TYPHOON YOLANDA HEALTH CLUSTER

BULLETIN Guerrero WHO/Frainisco Photo:

ISSUE #8 DECEMBER 18, 2013

HIGHGLIGHTS

 As of 18 December 2013, the National Risk Reduction Management Council (NDRRMC) of the reported 6 069 deaths, 27 665 injured, and 1 779 missing. A total of 16 074 856 people have been affected, 4 006 747 are displaced, and 101 527 are in 381 evacuation centers

 UNFPA has increasing concern about the level of support and reproductive health care needs of adolescents.

 The number of registered Foreign Medical Teams (FMTs) in the affected areas has de- creased to 55 as of 18 December

 The diagnostic capacity for TB is limited, especially in Region VIII. However, the DOH is reporting that across affected regions TB treatment facilities are almost 100 per cent func- tional.

Inside this bulletin:  Public health risks, needs, and gaps

 Affected population and areas

 Main public health concerns  Health cluster action

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 1 December 18, 2013

AFFECTED POPULATION AND AREAS As of 18 December 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 6 069 deaths, 27 665 injured, and 1 779 missing. A total of 16 074 856 people have been affected, 4 006 747 are displaced, and 101 527 are in 381 evacuation centers (Table 1). Table 1: AFFECTED POPULATION (NDRRMC, 18 December 2013) Number of % of total Number of % of inter- affected popu- population Displaced nally dis- lation of the area* Population placed

Region IV A 27,076 0.2 - - Region IV B 466,120 17.0 1,960 0.07 Region V 692,020 24.9 - - Region VI 3,873,028 54.5 2,434,539 34.28 Region VII 5,909,955 86.9 205,933 3.03 Region VIII 5,015,434 122.3 1,452,826 35.42 Region X 19,592 0.5 19,592 0.4 Region XI 5,000 0.1 - - Caraga 66,631 2.7 - - Total 16,074,856 34.0 4114850 8.6 Humanitarian Case Load according to 12,900,000 29.84% Flash Appeal Source: Situation report # 66 NDRRMC as of 18 December, 2013 Currently there are three different centers close, the Government is placed people are in this last categories of relocation sites in the establishing ‘transitional sites’ in group. affected areas. The first site cate- bunkhouses, to temporarily host gory is ‘evacuation centers’ in pre- families displaced for longer than A clearer picture is emerging of established buildings such as one month. A third type is a the damage to personal homes as schools, barangay halls, gymnasi- ‘spontaneous settlement’, which is response moves toward long-term ums or health centers. These be- an unofficial site where people live recovery planning. Details of the gan to close approximately two in makeshift, open housing struc- level of personal loses facing com- weeks ago as the response shifted tures on the side of the road, close munities are detailed in maps A from meeting acute need to long- to the site of their original their and B. term recovery actions. As these home. It is believed that most dis-

Map A TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 2 December 18, 2013

Map B PUBLIC HEALTH RISKS, NEEDS, AND GAPS

Public Health Concerns The 5 most reported health mation from the Department of There is increasing interest in re- events from surveillance in each Health takes a back seat to he provision of current services. Sur- establishing routine health care in region are: veys of users would be another affected areas as efforts shift from approach. A large scale multiclus- acute response activities to longer Region VI: acute respiratory in- ter household survey has been -term planning and rehabilitation. fection (ARI), wounds, fever, hy- completed by OCHA, which in- For example the sub- pertension and skin diseases. cluded 5 questions on health. Ac- national health cluster reports that cess to care was the only topic included. The survey found that the immediate basic health care Region VII: ARI, wounds, acute about a third of all respondents needs of the affected communities diarrhea, fever, and skin diseas- reported inadequate access to in the acute phase of the response es. care. Lack of transport and debris have been met. Now, rebuilding of were the major reasons for prob- health facilities and the re- Region VIII: ARI, wounds, acute lems with access. establishment of routine health diarrhea, hypertension and skin care provision aligned with the diseases. DOH strategies and systems and using foreign medical teams to reinforce regular care are taking Essential health services precedence. Information on post-typhoon con- ditions at the local level remains incomplete. A major focus of the Morbidity recovery planning process is to re- Wounds sustained during clean- establish and enhance the ser- ing up operations are still being vices that were available pre- typhoon. This is because data on reported across all regions. It every health unit is needed to appears that these will continue have a complete picture. Collec- as rebuilding activities increase. tion of this information from the clusters is qualitative, while infor-

