SOUTH SUDAN Emergency preparedness and Humanitarian Action (EHA) Week 39 (24 TH -30th) 2012 Office f or the Republic of South Sudan Highlights 1. Humanitarian situation The overall Security situation remained stable in the country although some rumors of the Lord’s Resistance Army (LRA) movement at the border line with Uganda, Democratic Republic of Congo (DRC) & Central African Republic (CAR) were recorded . Reports of Rebel Militia Groups in Jonglei states were also recorded this week with no c asualties but with displacements. The continued influx of refugees in to Maban county is straining the humanitarian operation. There are currently 105,000 refugees in Maban County, 65,000 in Yida, Pariang, in addition to 15,000 in Lasu ( CES) and Makpandu (WES). These are living in extremely dire conditions characterized by poor water and sanitation resulting in large public healt h risks for both the refugee and host communities. In August 2012, the WHO STAFF TOGETHER WITH STAFF AT A HEALTHY FACILITY IN LAKES STATES CHECKING THE CONSULTING Ministry of Health declared hepatitis E virus outbreak REGISTER FOR MORBIDITY TRENDS in Maban County. With renewed fighting in the bordering states, it is anticipated that there will be an During this week, WHO; increased refugee influx o f 150,000 in the next few month. Currently, Yida has additional new refugees 1. Supported the County health department in compared to the Maban , mainly due to poor access due to the rains. Maban to coordinate the refugee response with emphasis on disease surveillance in the South Sudan, remains a very expensive and challenging country due to the poor infrastructure. Up to 60% of community. the country is currently cut off due to the heavy rains 2. Conducted an assessment for Kala azar upsurge and floods making delivery of emergency assistance in Koch County, Unity State to verify reported very costly. cases Returnees continue to arrive in Juba from the Sudan. To 3. Supported the SMOH W estern Equatoria State date 120,000 persons have returned to South Sudan. to verify rumors of s uspected Ebola case from This reporting week, a total of 480 returnees were flown in by African Inland Church from Khartoum. Bazungua Boma, Yambio Payam. Emergency assistance and a re-insertion package were provided to the returnees in the final area of destination. 4. Participated in an interagency assessment of An estimated 12,000 others are still stranded in Renk flooding in Maban County . (Mina, Abyouk and Pay er sites) , 3000 are in the ways stations in Juba and National Teachers Training Institute, and 3000 stranded in Kosti, White Nile State, 5. Supported Akoka and Longechuk counties with Sudan. Kala azar drugs, rapid tests and syringes to support the rising cases . 1 SOUTH SUDAN Emergency preparedness and Humanitarian Action (EHA) Week 39 (24 TH -30th) 2012 Office f or the Republic of South Sudan 2. Public Health threats and concerns i. The hepatitis E outbreak in Maban is still evolving; this peaked in Jamam the epicenter . However it’s too early to judge as to whether rain s still hamper efforts to improve sanitation and availability of clean water at the camps. With surface floods affecting the refugee camps, the water and sanitation condition of the water will deteriorate due to repeated contamination duelto low latrine coverage ii. Floods remained a main public health risk this week. WHO/MOH received reports from the states showing a growing trend of malaria, diarrhea and eye infection cases . T he potential of a disease outbreak remains a key concern in the areas affected by floods in Northern Bah r el Ghazal, Lakes, Jonglei, Unity and Upper Nile state. iii. In Warrap state, two AFP cases were reported from Gogrial West County while in Western Bahr el Ghazal states, 4 new case s of anthrax were reported and are currently under investigations. 3. Coordination, Emergency Preparedness and Response 1. With torrential rains affecting the refugee settlements in Uppernile. WHO took part in the interagency assessment of flooding in Maban County. The team led by the Deputy Governor of Upper Nile State included other NGO partners. The main objective of the assessment was to identify the critical needs that are affecting the population in the county following the influx of over 105,000 refugees from North Sudan. This has greatly impacted on the thin social services available for the host community ( 45,000) and most especially the health services. In resp onse to the identified gaps, WHO provided WHO TECHNICAL OFFICER CONDUCTS AS ASSESSMENT IN AWEIL TOWN FOLLOWING FLOODING. 2 SOUTH SUDAN Emergency preparedness and Humanitarian Action (EHA) Week 39 (24 TH -30th) 2012 Office f or the Republic of South Sudan Basic kits, Inter agency Emergency Health Kits and anti-malarials weighing 500kg . These were given to support service delivery at the Primary Health Care Centers (PHCCs) and Primary Health Care Units (PHCUs) run by the County Health Department (CHD) . 