( camp NowsheraEmergency - Photograph Humanitarian by Syed Haider Action Ali)

Floods in Situation Report 2

1 August, 2010

WHO PAKISTAN-park road, Chak shazad, - [email protected] - T: +92 051-9255184/5 Fax +92 051-9255083

Situation Overview and Current Scope of Disaster

Due to disruption in infrastructure the loss of human lives and extent of property damage from the heavy down pour/flash floods across the Province of (KPK) are still not clear as access to affected areas is limited and most of the communication networks are disrupted. According to the National Disaster Management Authority (NDMA) at this moment it is difficult to assess but nearly one million population is affected by this natural disaster.

In Khyber Pakhtunkhwa (KPK), the worst-affected province, the Provincial Government now puts the death toll at nearly 800 people, with more than 100 people still missing. The actual figures could be higher as

Emergency Humanitarian Action, WHO Country office, Pakistan communication networks in many areas are still disrupted. Initial assessments indicate that , Nowshera and are amongst the worst-affected . Other badly hit areas, including Lower and Upper , remain largely inaccessible to humanitarian actors. An estimated 150,000 families require emergency assistance, such as food, clean drinking water, tents, and medical services. As the water level recedes, measures to prevent water-borne diseases will also become a priority. Rescue remains a key priority in KPK for 27,000 people who are still waiting to be evacuated from flooded areas. Access remains the main obstacle in terms of providing assistance to the affected areas of KPK. The floods have significantly damaged roads and bridges - for example, all major bridges crossing the Swat River have been swept away. Roads, including the Islamabad- motorway, have been seriously damaged. Communication has been made difficult due to damaged telephone lines, electricity, and gas pipelines. Mobile phone networks are still not functioning in many of the worst-affected districts (source UNOCHA)

The State of Azad Jammu & was under the wave of constant heavy rains from 27th to 29th July. This monsoon spell has caused abnormal raise in water level in Neelum and Jehlum rivers. It has also caused landslides in many areas which resulted deaths of many people and blocked the roads. The road link between Muzaffarabad and other districts is still cut off. A high level flood in has passed through Muzaffarabad city on 29th July at 2230 hrs. The height of water level in Neelum was approximately 17 to 20 feet than its normal flow level and 12 feet to 15 feet in Jehlum River. According to SDMA (State of Azad Jammu and Kashmir Disaster Management Authority) some 550 Families affected in Muzaffarabad City and 720 Families are affected in Neelum Valley

The hard hit districts by flash floods in Khyber Pakhtunkhwa are Charsadda, Swat, Nowshera, D. I. Khan, Tank, and Lower and Upper Dir.

Charsadda district is cut off from the Provincial Capital Peshawar and large areas of the town are submerged in several feet of water. Several dozen deaths were reported in Charsadda, where thousands of people are still trapped on their houses rooftops, where in some cases their house second floors are also under water. A total of 8 Basic health units are destroyed by flood waters.

The highlights of health issues and urgent needs from multi clusters Rapid assessment conducted in Charsadda district are;

Issues Main issue is accessibility to the area due to destruction of roads and bridges. Diarrheal cases are increasing due to contaminated water The district health staff is also affected by the floods. Human resource support is provided by EDO H, Roads were closed for the last 2 days – now Charsadda – Mardan and Charsadda- Peshawar partially opened today. Medicines stock damaged/destroyed in most of the health facilities.

Urgent Needs: Establishment of Diarrheal Treatment Center in DHQ Charsadda Diarrheal kits, IEHK kits and Anti snakes venoms are needed. Psychosocial support is urgently needed because the affected population has lost property and shelter. Hygiene promotion interventions – water purification tabs, mineral water, water tinkering is some areas is needed for next 5-6 days. Chlorination of water

Emergency Humanitarian Action, WHO Country office, Pakistan Tents are needed for temporary health facilities at different places., Referral system needed to be strengthened. Vaccination campaigns Mass communication campaigns/awareness

Nowshera district was also devastated by water from , which entered also parts of Nowshera district, flooding houses and stranding thousands of people in their homes. In the , the Swat River has washed away most of the bridges along with dozens of shops, hotels and private residents. Thousands of civilians had to be evacuated to high grounds north of the District Capital . The worst affected area is Madyan where flood water has washed away almost everything including health facilities in its vicinity. Also, the Districts of Tanks and D. I. Khan have been affected, where several hundred mud houses have been destroyed by the rain and floods. The water entered the district capitals and set parts of both cities under water.

The highlights of health issues and urgent needs from multi clusters Rapid assessment conducted in Nowshera district today are;

Issues: DHQ Nowshera is fully affected by floods and hospital infrastructure is fully damaged. Jalozai camp was cut off for last 3 days due to destruction of main bridge by floods. Diarrheal cases are increasing in Jalozai camp due to contaminated water The district health staff is also affected by the floods. Human resource support is provided by EDO H, Peshawar to Satellite Hospital. Drugs stock is damaged, Cholera kits, IEHK, MEHK needed.

