SOLOMON ISLANDS GOVERNMENT
MINISTRY OF HEALTH AND MEDICAL SERVICES
P.O. BOX 349, HONIARA
MINISTRY OF HEALTH EMERGENCY OPERATIONS CENTRE (MOHEOC)
SITUATIONAL REPORT 6 (18th April to 21th April 2014)
Events Flash and River Flooding – 03 April 2014
Tsunami warning/watch – 13th April 2014
Date Issued: 22/04/2014 Time Issued: 3pm Next update: 3pm, 23/04/2014
From: Incident Controller To: Chairperson, PDOC HCC, PDOC GP, NDOC, NDC, Chairpersons – All Clusters
cc: Government Ministries, UN Agencies, NGO’s
Situation Description
At 11:00 am on April 3, 2014 a tropical low with a central pressure of 1002 hectopascals as relocated near 11.1 degrees latitude south and 158.7 degrees longitude east, approximately 63 nautical miles northwest of Bellona Island and 100 nautical miles south of Guadalcanal island. As a result of flash flooding, approximately 10,000 people in Honiara city and 40,000 people in Guadalcanal Province were affected.
On 13th April 2014, at 7:20 am an earthquake with a magnitude of 8.3 later down-graded to 7. 6 occurred at a latitude of 11.3 degrees south and longitude of 162.3 degrees East, 108km SSE of Kirakira, Makira Province. A Tsunami Warning was issued by the SI Meteorological Service at 7:33am. Further after-shocks occurred through-out the day.
HEALTH SECTOR CONTROL CENTRE AND COORDINATION
Since the health emergency operation centre was activated on the 5th April 2014, the Ministry of Health continues to support the Honiara Health Division and the Guadalcanal Health Division with key public health and curative assessments and interventions.
The primary objectives of the Ministry of Health during the response and immediately post disaster are: a. WASH
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b. Public Health Assessment and Interventions in the affected areas, including Vector-borne disease control interventions, Health Promotion, Environmental health interventions, social welfare services. c. Acute clinical care involving Maternal and Child Health, Nutrition, and vulnerable populations including the psychologically affected individuals in the affected areas. d. Enhance surveillance coordination, information management, communications and response including preparation for surge in demand. The Health Sector noted the directions from the P-DOC (HCC) as follows: a. Reducing the number of evacuation centres. b. Providing relief assistance at home. c. Conduct survey of IDP in all evacuation centres. d. Infrastructure and economic assessment of impact. e. A package for voluntary repatriation. And the health sector has been tasked to make an environmental assessment of the original homes of evacuees as well as assessments of FOPA village as an alternative evacuation centre for the immediate term. The Ministry of Health has established a Health Command and Control Centre at the Henderson Police Post to support Guadalcanal Province PEOC. The Ministry of Health has been working closely with the Honiara Health city services and as of today has assigned a senior health official to establish a health command and control center at the HCC health services Head-quarters. The Ministry of Health continues to operate a 24 hour 7 days a week, Command control Centre at the NRH. The health sector has been coordinating with the IDP/welfare cluster, and has completed and sent the HAP to NDMO on 15th April 2014. The NDMO Multi-sectoral Assessment Team was assembled on 15/4/2014 of which Health has been requested to be a part of. The assessment forms (including health –specific assessment forms) have been reviewed and training is planned for the Team on the 16/4/2014, before they are dispatched to perform the assessments. The Health Cluster along with WASH will assess the Burns Creek area on 21st April 2014 for suitability of return of IDPs.
HEALTH INFRASTRUCTURE STATUS
All HCC Clinics are fully functional except for the 3 clinics that were affected (White river, Mataniko and Pikinini Clinics). Safety assessment has been done for White River clinic on 11th April as well as for the Mataniko/Pikinini Clinics on 12th April 2014. Spraying by the Fire Service commenced on 15th April at the Mataniko and Pikinini Clinics with clean-up is being assisted by local volunteers. Volunteers started cleaning up the White River clinic as of 16th April 2014. Cleaning of the affected clinics continued into 17th April.
As of 18th April the interior of White River Clinic has been cleaned but the surrounding area is still full of mud. Mataniko Clinic still requires interior additional cleaning while the Pikinini Clinic needs further assessment of the building structure in addition to cleaning up of its interior and surroundings.
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A: White River Clinic; B: Mataniko Clinic; C: Pikinini Clinic. At the NRH there is erosion of the coastline (2.5meters), which has caused risk to the children’s ward being inundated by high tides and weatherly conditions. The immediate solution was discussed which include filling up the coast-line with tripod sea breakers, or option recommended by infrastructure cluster. A request for assessment of the National Referral Hospital, physical, environmental and functional capacity has been included in the HAP.
The physical status of the antenatal and postnatal wards has now been condemned and currently is not being used.
The drainage system at the NRH is currently blocked which is also causing sewage drainage blockage. It has been observed that this is due to the rising sea level which frequently blocks the outlet.
HEALTH SERVICE DELIVERY
1. Honiara City Health Services
MoH/HCC combined mobile clinics which started on the 7th April 2014, are currently providing services to the evacuation centres. They have also made some assessment in at least 14 evacuation centres as at 7th April 2014. The health services delivered at the evacuation centres is being coordinated by the IDP/welfare cluster. There is now resumption of normal services in the non-affected HCC clinics, as well as focused enhanced services and assessment in MCH, surveillance and general outpatient services.
On the 14th and 15th of April, the three HCC mobile clinics visited all evacuation centres. Normal services in the non-affected HCC clinics continue, as well as focused enhanced services and assessment in MCH, surveillance and general outpatient services with 2 medical officers each assigned to cover the East and West HCC clinics. There is currently MSF team support in public health consultation and psychological services which have been so far provided to the FOPA, Panatina Pavilion and Mbokonavera evacuation centres.
A health team from Taiwan is assisting with health care in HCC located camps. These visits still need better coordination with the existing HCC teams for optimum delivery of health services.
Mobile clinics continue visits to ECs from 18th to 21th April with the 3 teams being reduced to 2 teams on 20th April. The MSF team continued to provide supporting clinical and psychological services.
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HEOC notifiable diseases seen by HCC mobile clinics
50 41
40
30 24 24 20 21 17 20 15 15 13 13 11 10 9 8 10 8 9 9 10 6 4 6 4 6 5
1 01 2 00 0 11 1 21 0 00 0 0 1 10 1 0 0 0 00 0 11 0 0 0 21 0 0 0 0 00 1 2 20 1 00 0 0 0 10 1 0 0 20 0 0 0 NumberofCases 0 8-Apr 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 20-Apr 21-Apr
Diarrhoea without blood Bloody diarrhoea Red Eye Influenza like infections Suspected dengue Malaria
The above chart illustrates the number of post-disaster notifiable diseases seen by the HCC mobile clinics each day.
Albendazole and Vitamin A treatment covered by mobile clinics
Albendazole Vitamin A
300
200
100
0 Number of cases of Number
The above chart illustrates the number of cases receiving deworming and vitamin A treatments from the HHC mobile clinics per day. As the days progress the number of children being treated reduces as they near towards the treatment of all at risk children.
1.1 Health Promotion
On 14th April the HP headquarters had a meeting with the WHO Risk communication expert and conducted a second meeting with other stakeholders/ agencies including WHO, UNICEF, WV, RC and CARITAS to enhance proper coordination and support of HP activities to the ECs & affected communities.
IEC materials on WASH materials and a personal hygiene fact sheet have now been developed and the HP component for HAP Health /Nutrition cluster has been completed.
Also on 14th April, training on WASH and Hygiene Promotion of the camp leaders/ ECs group leaders for FOPA and Panatina ECS was done. Health awareness talks on the same topics were carried out in nine (9) classes at the Panatina ECs. Provision of interpersonal communication by the incorporation of nursing staff to the five (5) ECS (White river, Bishop Epale, Police club, Mbokona, Naha school) was done.
As of 10th April the HP division have developed IEC materials comprising information on a new born baby and a fact sheet on WASH. Media support continues through the Daily Radio Health radio program. Two groups were
Page 4 of 34 deployed with the first group focused on establishing and training IDP Camp advocators at the KG VI and Mbuavalley camps on personal hygiene, washing of hands, boiling of water, cleaning up of surroundings, proper rubbish disposal/ management and proper use of toilets. The second group focused on health awareness to patients presenting to Rove, Mbokona, Mbokonavera, Kukum, Vura and Naha clinics on identified health issues such as diarrhoea, red eye, dengue, common cold and acute respiratory infections.
