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Home , Amazai, Buner District, Ellai, Mingora, Shangla District

HEALTH CLUSTER Crisis in

Issue No 4 20 March‐12 April, 2010

• As of 15 April, 300,468 individuals or 42 924 families are living with host communities in

Hangu (15187 families,106 309 individuals) (1910 families,13370 individuals) and (25827 families,180789 individuals) Districts, displaced from Orakzai and Kurram Agency, of Khyber Pakhtunkhwa province formally known as North West Frontier Province (NWFP).

• In addition to above there are 2 33 688 families or 1 404 241 people are living outside camps with host communities in , , Charssada, Pakistan IDPs living in camps and Host Nowshera,Kohat, Hangu Tank, communities DIKhan, Peshawar Abbotabad, Haripur, and Battagram districts of NWFP. There are 23 784 families or 121 760 individuals living in camps of Charssada, Nowsehra, Lower Dir, Hangu and Malakand districts (Source: Commissionerate for Afghan Refugees and National Data Base Authority)

• In order to cater for the health sector needs, identified through recent health assessment conducted by health cluster partners, in Kohat and Hangu districts due to ongoing military operation in Orakzai Agency, Health cluster partners ( 2 UN and 8 I/NGO’s have received 2.4 million dollars fund from Central Emergency Response Fund (CERF). This fund will shoulder the ongoing health response for the IDPs and host communities living in Kohat and Hangu Districts

499 DEWS health facilities reported 133 426 consultations from 20-26 March, of which 76 909 (58 %) were reported for female consultations and 56 517 (42%) for male. Children aged under 5 years represented 33 972 (25%) of all consultations. out of those, 5,614 (17%) consultations in children under five, were for Acute Diarrhea and 1,709(5%) for lower respiratory track infections. There were 1756 visits for antenatal care reported from 63 health facilities.

• From 20-26 March, six alerts for suspected measles (Peshawar, Mardan, Lower Dir, Nowsehra, and Buner districts), one outbreak of measles (Nowsehra district) and One alert of acute watery diarrhea (Swabi) were received and responded accordingly Acute upper respiratory tract infection (37,290 (28%) patient consultations) remains the leading cause of morbidity, followed by acute diarrhea, according to data from reporting health facilities.

• From 20-30 March WHO prepositioned life saving medicines, including emergency, cholera, maternal health essential drugs (30 mini emergency Kits to DI Khan and Tank districts.) These medicines are sufficient for the population of 118 000 for two months.

• Cluster members are prioritizing reproductive health care services in Lower Dir, , DI Khan and Tank districts. In the last week of March, UNFPA supported 9 health facilities (District Head Quarters Hospital Tank, Rural Health centre Gomal Bazar, Parroha, Paharrpur, Basic Health Unit Dabarrha, Mufti Mehmood Memorial hospital, Tehsil Headquarters Hospital Matta and Samarbagh) in these districts. . A total of 4,921 patients were consulted during 1 April to 12 April in district D I Khan, Tank, Swat and Lower Dir This includes 397 antenatal consultations, 127 postnatal consultations, 124 deliveries, 17 post abortion care, 6 case was referred for C-section, 21 syndromic case management of sexually transmitted infections, 193 family planning consultations, 326 ARI, 968 gastroenteritis, 765 fever, 151 scabies and 1,773 consultations for other minor general outpatient services etc. During the above mentioned period 123 newborn and 370 hygiene kits were distributed for improving menstrual and personal hygiene as well as psycho-social support of the affected women at reproductive age group to overcome/transform socio-cultural taboos in women accessing reproductive health care.

