHS / EDCD Response • On 4 August, the Honourable Minister of Health and Population, Mr G M Pokharel, inspected flood-affected areas in Saptari district • The Ministry of Health and Population has formed a high-level committee for mitigation of health impacts of the floods and landslides chaired by the Minister of Health and Population • The high-level committee established six health teams to coordinate field response and provide emergency medical care and public health guidance. Each team consists of a coordinator from the Ministry of Health or the Department of Health Services, a medical doctor, a paramedic and a nursing staff. Since 1 August, the teams have been dispatched to the following districts: ¾ Janakpur covering Dhanusa, Manotari and Sarlahi districts ¾ covering Bara, Parsa and Rautahat districts ¾ Bhairahawa covering Rupandehi, Nawalparasi and Kapilvastu district ¾ Nepalgunj covering Banke, Bardia and Kailali districts ¾ covering Jhapa, Morang and Sunsari districts ¾ Lahan covering Siraha and Saptari districts • EDCD has deployed two public health teams to Birtnagar and Nepalgunj and the Department of Health Services has dispatched a team to Janakpur. These teams work together with DHOs / DPHOs and Rapid Response Teams in the affected districts to provide public health guidance and epidemiological support WHO NEPAL – Flood & Landslide Sitrep 5

The map below highlights public health response measures initiated in affected districts:

FLOODS & LANDSLIDES NEPAL 2007

Public health monitoring based on Epidemiology and Disease Control Division, WHO and media reports, 05.08.07 HUMLA

DARCHULA

BAJHANG MUGU BAITADI KATHMANDU BAJURA

DADEL- JUMLA BHAK DHURA KALIKOT DOTI ACHHAM DOLPA China MUSTANG KANCHAN- LALIT PUR DAILEKH KAILALI JAJARKOT

RUKUM MANANG SURKHET

MYAGDI SALYAN GORKHA BARDIYA ROLPA B KASKI A G LU LAMJUNG NG PARBAT RASUWA PYUT- HAN BANKE GULMI DANG ARGHAK SYANGJA TANAHU SINDHU- HACHI NUWAKOT PALCHOK PALPA DOLAKHA KAPIL- DHADING KATHM RUPAN- BASTU NAWAL BHAK SULUK- DEHI PARASI HUMBU P SANKHUWA- A TAPLEJUNG MAKAWAN- LALIT KAVRE H SABA CHITWAN H PUR C E M A R OKHAL- PARSA DHUNGA SINDHULI KHOTANG TERHA- R BARA A BHOJ- THUM TH E RAUT- H India PUR C EHA Pre-positioning of Diarrhoeal Kits AHAT SARLAHI UDAYAPUR DHAN- PA MAHO- KUTA TARI ILAM DHA DHO / DPHO Rapid Health Assessment Conducted NUSA SIRAHA SUNSARI MORANG SAPTARI JHAPA EDCD Central Level / Field Assessment Conducted EDCD Flood Response Teams MOHP Flood Response Teams

• From 26 July to 5 August EDCD has dispatched 31 sets of emergency medicine to flood and landslides affected districts and regional medical stores • EDCD has opened a hotline for Rapid Response Teams to call and inform urgent health updates. The hotline is open from 6 am till 6 pm on the following numbers: 4255796 (phone) and 4262268 (phone / fax) • The National Health Education and Information Centre has disseminated health messages through mass media

NRCS Response • NRCS district chapters have mobilised staff and volunteers to assess and coordinate relief operations • NRCS has provided food to over 13,420 families and non-food items to 3,223 families (4 Aug) • Apart from providing food and non-food items to the affected population, NRCS coordinates with local government authorities and other stakeholders to run relief and response operations

WHO NEPAL – Flood & Landslide Sitrep 6

Other Health Agencies: • UNFPA provided food and non-food items to 1,000 flood victims in Mahottari District, including medical support to the District Hospital and District Jail • IRC Surkhet donated drugs and supplies worth USD 1,150 to IRC Rajapur for use as an emergency stock including replenishing PHC stocks if necessary

5. WHO’s Response • Prior to the flood, WHO had pre-positioned diarrhoeal and emergency health kits in Kathmandu, Nepalgunj and Birtnagar • After 27 July, WHO mobilized the IPD Surveillance Medical Officers in the field to conduct assessments, assist DHOs / DPHOs and provide public health guidance • On 3 August, WHO delivered emergency medicine to five MOHP teams at the Department of Health Services. Two sets of medicine have been dispatched to teams in Nepalgunj and Bhairahawa and a third set is on its way to Biratnagar • On 2 August, WHO called an Emergency Health and Nutrition Working Group meeting to discuss the flood situation in the country. The meeting provided a forum for exchange of information and operational planning. Some members expressed concern about lack of systematic situation analysis, limited response capacity and lack of coordination. Several INGOs offered to assist in health assessments (notably IRC and MSF-Holland) and encouraged WHO / EDCD to arrange a follow-up meeting when field data become available • On 3 August, WHO attended a flood response meeting at the Ministry of Home Affairs and briefed about the current health situation and risk of outbreaks. At the meeting, WHO emphasized the importance of allowing national response mechanisms to function rather than substituting them by international interventions • Based on feedback from the field, WHO is refining the post-emergency disease surveillance format. Following a technical review by epidemiologists, this format will be translated to Nepali and made available to health facilities in the affected areas

6. Contact Information Dr Kan Tun WHO Representative World Health Organization UN House, PO Box 108 Pulchowk, Kathmandu, Nepal Tel: +977 1 5523200 extension: 1300 E-mail [email protected]