The HP headquarters coordinated Risk Communication training on 15th April, facilitated by a WHO/RC Specialist for HP staff and teams from HCC & GP. Mapping out of the challenges experienced in the field after 11 days of commencing HP activities was done including the setting up of the direction for the 2nd phase of the risk communication plan with identified gaps for possible assistance by partners in the HPCWG. The second health promotion communication working group (HPCWG) meeting was coordinated and conducted and consisted of various agencies including WHO, UNICF, WS, RC and CARITAS. HPCWG selected appropriate IEC materials from RC, UNICEF & WV for adoption and have delegated and funded mass printing to partners (RC & UNICEF).
RC has indicated support for the personal protection of HP outreach teams through provision of gumboots raincoat and hand gloves. UNICEF is also prepared to support the HP media coverage through health spots in the SIBC and the health column in the newspaper whilst HPCWG has also agreed on 30 HP Volunteers to be coordinated through RC for HCC and GP evacuation centres and affected communities with RC meeting the cost of HP volunteers.
HCC HP team attended the Risk Communication training in the morning of 15th April then went on into their 2 teams with HPD team 1 conducted camp leaders training for the three camps, namely White River, Bishop Epalle and Rove police club. The HPD team 2 conducted interpersonal communication counselling for the camps situated at Holy cross, HCC education, Coronation school and Koloale school. On 16th April, one HPD team conducted training of camp leaders on WASH and hygiene practices as well as conducting awareness talks at Varamatha, Koloale and Kukum Parish. The other team covered Rove, Mbokona, Mbokonavera and Kukum clinics.
On 17th April the HP team continue preparations for volunteer training for disaster outreach scheduled for 23rd April. The HP team in collaboration with the WHO/ Risk Communication specialist has developed a time table for the media forum for health promotion.
The HP team with the Mental Health team have conducted awareness programs at the KGI camp on 17th April. Another session is scheduled for the Mbokonavera EC during the night. Furthermore, a team has conducted Health awareness talks targeting diarrhoea at the NRH outpatient and the use of the portaloos installed at NRH. The HP team has also conducted Health awareness talks for the Mbokonavera camp leaders, on WASH and Hygiene Practises.
The HP team are now doing after hours awareness talks at evacuation centres.
1.2 Vector-borne Disease and Control Program
On Wednesday the 9th, fogging was performed in East Honiara. As of the 10th April 2014, 2158 mosquito nets (LLIN) have been distributed to the evacuation centres.
Larval surveillance of potential malaria mosquito breeding sites in temporary flooded areas in Burns Creek, and drainage line is Kukum has been done. No Anopheles breeding detected, but high levels of non-vector Culex in the temporary pools. Some controls measures have been applied.
LLIN top campaigns were conducted at KGVI and FOPA, targeting new residents inside the camps that have Page 5 of 34 moved in since the mass distribution of bed nets last week. This work will continue at all of the major Evacuation Centres.
ULV treatments were applied at NRH compound with a backpack machine, and at high risk dengue transmission areas in Honiara, including: Bahai, Kola Ridge, Mbua Valley and Kukum.
Exterior residual spray treatment was applied at the Varamata EC. Interior treatments will be applied at this site on 15th April.
As of 15th April, LLIN top up operations have been completed at all major ECs including Panatina Pavilion and Mbokonavera School. Precautionary preventative interior and exterior treatments have been applied at all major ECs in Honiara with populations over 150 people. Locations treated on 15 April include Tuvaruhu School, Varamata, Mbuavalley School and the Catholic Hall next door.
Some of the NVBDCP responses will be restricted to the larger, more permanent ECs, as it appears that populations in many of the smaller ECs are dwindling rapidly, so will not require longer term preventative measures.
Dengue case house responses were conducted in west Honiara on 14th April, and this mode of treatment will continue targeting houses with recent transmission, with the aim of knocking down any infective mosquitoes in that area.
All preventive measures have been completed and fogging at dengue hotspots and around camps continue.
No new update.
1.3 Environmental Health and WASH
The EHD are coordinating with Camp Managers who have just recently identified and reported which evacuees wish to return to their homes so that the EHD can then carry out assessment on HCC evacuees’ houses to determine whether their original sites are safe and meet WASH minimal requirements. During the first week post disaster, the WASH Cluster has completed its initial assessment. Over the last 10 days the WASH Cluster has improved the delivery of water to affected communities and evacuation centres. As of 9th April, a total of 157,800 litre of water have been distributed to affected communities. Sanitation facilities in the evacuation centres remain a challenge. For instance, in the Mbokonavera centre the number of latrines is approximately 200 persons/latrine which is also the case in the FOPA village. Distribution of sanitation materials in collaboration with NGOs is ongoing. The WASH Cluster is currently finalizing the HAP.
The EHD and WASH team are planning to do assessments of sites to determine the safety of returning IDPs. The current focus of activities is on solid waste management.
Solid waste collection at ECs is still posing a challenge and additional latrine installations at current ECs have been advised to be halted as IDPs are to be either repatriated or relocated to a single EC this week.
From 12th to 14th April, assessment teams went out to Honiara communities from which IDPs originated, based on information from the camp managers. A rapid assessment was done at a community wide level to get a feel for the overall situation from a WASH perspective. Communities visited were: Burns Creek, White River, and Mataniki River side from Tuvaruhu and downriver.
General findings from this assessment are as follows:
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1) Most houses in Burns Creek and White River are ok; 2) The environment along the Mataniko River is generally not suited for return; 3) Some water is available, but drinking water is an issue in most areas; 4) Most toilets are gone but the majority practiced open defecation prior to the flooding so little change in the practised use of toilets. [Refer to Annex 3 for tabulated results]
1.4 Maternal and Child Health
A. Nutrition
A rapid nutritional survey done in two evacuation centre in east Honiara showed undernourished children. Micro nutrient supplements, deworming and vitamin A are being given to children in the evacuation centres and a food basket recommendation is being put forward. Mothers are being trained how to administer micronutrient sprinkles. There is a need to liaise with partners on the poor nutritional quality of food being supplied at the camps. A meeting has been held with WHO Food Safety expert on 14th April, with further support from UNICEF.
An Urgent food partners cluster meeting was held with NDMO on 15th April to discuss the nutrition situation in the evacuation centres. WHO/MHMS have been tasked to present weekly requirements list (including fruit and vegetables) to NDMO and discuss urgent food needs for affected populations. A comprehensive nutrition assessment proposal is to be submitted to WHO this week and an assessment will be conducted week 6 post disaster. As an immediate measure, women’s groups from churches have been organised to provide one hot meal per day to evacuation centres. The nutrition team will work with these groups to ensure nutritious meals are provided. Women’s groups continue to provide hot meals to care centres as of 19th April and collaboration with WHO is underway for the creation of a hot meal program for schools.
The food alert was presented to the Provincial government on 17th April and the MCH team is now having regular meetings with the welfare cluster. A nutritional assessment will be conducted from 22nd to 24th April in HCC with assistance from UNCEF who are leading the proposal to OCHA, alongside FPA, FAO and WHO, for funds for supplementary food to evacuation camps for the next month. Team leader training for the nutritional assessment was done on 21st April while training of 40 volunteers for the nutritional assessment starts on the 22nd of April. In-depth nutritional assessment focused on the communities of IDPs once they’ve resettled is being planned this week while the nutritional assessment of ECs has now been cancelled as repatriation of IDPs is now in progress.
From 19th to 21st April the MCH are working with WHO to best address clinical cases of malnutrition. Solutions include advocating for assistance and training and commodities for the treatment of malnutrition with a nutrition clinician to be provided by UNICEF in nutrition planning.
B. Safe Motherhood
Up until the 15th of April, 66 antenatal mothers have been identified in the evacuation centres. 12 of these antenatal mothers are adolescents between the ages of 15 to 19 years of age while a total of 29 antenatal mothers are unbooked. A total of 5 antenatal mothers identified at the Pavilion on 10th April had no birth plan or accessible contact information in the event that they go into labour. Birth plans have been developed with the development of an alert/referral system for antenatal mothers. A recommendation has been made for the issue of identification stickers on antenatal cards of pregnant mothers identified in camps to ensure they are not discharged early from the hospital.
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Age Distribution of Antenatal Distribution of antenatal mothers
Mothers Residing in Evacuation according to pregnancy stage
Centres
50 40
50 30 17 23
mothers 4 5 antenatal antenatal
12 of Number
mothers 0
antenatal
Number of Number 0 15-19 20-24 25-49 years years years Age Pregnancy stage
Above illustrate charts of the age distribution and stage of pregnancy distribution of antenatal mothers residing in evacuation camps. As of 21st April the number of antenatal mothers is now 71 with 49 of them now in their last trimester.
On 14th April a reproductive health alert is to be issued focusing on safe delivery, care of the neonate, Family Planning and gender based violence. Increased supplies of Reproductive Health commodities to Honiara City Health service clinics is planned of which 100 cartons of dignity kits have just arrived on 14th April 2014.