HEALTH ASSESSMENT

Hangu district Health Assessment

A Health Cluster team conducted assessments of health facilities in Hangu districts during 22 to 24 February. Sixteen medical officers from cluster partners and Government officials, using WHO assessment tools, assessed Hangu district. The team assessed gaps in service delivery in 18 public health facilities in the district. This comprised of the 1 Tehsil headquarter hospitals(THQ), 1 Civil Hospital, 1 Rural Health centre, 13 Basic Health units(BHU) and 2 Maternal and Child health centers. In addition to this 1 Camp, 3 warehouses and 3 diagnostic laboratories were also assessed. Currently, there are around 78,719 IDP’s residing with the host communities in district Hangu and as per the information shared by the Social Welfare department and Executive District Officer (Health) Hangu. There are twelve health facilities which are providing health care to these IDP’s. . According to Health facilities assessment the case load at these health facilities has increased enormously since security operation escalated in Orakzai Agency. The essential drugs, service provision and qualified health workers, especially female doctors are identified as urgent needs and insufficient to cop for the extra load of 116 821 displaced people visiting these 10 health facilities. The three health facilities which are most overburdened by the IDPs are THQ Hangu with 32,627 IDPs, BHU Shahoo Khel(This health facility is not functional as it was destroyed in 2009) with 16, 890 IDPs and BHU Ibrahimzai 11, 072 IDPs. The availability of essential drugs in the overburdened health facilities is quite low and not enough to cater the extra load of the IDP population visiting these 12 health facilities.

The detail assessment is available at http://www.whopak.org/idps/documents/assessments/Hangu%20assessment%20draft.pdf

Disease Surveillance

The disease early warning system (DEWS) network has been established in the 10 districts hosting IDPs affected by conflict in NWFP. Full expansion of the DEWS network to Kohat and Hangu districts, which host IDPs from Orakzai and Kurram agencies, is in process.

Districts in the DEWS network coverage in NWFP crises

Nature of involvement Number Districts Peshawar Hosting IDPs of and Mardan Bajour Agency 5 Charssada Swabi Nowsehra Buner IDP Return Districts in Malakand 3 Swat Division Lower Dir Hosting IDPs of South Waziristan Agency Tank 2 DI Khan

Total 10

Alert and outbreak investigations and response:

From 20-26 March, six alerts (from Districts Mardan, Lower Dir, Buner, Peshawar and Nowshera) and one outbreak (from District Nowshera) of suspected Measles and one alert of acute watery diarrhea (district Swabi) were received and responded accordingly.

Suspected measles:

• Five alerts for suspected cases of Measles were reported, two from Nowshera while one each from districts Mardan, Lower Dir, Buner. Blood samples from all suspected cases were sent for laboratory confirmation and all of these were reported negative for Measles from National Institute of Health (NIH), Islamabad. Field investigation was conducted and no more suspected cases were found. • Six suspected cases of Measles were reported from Badshah Khan Kallay, in district Nowshera. Two patients were children less than five year age 4 patients were over five year old and belonging to same vicinity • Blood samples from six the patients were tested at National Institute of Health, (NIH) Islamabad and 5 samples were reported positive for Measles IgM, However result for one sample is awaited. The Executive District Officer- Health and DEWS team is actively monitoring the Measles situation in the area and planning mop up vaccination if needed. No more suspected case reported from the area. • One alert for suspected acute watery diarrhea from Mohalla Ter Watu, district Swabi. Stool samples were collected from all the patients and sent to NIH for laboratory confirmation and the result is negative for acute water diarrhea.

Morbidity and mortality (20 to 26 March, 2010)

499 DEWS health facilities reported 133 426 patient consultations in the 10 districts hosting IDPs and affected by the NWFP crisis. 59 DEWS reporting sites also reported 1488 visits for antenatal care.

The table below shows the overall distribution of patients by gender and the number of consultations and the percentage for the priority communicable diseases under surveillance recorded 20-26 March, 2010.

Male/Female consultations and percentages Gender Number of consultations Percentage Female 76 909 (58%) Male 56 517 (42%) (Source: DEWS, 2010)

Of the total number of consultations, 33 972 (25%) were made by children aged under five years.

Detailed data of these diseases is available from the Weekly Morbidity and Mortality Bulletin 12 available at www.whopak.org

COORDINATION

Islamabad

The 52nd Health Cluster meeting was conducted in WHO conference Hall, Islamabad on 18 March. The highlights are as follows:

