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Home , Jalozai, Nowshera District, Quetta

Floods in Pakistan Health Cluster Bulletin No 6 5 August, 2010

Out -patient consultation in a static clinic operating in Nowshera -Photo by Syed Haider Ali-WHO-EHA

Highlights:

Around 1.6 million people have been affected overnight in Punjab. A multi cluster rapid assessment mission (MCRAM) has commenced on 5 August.

Infrastructure damage is hampering access to public health facilities in multiple

locations in Khyber Paktunkhwa.

The flood waters continue to destroy South of Punjab while heavy rains crippled lives in upper .

One alert of acute watery diarrhea was reported from Chendangari of FR area where 70 patients have been reported so far though unconfirmed sources

WHO, Government and Health Cluster partners are continuing the health response and struggling to reach communities and individuals in areas which are inaccessible.

Situation Overview and Current Scope of Disaster

Exact figures of deaths are still not clear but at least over 1,500 people have lost their lives with over a thousand injured. Initial findings of a WFP assessment suggest that some 250,000 families or 1.8 million people would be in need of assistance in KPK alone. These figures may rise as more areas are becoming accessible. The number of flood affectees in Punjab province is reported to be nearly 1.4 million people. According to UNOCHA some 4 million people have been affected due to country wide floods in Pakistan.

Currently the flood wave of is in Muzaffargarh district (Southern Punjab) and after devastating Kot Addu town, it has entered Kot Mithon. Sanawan and Qasba Mahmod Kot are also affected due to the rising flood waters. The Rajunpur district has faced the worst flood in the province.

Due to heavy rains in , district of , people from Trehar and Tehdi areas have been shifted to Lehri Town and whole Lehri Tehsil (except Lehri Town) is badly affected. People from Sultankot Talli have been shifted close to safe areas. In Barkhan district there is once again flash floods due to rain and the heavy water flow from mountains again devastated already crippled areas of Dera Bugti. In Barkhan district, 4 union councils Nahrkot, Barkhan Sadar, Joharkot and Radkan are once again affected due to the day long rainfall. There are about 15,000 IDPs in the district particularly in Nahrkot.In district Naseerabad, people in Manjo Shori, Qooba Sherkhan and Qaboola union council area moved to the high lands near high banks of Patfeeder canal, as the low line areas were again flooded due to rain.

The Upper Sindh, where over 350,000 people have been moved to safer places (based on the Meteorological Department’s flood alerts), however torrential rain in the upper Sindh crippled the ongoing evacuation and prepositioning relief activities. The rain water is flowing downward to the lower Sind, thereby flooding seasonal streams. These rains have added risk to the province as the flood waters have started entering in the province. According to early warning Flood Telemetry system, more than 8 million cusec water will pass through province in next 24 hours.

In (KPK) which was the worst affected province. The relief activities in many parts of province were at the peak as the weather was almost clear in the lower areas of the province .

According to latest NDMA figures, over 252,000 houses have been damaged in three flood affected provinces as well as in FATA, - Baltistan regions and Jammu and Kashmir.

Alerts and Out Break

One (1) alert of acute watery diarrhea was reported from Chendangari village of FR Peshawar area where 70 patients have been reported so far though unconfirmed sources

Health impact Daily disease surveillance reports received from health facilities in affected areas in district Naseerabad and Sibi show that in Naseerabad a total of 1 692 patients were treated between 29 July to 3 August. From the total consultations, 20% were acute diarrhoea cases. As response, diarrhoea prevention activities have been initiated by the district health team in the affected area. Moreover, 16 snake bites have been reported from Naseerabad while in Sibi, 10% of the patient visits reported diarrhoea. Weekly pattern of acute diarrhea, IDP crisis and hosting , Khayber Pakhtunkhwa (2009-2010) 15 2009 2010 13

11

9

Percentage 7

5

3

1

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Epi-week

Increasing cases of diarrheal diseases reported in affected areas, but no large-scale outbreaks confirmed. The diseases early warning system teams cannot access the FR Peshawar area where this AWD alert has been generated as the said area is restricted due to security reasons. However the team is trying to intervene in the said locality through department of health.

In Khyber Pakhtunkhwa Province, the total consultations during 31 July to 4 August were 37526 through diseases early warning system. The details are underway

Health Cluster meeting was conducted in Baluchistan district in DGHS Office, .The cluster approach is adapted to avoid duplication in service delivery and putting in place a proper coordination mechanism to respond to health needs in emergency/s

Health Cluster partners have been speeding up emergency health support activities in the country.

In Khyber Pakhtunkhwa Province, the total consultations during 31 July to 4 August were reported as 37526 through diseases early warning system. The leading cause of morbidly is acute diarrhea with 5223(13%) cases.

Daily disease surveillance reporting is closely monitored in the current scenario to have a close watch on water born and related diseases especially, acute diarrhea. The prevention activities have been initiated, loads of essential medicines are in continuous supply through health cluster in order to support the case load of health departments in the affected districts.