Lack of privacy for medical examination is another issue raised by the evacuation centres. The SINU clinic at the Pavilion centre has now been reserved for antenatal examinations whilst mobile clinics are requesting tents to provide more privacy for patients.
MHMS staff have planned to procure 10 mobile tents and beds for mobile health teams in both HHC and G Province, to be used for antenatal assessments and private care. UNFPA will procure the cost of RH 1-12 Kits of which some have started to arrive on 15th April.
On 17th April UNFPA dignity kits have been received and are ready to be distributed to pregnant women at evacuation centres as part of focus groups. A total of 11 dignity kits have now been distributed to 5 evacuation centres on 17th April. The number of postnatal mothers is increasing with now a total of 8 postnatal mothers at Mbokonavera. They were visited yesterday by HCC and MCH staff.
SIPPA on the other hand will replenish its office. SIPPA/UNFPA emergency training was carried out on 17th April from 10am to 12pm. IEC materials continue to be developed by SIPPA and they will feed these materials through Health Promotion Unit.
As of 19th April the MCH team continue to assist in conducting focus discussions with antenatal and postnatal mothers and is planning with UNFPA to provide multivitamins and high protein biscuits/bars to this group of mothers.
As of 21st April, 49 UNFPA dignity kits for antenatal and postnatal mothers have been distributed while another load of 104 dignity kits are expected to arrive this week. UNFPA have suggested that mothers who are 1 week prior to labour and 1 week after delivery of their baby should be allocated to a rest house which is being looked into by the MCH team. Stickers for EC residing antenatal mothers will be prepared this week as well.
C. Adolescent Health
The review of adolescents in evacuation centres by the MHMS is to be completed next week. A new evacuation site at Tanagae, situated near Kakabona, of which a whole school of adolescent students of both gender are Page 8 of 34 residing was visited on 15th April. UNFPA staff led GBV focus group discussions at Tanagae on 16th April. On 19th April, another focus group discussion conducted alongside UNFPA on sexual health has been done on 2 groups of adolescent male and female students at Tanagae where dignity kits were distributed. Needs identified by students included school books, stationaries and eating utensils. This will form the baseline and preliminary assessment results for the MHMS. Further assessment is planned to occur post MISP. The MCH team is also meeting with AFL who will be organising sporting activities and health activities in affected communities.
On 19th April an Adolescents Needs Pack (ANP) comprising IEC material and condoms has been created but is still waiting funding for its procurement and prepacking before distribution.
D. Gender Based Violence/STI/HIV
The Head of the Child and Maternal Health Division will be inviting Safenet representatives to attend MCH meeting 1-2 times a week and provide updates on gender based violence, STI/HIV activities. To date, SIPPA has been distributing condoms and providing education in the evacuation centres and will be in charge of providing information and awareness on Sexual violence and HIV/STI in evacuation centres. SIPPA will work closely with HIV/STI team in MHMS. IEC material on gender based violence (GBV) and STI/HIV continue to be developed and work is being done on the distribution of condoms along with the MHMS HIV/STI team.
Safenet conducted training of 30 participants including those from Red Cross and Christian Care centre while SIPPA is due to distribute 30,000 condoms over the next 3 weeks.
E. Child Health
The MCH unit has an immunization plan drafted whereby UNICEF will fund the vaccines. There is however a gap in the cost of implementing the immunization. Vaccination campaign will commence in 1 to 2 weeks’ time.
Work is still ongoing on logistics, micro planning, administration, social mobilisation, and implementation for the immunisation campaign budget. As of 19th April the plan and budget has now been completed and the first draft sent to the Financial Controller.
The MCH budget is being prepared for emergency response for MHMS and will include IEC materials and EPI.
On 17th April, “Wet feeding” has been added to the proposal being submitted to OCHA to encourage children to return to school.
From 21st April a child treatment manual and WHO pocket book is waiting printing by WHO while UNCEF will print the mother’s card and baby book. A Children’s kit has been developed and is also awaiting procurement.
1.5 Mental Health Services and Psychological Support
The team is currently putting together an action plan with support from overseas NGO (MSF). The MSF is supporting the HCC clinical mobile services with psychological services at the evacuation camps.
The MSF continues to support the HCC clinical mobile services with psychological services at the evacuation camps which have provide a positive impact. A psychosocial clinic was conducted at the Mbokonavera evacuation centre with on 14th April with a total of 64 consultations carried. An assessment report identified a significant number of IDPs have psychosocial needs and there is still the need for more mental health support.
MSF psychosocial services continue in evacuation centres. Findings from a psychosocial visit to Mbokonavera EC on 16th April show that children have been traumatized and need to resume school quickly. There is also the
Page 9 of 34 need for stationaries and backpacks for these children in preparation for school.
As of 19th April the MSF team is conducting awareness during the night alongside the Health Promotion team.
1.6 Social Welfare
The social welfare team are conducting assessments in the camps and distribution of food items to affected families who are not receiving assistance. The Social Welfare team have carried out assessments in the FOPA and SINU Pavilion Centres to date. They were scheduled to do assessment on 11th April at the KG VI School Camp but were notified of a security risk so this activity is postponed until a later date.
The social welfare team have conducted assessment in 5 ECs (Pavilion SINU, FOPA, Naha School, KGVI School, Mbokonavera and White River) and have identified issues ranging from non-proportionate, irregular distribution of food and basic needs to inadequate facilities and safety available at the evacuation centres. (Refer to annex 1 for details).
No new update.
2. National Referral Hospital
The National Referral Hospital located in Honiara, continues to provide secondary health services to the Honiara population, as well as providing outreach general clinical care services to GP as well as Honiara health services.
On the 13th April 2014, the NRH emergency operation centre coordinated the evacuation of 103 patients and 143 guardians (total 246) following the tsunami warning. All evacuees are now safe and have returned to the hospital after the tsunami warning was cancelled.
HEOC Notifiable Diseases presenting at ED 40 35
30 25 20 15
Number of Cases of Number 10 5 0 7-Apr 8-Apr 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr 7-Apr 8-Apr 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr Suspected Dengue 2 11 5 5 6 0 0 1 5 1 3 2 10 Influenza like illness 1 3 11 0 0 0 0 0 0 0 0 0 0 Diarrhoea with no blood 11 20 34 27 27 15 9 13 16 35 24 36 17 Diarhoea with blood 0 7 0 5 8 0 2 2 1 0 8 1 3 Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0
The above graph illustrates the number of HEOC notifiable diseases presenting to the NRH ED.
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Chart illustrating the total number of cases seen and admitted to the Emergency Department 189 200
168 155 160 155 141 139 150 115 108 108 100 63 66 66 50 50 37 50 33 26 28
13 Totalnumber ofcases 0 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr 15-Apr 16-Apr 17-Apr 18-Apr 19-Apr
Patients seen Patients admitted
The above chart illustrates the number of patients are seen and admitted to the emergency department per day. This number excludes those admitted to the other NRH wards. The ED has a total of only 26 beds with an added 4 beds to the dengue/diarrhoea holding area at the referral clinic.
A total of 19 nursing staff have now been rostered for shifts at ED. In response to the reported increase in watery diarrhoea presenting to ED, a triage system for diarrhoeal cases presenting at NRH has been developed. The OPD waiting area is being converted to outpatient management bays for diarrhoea cases with the referral clinic being marked for diarrhoea cases requiring admission. The eye ward is being prepared for admission of these cases. Guidelines for diarrhoea management is being devised and doctors and nurses are being identified and rostered for shifts at ED. Chronic gaps in human resources and infrastructure that existed prior to the flooding disaster persist and are major obstacles to the provision of adequate clinical services in this post- flooding situation. A request submission has been forwarded to the NZMAT to be on standby for surge in demand as well as filling in medical officer and nursing gaps at the NRH, HCC, and G Province.
Three pregnant mothers were referred to NRH from ECs on 11th April and delivered successful at the Labour ward.
A dengue and diarrhoea desk was activated on 15th April and is now functional at the NRH OPD waiting area where by severe cases are referred to the referral clinic for stabilization and assessment by a doctor. However, some issues hindering its optimal functionality remain to be addressed.
Toilets at OPD/ED are non-functional so 3 portable toilets have been secured from Bolmar Plumbing contractor on 16th April. The engineering of the set-up of these toilets needs to go through the EHD who can provide technical advice. As of 22nd April the portaloos are on site and awaiting installation.
There is good support from the additional medical officers being rostered at ED and a clinical guideline for the diarrhoea treatment protocol has been drafted. A request for the recruitment of additional security, cleaners and porters to support the ED department is being considered.
Elective surgery at NRH is still suspended. However, the NRH NDC clinic is still open to those with chronic diseases who required replenishment of medications and reviews.
It has been agreed that emergency referrals from health field teams and evacuation centres can be done through the control centre on 25256 24/7.