2. There is an anticipated arrival of 600 returnees from Khartoum to Malakal by air. To ensure that the health needs of the returnees are taken care of, WHO prepositioned 2 basic kits and 3 boxes of antimalarials to Malakal way Stations managed by INTERSOS in preparation for the receipt of the r eturnees. 3. During the week an al ert case of Ebola rumors was reported from Bazungua Boma, Yambio Payam . As a follow up, WHO in collaboration with the State Ministry of Health (S MOH ) emergency team investigated and verified the suspected case. The team established that the suspected case did not present with signs and symptoms to match the criteria for the case definition of Ebola. The patient was however diagnosed with ‘Acute Renal Failure. 4. In Northern Bahr el Ghazal state, persons affected by floods were relocated to Adapa. WHO contin ued WHO STAFF CONSULTANTS WITH THE COMMUNITY DURING AN to support a mobile clinic in the ASSESSME NT OF THE FLOODED HOMES IN AWEIL TOWN. affected areas by providing drugs and incentives for health workers operating the clinic. In this reporting week, 877 patients were treated for common illnesses, 79% of them being malaria cases. The State Rapid Respons e Team continues monitoring disease trends in the state in anticipation of epidemic prone diseases. More focus and emphasis has been put in the Apada area hosting persons affected by the floods. 5. In this reporting week, WHO conducted a verification exercise following reports of an upsurge of Kalazar cases in Koch County, Unity state . The team established that over 314 cases have been reported since the start of 2012, with a slight increase in cases reported in the last three weeks. The drug situation was also found to be relatively below the acceptable level . In order to support the health authorities in Unity state, WHO provided test kits and assorted Kalazar drugs of Ambisome,Paramay ocin and R apid Diagnostic Tests kits to respond to the increasing number of cases in the PHCC where the patients are managed . In the Upper 3 SOUTH SUDAN Emergency preparedness and Humanitarian Action (EHA) Week 39 (24 TH -30th) 2012 Office f or the Republic of South Sudan Nile state, WHO also supported Akoka and Longichuk counties with Kalaazar drugs, rapid tests and syringes to support the increase of the reported cases of Kalaazar in the two counties. 4. Communicable Disease Update Maban response 1. WHO maintained an epidemiologist in the county of Maban to support the county health department. The Epidemiologist was deployed to the county to assist the health authorities and health cluster members to strengthen Early Warning, Alert and Response Network (EWARN) system at county level. In Maban and Yida refugee camps, reporting performance from health facilities serving the refugees and surrounding ho st communities has greatly improved and remained high due to WHO interventions . The current early warning surveillance system in the refugee camps and host community is also very effective, timely and sensitive. Acute Jaudice Syndrome continued to be reported in the 120 refugee community in Jamam, Epi Curve by Camp Gendrassa, and Batil Camps. 100 Follow up of cases that were reported from the host 80 community at Jamam PHCC was not successful. The 60 cumulative number of cases Gendrassa from Maban in week 39 stood 40 Batil 783 and 22 deaths(CFR is of No.AJS Cases of No.AJS Cases Jamam 2.8%.) 20 Factors for the decline in the 0 incidence rates could be 30 31 32 33 34 35 36 37 38 39 attributed to increased safe Week water, and improved sanitation and hygiene practices in the camps. At the beginning of this reporting week there was limited movements of people in Batil and Gendrassa d ue to clashes between the refugees and the host community. This affected Out Patient Department attendance and active search of cases. Another factor could be the tendency of some members of the community to seek medical treatment from traditional healers. This calls for increased community sensitization. There is need to strengthen inter agency collaboration and support NGOs that are promoting behavioral ch ange in the camps. In week 39, nine (9) out of 15 C ounty Health Department facilities reported. Six Primary Health Care Units did not report while five were inaccessible. Notifiable diseases that caused high morbidity in both host and refugee communities i ncluded Malaria, Acute Watery Diarrhea, and Diarrhea with blood (Shigellosis). 4 SOUTH SUDAN Emergency preparedness and Humanitarian Action (EHA) Week 39 (24 TH -30th) 2012 Office f or the Republic of South Sudan The table below shows details and a graphic presentation of the analysis. Malaria Acute Water Diarrhea with Total OPD Diarrhea Blood attendance Host Community 617 (31.92%) 124 (6.42%) 54 ((2.8) 1,933 Refugees 1937 (20.4%) 703 (7.4%) 78 (0.83%) 9,488 Total 2554 (22.37%) 827 (7.25%) 132 (1.16%) 11,421 The statistics above shows malaria as the highest cause of morbidity followed by Acute Watery diarrhea.