HEALTHCLUSTERPAKISTAN CrisisinKhyberPakhtunkhwa IssueNo4 20MarchR12April,2010 As of 15 April, 300,468 individuals or 42 924 families are living with host communities in Hangu (15187 families,106 309 individuals) Peshawar(1910 families,13370 individuals) and Kohat(25827 families,180789 individuals) Districts, displaced from Orakzai and Kurram Agency, of Khyber Pakhtunkhwa province formally known as North West Frontier Province (NWFP). In addition to above there are 2 33 688 families or 1 404 241 people are living outside camps with host communities in Pakistan IDPs living in camps and Host Mardan, Swabi, Charssada, Nowshera,Kohat, Hangu Tank, communities DIKhan, Peshawar Abbotabad, Haripur, Mansehra and Battagram districts of NWFP. There are 23 784 families or 121 760 individuals living in camps of Charssada, Nowsehra, Lower Dir, Hangu and Malakand districts (Source: Commissionerate for Afghan Refugees and National Data Base Authority) In order to cater for the health sector needs, identified through recent health assessment conducted by health cluster partners, in Kohat and Hangu districts due to ongoing military operation in Orakzai Agency, Health cluster partners ( 2 UN and 8 I/NGO’s have received 2.4 million dollars fund from Central Emergency Response Fund (CERF). This fund will shoulder the ongoing health response for the IDPs and host communities living in Kohat and Hangu Districts 499 DEWS health facilities reported 133 426 consultations from 20-26 March, of which 76 909 (58 %) were reported for female consultations and 56 517 (42%) for male. Children aged under 5 years represented 33 972 (25%) of all consultations. out of those, 5,614 (17%) consultations in children under five, were for Acute Diarrhea and 1,709(5%) for lower respiratory track infections. There were 1756 visits for antenatal care reported from 63 health facilities. From 20-26 March, six alerts for suspected measles (Peshawar, Mardan, Lower Dir, Nowsehra, and Buner districts), one outbreak of measles (Nowsehra district) and One alert of acute watery diarrhea (Swabi) were received and responded accordingly Acute upper respiratory tract infection (37,290 (28%) patient consultations) remains the leading cause of morbidity, followed by acute diarrhea, according to data from reporting health facilities. From 20-30 March WHO prepositioned life saving medicines, including emergency, cholera, maternal health essential drugs (30 mini emergency Kits to DI Khan and Tank districts.) These medicines are sufficient for the population of 118 000 for two months. Cluster members are prioritizing reproductive health care services in Lower Dir, Swat, DI Khan and Tank districts. In the last week of March, UNFPA supported 9 health facilities (District Head Quarters Hospital Tank, Rural Health centre Gomal Bazar, Parroha, Paharrpur, Basic Health Unit Dabarrha, Mufti Mehmood Memorial hospital, Tehsil Headquarters Hospital Matta and Samarbagh) in these districts. A total of 4,921 patients were consulted during 1 April to 12 April in district D I Khan, Tank, Swat and Lower Dir This includes 397 antenatal consultations, 127 postnatal consultations, 124 deliveries, 17 post abortion care, 6 case was referred for C-section, 21 syndromic case management of sexually transmitted infections, 193 family planning consultations, 326 ARI, 968 gastroenteritis, 765 fever, 151 scabies and 1,773 consultations for other minor general outpatient services etc. During the above mentioned period 123 newborn and 370 hygiene kits were distributed for improving menstrual and personal hygiene as well as psycho-social support of the affected women at reproductive age group to overcome/transform socio-cultural taboos in women accessing reproductive health care. HEALTH ASSESSMENT Hangu district Health Assessment A Health Cluster team conducted assessments of health facilities in Hangu districts during 22 to 24 February. Sixteen medical officers from cluster partners and Government officials, using WHO assessment tools, assessed Hangu district. The team assessed gaps in service delivery in 18 public health facilities in the district. This comprised of the 1 Tehsil headquarter hospitals(THQ), 1 Civil Hospital, 1 Rural Health centre, 13 Basic Health units(BHU) and 2 Maternal and Child health centers. In addition to this 1 Camp, 3 warehouses and 3 diagnostic laboratories were also assessed. Currently, there are around 78,719 IDP’s residing with the host communities in district Hangu and as per the information shared by the Social Welfare department and Executive District Officer (Health) Hangu. There are twelve health facilities which are providing health care to these IDP’s. According to Health facilities assessment the case load at these health facilities has increased