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Daily census of NRH inpatients 400 350 Category 4 & 5 patients 300 evacuated 250 to FFA 200 150 100
Numberofinpatients 50 0
Date
NRH has a total bed capacity of 303 beds. The total number of NRH inpatients remains between 250 - 300 patients from 17th April 2014.
The AUSNZMAT team has been incorporated into the roster and have commenced work at NRH on 17th April. The team will also be deployed to HCC and GP at a later date.
OPD/ED is still without the portable toilets whilst the dengue/diarrhoea triage system is in place and is working well at ED. Supplies such as burettes are still not enough so work is in progress to acquire these.
The dengue/diarrhoea triage desk continues with the observation bay cleared by the evenings. There is a short supply of burettes for IV hydration of children so hydration is heavily reliant on ORS with burette use only permissible by request of an experienced medical officer. New supplies expected to be received 22nd April.
3. Guadalcanal Province
The Guadalcanal Provincial Health Services has established an internal structure, team leaders and terms of reference in order to manage the emergency disaster response. This includes 4 domains namely, the Planning Domain, the Curative Care Operations Domain, the Public Health Operations Domain and the Logistics Domain. The Guadalcanal Provincial health services has prioritized field level health assessments as well as provision of curative care. Key emergency health issues include environmental health and public health interventions. GPHEOC is on standby for emergency referrals and is preparing for surge in demand, especially from the Guadalcanal Plains.
The Guadalcanal Health Department systematically assessed 64 non-randomly selected accessible communities in the most affected Health Zones in Northern Guadalcanal Province in order to provide a rapid overview of the health situation of affected population. Key findings include:
Only 13% of assessed communities reported adequate clean water; Only 29% of communities reported a functional toilet; 62% of communities reported that more than 50% of the population defecated in the open; Only 3% of communities report adequate food and 13% have received food assistance; Only 17% of births have been attended by a skilled personnel; Only 11% of the communities have received health promotion messages.
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Although all areas assessed require enhanced attention, the available data indicated that Health Zone 6 which covers the floodplains of central-northern Guadalcanal and has the largest population in Guadalcanal, is the most seriously affected with the most concerning health and WASH metrics.
Recommendations as a result of this assessment are:
1. Systematically upgrade the Guadalcanal response with initial steps to include supporting and strengthening the GEOC. 2. Expand ongoing Guadalcanal assessments and recruit additional partners as necessary to support this activity, assuring consistent data collection tools and methods. 3. Urgent detailed review of the preliminary assessment findings by the Health, WASH and Food security clusters with timely and appropriate follow-up actions. 4. Prioritize Guadalcanal infrastructure rehabilitation to assure access to inaccessible communities, with particular attention to Health Zone 6. [ Refer to annex 2 for full report]
The 5 integrated community health assessment teams were dissolved on 15th April and teams have been renamed and reallocated according to the different health clusters to serve their purpose in the next phase of addressing health needs of affected populations that have been assessed during the previous phase of assessment.
The 5 new teams are:
I. Good Samaritan Team- this team will be responsible for the patients at the Good Samaritan Hospital. This includes OPD, in-patients, and emergency and referred patients. This team includes the GP medical officers as well as GSH staff. On 17th April a meeting was organized for the hospital staff through which a general planning session was done aiming to find ways of increasing the clinical capacity of the hospital in response to the public Health Disease Outbreak following the recent Flush Flood to Guadalcanal Province. An inspection of the wards and patient area is also done. II. Maternal Child Health team (MCH)/Clinical Team- this is a mobile team that moves around the identified communities to address MCH issues. Examples of their task include immunization, deworming, and Vitamin A supplement programs. III. EHD/RWASH- this team has been assigned to continue with WASH activities that have been initiated in the previous phase. Their tasks include cleaning and pumping of wells and water container distribution. IV. Vector Borne- this team is assigned to continue with Malaria-related tasks such as bed net distribution, spraying, fogging, and Mass blood testing. V. Health Promotion- this is a team comprised mainly of health promotion officers who will be assigned to present communication risk awareness, distribute IEC materials to affected communities.
GP HEOC cluster team leaders met on 15th April and a one-month micro-plan for each cluster is being devised for implementation of activities on 17th April.
3.1 Health Promotion
On 14th April the 5 integrated teams conducted health awareness talks and WASH and hygiene practices at the Page 13 of 34
Selwyn, Lambi, Numbu, Barande, the Koli points communities, Ngalibu river side surrounding communities and lengalau to Mbebe sea side communities.
The integrated GP team conducted health awareness talks in 22 villages in Tandai Ward, West Guadalcanal and 35 villages in the Guadalcanal Plains.
The GP/HP team members attended the Risk Communication training on the morning of 15th April 2014 and on 16th April conducted health awareness talks on diarrhoea, red eye, WASH and hygiene promotion at Don Bosco, Christian Care Centre and Tetere Care Centre. Another team covered the same activities at NAC and Tenaru beach.
The team started on 17th April with one risk communication awareness program in Zone 1 and two in Zone 6.
On 19th April the team did risk communication talks at Tanaghai, Don Bosco, and Tetere evacuation centres. Topics covered were diarrhoea, red eye and dengue fever. Hand washing demonstration was done with a total of 435 leaflets distributed.
On 21st April the team did risk communication talks at Vatupilei, and Tamboko area in Zone 1 (West Guadalcanal). Topics covered were diarrhoea, Red eye, Dengue fever, and Malaria with a total of 180 related IEC materials distributed.
3.2 Vector-borne Disease Control Program
In G province, distribution of bed nets in Poha area started on the 9th of April 2014 as most have lost their nets during the flood. On the 11th LLIN were distributed at GPPOL 1. On 12th April, LLIN were further distributed to Don Bosco evacuation centre, Foxwood evacuation centre, Ngalimbiu Primary School and Talaura which brings a total of 1500 nets distributed.
ULV spraying was done at Don Bosco, and Tetere evacuation centres on 11th April. Assessment was done at GPPOL before spraying. ULV & Fogging are planned for Don Bosco EC and GPPOL 1.
Ongoing work which includes LLIN distribution and precautionary IRS and ERS treatments, as well as ULV fogging is being conducted in GP, and data and information on this work will be included in the weekly NVBDCP sitrep.
An up to date community list with GIS location being used for bed net distribution is being integrated with the assessed community list for the purpose of increasing coverage whilst budget for one month was submitted as well. Preventive measures are ongoing with 4-5 night cycles for fogging being carried out. Lunga has been monitored for larva breeding but no evidence shown to date.
On 21st April the VBDC divided into 2 groups where group 1 did bed net distribution at Kaotave in Zone 6 while group 2 did bed net distribution in Vatupilei and Tamboko coastal area in zone 1.
3.3 Environmental Health and WASH
The G Province team is being supported by SOLBREW to distribute water in the Guadalcanal plains as there is urgent need for water. There is a situation of well and bore hole contamination throughout the plains. A private company: Capital drilling company is assisting G Province with logistics to service bore holes – water blasting. Red cross have supplied water purifiers in the East and Poha area in the West.
The WASH team has been divided into 3 teams whereby the first team is tasked to distribute 46 water
Page 14 of 34 containers in 14 communities in Sali Area, the second team are servicing wells in the GPPOL area with only a single pump in their disposal whilst the third team are continuing to identify contaminated/damaged wells in affected area.
A water purifier is now operational at Nguvia school while 1420 containers have now been distributed to 27 communities as of 12th April.
There is an urgent need for more pumps to speed up water provision and also provide back-up and relieve the load on the single pump currently being continuously used.
The EH/WASH team have sent s request to the GP Health accounts for procurement of 2000X10L water containers and 5 generator pumps on 17th April. UNICEF has agreed to supply 1000 water containers and 8000 soap on 18th April. The team also placed a request to the national WASH cluster for 31 X 800 gallon water tanks for the affected communities. To date, the National WASH cluster group has already supplied 1X 1000 gallon water tank, 2 X 40HP OBMs, and 1 boat.
On 19th April the team continued pumping of wells where they left off on 18th April at Koli Point area whilst still waiting for the procurement of 2 extra water pumps. The team worked with a WASH engineer from Save the Children to make assessment of affected sites for possible rehabilitation as well as collaborated with World Vision and Red Cross for the distribution of water in GPPOL 3.
On 20th April the team liaised with a WASH engineer and arranged by Australia DFAT to acquire 2 water pumps, 2 ladders, and some buckets.
On the 21st of April the WASH group 1 postponed pumping of wells today as the team was redeployed to Visale clinic catchment area to check if the current diarrhea outbreak there was related to WASH. The 2nd group accompanied Save the Children team to Talaura, Popoloi, Suaghi, and Rarata to identify affected wells for pumping.