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 3 December 18, 2013

HEALTH CLUSTER ACTION

Health Cluster coordination from the acute phase of the emer- services and 1 teams with special- The Department of Health is the gency into early recovery. This ty type 3 services. lead of the Health Cluster, with may indicate that rapid assess- FMTs that wish to donate equip- ments are finalising and there will WHO as co-lead at the national ment and supplies to local ser- and sub-national levels. be an increase in program report- vices are requested to go through ing and status updates. the DOH to register their dona- As of December 16, the DOH tions. A guidance note from the downgraded the situation from Response DOH on the entry and exit strategy Code Blue to Code White, indicat- Health Care Services of FMTs can be found at: ing the Government’s vision of activities returning to pre-typhoon The number of registered Foreign http:// levels. Medical Teams (FMTs) in the af- www.philippineconsulate.com.au/ fected areas has decreased to 55 surgical-and-medical-missions-to- Assessment as of 18 December (refer to map the-phl.html The number of rapid assessments C, D and E). Forty-nine of the has been decreasing over the last teams are functioning with basic type 1 services, 5 teams function- two weeks, as there is transition ing with more sophisticated type 2

Map c

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 4 December 18, 2013

Map D

Map E

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 5 December 18, 2013 In Ormoc the Australian Army has WHO has distributed solar fridg- In Leyte, notifications of suspected developed an early recovery plan, es, including 4 delivered to hospi- leptospirosis via SPEED are lower including rehabilitation of dam- tals in city and 11 to than in the previous week, despite aged schools, assessment of support cold chain needs in North- increased SPEED reporting. health centers and assistance to ern Leyte. re-establishing routine water sup- Three suspected Dengue cases plies. The Norwegian Red Cross is UNICEF’s team of cold chain ex- were reported with manifestations currently based at Ormoc District perts have completed assess- of Acute Haemorrhagic Fever. Hospital, providing services for ments of 119 health facilities cov- deliveries and surgery. ering regional, provincial and mu- Given concerns about possible nicipal level vaccine storages in dengue and leptospirosis, close Japan Anti-Tuberculosis Associa- Regions VI , VII and VIII. The main attention is being paid to Guiuan, tion (JATA) and Japanese Interna- obstacle to cold chain restoration given an increase in fever cases in tional Cooperation Agency (JICA) in Region VIII has been unstable the past two weeks. Otherwise, are visiting Tacloban, Palo and power supply and a lack of reliable the apparent increase in fever in Tanauan, in addition to some are- generators to keep refrigerators the past two weeks is largely due as in Eastern Samar. continuously operating. to an overall increased reporting.