• UNFPA will meet Health Emergency Preparedness and Response (HEPR) on Rural Health Centre Parova, DI Khan duplication issue which is still pending. Need to be resolved on priority basis. ( Action to be taken by UNFPA, HEPR) • Health needs for Mohmand Agency were reviewed at provincial health cluster meeting in . There is a need for medical supplies in 43 health facilities in the agency. 1 Agency Head Quarter Hospital, 1 RHC and 24 BHUs need immediate support and assistance to health services. (Action to be taken by Health Cluster Partners) • Urgent mass vaccination is required for measles outbreak in 2 union councils of Nowshera (Action to be taken by UNICEF, WHO, Executive District Officer, Nowsehra). • Health Cluster quarterly review to be undertaken by end of April, 2010. (Action to be taken by Health Cluster Partners,(HCP)) • Mental health to be integrated in the assessment of health facilities in the IDPs hosting areas and return areas. • Develop matrix of Kohat and Hangu for Health Cluster Partners covering the health facilities.(Action to be taken by WHO/HC Partners). • Regular updates on gender issues in health cluster meeting will be shared with partners as gender is one of the cross cutting issue. Concrete steps are needed for inclusion gender issues in health cluster. More access for women to health services, include female health care providers in health interventions and integrate gender issues in health.( Action to be taken by HCP) • One response website which is a portal for all humanitarian workers needs to be updated by partners before next health cluster meeting. (Action to be taken by HCP)

Swat:

• A meeting was held with Expanded Programme of Immunization (EPI) Coordinator, Swat. The situation of measles clustering in different areas of Swat was discussed. WHO Suggested to District authorities to conduct Measles Mop Up in Matta, Kabal, Charbagh and Fatehpur. The EPI Coordinator discussed the matter with EDO Health, UNICEF and Provincial EPI Office. The District authorities decided to conduct Mop Up from Monday, 12th April 2010. • DEWS Training for Newly appointed staff of CWS, ABKT, ARC and Save the Children were arranged on 8th April 2010 in the Office of CWS. 44 Participants were trained about DEWS. • A monsoon contingency planning meeting was held on April 5, 2010 at 11 Am in DHDC Swat. DoH in collaboration with WHO, Merlin, CWS and CRDO is establishing a Diarrhea Treatment Center at Saidu Group of Teaching Hospital, Swat. • A meeting was held with representatives of MSF Belgium. They showed interest to start their work in Swat in May 2010. Health working group meeting of District Swat was held on 7th April 2010. • MSF Belgium attended the meeting for the first time and showed interest in starting their work in Swat. • A plan will be made by DoH in collaboration with WHO, TMA and all Partner Organizations for Stray Dogs in Swat. • It was pointed out by IRC, that Lady Health Workers of the district are facing problems in getting their salaries. EDO Health informed that the delay is at Department of Health at Federal level and beyond his provincial jurisdiction control. • It was decided that EDO Health will be making a plan for Mobile Medical Camps for Community Relief and Development Organization (CRDO) and the organization will be following that. • American Refugee Committee informed that 1000 books having messages regarding Flood affected areas hygiene prevention are printed and ready. WHO requested Department of Health(DoH) to include services of WHO-EHA and Polio Eradication initiatives(PEI)/Expanded Programme of Immunization(EPI) in W3(“who” is doing “What” and “Where” of the district. • Handing over Ceremony of Medical equipments from Save the Children to DoH was held on 6th April 2010. The ceremony was attended by WHO officials.

Buner:

12th District Health working group coordination meeting held on 6th of April.

• Save the children informed that they will phase out its services at Civil Dispensary and Ghazikot. Medicine Du Monde-France informed that repair of Basic Health Unit Topai will be delayed due to funding constraints. • Mother and Child (MCH) week inauguration held on 2nd of April at EDO health office ,week scheduled from 5th April till 10th of April, During the week target population of 0.15 million(mothers & children’s) will be covered by LHWs in district ,EDO(H) requested WHO to coordinate with the partners for support in the MCH week. • It was assured by the partners that Mother and Child Health week partners will be fully supported through Lady Health Workers and Expanded Programme of Immunization staff during MCH week. MCH partners will share list of children de wormed during MCH days camps with national program to avoid second dose within six months of first dose. Centralized outpatient department registration at Health facilities to avoid duplication of consultations in DEWS data. It was further briefed that the department of health staff will be responsible for Birth certification & medico legal cases handling at Health facilities. • International Medical Corps requested EDO (H) for allocation of 6 health facilities.