3.4 Maternal and Child Health
On 17th April, preparation for deployment which included Vaccines, Medical stock, patient record cards, and stationeries was assembled. Planned services proposed are attending out patient, deworming, updating and booster immunization, and providing MCH services. Current human resource allows for 1 group to be mobilized in Zone 1 and 2 groups in Zone 6. Discussion was held with the national Maternal Child Health cluster for ways to collaborate activities.
A nutritional assessment will be conducted from 22nd to 24th April alongside HCC.
On 19th April all three groups were deployed to the field where group 1 visited Tanaghai Evacuation Center where Ruavatu students are still temporarily residing. Group 2 visited Don Bosco and Lunga Evacuation Centers where the team escorted 1 diarrhoea case to Good Samaritan Hospital. Group 3 were deployed to Tetere Evacuation Center where only a total of 11 patients presented to the team.
On 21st April, group 1 was deployed to Visale with extra supplies to assist the nurse who is attending an increasing number of diarrheal cases. Group 2 Return to Don Bosco evacuation center upon request from PEOC to revisit patients and attended to a total of 25 out patients out of which 2 were referred to GSH for further diarrhoea management. Group 3 was deployed to Kalaubola and Baravule communities for that day.
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4. Surveillance and Laboratory
There has been an increase in Diarrhoeal disease since EPI week 8. This started before the disaster and the trend immediately post disaster continues to show increase in diarrheal cases in some of the evacuation centres namely: KGVI evacuation centre, Mbokonavera and Panatina Pavilion. On the 9th of April 2014, the MoHEOC dispatched an investigation team to KGVI evacuation centre to verify report of diarrheal cases in the centre. Their finding showed four cases of diarrhoea. A sample obtained was tested using RDT which is negative for cholera and Rota virus. Result of the culture of the sample showed no growth of organisms after 48 hours of culture. Sample obtained from a patient in the children’s ward with diarrhoea also showed negative RDT test for cholera and Rota virus. On 11th April a further 3 patients were admitted to Medical ward, ED and Children’s ward respectively and samples collected showed amoeba on microscopy for the ED and children’s ward admissions. All 3 samples tested negative for Cholera and Rota virus on the RDTs and were also all culture negative for Salmonella or Shigella after 48 hours.
Labotory results of stool samples tested at NRH (from 9th to 15th April)
10
5
of samples of
Total number Total 0 Cholera RDT Rotavirus RDT Culture Laboratory tests Samples tested positive Samples tested negative
As of 17th April a total of 11 stool samples have been tested at the NRH Medical Laboratory. The above chart illustrates that 2 samples have tested positive for Rotavirus. Note that 2 of the 11 samples were unsuitable for RDT testing while the 2 most recently collected samples are still pending culture results.
Surveillance Unit completed post disaster risk assessment and presented with priority recommendations one of which is the roll out of the Post-Flood Early Warning Surveillance has been finalised and planned to be implemented in Honiara health facilities this week. An Outbreak Response System is being developed.
Below is the trend of diarrhoea cases to date which shows diarrhoea cases prior to the flooding with a 4.5 times increase within 4 days post flooding.
400 Number of diarrhoea cases collected from the National Syndromic *4.5 350 Surveillance System, Solomon Island, 2013-2014 days
300 All Diarrhoea Bloody diarrhoea
250 200
150 Reported Case Reported 100 50 0 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 2013 2014 Page 16 of 34
The current status of Laboratory reagent stock as of the 7th April 2014 is as follows:
1360 Dengue test kits, 200 Leptospirosis test kits, 200 cholera test kits, 1000 rota virus test kits, ILI swabs for influenza test.
List of needed lab reagents and out of stock emergency medical supplies was given to WHO.
EWARS rolled out already to HCC and GP training on disease case definitions at HCC on 12th April & GP 15th and 16th April. The surveillance team has been divided into 2 teams to investigate the information received from GP HEOC regarding a rise in diarrhoeal cases.
The Health Surveillance team is continuing their surveillance assessments, and have as of 15th April 2014 moved out into northeast and northwest Guadalcanal. The team is also setting up the enhanced surveillance system, as well as training healthcare workers in the healthcare facilities on Guadalcanal on the use of assessment forms and surveillance sheets.
In Honiara, the three sentinel reporting sites (NRH, Rove and Kukum Clinics) have all reported an increase in all contacts, when compared to epi week 14(which also include increase in the total number of diarrhoeal diseases). The complete report for epi week 15 is scheduled to be released on 18th April.
WHO surveillance team has confirmed on the 17th of April that the following 7 clinics are to be included in the EWARS: Visale, Kohimarama, Marara, Tinaghulu, Good Samaritan Hospital, Aola, and Totongo. Investigations into the dysentery outbreak at Aola and Verani show that these occurred before the disaster from flooding. The stool samples collected are awaiting results from the NRH laboratory.
As of the 17th of April, the national syndromic surveillance system is collecting data among 8 sentinel sites in Solomon Island. Four of them are located in Honiara city (with one in the National Referral Hospital).
One week after the flood (epidemiological week 14), the number of diarrhoea cases has dramatically increased. A total number of 370 cases was reported, with 87% in Honiara city, the most affected area by the flush flood. The evolution of this spike has to be followed carefully over the next few weeks.
The number of cases of dysentery is increasing also and some samples have been collected in order to define the bacteria or parasite and provide the more adequate treatment.
With regards to dengue surveillance, the samples sent to the ILM lab for serotyping have confirmed that the type of dengue present in Solomon Island is DENV-3, same type than the one that was causing the dengue outbreak last year. As of 18th April, 754 cases have been reported since January 2014 with an additional 138 cases reported this week.
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The increase of cases could be due to the increase number of vectors.
No new update.
5. National Pharmaceutical Supplies
The National Medical Store assessed HCC clinics of which only 6 were open for pharmaceutical assessment on 11th April. Standard assessment using the WHO priority list for Mothers/Children 2012 was used. Average availability of drugs in these clinics showed an overall 88.24% of the 17 items present on standard assessment. Paracetamol supplies have been received from Fiji on 14th April and NZAF have supplied stethoscopes, BP machines and iv cannulas. Main tender for medical supplies for this year have been placed and will be coming on its normal schedule in May/June. Medical Laboratory have placed orders for reagents and consumables with haematology reagents already on site.
The NMS continues to track stocks and identify gaps in supplies. There is now a renewed stock of Amoxicillin suspension and bathroom scales have been delivered to health facilities in Honiara and Guadalcanal Provinces. On 16th April the NMS will assess the cold chain at the HCC clinics. Disaster Kits have been received from UNICEF which will initially be supplied to HCC clinics. One disaster kit has already been supplied to Good Samaritan Hospital on the 14/4/2014.
No new update.
6. Logistics
Availability of vehicles has been a key item for assisting mobility of clusters during the emergency response. The absence of detailed up to date vehicle registry identifying the status of vehicles within the Ministry has impeded effective vehicle management and fuel allocation to emergency response designated vehicles.
Purchases initiated during the response include, water tanks, insecticide for mosquito control, 2 Toyota Hilux vehicles, food, water and hygiene for response teams and flood evacuees and printing items for production of health promotion material and emergency staff IDs.
Communication mechanisms have been enhanced by availability of mobile phone credits for HCC team leaders, internet dongles for Guadalcanal personnel and reestablishment of internet access within the MHMS Command and Control Centre. Communications within the most remote areas of Guadalcanal without mobile phone coverage remains problematic with options to be identified to facilitate improved communication.
A MHMS Health Emergency Response Fund Standing Imprest of SBD40, 000.00 requested by WHO and VBDCP as a result of the Dengue outbreak has been initiated and will be administered by the MHMS. This should provide more expedient access to urgent funds during the initial stages of the health emergency response.
No new update.