enormously since security operation escalated in Orakzai Agency. The essential drugs, service provision and qualified health workers, especially female doctors are identified as urgent needs and insufficient to cop for the extra load of 116 821 displaced people visiting these 10 health facilities. The three health facilities which are most overburdened by the IDPs are THQ Hangu with 32,627 IDPs, BHU Shahoo Khel(This health facility is not functional as it was destroyed in 2009) with 16, 890 IDPs and BHU Ibrahimzai 11, 072 IDPs. The availability of essential drugs in the overburdened health facilities is quite low and not enough to cater the extra load of the IDP population visiting these 12 health facilities. The detail assessment is available at http://www.whopak.org/idps/documents/assessments/Hangu%20assessment%20draft.pdf Disease Surveillance The disease early warning system (DEWS) network has been established in the 10 districts hosting IDPs affected by conflict in NWFP. Full expansion of the DEWS network to Kohat and Hangu districts, which host IDPs from Orakzai and Kurram agencies, is in process. Districts in the DEWS network coverage in NWFP crises Nature of involvement Number Districts Peshawar Hosting IDPs of Malakand Division and Mardan Bajour Agency 5 Charssada Swabi Nowsehra Buner IDP Return Districts in Malakand 3 Swat Division Lower Dir Hosting IDPs of South Waziristan Agency Tank 2 DI Khan Total 10 Alert and outbreak investigations and response: From 20-26 March, six alerts (from Districts Mardan, Lower Dir, Buner, Peshawar and Nowshera) and one outbreak (from District Nowshera) of suspected Measles and one alert of acute watery diarrhea (district Swabi) were received and responded accordingly. Suspected measles: Five alerts for suspected cases of Measles were reported, two from Nowshera while one each from districts Mardan, Lower Dir, Buner. Blood samples from all suspected cases were sent for laboratory confirmation and all of these were reported negative for Measles from National Institute of Health (NIH), Islamabad. Field investigation was conducted and no more suspected cases were found. Six suspected cases of Measles were reported from Badshah Khan Kallay, in district Nowshera. Two patients were children less than five year age 4 patients were over five year old and belonging to same vicinity Blood samples from six the patients were tested at National Institute of Health, (NIH) Islamabad and 5 samples were reported positive for Measles IgM, However result for one sample is awaited. The Executive District Officer- Health and DEWS team is actively monitoring the Measles situation in the area and planning mop up vaccination if needed. No more suspected case reported from the area. One alert for suspected acute watery diarrhea from Mohalla Ter Watu, district Swabi. Stool samples were collected from all the patients and sent to NIH for laboratory confirmation and the result is negative for acute water diarrhea. Morbidity and mortality (20 to 26 March, 2010) 499 DEWS health facilities reported 133 426 patient consultations in the 10 districts hosting IDPs and affected by the NWFP crisis. 59 DEWS reporting sites also reported 1488 visits for antenatal care. The table below shows the overall distribution of patients by gender and the number of consultations and the percentage for the priority communicable diseases under surveillance recorded 20-26 March, 2010. Male/Female consultations and percentages Gender Number of consultations Percentage Female 76 909 (58%) Male 56 517 (42%) (Source: DEWS, 2010) Of the total number of consultations, 33 972 (25%) were made by children aged under five years. Detailed data of these diseases is available from the Weekly Morbidity and Mortality Bulletin 12 available at www.whopak.org COORDINATION Islamabad The 52nd Health Cluster meeting was conducted in WHO conference Hall, Islamabad on 18 March. The highlights are as follows: UNFPA will meet Health Emergency Preparedness and Response (HEPR) on Rural Health Centre Parova, DI Khan duplication issue which is still pending. Need to be resolved on priority basis. ( Action to be taken by UNFPA, HEPR) Health needs for Mohmand Agency were reviewed at provincial health cluster meeting in Peshawar district. There is a need for medical supplies in 43 health facilities in the agency. 1 Agency Head Quarter Hospital, 1 RHC and 24 BHUs need immediate support and assistance to health services. (Action to be taken by Health Cluster Partners) Urgent mass vaccination is required for measles outbreak in 2 union councils of Nowshera (Action to be taken by UNICEF, WHO, Executive District Officer, Nowsehra). Health Cluster quarterly review to be undertaken by end of April, 2010. (Action to be taken by Health Cluster