Mardan:

• Meeting conducted with EDO-Health Mardan on 5th April, 2010. Health reporting sites which are not sharing data for consultations and diseases trends were discussed with him and he promised to ensure his full support. • WHO Surveillance Officer (SO) informed EDO about the confirmed and suspected cases of Measles from Mardan. He requested EPI Coordinator to conduct measles mop up vaccination campaign at Mohib Banda and Mohabbat Abad • Meeting conducted with Expanded Programme of Immunization (EPI) Coordinator on 10th April, 2010. WHO SO conducted a meeting with EPI Coordinator and informed her about the suspected and confirmed cases of Measles in Dist Mardan. She was informed about the 5 alerts reported from the same house in Union Council Mohib Banda. Around 15-20 children live in the same house who are only vaccinated for polio. No other vaccinations done. Kopliks spots were present in one child of 2 years age and therefore she was asked to conduct a mop up vaccination at that place. She was also informed about the alerts of suspected Measles from BHU Mohabat Atab.EPI Coordinator told WHO SO that a mop up Measles Vaccination Campaign will be held in the two areas on Monday or Tuesday (12-04-2010 to 13-04-2010).

DI Khan:

• A meeting with EDO-H in his office to conduct the Supervisory and Monitoring visits to the Health facilities held by Partner organizations. It was agreed that in future, joint visits will be carried out by the EDO-Health and WHO Officials. • Meeting with EPI Coordinator held to discuss Measles Situation in the district and availability of Measles Vaccine. The purpose of the meeting was to work together in case a need arise for Mass Campaign of vaccination. • Pakistan Paediatrics Association (PPA) has started a programme with the partnership of UNICEF in DHQ- Hospital D.I.Khan. PPA has requested WHO to deliver diseases early warning systems (DEWS) training to its staff including doctors and paramedics. WHO DEWS official met Project Coordinator of PPA to finalize the date and venue for upcoming DEWS Training to the staff of PPA. • International Medical Corps has completed the repair & maintenance work in 05 health facilities and offered to do the same in more health facilities. • Merlin has completed its recruitment process for district Tank and D.I.Khan as it wants to extend its activities. • ICRC has started its services at Rural Health Corps Paroa. It is working to improve the infrastructure of the RHC also including the Operation Theatre & the Labor Suit. • Surveillance Officer. (DEWS) WHO attended a Seminar on Mother and Child’s Day arranged by Gynaecology & Obstetrics Department of Mufti Mahmud Hospital and Gomal Medical College D.I.Khan with sponsorship of NGO SAHARA (Implementing Partner of UNICEF). • Coordination meeting with EDO-Health, VEER Development Organization & International Rescue Committe on 6th April, 2010 for sharing progress regarding water supply & sanitation improvement of the identified health facilities in district DI Khan.

Tank:

• Health coordination meeting was postponed due to the critical security condition of the District.

FILLING GAPS

Care International continued providing health services through two mobile and three static clinics in , Koga, Makhrani, Nawagai, Karapa union councils of . 2582 patients were provided primary health care (including MCH & referral services) and in static clinics 1031 (including 347 females and 499 children) by Care teams during the fourth week of March. Additional 12 mobile camps in the same union councils of Buner district were also arranged where 1551(588 females and 593 children) patients were treated. 30 health and hygiene were also conducted in which 515 persons attended these sessions. The organization has started providing primary health care services through 2 mobile medical teams and 2 static clinics in sub-districts in Mingora & Matta of where 24 mobile camps were arranged. 3074 patients were provided health care services, including 1000 women and 1163 children. 2071 patients received consultations, including 778 females and 888 children, from the two static clinics of Matta sub-district.

Cordaid medical teams are serving patients in 3 rural Union Councils of Shangla, supporting 3 remote Basic Health Units with a catchment of more than 60 000 conflict-affected people still living under curfew and having no other access to basic health care. Cordaid also supports the District’s Head Quarters hospital (DHQ) , the central health facility of . Mobile Medical Units are continuing their consultations. They had in total 1070 consultations with males, 660 females’ and 410 children. Bad weather, landslides caused by reconstruction of road was the main reasons for inaccessibility and fewer consultations. Most cases are of acute respiratory infections, diarrhoea and scabies. Cordaid has started an advocacy campaign through religious leaders and their messages on health awareness are also discussed in Friday sermons. Cordaid is providing incentives to MoH officials at all 3 BHUs to ensure maximum presence of MoH Staff members at the concerned health facilities. Cordaid Medical teams also monitor distribution of free medicines, attendance of MoH staff and the teams also provide technical assistance to MoH officials to enhance their capacities.