Sender Details Receiver Details Name Ventis Vahi/A Oritaimae Name NDMO,MOHEOC , HCC-PEOC, GP-PEOC, Chairman of all clusters Contact 7612250/25256 Contact Time 3:00PM Time Signature VV Signature
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ANNEX 1 EVACUATION CENTRE PROTECTION ASSESSMENT DEBRIEF FINDINGS: SUMMARY Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Unequal distribution of - Food and water not - Rice, noodles, tuna, coffee - Food and water not - Enough food for everyone - Specific needs not being food sufficient for numbers per mix, sugar, and biscuits sufficient for numbers per but unbalanced diet with met – pregnant women,
Food - Some did not receive food house and family distributed – IDPs told it is house and family - 1 small no nutrients people with disabilities
- yesterday enough for 2 days but it bottle of water distributed hidden and not receiving - No baby food really isn’t - it’s centrally to most families per day, items (not happy with - Food not appropriate for cooked and given out. regardless of number in distribution) pregnant women or Families don’t have their family - 1 girl with disability is breastfeeding mothers own portions. - Committee members allergic to tuna and not - Private people giving food - Clothes and food provided keeping food, not letting eating at all Distribution Distribution – distribution channelled from churches others be involved in - Honourable members through appropriate distribution giving corned beef to authorities - Big groups and small some families and not - Only food provided is rice, groups being given same others noodles and biscuits amount of food regardless - Some women buying own - Portion sizes are the same of how many people in vegetables and fruit from for each family regardless the group market of how many family members. - Food has expired - to be returned - Different days different amount of foods are delivered by HCC/Red Cross. NDMO using different formulas? Distributors take the food? Private offers? - Distribution comes at different time every day. Sometimes at midnight when children are asleep, which means they skip meals
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Not enough tarpaulins - No bedding provided - - No utensils or pots - Towels toothpaste and - Not enough clothes for - Pregnant women have no
- Not enough sleeping mats most are sleeping on provided soap provided per family everyone – young girls mats – using lavalava NFIs
- No utensils gravel - Just received World Vision regardless of how many in don’t have many clothes - Not enough towels - - Many children do not have - No cups, plate, cutlery, or family kits – not enough family - No cooking utensils clothes utensils distributed within the kits for bigger - No bedding provided – - Distributed clothing not fit - Extra tents/tarpaulins families. Only given to most are sleeping on for young women needed to prevent rain some families. concrete - Clothes only for boys and from coming inside - Mats and mosquito nets - No cups, plate, cutlery, or
food given to women - Women, girls, boys and given out per family, not utensils distributed Distribution Distribution - No clothes for pregnant babies need clothing per person - Committee members women - Mosquito nets provided keeping NFIs, not letting - No utensils - contributes to but no rope others be involved in health issues as people - Bushknives needed for distribution eating with hands cutting firewood - World Vision Family Kits - No beds for women and - allocated per family children (regardless of how many - Mosquito nets distributed people in that family) but no ropes to hang them - so they are not used - No detergents or cleaning products - No waste bins - No sanitary pads - No mats. Zone 3, 4, 6, 10, 11, 12 had no mattress, blankets, pillows (first come, first serve/ not enough?)
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Leaders distributing but - Number of IDPS has - Potential for unfair - Suppliers are not - Some people living at - Families being counted, people not involved in substantially increased distribution – centre is supervising distribution – home (possibly not not number of members consultation - equity issue. over last few days – split into ethnic groups IDPs want NGOs to do affected by disaster) of families - Same things given to supplies are reflecting and Items are distributed distribution, not visiting centre to collect - Committees taking care of everyone regardless of original numbers, and not to dominant group, who committees food and NFIs their wontok and not need taking into account this then distributes to other - Women afraid to - No identification of others
- People just come and drop increase groups participate in decision people who actually need - Committee with 6 active process/ Other process/
supplies and then they - Breakdown of making because men are assistance members – leave. communication between telling them they - No female representative - Distribution based on - No women in distribution committee members and shouldn’t in Council – positions number of families, not committees other IDPs - Distribution based on allocated by men number of people - Only men managing - FOPA Committee Chair original numbers but - 2 committees – I for - Some happy with distribution receives zero support – no more families have arrived distribution 1 for distribution in general - Some people want to phone for communication, since original count repatriation (not really - IDPs using different Distribution Distribution return home but need has spent all of his money - Some people moving back strong) surnames to get more provisions such as food, on Evacuation Centre and forth from centres at food and NFIs utensils etc distribution time to get - Non-voters not receiving - Distribution based on more food and NFIs anything number of families within - Some people visiting for each zone – number of distribution and returning family members not home considered - They would like to be consulted on what they need – some would prefer tools and seeds for resettlement so they can go home
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Men, women and children - Drunk people visiting at - Only 1 room with lights - Drunk men at night - No private space for - Toilets separated by sex sharing bathroom facilities night (but torches and candles - Dam nearby – concern intimacy – risk of GBV - Toilet at back – no lighting - No security during nights - Very large pool of provided) about flooding when men forcing women - No rationing of water – Safety - Some blocks have no stagnant water – - IDPs staying within school - Incident where boy into sex/women refusing just taken as needed power mosquitoes, dirty water, boundaries – not leaving assaulted sister and sex - No security - Toilets are some distance children can access it (not (fear of leaving) another boy due to anger - Children stay close to road - Drunk people from from populated areas fenced off) - Police visit frequently over sexual relationship and big drain – safety risk outside visiting - Young girls have no - Lack of privacy creating - Potential for aggression – between the two - 2 women had a physical privacy- no space to change risk of gender based ethnic groups definitively - Children are fighting and alteration due conflict - Shower in boys dormitory - violence (no space for separated stealing over food distribution and they all use one bathroom intimacy) - General physical - Women won’t go to space (mixed) - No trust in SI Government environment unsafe – Committee meetings to organise the response – very muddy, cooking areas because they afraid of - Boys saw men talks of planning anti- next to rubbish piles, people stealing their touching/harassing girls - government burning rubbish close to belongings worried for their relatives demonstration (this risk living quarters - Child protection – parents has decreased as of 4pm - assaulting children (eg. - One wife forced to have as distribution child with disability) sexual intercourse by commenced) - Need for CFS and child husband - Issue of privacy - Anger about Ministers friendly spaces and GBV using relief money to - Young girls getting drunk - Boys being slapped by respond to their at night time disrupting security constituents only families and mothers worried about exploitation – health related issues – children seeing this behaviour
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River
Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- No utensils - contributes to - Types of food provided – - Sleeping on concrete is - Types of food provided – - 5 Pregnant mothers – 2 - Scheduled visit for health issues as people no nutrients making people sick no nutrients due soon. I delivered at medical assessment and eating with hands - Breastfeeding mothers, - Some people using clothes - Breastfeeding mothers, No.9 and returned to treatment Health - Not enough medicines, pregnant women and or cardboard to sleep on pregnant women and centre next day – - Not enough medication – particularly for skin children not receiving any - Breast feeding mothers, children not receiving any extremely high risk for many go without conditions and eye nutrients in diet – no nutrients – one mother nutrients in diet – new baby and mother - Nurses visit from local breastfeeding mothers feeding baby coffee mix breastfeeding mothers in getting sick conditions clinic (closed) not producing milk instead, baby not sleeping pain when feeding - No space for post-natal - Red eye, flu, women look at night - Children - Diarrhoea, red mothers - Food provided offers no stressed - Extra support needed for eye and flue, vomiting - Pregnant women being nutrition - Most sleep on floor – not sick children – medical referred to nearby clinics - Diarrhoea outbreak enough mats examinations, medicine - Widespread diarrhoea - Dehydration - Unbalanced diet – no - Medical examinations - Medication needed nutrition needed – especially for - Children have health issues - Given coffee mix, rice, IDPs caught in floods – eye and skin infections noodles only - Children with diarrhoea obvious - Children with flu - No disinfectant for cleaning - Pregnant mother - No toilet paper confirmed malaria - Capacity of water tanks not - No safe playing area for enough to supply everyone children – playing in mud for 1 day - Older women sleeping on floors
- Waste management - - - 4 female toilets (not - - No rubbish collection - No rubbish bin or urgent need of Rubbish flushing) collection bins and collection - 4 male toilets (not - Water around ground WASH - Sanitation - toilets are flushing) everywhere – no drainage blocked - Bucket showers - Some rooms filled with - Drinking water tank has water - not yet emptied – but - 2 toilets blocked, no saving water for school water, no drainage staff – may become an - 1 tank used for shower urgent need as only water source
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Too crowded - No activities for children - Lots of children - No activities or space for - No activities or place for - No space for additional - Lots of anger - People are (though UNICEF has set up - Anxiety about repatriation children children IDPs – some living close by a tent for this purpose) – safety of houses (no - Rehousing anxiety – some - Rehousing anxiety – in affected houses