Urgent Needs:

Establishment of Diarrheal Treatment Center in Pabbi satellite Hospital and Jalozai camp, DHQ Cholera kits, IEHK, MEHK needed. Psychosocial support is urgently needed because the affected population has lost property and shelter. Hygiene promotion interventions – water purification tabs, mineral water, water tinkering Nowshera and suburbs villages. Referral system needed to be strengthened. Vaccination campaigns needed to be started in the accessible areas. Mass communication campaigns/awareness on health hygiene etc.

Punjab Province is in the high spill over of the much devastating floods from north of country. According to flood early warning and flood telemetry system, it is the record high in terms of passage of waters from water monitoring gadgets from the last 40 years. The head works or water reservoirs (Bayrajis) are standing feeble against the hundreds of millions cusecs of water which are passing by them. The worst affected districts in order of devastation are Rajanpur, , Liyah, Bhakar, , , Muzaffargarh and Shorkot. Several links of Jinnah Bayraj(reservoir) were broken to save Mainawali district and its electricity power plant but even then the water levels in Mainwali are at record higher.

In Province the same high flows are expected to pass from Sindh province. The Super Flood warning has been issued and authorities have evacuated hundreds of villages as it is suspected that the flooding in River Indus may not give a chance to even escape, on its onset

Emergency Humanitarian Action, WHO Country office, Pakistan The medicine stock provided to Department of Health KPK in line with contingency plan for monsoon season was further distributed to the health facilities in the flood suspected districts, but according to Department of Health it is feared that 60 % of the stocks are destroyed by flood waters, the assessment is in process and details will be shared soon

Preliminary reports of effected population

Sr. No. Province District Severity Total population Affected Population 1 AJK Bagh Severe 515365 3608 2 AJK Moderate 737629 30 3 AJK Mirpur Moderate 436858 225 4 AJK Muzaffarabad Severe 812240 3180 5 AJK Neelum Severe 164683 3285 6 AJK Poonch Severe 538449 525 7 AJK Sudhnoti Moderate 293547 263 8 Balochistan Barkhan Severe 130000 9100 9 Balochistan Bolan Severe 361000 2087

10 Balochistan Jhal Magsi Moderate 138000 11 Balochistan Kohlu Severe 125000 1344 12 Balochistan Nasirabad Severe 308500 3222 13 Balochistan Sibi Severe 226500 32585 14 FATA Mohammad Agency Moderate 433246 15 KPK Moderate 840500 16 KPK Moderate 381000 17 KPK Charsadda Severe 1269000 * 500,000 18 KPK Moderate 396000 19 KPK D I Khan Severe 1058000 20 KPK Haripur Moderate 859000 21 KPK Severe 698500 22 KPK Kohistan Severe 586500 23 KPK Lowerdir Moderate 891000 24 KPK Moderate 1431500 25 KPK Mardan Moderate 1812000 26 KPK Nowshera Severe 1085000 *700,000 27 KPK Peshawar Severe 2505500 28 KPK Shangla Severe 539500 29 KPK Swat Severe 1560500 30 KPK Tank Severe 296000 Azad Jammu and Kashmir (AJK) Khyber Pakhtunkwa(KPK) Source, NDMA, PDMA, UNOCHA,SDMA *recently received through rapid assessment in Nowshera, Charsada quoted by Assitant coordination OfficersCharssada and DCO office Nowsehra, BEEJ, CRS,SPO Balochistan)

Emergency Humanitarian Action, WHO Country office, Pakistan Damaged destroyed Health facilities (As the reports are coming)

Health facility District-Tehsil Statuts (damaged, completely destroyed)

8Basic Health Units (BHU) Charsadda (KPK) destroyed

District Headquarters Nowshera district (KPK) Submerged in water till second Hospital(DHQ) Nowshera floor, badly devastated

BHU Azekhel Nowshera district (KPK) destroyed

BHUAkora Nowshera district (KPK) destroyed

BHU sabaq Nowshera district (KPK) destroyed

BHU Kakinabad Nowshera district (KPK) destroyed

BHU Nowsehra Kalan Nowshera district (KPK) destroyed

Health facilities of Madyan in Swat Swat district destroyed

Diseases Alerts and Outbreak

One alerts for Acute Watery Diarrhea was reported in and was responded and mobile teams visiting the area and monitoring situation

Health response

Health Coordination Emergency Cell is established by Department of Health, Swat which is functioning round the clock in three shifts. Different Medical teams are assigned in the field and daily feedback is being share at 6:00 PM and all partners are participating. Health partners have been requested to share daily DEWS reports to monitor the disease situation on daily basis. Health Partners conducting medical camps in different areas of Madayan, Bahrain, Marghuzar, Saidu Sharif, Mingora, Charbagh.