Save the Children. During 1 to 12 April 9541 patients were treated by Save the Children medical staff deployed at 24 Save the Children supported health facilities in Mardan, Swat, Buner, Swabi and DI Khan districts. Out of these 9541 individuals, 5852 were women and 1789 were children under 5 years of age. Referral system was intact through 19 ambulances and a total of 16 individuals were referred to secondary & tertiary level facilities through Save the Children ambulance service. Health & Awareness sessions continued in all 5 districts and a total of 704 individuals benefited from them. 717 pregnant women were provided with Antenatal Care, Post natal Care as well as health education messages. Distribution of clean delivery kits continued in all 5 districts, among pregnant women and 196 pregnant women received clean delivery kits during the reporting period. Screening and enrollment of acutely malnourished children and pregnant & lactating women was continued in four districts Buner, Swabi, Mardan and Swat. A total of 4194 individuals were screened, out of which 3208 were children between 6-59 months while 986 were Pregnant & Lactating women. Out of these 4194 screened individuals 325 were registered in Supplementary Feeding Program (SFP) while 35 individuals were registered in outpatient therapeutic feeding program (OTP). 10 children were admitted in Stabilization center during the reporting week.

International Medical Corps continued providing 24/7 comprehensive primary healthcare services in Palosa camp in Charsadda including Mother and Child Health, health education and referral services. There were 321 consultations conducted in Palosa camp in the last week of March. Healthcare services were also made available to IDPs living with host families in Shubqadar, Charsadda District by coordinating with National commission of Human Development through provision of medicines. In Buner District, IMC is providing comprehensive primary healthcare services including health education, MCH and referral services in BHU Tor Warask, RHC Deewana Baba, DHQ Daggar and RHC Bagh. A total of 2699 consultations were conducted in the above mentioned period. Health care providers were also trained on Gender Based Violence, Mental Health and Waste Disposal. In this regard 26 health care providers were trained in Peshawar district.IMC provided health care services in RHC Khazana and CH Khawazakhela. The organization also supported BHU Banjhut, Mian Kalay, Nazr, Khuz Shawar and Charbagh in Khawazakhela. The total consultations were 8706 during the last week of March. In D.I. Khan IMC is providing services in BHU Muryali, BHU Shorkot, BHU Zafarabad, BHU Potah and CD Dinpur. Total consultations during last week were 2,183.IMC carried out minor repairs in the above mentioned health facilities in D.I.Khan

UNICEF continued its health care services to the Idps in Host communities of NWFP. During 29 march t o 12 April, 1508 patent consulation incliding Mother and Child Health(MCH) at UNICEF supported facilities in IDP camps (Jalozai, Nowsehra district and Mohammad Khawaja, Hangu District). Antenatal consultations(ANC) were provided to 602 pregnant ladies and 43 deliveries were also supported. In the first quarter of year 2010 a total of 8464 consultations had been provided through UNICEF supported health facilities in IDP camps Through UNICEF supported eight (8) public sector health facilities of DI Khan, 3188 patients had been provided MCH Services. ANC was provided to 482 females and 25 deliveries were supported in the above mentioned period. UNICEF’s partner Pakistan Pediatric Association is providing specialized pediatric services in DHQ hospital DIKhan. During the reporting period 49 children were provided indoor services. Third round of Mother Child Days is about to end. During the reporting period 16614 families were reached ( total reached 96026 ) where 1422 children (2-5 years) were de-wormed (total de-wormed 29,372), 10,313 children under 2 years were provided MM sachets (total 52,794) and 514 children under 2 years were vaccinated with different antigens (Total vaccinated 9851). ANC services were provided to 4881 pregnant women (total 19200), of which 169 high risk pregnancies were referred (Total referred 1035), while 1279 pregnant women in their last trimester were provided with clean delivery kits (Total 9678), 2828 were provided with MM Tablets (Total 15,179) and 2863 were provided with ITNs (Total 7073). Since January 2010, 4111 less than 2 children had been vaccinated in IDP camps, 1358 in host families and 9851 less than 2 children in area of return(Swat, Buner, Lower/Upper Dir were provided Expanded Programme of Immunization services. (Total 15320). About 1701 females in IDP camps.1172 in host families. 5363 females in area of return are vaccinated against tetanus since Jan 2010. (Total reached 8238 in 2010 ) During the reporting period 724 health education sessions were conducted on different MCH topics in IDP camps where 9985 people participated (Total reached in 2010 11780 people benefited). Total 718 health education sessions (Total sessions reached in 2010 are 5546) were conducted benefiting 9924 individuals (Total benefited 67820in year 2010) through Mother and Child days in areas of return. A total of 121 health education sessions were conducted benefitting 1372 individuals in DI Khan. Mother Child week celebrated in all 24 districts and IDP camps from 5th to 10 April 2010. In Camps about 13670 children between 2-5 years of age were de-wormed .About 2968 children less than 2 and 2020 females were vaccinated during the week. Through 3456 health education sessions about 34983 participants were benefitted including 19033 Pregnant and Lactating Women (PLW).

