HEALTH CLUSTER BULLETIN Bulletin 9 PAKISTAN 19 August 2009

Conflict-Displaced Persons Crisis HEALTH CLUSTER BULLETIN Bulletin 9 PAKISTAN 19 August 2009

Highlights • 218 452 IDP families have now retur- ned to their homes and villages in Malakand Division. Another 15 564 families from Malakand Division remain scattered in camps and other locations in the North West Frontier Province (NWFP). Five new camps have been opened in Buner and Lower Dir. The Suwari and Karapa camps are currently hosting 889 families, while another 2,150 families have been registered at the Munda, Wali Kundo and Khungi Shah camps. J.G. Brouwer/WHO • Outpatient consultations for maternal, WHO staff teaches IDPs in Jalozai camp on how to treat water. neonatal and child health care have decreased by 8% in 7 maternal neonatal and child health care service delivery points in Lower Dir, Mardan and Nowshehra.However, At the same time, pre- and postnatal consultations have increased by 37% and 33% respectively.

• WHO environmental health engineers are continuing to monitor water and sanitation in all IDP camps as well as in all host communities reporting a waterborne disease alert or outbreak. A total of 33 water samples were tested for biological contamination, and another 40 samples were tested for residual chlorine and over one fifth were found unfit for drinking. Water test results were forwarded to the Water, Sanitation and Hygiene (WASH) cluster for appropriate actions.

• Additional maternal, newborn and child health care services are badly needed in returnee districts to handle the increasing number of patients. Securing the services of trained female health care providers is a challenge given the precarious state of security.

• Due to heavy rains on the night of 15 August 2009 flash floods affected District Swabi and Mardan. Due to these floods union councils Ismaila, Adina, Kalu khan and Shaikh jana of district Swabi were badly affected and Mohib Banda, Battagram, Garhi Daulat Zai, Garhi Ismail Zai, Charmung, Galyara, Machi, Usai, Dogar, Rustam, Chargulli, Zandu, Shahbaz Garhi, Bala garhi and Kot Ismail zai of district Mardan. (source: DCO Office Mardan)

The health facilities which are affected by flood include RHC shahbaz garhi, BHU Zandu, BHU chargulli, BHU Battagram (source: EDO-H ) in Mardan . WHO has done an assessment on 17 August for health needs and interventions.

The approximate population of these union councils is 50 000 – 55 000 individuals (source: District Nazim authorities). The flash flood badly affected the population by damaging the infrastructure. (Annex 2: Map of areas affected by flood)

IDP Profile • According to a report presented during the district health cluster meeting held at EDO-H Peshawar on 11 August, the number of schools in Peshawar hosting IDPs has decreased considerably, from 578 to 137. Currently, 5 478 IDPs are registered in Peshawar schools. Most of the IDPs who were previously enrolled have returned to their districts. • 218 452 IDP families have now returned to their homes and villages in Malakand Division. Another 15 564 families from Malakand Division remain in camps and other locations in NWFP. (source: Provincial Relief Commissionerate Emergency Response Unit.) • The following IDP camps have been closed by the Government: Palosa 2, Jalozai 2, Sheikh Shahzad, Sheikh Yaseen, Mazdoor Abad, Chota Lahore, Shah Mansoor 1, Shah Mansoor 2, Larama, Saleem Sugar Mill Camp. The total population of these camps reached 25 112 families. • Five new camps have been opened in Buner and Lower Dir, IDP’s districts of return, due to continuing insecurity. The Suwari and Karapa camps are currently hosting 889 families, while another 2,150 families have been registered at the Munda, Wali Kundo and Khungi Shah camps. (Data from the Provincial Relief Commissionerate Emergency Response Unit.)

COORDINATION

• Training on Rapid Health Assessments was conducted on 12 August 2009 in Peshawar for twenty two Health Partners to assess health facilities and gaps in health services needs in Districts of D.I. Khan and Tank. Assessment for D.I Khan is scheduled on 24 August 2009. • During the provincial health cluster meeting held on 13 August, the Deputy Director of Public Health updated partners on Pandemic (H1N1) 2009, and shared the Ministry of Health’s preparedness plan. The DoH has sufficient stocks of antiviral medicines. Fourteen disease surveillance sentinel sites have been established in NWFP. • Based on the recommendations of the Inter Cluster Diagnostic Mission that visited Pakistan during 13-17 July 2009, global health cluster has conducted series of workshops on health cluster coordination on 17, 19 and 20 August 2009. During the workshops the cluster mechanism, roles and responsibilities and challenges were discussed.

HEALTH ASSESSMENT • Outpatient consultations for maternal, neonatal and child health care have decreased by 8% in 7 maternal neonatal and child health care service delivery points in Lower Dir, Mardan and Nowshehra.However,at the same time, pre- and postnatal consultations have increased by 37% and 33% respectively. There has been an 83% decrease in family planning consultations at the UNFPA-supported government health facilities as well as in maternal, newborn and child health clinics in the camps. • A rapid health assessment for Disrtict Tank was planned for August 17th. It has been postponed due to security reasons, while the one for DIK will be conducted on the 24th

Disease Surveillance • Below is the pattern of the five most common communicable diseases in the IDP camps in NWFP.