Social fighting, frustrated, scared - Rehousing anxiety forms provided) told they must leave by 2 principle gave deadline for - Can’t move home because and lost trust for - No privacy within houses - IDPS have heard about pm TODAY by the leaving 6 days ago houses full of mud, not authorities and each other mixed families Gold Ridge contaminating Committee - Parents concerned about safe - People don’t know what water supply – reason for - No repatriation forms raising money for their - Need tools for rehousing services are coming and not wanting to return provided children’s school – has this - No resources for cleaning when, so they miss out (no home - What will the government been considered in up information given out) - Mud covered gardens in do to help them with repatriation plan - Most people spending - Churches not present floods – source of income repatriation – fear of - Confusion around what their time cleaning up - Big need recreation for gone returning – will land be “repatriation” means houses children and young (sports) - Little privacy – no space provided? Proper - People starting to tire of - Some activities starting for intimacy assessment of who wants agencies asking questions with young children - Families being separated to return and who wants and taking notes but no - Need for prayer time between centres to stay response seen - Meeting spaces for young - Children traumatised – - Parents of students telling - Children need school people and mothers fear of returning home IDPs they should leave material/stationery to go - Boys not doing anything - Need financial assistance back to school - PE lessons provided for to rebuild homes children (with expectation - Need help to get gardens of support to be provided) back for income - Rooms overcrowded - No activities for children - Many children looking or young people stressed/distressed - No activities for children – need to identify what organisations can do - People with disabilities are hidden - Boredom – nothing to do all day - Churches not present - Insecurity/lack of clarity about what is happening to them next -
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Not many relief workers - - No information received - No information from - No woman representative - No information or talking to internally about anything – rights, committee provided for women to report to awareness raising displaced people updates on what’s - No official reporting - Honourable Moffat Fugui - People asking for - Repatriation – confusion happening , protection, mechanism set up announced 400 plots of awareness on health around what this entails, if distribution times, - No information from land at Lau Valley - No information on roles of and how stocks of food will messaging etc assessments given to IDPs available and that organisations/agencies Information be provided, the rights of - Medical supplies, money – would like feedback committee should identify - No updates on anything internally displaced people and tools for livelihood - No information from a list of people to move except food and assessment of houses. needed – no one has told government provided onto land, to take to Communication issues them what they will parliament. Only men present (HCC needs to receive if they leave present during this clarify) - Evacuation centre announcement. Risk of - People don’t know what generally good, but IDPs raising expectations and services are coming and concerned about it being of unequal allocation of when they are coming, so a school – when will land they miss out - No children come return, - Honourable Moffat Fugui information shared using electricity and questioned about where - They received talks from water. Who will pay for money is, and he health on wash the bills? responded $300,000 of - Messaging on health, - RCDF has gone to NDMO hygiene, protection, return and conditions at home, activities and when services provided in the centre, services available, sexual and reproductive health, info on who is giving what, weather and cancellation of emergency (what is going on outside) their rights in this situation (people just accept situation), list of numbers they can call - High levels of anxiety about if/when they will be moved out of centres
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Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- Worry about not having - - - Drunk men at night - - Toilet at back – no lighting enough food - Dam nearby – concern - No security - Security - drunken people about flooding - Drunk people from - outside visiting Threats at night, theft of items - 2 Security SINU patrolling block- two children slapped by them – not trusting - People smoking inside where children sleeping - Teenagers drink kwaso in the centre - Main building without walls- weather and safety - Fights to share utensils and pots - cooking takes a long time and children/parents argue over food - Not enough wood for cooking - Overcrowding- people not used to urban environment - Limited lighting at night time - All children have diarrhoea, pooing in room, nothing to clean it with, no nappies - Harassment to the girls and the boys that try to intervene - Shared showers - no privacy to change clothes
- - - - -
Ethnic
groups present
Page 26 of 34
Location: Pavilion SINU FOPA Naha School King George School Mbokonovera White River
Date: 9 & 10 April 11 April 12 April 14 April 14 April 14 April
- 2 pregnant women @ 9 - Over 7 people with - 1 mother with 6 children - - 2 children with disabilities - 2 people with disabilities (I - At least 1 pregnant months disabilities – needs are not needs separate space – needs are not being left) woman - 2 pregnant women @ 8 being considered (though - 1 person with a disability considered (1 has left - Breastfeeding mothers - 5 babies
Groups months CBR has visited for – cannot speak or move. already) need nutritious food - At least 3 people with - 1 pregnant woman @ 7 assessment) Moved by family to area - Pre and post-natal care - Infants need space disabilities months at risk of landslide, as urgently needed because of over crowding - 1 teenage girl with special - Nothing ready for labor, Naha was not suitable for – particularly vulnerable need (Downs Syndrome)- her group lots of people watch her police/health aren’t - Single mothers not shower contactable, they can’t rest provided with support and have swollen legs - Older people need rest
Special Needs/ Vulnerable Vulnerable Needs/ Special - Imbalance of diet- breastfeeding mothers stop lactating (cabbage)
- Lights in houses come on - Presence of Outdoor - Red Cross providing water - Church providing food - SDA provided cooked food every night Global Evangelical Church (but IDPs not sure if it is (though unsure how one night – chicken wing, - UNICEF setting up - No threat from outside safe for drinking) distribution is done) half one banana, one - MHMS providing cleaning people – community and - Church programs have piece of melon (but not Positives products and raising church is very supportive commenced enough for everyone) awareness about hygiene - IDPs happy with how they - Medical team – 2 nurses - Basketball court for - HCC provided skip for have been treated by visit regularly children to play on rubbish relief workers - Children playing and being - World Health Project - Older people are ok creative – some seem (MHMS) – spraying for - No stories of child abuse happy mosquitoes or gender based violence - Resilience of IDPs - - School treating IDPs well - Women contributing by - Committee established cleaning amongst IDPs - Reporting mechanism is to the committee - Showers separated by sex - Security fence - Youths visit daily to lead prayers for everybody - Red Cross doing health checks – malaria and dengue testing Page 27 of 34
ANNEX 2
Flash-Flood Emergency Assessments Guadalcanal, Solomon Islands – 8 to 11 April, 2014
Executive summary
Following the flash flood emergency in the Solomon Islands on 3 April 2014, the Guadalcanal Health Division performed rapid health and WASH assessment in many of the flood-affected communities in
Guadalcanal Province. A total of 64 communities across North of Guadalcanal Province were assessed fro m 8 to 11 April 2014. This interim report documents the findings of the assessments and highlights a number of areas that require urgent follow-up actions by the Health, WASH, and Food Security clusters.
Key findings included:
Only 13% of assessed communities report adequate clean water
Only 29% of communities report a functional toilet 62% of communities report that more than 50% of the population defecate in the open Only 3% of communities report adequate food and 13% have received food assistance Only 17% of births have been attended by a skilled personnel Only 11% of the communities have received health promotion messages
Recommended urgent priorities include:
Expand ongoing assessments and recruit additional partners as necessary to support this activity, assuring consistent data collection tools and methods Urgent and detailed review of these preliminary assessment findings by the Health, WASH and Food Security Clusters, with timely and appropriate follow-up actions
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Background
From April 1-3, 2014, heavy rain from a tropical depression caused severe flooding in Honiara and Guadalcanal Province (pop. 64,609 and 93,613, respectively, 2009 Census). Multiple rivers burst their bank washing away houses and affecting an estimated 10,000 and 40,000 people in Honiara and Guadalcanal Province (GP) respectively. There are approximately 10,000 displaced persons in evacuation centres (ECs) in Honiara and an unknown number in GP. Many bridges were damaged or destroyed and transportation to much of Guadalcanal is only by boat, limiting assessment and relief efforts. The Northern part of Guadalcanal, in particular north-central Guadalcanal, is characterized by extensive floodplains and multiple rivers that flow from the mountains in the south to the flat and open plains of the North. Much of the Guadalcanal population live in this section of the Province.
A substantial multi-sector emergency relief effort by the Government of the Solomon Islands supported by multiple United Nations Agencies, Non-Governmental Organizations (NGOs), and foreign governments, has provided substantial assistance to many of the affected population, especially in Honiara. Damage to multiple bridges and widespread and deep mud in the badly affected North-central Guadalcanal Province has severely limited access.
Despite serious access challenges, the Guadalcanal Health Division conducted rapid health, WASH, and food security assessments across much of Northern Guadalcanal Province. The assessments are ongoing, but this interim report documents the key findings thus far.
Methods
Five assessment teams started assessments on 8 April 2014 using a standardized rapid assessment form (Annex 1) modified from the Inter-Agency Standing Committee (IASC) Initial Rapid Assessment (IRA): Field Assessment Form. The modified form has four components:
1) General population characteristics 2) Water and sanitation 3) Population health 4) Health facilities
Each assessment team was composed of 3-4 nurses from the Guadalcanal Health Division. Target communities were chosen by the Guadalcanal Emergency Operations Centre [Health] and the assessment teams based on likelihood of flood impact and ability to access by vehicle or boat. Assessment forms were completed by the assessment teams in the field using a combination of qualitative and quantitative methods including direct observation and interviews with community residents. Completed forms were collected at the end of each day at the Guadalcanal EOC and entered into a Microsoft Access database for descriptive analysis. Data for this report is based on assessments conducted from 8-11 April, 2014. The health facility assessment data is not included in this brief interim report.