MEDECINS DU MONDE-FRANCE (MDM-F) provided Primary Health Care services, Expanded Programme of Immunization, Nutritional screening and Reproductive Health through two teams working in , in 6 different villages (Naranji, Palodand, Goati, Amankot, Qamar Dand and Zumra) and running Out Patient Department for IDPs in Swabi in District Head Quarters Hospital. In Buner district, one medical mobile team is working in Sarwai Union Council in 3 different villages Dargalai, Mangaltana and Dakara. Another team is working in Kawga and Shal Bandi Union Councils (Ambella and Amnawar). Outpatient Department is supported by a medical team in Liaquit memorial Hospital whereas two other teams are supporting Jarma and Zaramela union councils. A total of 2511 curative consultations have been performed in during 1 to 12 April, 2010)) in the above mentioned locations. 54.48 % of the total consultations were female consultations, 22.18% of the total consultations are reported in children less than 5 years age, acute upper respiratory infection with was the leading cause of morbidity followed by Skin diseases in all age groups.332 children between 6&59months are currently in the active file of weekly nutritional program.

CAMP continued providing primary health care services including referrals, for the IDPs residing in phase six of Jalozai camp, Nowsehra district. Total consultations were 880 during 1 to 12 April. Other activities include clinic based Health Hygiene Awareness session (two sessions) for female patients on daily basis. Each session comprises an average of 15-20 participants. The Medical Officers regularly attended the weekly coordination meeting carried out at camp level and share the health related and other issues with the Implementing partners.

Association for Behavior & Knowledge Transformation continued providing Health support services in Basic Health Unit Tirat, Tootanu Bandai and Dhera Kanju in Malakand Division of NWFP. Number of consultations by medical officer at BHU Tirat were 528 (222 females; 85 males; 221 children) whereas at BHU Tootanu Bandai the reported consultations were 310 (97 males; 198females; 15 children). ABKT is also providing MNCH services at BHU Dherai Kanju through Lady Health Visitor, where 161 (46 antenatal care; 25 post natal care; 32 adolcent; 58 children) were provided in third week of March.

Medical Emergency Relief International (MERLIN) continued its provision of health services in the month of February 2010 to IDPs in the districts of Swat, Buner, Mardan, DI Khan districts and the IDP camps in Jalozai (Nowsehra district). In Swat district, a total of 229 health promotion sessions were conducted where 3 675(with 1638 male and 2037 females) participants attended. The total consultations during the above mentioned period were 11 565(4 993male and 6 572 female). In Buner district the total number of consultations conducted were 853 (274 males and 579 females) in 13 health facilities allocated to MERLIN. There were 685 Health & Hygiene and nutrition education sessions were 9802 population participated in these sessions. In Jalozai camp, six static health facilities provided 24/7 Health care services. The number of consultations during the last week were 1 5531 with 7 680females and 7 581 males. In DI Khan the number of consultations during the above mentioned period was 9234 with 5347 females and 3887 males. Mobile health services started in CD Ara and Dub Shumali assigned by EDO-H. The three new HFs for PHC became functional in this week with total functional health facility 20/24 in DI Khan. The third ambulance is handed over to EDOH office after completion of repair work. The Generators were donated to 17 HFs, Freezer to 16 HFs, while it is functional in 10 HFs. The Generator in Mufti Memorial Hospital and DHQ Tank will be functional in this week. In the number of consultations during last week were 3 151 with 1305 males and 1846 females.