The diagnostic capacity for TB is Surveillance and communicable Region VII limited, especially in Region VIII. disease control Reporting is reducing from Cebu However, the DOH is reporting As of last week, there is a weekly City and surrounding areas as that across affected regions TB EWARS report that will be sent out people leave evacuation centers. treatment facilities are almost 100 with the Health Cluster Bulletin per cent functional. every week. Highlights from this There have been no reported report are detailed below by Re- alerts from Region VII. Vaccination and cold chain gion. The vaccination campaign is still Region VI continuing in key priority areas, Region VIII There has been a significant in- including Northern Leyte. This There continues to be challenges crease in fever reported in San campaign would not have been with telecommunications making Remigio, in Antique province. possible without strong support reporting difficult from many areas from Save the Children, Salvation within Region VIII, particularly for Two suspected cases of leptospi- Army, Philippines Red Cross and areas surrounding Tacloban City rosis were reported in the province the Japanese Self Defence Force and Eastern Samar. In addition, of Iloilo. (JSDF). JSDF have completed many health services are not func- their work with the campaign as of tioning. WHO and DOH staff are Seven suspected dengue cases 12 December after conducting the active in these areas promoting were reported with manifestations immunisation campaign in Mani- the use of SPEED by training of Acute Haemorrhagic Fever. cani and Victory Islands of Gui- health workers and collecting data uan. to enter. There has been an in- No confirmed cases of measles crease in the number of health have been reported in region VI. To date the vaccination campaign facilities reporting in the past has reached 35,522 children for week. FMT’s are requested to input into measles, 36,095 for polio as well SPEED to provide better coverage as 24,505 for doses of Vitamin A A total of 24 suspected measles of the affected areas. across Region VI, VII and VIII. cases were reported in Paranas Western Samar via the Event- Table 2 shows the number of The regional DOH in Region VIII Based Surveillance system run by health facilities reporting between announced that the campaign will the National Epidemiology Centre 10-18 December 2013. be completed in its priority areas (ESR). A team from DOH NCDPC on 20 December. As the mass together with CHD 8 conducted immunization campaign winds further investigation, collected Table 3 tracks the tends for health down the DOH will focus its efforts blood samples and undertook im- facilities reporting since the begin- on supporting the Local Govern- munization activities in the identi- ning of the Typhoon Yolanda re- ment Units to re-establish routine fied area. sponse immunization programs. Table 2: Summary of SPEED Reporting in Typhoon Yolanda affected Areas 10–18 Dec 2013 (Table 2) Region Provinces (#) Municipalities (#) Health Facilities and Reporting Sites (#) VI 4 58 69 VII 1 1 2 VII 3 14 26

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 6 December 18, 2013 Table 3:

Note: The total number of sites used as the denominator calculated as percentages is the total number of sites registered for SPEED. It is recognised that, particularly in Region 8, this will overestimate the true denominator. Reproductive Health in Palo, Leyte to offer complete vices and clinical management of In accordance with guidelines on health-care services for pregnant sexual violence for 10,000 people Essential Newborn Care, Chlor- and lactating mothers as well as over 3 months. hexidine will not included in the list rape survivors dealing with injuries of essential drugs. The DOH is in related to the abuse. There is increasing concern about the process of preparing guidance the level of support and reproduc- on this topic. The Reproductive Emergency transport capabilities tive health care needs of adoles- Health Working Group is in the of the four provincial hospitals in cents. process of finalising guidelines for Leyte and Eastern Samar are en- four sets of kits for the following hanced with the turnover of four There was one reported death due categories: well newborns, sick ambulances. Three custom-made to neonatal tetanus was been re- newborns, well infants and sick motorized vehicles, E-rangers, ported in Region VIII. infants. design for maternal health care were also given to the rural health Water, Sanitation and Hygiene The United Nations Population units of Palo (Leyte), Balangiga (WASH) and Environmental Fund (UNFPA) provided emergen- and Guiuan (Eastern Samar) to Health cy maternal care units to the pro- provide emergency transport facili- An assessment was performed in vincial hospitals of Leyte and East- ties. the Ormoc area during which 33 ern Samar. The Leyte facility has potable water samples were ob- already started its operation to Reproductive health kits have tained and 13 were positive for respond to an expected 1,300 ob- been provided to in Roxas City E.Coli. While there is an adequate stetric complications in Leyte prov- (Capiz), Carles (Iloilo) and Palo water supply, there is inadequate ince over the next 3 months. (Leyte) to serve 30,000 people chlorination. In addition UNFPA has set up an over 3 months. Also provided are Emergency Maternity Unit (EMU) materials for family planning ser-