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Figure 1. Guadalcanal Province and Assessments by Health Zone
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RESULTS
Zone 6 - Health Zone-strafified MHMS assessment data - Zone 1 - Zone 5 - Total % % Good % % Guadalcanal Province Marrara Aola (Zone 1, 5, 6) Samaritan Total estimated Health Zone population (MHMS data 2013) 20263 12042 31826 64131 Total number of communities UKN UKN UKN UKN Total number of assessed communities 11 2 51 64 Total estimated population of assessed communites (quick 3542 17% 800 7% 11234 35% 15576 0% estimate by Ministry of Health staff) Number of communities in which the population has been 2 18% 1 50% 12 24% 15 24% officially counted (systematic count by police or NGO) Number of communities in which the population is: · Increasing 8 73% 0 0% 9 18% 17 27% · Decreasing 2 18% 0 0% 7 14% 9 14% · Staying the same 1 9% 2 100% 35 69% 38 60% Relations between the displaced and the host community · Host community willing to assist 5 45% 1 50% 8 16% 14 22% · Tensions 0 0% 0 0% 1 2% 1 2% · Other 0 0% 0 0% 3 6% 3 5% Number of dead, missing or injured due to the crisis · Dead 0 0 0 0 · Missing 0 0 0 0 · Injured 2 0 8 10 Estimated number of unaccompanied children 11 0 0 11 Total number of water sources in the health zone pre- 34 2 129 165 disaster Total number of water sources providing clean water post- 28 2 40 70 disaster Total number of communities with enough clean water 4 36% 0 0% 4 8% 8 13% supply post-disaster Total number of communities with >50% of people currently defecating in the open (ie. seaside or bush), not in a defined 7 64% 2 100% 30 59% 39 62% and managed defecation area Total number of communities with a functional toilet 5 45% 0 0% 13 25% 18 29% Total number of communities with feces substantially close 1 9% 0 0% 4 8% 5 8% to shelters (<20m) Total number of communities with feces substantially close 0 0% 0 0% 3 6% 3 5% to water sources (<20m) Total number of communities with mosquito nets within the 7 64% 1 50% 16 31% 24 38% health zone available for use Total number of communities which everyone has access to 5 45% 1 50% 15 29% 21 33% a mosquito net
Total number of births within the communities post-disaster 2 1 9 12
Total number of births attended by skilled personnel within 1 50% 0 0% 1 11% 2 17% the communities post-disaster Total number of visibly pregnant mothers within the 6 1 35 42 assessed communities post-disaster Total number of cases of fever and rash post-disaster 29 0 34 63 Total number of cases of malaria post-disaster 7 0 15 22 Total number of cases of diarrhea post-disaster 10 0 33 43 Total number of cases of ARI post-disaster 70 5 91 166 Total numberr of cases of dengue post-disaster 0 0 0 0 Total number of injury cases post-disaster 4 0 5 9 Total number of pregnancy-related complications post- 0 0 0 0 disaster Total number of communities where an outbreak rumour 0 0% 0 0% 2 4% 2 3% has been reported Total number of communities which have received food 2 18% 0 0% 6 12% 8 13% supplies Total number of communities that have an adequate food 1 9% 0 0% 1 2% 2 3% supply Total number of communities that have received health 0 0% 0 0% 7 14% 7 11% promotion messages
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ANNEX 3: Environmental Health/WASH Rapid Assessment Results COMMUNTY SUB-AREA WATER SANITATION ENVIRONMENT NOTES: Burns Creek Riverside (Zone 2) . 1 bore, needs repair; . some slabs, all flooded . 8 houses reported washed away; . People from Perch and KG6 Date assessment: . 5 wells flooded . area accessible again, some mud, camps 12 April . 2 rainwater tanks; lots of mosquitoes Ivara (along riverside) . SSEC church has small tank; . some toilets, all flooded; . Houses ok, some mud . people going to main road or . mostly OD as before camps to get water; . 3-4 wells, all flooded; Rice Farm . 2 wells, flooded . 2 toilets, destroyed . road access difficult; . most from KG6 . now collecting drinking water . lots of mud and stagnant water; from Blue Lagoon or Bethlehem . still very wet Church; . smelly Mosquito . wells contaminated, people . some slabs available, still ok . Dry; . residing behind Soap boiling the water; . very few houses affected; Factory; . using water from Soap Factory . Chief said people are (RWSS tanks; staying in camps for free handouts – they can return; LR . about 11 wells, contaminated (1 . the few toilets are damaged, . Dry , little mud . from KG6 and some from LR dead animal?); all using river now Warehouse . some tanks there but most get water from Blue Lagoon; Tanakake (Penatina SIWA available but 1 tap only, . 3 raised toilets but flooded . 16 houses flooded, still bad . From Pavillion camp, have valley) people have to pay for use; anyway; returned home now . SIWA water dirty now so not . using creek used, collecting from Pavillion tanks White River Upper Namoruka .SIWA not on yet; . 1 toilet there before, gone . access almost fully restored; . people ran up the hill, never (upper White River) .Some tanks used; now; . 2 houses reported washed away; went to evac centers; Date: 13 April . 1 bore used; . using river . some debris yet . washing and laundry in river Lower Namoruka As above As above . houses generally ok; .some mud still; . 1 house reported swept away Central White River . No SIWA; . the few toilets there still ok, . lot of mud and stagnant water, . 790 people (Riverside) . 1 bore used for washing and rest using river . smelly . sleeping at school, cleaning drinking; at day . Children received bottled water Independence Valley . 3 piped springs used; . most have private toilet, . Muddy and drainage issue; . pop 1070 (50+ HHs); damage not assessed . still flooding . Mamanawata . 4 wells, 1 used for drinking, rest . still using sea . no flooding issues here . asked for assistance getting for other use (possibly saline) rubbish cleared White River Tanakake Valley . SIWA there (Penantina Valley) (World Vision Laundry Valley . 1 SIWA tap @ SBD150/month; . 1 PF toilet, ok; . 30+ people. (5HH) Page 32 of 34 assessment) . using stream as well; . need raised VIP toilet . no tanks seen Tikopia . SIWA access; . OD, as existing toilets flooded . 74 (12+HHs) . no tank seen . need raised VIP latrine Gilbert settlement . SIWA access; . using White River school toilet; . 74 people (12+ HHs) . no tanks seen . using nearby stream Wind Valley . SIWA access; . OD . 2 wells flooded Mataniko River No 3 . SIWA on but broken pipes so few . No toilets acvailable anymore . almost all houses uninhabitable; from Tuvaruhu water points . debris and rubbish everywhere; down . rubbish dumped in river
Date 14 April Vara Creek Riverside . 1 small spring used; . no more toilets; Debris and mud everywhere; . people staying at Varamata . some rainwater collected . using river; . most houses destroyed SDA church . diarrhea reported Vara Creek (before . intermittent SIWA; . many of previous toilets still . lots of mud and debris; . people staying at wantoks bridge) . some drinking water supplied; ok; . rubbish pick up is needed badly; . not boiling SIWA . one septic tank used, goes . some houses washed away straight into river Marble Street/Town . SIWA water available; . indoor toilets now blocked by . majority of houses washed away; . mainly staying with relatives council housing . children drinking bottled water; mud; . malaria with some people . some rainwater collected . sewage straight into river (outlet broken at Tuvaruhu Lelei . using nearby stream and river; . all 7 PF toilets flooded; . access partly restored; . never went to evac centers . using river and bush . some debris but generally did not enter houses; . 8 houses reported washed away Tuvaruhu River side . used to use stream; . used to have toilet, all washed . 5 houses washed away, 1 partially . ran uphill, then returned (East) . now using 2 tanks at school away; destroyed; . now at relatives . debris around, some houses filled with mud; . access good Fijian Qtr . 1 SIWA stand instlled on 13th . some toilets still working; . lots of mud and stagnant water; . ran uphill, then returned April; . rest using river . smelly and wet . one rainwater tank used Mataniko/Ngalitatae . 2 SIWA taps in operation; . all 5 toilets gone; . access through the river; . ran uphill, then returned . Red Cross providing water as well . using river . still debris around houses; . 3 houses reported washed away, 1 partially damaged Vatusu . SIWA not working anymore; . only 2 toilets still used . generally clean area; . ran uphill, then returned; . using 2 nearby streams; . Caritas assisting with temporary . affected evacuated to . No water tank available shelter for homeless; church building . 6 houses reported as washed away Tamatanga 1 . using one person’s SIWA supply, . OD at nearby drain; . general environment ok; . ran uphill and stayed with and nearby streams . one slab currently being . 2 houses reported as washed away, relatives Page 33 of 34
cleaned; other full of mud; . cleaning up now; Tamatanga 2 . SIWA disconnected due to land . 2 toilets buried . debris needs removing; . ran uphill, then returned issues; . 4 houses washed away; . their well was buried; . using one private SIWA connection Koa Hill . No SIWA; . some uphill using toilets, rest . lots of mud and debris to be . some reside at . using nearby spring, but pipeline river; cleared; Mbokonavera and Holy Cross from dam is damaged; . community needs tools; centers; . rest returned home
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