In district Peshawar 13 mobile medical team(each with 1 ambulance, 1 Medical Officer (MO), 1 Medical Technician, 1 Expanded Programme Immunization Technician, and helpers), D I Khan 12 , four mobile teams from Peshawar are supporting Nowshera, each with 1 ambulance, 1 MO, 1 MT, 1 EPI Tec, and helpers, Buner 3, teams are providing outreach services in the field. In Charsadda district the number of mobile teams(medical officer along the other health staff) are increased to 18 for provision of health services in the district, National Commission for Human Development has provided vehicle and human resource support to the department of Health in district through 6 mobile teams

Thirty nine (39) mobile teams and fixed health facilities in the affected areas attended total 9002 patient out of those 1583 patient visits were reported for Acute Diarrhea.

Emergency Humanitarian Action, WHO Country office, Pakistan Medicine sans France-Belgium (MSF-B) is supporting the causality Department of Saidu Teaching Hospital. So far they have received 3 patients from upper Swat who were airlifted. They established Diarrhea treatment center and will install water purification plant in Magora city.

WHO representative is in the Joint assessment mission to two worst effected districts (Nowshera, Charsadda) of Khyber Pakhtunkhwa. The details are attached along with this document within the email correspondence

WHO has sent 73 Diarrhea treatment kits, 28 Mini emergency kits, 2 Inter-agency health kits, 300 saline infusions, 300 Ringer solutions and 400 oral rehydration salts altogether in Pakistan. The details of supplies are in Annex A

A telephonic conference has been conducted between Acting WHO Representative and WHO (KPK) teams for situation updates, Field issues, Communication barriers due to loss of infrastructure, movement of responding teams, Replacement of drugs and supplies, which were altogether agreed upon

In initial response WHO has provided 102000 Aqua tablets and 4600 water purifying Sachets to Peshawar and Nowshera districts

WHO team visited Jalozai camp and assessed the damage due to recent flash flood. All the Health posts are functional and the staff is conducting its routine activities. The flash flood has passed and normalcy of life is restored. All the water sources tube wells are functional with chlorinators working properly.

In Swat six medical teams of health partners were mobilized on hygiene promotion and sent to the field.WHO in collaboration with Tehsil Municipal Authority (department responsible for water and sanitation) Swat and provided 1300 Jerry canes, 2000 water purifying sachets and300 soaps to health cluster partners working in Swat district .WHO also distributed 3900 sachets, 20000 aqua tabs and 250 sets of Information, Education and Communications materials in Kohat and Hangu districts to health partners for further distribution

WHO diseases early warning system teams which are present in 11 districts of Khyber Pakhtunkhwa (Peshawar, Charsadda, , Swat, Buner , Nowshera, Mardan Upper and Lower Dir, DI Khan, Tank and Kohat) along with all health partners working static & mobile health units in district are on epidemiological surveillance and vigilantly watching the situation. The line listing of the number of acute diarrhea cases, to coordinate & reports alert situations to the WHO is following its Standing Operating Procedures.

Annex A

Items/Kit Name Coverage

MEHK(Mini Emergency Health Kits) (6,000 population for one month)

IEHK(Interagency Emergency Health (30,000 population for one month) Kits )

Diarrhea treatment Kits (400-500 interventions)

Trauma Kits (100 sever interventions)

Emergency Humanitarian Action, WHO Country office, Pakistan

Updates of Medical Kits/Supplies Delivered

S/No District name Diarrhea treatment IEHK MEHK Other Kits Delivered Supplies

1 (Baluchistan) 5 8 500 Hygiene kits

2 (Punjab) 2 (1 each for 4 (2 each for Mianwali and Mianwali and Rajanpur) Rajanpur)

3 (Sindh) 16

4 Peshawar (KPK) 15 1 11 (Buffer Stock)

5 Nowshehra (KPK) 3 1 1 300 Ringer, 400 ORS, 300 Normal Saline Infusion

6 Mardan (KPK) 2 kits (EDO), 2 kits (DHQ)

7 Swat (KPK) 11 (6 kits ready) 3 Mini Surgical for DHQ (Ready for dispatch)

8 Buner (KPK) 11 (6 Kits for EDO 4 ready for Delivery)

9 Lower Dir (KPK) 3

10 Kohat (KPK) 1

11 Hangu (KPK) 1

12 Tank (KPK) 2

13 Charsadda (KPK) 1 1

Emergency Humanitarian Action, WHO Country office, Pakistan Requests which are (In process)

S/No District name Requesting Health Detail of Request Partner

1 IDEA 2 MEHK 1 Cholera Save the Children 1 MEHK

Swat HELPING HAND 1 MEHK

American Refugee 2 MEHK Committee 1 Diarrhea treatment Kit 2 Charsadda Muslim Aid 1 MEHK (

3 Punjab Department of 10 MEHK Health 10 Diarrhea treatment Kits

Flood Devastation and Health action in crises Photos in KPK

(The situation report 2 is compiled in the scenario of disrupted communication channels and infrastructure in the flood affected , which is a gap/challenge hampering all the humanitarian missions/workers in terms of loss/damage assessment at this moment)

For further information please contact

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]

Emergency Humanitarian Action, WHO Country office, Pakistan