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 7 December 18, 2013

The affected community would vices. also providing psychosocial inter- benefit from aquatabs, hypersol or ventions, primarily based at City Gerry cans, but there are very lim- Long-term recovery planning with Health Office, as well as operating ited supplies in the area. disability inclusion will focus on re- some mobile clinics. establishing and enhancing pre- Disability Inclusion typhoon services in community- International Medical Corps has The primary concern for persons based rehabilitation in affected been assessing mental health and who sustained injuries during the areas. psychosocial needs in Roxas and typhoon is the need to access to rehabilitation services and assis- other affected areas. They will re- tive devices following discharge Mental Health and Psychosocial porting on the results of the as- from medical services. Support (MHPSS) sessments in the coming weeks. Mental health and psychosocial Handicap International has report- services (MHPSS) meetings are WHO Philippines country office ed that they renovated the being conducted and psychosocial website has created a resources Tacloban public hospital rehabilita- interventions are being implement- webpage for MHPSS: tion unit allowing three physiother- ed in schools and communities in apists to return to activities with Ormoc City and in some munici- http://www.wpro.who.int/ the hospital patients. Two Handi- palities, with assistance from for- philippines/topics/mental_health/ cap International physiotherapists eign and local medical teams. en/index.html and one occupational therapist will Partners with MHPSS-related in- Planning also provide support for 4 hospi- terventions in the area include Is- A $791 million strategic response tals in the town of Tacloban. raAID, ChildFund, Magna Children plan to assist 3 million people af- at Risk, MSF, Clarion, Mercy Ma- fected by (Yolanda) was launched yesterday Department of Social Welfare and laysia, World Vision, and the Development (DSWD) are regis- by more than 50 organizations. DOH. Magna Children at Risk is The plan, which is 30% funded, tering people with a disability and starting provision of psychosocial will be implemented over a 12- NGO’s in the affected areas are services in Kananga. IsraAID op- month period and will complement setting up help desks locally to erates mobile clinics, and provides the government-led Yolanda re- support the elderly and people psychosocial services. Clarion is covery and response plan, to be with a disability to access ser- launched on 18 December. FUNDING STATUS OF ACTION PLAN As of 18 December 2013, OCHA has updated the action plan, which is now at is 28% funded for the health sector (table 4). Table 4: FUNDING STATUS OF ACTION PLAN FOR HEALTH (US$)

Project Appealing Amount Funding % Cov- Agency Required ered Merlin & Save the Children Essential Save the Health Services for Preventing Excess children Mortality and Morbidity in Typhoon Hai- yan affected Population 4707706 800000 17% Ensuring Access to Reproductive UNFPA 15% Health Services in the Aftermath of Ty- phoon Haiyan 10000000 1499518 Provision of emergency health services WHO to typhoon affected populations 15000000 14306932 95% Immediate assistance to injured and HI vulnerable persons affected by Haiyan typhoon in Philippines 240000 237417 99% Emergency Health care, public health IOM and referral initiatives for displaced and affected persons ‘on the move and their vulnerable host communities’ 1810511 0 0%

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 8 December 18, 2013

Provision of life-saving interventions for UNICEF health to children 0-59 months affected by Typhoon Haiyan emergency 19000569 6158542 32% Provision of quality medicines and de- IHP veloping resilience in the supply chain to avoid gaps by strengthening the de- partment of health medicines stock management systems 806000 806000 61% Prevent increase in maternal, neonatal Plan and child mortality post disaster through ensuring continuity of services for these more vulnerable groups 3960422 0 0% Promoting mental health and psychoso- IMC cial wellbeing of populations affected by Typhoon Haiyan 727961 0 0% Ensuring the health needs of older peo- HelpAge ple in Typhoon Haiyan International 465000 465000 100% Health care support for Typhoon Haiyan IMC affected populations 3865225 0 0% Enhancing coordination within and out- WHO side the health sector 1816100 0 0% Surveillance, outbreak prevention and WHO vaccination 3929850 0 0% Local health system recovery for social WHO and economic protection 4061800 0 0% Delivery of essential health services to WHO meet the immediate health needs of the affected population 3524500 0 0% Typhoon Haiyan emergency health re- WV Philip- sponse pines 400000 400000 100% Health assistance for disaster affected RI communities of inland Leyte and coastal Barangays of Tacloban municipalities of Tacloban City, Jaro, San Miguel and Carigara 955500 0 0% Provision of emergency medical assis- MDM France tance to affected population of the Ty- phoon Haiyan 2700000 0 0% Saving Women’s lives in Typhoon af- Saude em fected provinces through reproduction Protugues health 1150800 0 0% Restoration of basic health package AAI within Concepcion Municipal Health Of- fice area 310000 0 0% Sub total for health 79431944 24356008 31% http://fts.unocha.org/reports/daily/ocha_R32_A1043___18_December_2013_%2803_00%29.pdf