UNFPA continuous supporting 9 health facilities (District Head Quarters Hospital Tank, Rural Health centre Gomal Bazar, Parroha, Paharrpur, Basic Health Unit Dabarrha, Mufti Mehmood Memorial hospital, Tehsil Headquarters Hospital Matta and Samarbagh) in these districts. . A total of 4,921 patients were consulted during 1 April to 12 April in district D I Khan, Tank, Swat and Lower Dir. This includes 397 antenatal consultations, 127 postnatal consultations, 124 deliveries, 17 post abortion care, 6 case was referred for C- section, 21 syndromic case management of sexually transmitted infections, 193 family planning consultations, 326 ARI, 968 gastroenteritis, 765 fever, 151 scabies and 1,773 consultations for other minor general outpatient services etc. During the above mentioned period 123 newborn and 370 hygiene kits were distributed for improving menstrual and personal hygiene as well as psycho-social support of the affected women at reproductive age group to overcome/transform socio-cultural taboos in women accessing reproductive health care.

The World Health Organization (WHO) prepositioned life saving medicines form 15 to 30 March including emergency, cholera, maternal health essential drugs (30 mini emergency Kits, to DI Khan and Tank districts.) These medicines are sufficient for the population of 118 000 for two months.

Funding situation

As of 12 April 2010, the Health Cluster has received 3,591.483(5%) of the total appeal 73,470,100 requested in the UN Pakistan Humanitarian Response Plan (2010) document. Source: OCHA Pakistan, 12 April, 2010)

Communication and advocacy activities

Efforts are being made to raise the visibility of the health response to the crisis through:

• Production of South Waziristan situation reports • Pakistan Health in Photos • Production and distribution of Health Cluster bulletins • Packaging of disease surveillance film for distribution • Updating of Health Cluster website • Production of NWFP crisis slide show

Web links:

WHO Pakistan: http://www.emro.who.int/pakistan/

WHO HQ: http://www.who.int/hac/crises/pak/en/index.html

Health Cluster Pakistan: http://www.whopak.org/idps

Provincial Relief Commissionerate: http://www.helpidp.org

Pakistan MoH: http://www.health.gov.pk

WHO EMRO: http://www.emro.who.int/eha/Pakistan_more.htm

Relief Web FTS: http://ocha.unog.ch/fts/pageloader.aspx

Contacts:

For further information please contact:

WHO Pakistan Country Office Dr Khalif Bile Mohamud WHO Country Representative to Pakistan e-mail: [email protected]

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

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

WHO Regional Office for the Eastern Mediterranean Dr Irshad Shaikh EHA Regional Adviser e-mail: [email protected] tel. + (202) 2276 5525 mobile: + (201) 01733924 http://www.emro.who.int/eha/

WHO Headquarters Mr Paul Garwood Communications Officer Health Action in Crises e-mail: [email protected] tel. +41 22 791 3462 mobile: +41 79 475 5546 www.who.int/disasters Acronyms

AWD: Acute Watery Diarrhea ACD: Association for Community Development BHU: Basic Health Unit CD: Civil Dispensary CERD: Centre for Excellence for Rural Development DART: Disaster Assistance Response Team DEWS: Disease Early Warning System DHQ: District Headquarter DTC: Diarrhea Treatment Centre DSM: District Support Manager EDO: Executive District Officer EMRO: Eastern Mediterranean Regional Office ERU: Emergency Response Unit FP: Family Planning IEHK: Inter-agency Emergency Health Kit HRDS: Human Resource Development Society HTH: High test Hypochlorite INGOs: International Nongovernmental Organizations LHV: Lady Health Visitor LHW: Lady Health Worker LSS: Logistic Support System MCHC: Maternal Child and Health Centre MEHK: Mini Emergency Health Kit MMT: Mobile Medical Team NIH: National Institute of Health MNCH: Maternal, Neonatal and Child Health NWFP: North West Frontier Province MSU: Mobile Service Unit OFDA: Office of Foreign Disaster Assistance ORS: Oral Rehydration Salts ORT: Oral Rehydration Treatment PHRP: Pakistan Humanitarian Response Plan PIPOS: Pakistan Institute of Orthotics and Prosthetics Sciences, PPE: Personal Protective Equipment PPHI: People's Primary Healthcare Initiative PRC: Provincial Relief Commissionerate PRCS: Pakistan Red Crescent Society PWDs: Persons with Disabilities RH: Reproductive Health RHC: Rural Health Centre THQ: Tehsil Headquarter WMO: Woman Medical Officer