The graph below shows weekly pattern of Acute Diarrhea situation in year 2009 and 2010 in KPK:

Health sector response

Save the Children conducted 2 129 consultations at five health facilities in Swat, DI Khan and Buner on 5 August, 2010. Two ambulances have been deployed from Buner to Swat, district to assist in the relief and rescue efforts.12 clean delivery kits, 12 bed nets and 58 hygiene kits were altogether distributed in the districts

Pakistan Red Cross Society (PRCS) in District Shangla, examined 275 patients in 7 health facilities.

Church World Service conducted an average of 575 daily consultations in the last three days in Tehsil kabal, Charbagh and Matta in . In , the organization has conducted 155 consultations in Tehsil Headquarter Hospital Balakaot and treated 155 patients through a mobile clinic.

Johanniter International is supporting district through 2 mobile units. The organization treated 478 patients on 5 August.

International Medical Corps is supporting through a Mobile Medical Unit at Government Higher Secondary School No. 1 in Peshawar City, where 2100 flood affectees are residing, has treated 275 patients. Referral service is supported through ambulances.

American Refuge Committee is supporting 7 health facilities in Swat district, where 418 people have been treated on 5 August. In Baluchistan district the organization is supporting 5 health facilities and treated 525 patients.

UNFPA is continuing its health support including maternal-neonatal child health services through 10 health facilities in Swat, Hangu, Lower Dir, DI Khan and Tank. . UNFPA has moved 1 Mobile service unit to provide health support to flood effected through female medical officers and staff, in . It has also given 600 clean delivery kits, 8000 ORS and 1000 scabies treatment solutions to department of Health in DI Khan and Tank districts of KPK.

Malteser International conducted a medical camp at Murghazar area along with Merlin and SPADO where 600 people were facilitated with medicines, hygiene promotion, food and non food items. Also 132 vaccinations were conducted. The organization also distributed 600 Jerry cans and 1500 sachets were distributed for water purification.

CERD gave 375 consultations in Nowshera district through a mobile team and distributed 300 face wash soaps, 200 laundry soaps and ORS.

Merlin continued its health activities for the flood affected as well, where 3013 patients were treated through 11 mobile teams in Nowshera, Buner and Swat district of KPK. . As a response to flood, number of Merlin supported health Units through 28 static clinics ( 12 Swat, 10 Buner, 6 ) and 3 Mobile teams ( Buner) to 27 static clinics ( 11 Swat, 10 Buner, 6 Jalozai) and 13 Mobile teams (6 Swat, 3 Buner and 4 Nowshera). Merlin mobile teams were airlifted to far flung locations in upper Swat for provision of health services today.

UNICEF has also provided 4 Inter-agency emergency Health Kits (IEHK) to Nowshera and 2 kits to Charssada health departments. The organization has also supplied 10,000 ORS in each district

Care International is supporting flood affected people through 4 health facilities in Upper Swat district and 14 Mobile clinics in the area. Care International has treated 3700 people on 5 August.

Abassin Foundation has provided600 families with 600 aqua tabs, Gerry cans, Information Education and Communication material. Health and education session held in area of Khwaza Khela also 67 Measles vaccination and 46 Tetanus immunizations conducted.

WHO - provided 5 mini-emergency health kits through MERLIN to support the health services to flood affected in Nowshera district .

From warehouse, WHO has moved 2 MEHKto Church World Services and 2 MEHK to American Refugee Committee supporting in Swat district.1 diarrhea treatment kit and 1 MEHK was provided to Executive Department of Health in DI Khan. Also 1 Diarrhea kit and 1 MEHK were provided to District Headquarters DI Khan. WHO has also sent 100 000 aqua tablets, 2 016 soaps, 200 nerox filters and 150 kg of HTC 70% chlorine.

WHO has also prepositioned 2 diarrhea kits and 5 MEHK as reserve stock for pre-positioning in the district to department of health, DI Khan district.

WHO is also supporting the disease early warning and response system throughout the flood- affected areas.

In Punjab province, a total of 4749 patient consultations have been reported from 9 flood affected districts in the province. Respiratory tract infection was the leading cause of morbidity with 2774(58%) patients, followed by 2031 (42%) acute diarrhea cases. The health department distributed 337,547 ORS and some 8140 mineral bottles were distributed.

In Balochistan province, the Department of Health in Sibi district carried routine immunization activities in flood affected areas of Talli and Bakhtiarabad. Anti snake venom, ORS and other lifesaving drugs are available because a medicine worth of 250,000(PKR) has been supplied from Provincial Health Department. The consultations from Baluchistan could not be received as the movement of DEWS surveillance team was restricted due to security situation.

In Sindh province heavy rains, security restrictions and evacuation of the population (in progress in view of coming floods) hampered the daily consultation information.

Annex A

Medicine legend Items/Kit Name Coverage

MEHK (Mini Emergency Health Kits) (6,000 population for one month) IEHK (Interagency Emergency Health Kits ) (30,000 population for one month) Diarrheal treatment Kits (400-500 interventions) Trauma Kits (100 severe interventions)

For further information please contact

Dr Hendrikus Raaijmakers Emergency Preparedness and Humanitarian Action Coordinator e-mail: [email protected]

Alfred Dube Health Cluster Coordinator e-mail: [email protected]

Syed Haider Ali Communications Officer mobile: 0092 3004005944 e-mail:[email protected] [email protected]