Major WHO donors: Australia, Canada, Norway, Japan, the United Kingdom and the UN Central Emergen- cy Response Fund (CERF), Russian Federation, Sweden and the United States of America, and from the European Commission and Civil Protection (ECHO).

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 9 December 18, 2013

Health Cluster Partners National- Manila: Eversly Child Sanitarium, GOAL, Glo- AECID, Americares, Australian Aid, ry Reborn, ICRC, IFRC, IEAD relief, CDN- DART, CFSI, ChildFund, DFID, Health Organization of Mindanao w/ DOH, FPOP, Handicap International, Helping Hand relief and Development, HuMa, IFRC, IHP-UK, ILO, IMC, IOM, International Medical Corps, JICA, IRC, ISAR-Germany, JICA,MERLIN, Japan Red Cross, LandsAid, Magna MDM, MSF, National Bureau of Inves- Children at risk, Med Japan, The Men- tigation , PHE, Philippines Red Cross, tor Initiative, Merlin, MSF, NYC Med- Relief International, Plan International, ics, PNA, Project hope, React Philip- Project Hope, PU-AMI, SCI, UNFPA, pines, Samaritan Purse, Samu Sevilla UNICEF, USAid, US Forces, WHO, International, SC, SCI, Spanish Red World Vision. Cross, Saint Anthony Mother and Child Hospital, Talisay District Hospi- Sub-national- Tacloban: tal, UNICEF, Vicente Sotto Memorial Medical Centre, WHO, World Vision AECID, ACF, ACTED, Action Pom- piersUzgenceInlanaVionus, ARC, ASEAN, ASYA SAR/KYM, Sub-national- Roxas: B-FAST, AUs, BomberosUnidos SP, ACF, Action Aid International, Canada Care, Christian Aid, DFID, DOH, DFAT, Child Fund, CRWRC, DoH, ECHO, Emergency.LU, Ericsson Re- GOAL, IOM, Japan Heart Foundation, sponse, EUCPT, First Relief Fund, Philippine Rural Reconstruction Move- First Response Radio, Fuel Relief ment, MSF-Swiss, NETHOPE, Save Fund, German Embassy, German Red the Children, UNDAC, UNICEF, Welt Cross, Globalmedic, GOAL, Good Hunger Hilfe, WFP, WHO, World Vi- Neighbours Intl., Good People Intl., sion International HUMEDICA,IFRC, International Disas- ter Relief, Internews, IOM, IsraAid, Sub-national – Guian / JICA, KIHI, KOICA, Leger Founda- Borangan: tion, Miral Welfare Foundation, MSF/ IOM, Medical Team International, F, OCHA, Oxfam, Philippine Red DOH, Plan, PHTO, Norwegian Church Cross, PompiersHumanitaires France, aid, Radio Bakdaw PUI France, Samaritan 119 Korea, SC, SCDN, Solidarities International, Spanish Red Cross, TGCFI, RTR hospital, UNDAC, UNDP, UNFPA, UNICEF, USAID, US OFDA, Voda- fone foundation, WFP, WHO, WISAR, World Vision.

Sub-national- Cebu: AmeriCares, ASB Austria, Canadian Emergency Response Unit, Canadian Medical Assistance Teams, CFSI, ChildFund, DOH, Embassy of Israel,

Health Cluster Contacts

National- Manila: [email protected] Sub-national- Tacloban: [email protected]; [email protected] Sub-national- Cebu: [email protected]

Health Cluster Website:http://www.wpro.who.int/philippines/typhoon_haiyan/en/

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN 10 December 18, 2013