• Upper respiratory tract infection (URTI) was the most common disease (16%) and was also the leading cause of morbidity both inside and outside the IDP camps, with the exception of district Swabi where acute diarrhoea was the leading cause of consultation. • Acute diarrhoea (AD) and lower respiratory tract infections (LRTI) are common causes of morbidity and the leading causes of deaths among children under five. • The number of cases of acute diarrhoea (AD) cases is expected to rise with the onset of monsoon rains. • Two alerts for suspected dengue haemorrhagic fever were reported, investigated and responded to. One case was reported from Khyber Teacher Hospital and the other from Lady Reading Hospital, Peshawar.

Environmental health, water and sanitation • WHO environmental health engineers are continuing to monitor water and sanitation in all IDP camps as well as in any host community that reports a waterborne disease alert or outbreak. • A total of 33 water samples were tested for biological contamination, and another 40 samples were tested for residual chlorine and over one fifth were found unfit for drinking. Water test results were forwarded to the Water, Sanitation and Hygiene (WASH) cluster for appropriate actions.

FILLING GAPS • Save the Children supported the operations of three static health teams in Swabi (RHC Ambar Kunda, Civil Hospital Kalu Khan and Civil Dispensery Col Sher Khan Kaley) and two in Mardan (RHC Shahbaz Gari and RHC Toru), as well as five mobile health teams in Mardan, Buner and Swat.

• UNFPA contributes to provide comprehensive reproductive health care services at seven maternal, neonatal and child health care service delivery points in Lower Dir, Noshehra, Charsadda and Mardan districts.

• Care International has conducted medical camps in consultation with the health cluster,( the Health authorities and the Nazims / Chairman Union Council,) in the respective union councils in the district Mardan. Total 6 mobile medical camps were arranged last week in Mardan for IDP living in host communities with 923 consultations ,403 females & 327 children were provided health care

• Islamic Relief has provided health services to Union Council Rustum,Chargulay, Katta Khat, Bakhsale and Machi. The number of consultation are 1519 with maximum number of upper respiratory track (229), followed by acute diarrhoea (180).

• Merlin is supporting 11 health facilities in Buner district including CH Totalai, CH Pir Baba, CH Nawagai, RHC Nagrai, the BHUs Mallaka, Gagara, Charorai, Nawakalai, and the MCH centre in District Head Quarters hospital Daggar. Additionally, one mobile team is operating in Sultanwas area. In collaboration with EDO-H Buner, Merlin is providing health care services in the newly opened Karapa camp. To date, Merlin has deployed 10 doctors (including one female), 10 dispensers, six LHVs, two midwifes, three male nurses, two pharmacists, and 20 health promoters.

All health facilities supported by Merlin have been provided with the necessary equipment, furbishing, generators and medicines. Repairs to the infrastructures will start next week. The training of different staff categories is ongoing. Three of the health facilities have begun transmitting DEWS reports.

Merlin has assessed nine health facilities in Swat district, where it has opened an office. An NOC from EDOH Swat hs been seconded to Merlin.

• ARC-International has continued its health services in RHC (Rural Health Centre) Yar Hussain with 1911 Out patient consultations. There were 126 Acute respiratory and 126 Acute diarrheoa cases treated. The number of delivries reported are 16.

• JSI-PAIMAN-supported NGOs working in Mardan are now moving back to Swat, while one NGO will move back to Buner next week. Last week, PAIMAN provided support to NGOs running 12 health camps in Mardan.

• WHO donated essential medicines and supplies (four mini-emergency health kits (MEHKs), one cholera kit, 100 antirabies treatments and 50 vials of snake antivenom) to EDO-Health of DI Khan, to be used as emergency stocks for IDPs. WHO also sent ORS & aqua tabs to Khat Kalay District Nowshera for acute watery diarrhoea interventions. WHO donated a second MEHK to IMC Buner for Swabi camp health interventions. One MEHK contains enough supplies to meet the medical needs of 6,000 people for one month.

• WHO and Child Advocacy International conducted a training of trainers workshop on Basic Life Support. Twenty health care providers from DHQ, THQ and RHCs of five IDP hosting districts (Charsadda, Nowshera, Peshawar, Swabi and Mardan) attended the workshop.

Urgent Needs: • Public health services, particularly MNCH, newborn, vaccinations, disease surveillance and secondary care facilities for chronic illnesses, need to be strengthened urgently in the districts of return. • Additional maternal, newborn and child health care services are badly needed in returnee districts to handle the increasing number of patients. Securing the services of trained female health care providers is a challenge given the precarious state of security.

Funding situation • As of 18 August, the Health Cluster has received 38% of funds required as presented in the UN Pakistan Humanitarian Response Plan (Revision) document. The Health Sector as a whole has identified needs at US$47 172 821. (Relief Web's Financial Tracking system)

Communication and advocacy activities Efforts are being made to raise the visibility of the health response to the crisis through: • Radio and television interviews with national and international outlets • Health Cluster Bulletins • Website materials/updates

Web links:

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 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]

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 Diarrhoea 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 Warring System DHQ: District Headquarter DTC: Diarrhoea Treatment Centre DSM: District Support Manager 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 Pakistan: Flash floods in Swabi and Mardan District- North West Frontier Province

Turkmenistan Tajikistan Tajikistan China Lower Dir Puran F.A.N.A. Swat Swat Martoong N.W.F.P. Aksai Chin P.A.K. Shangla Afghanistan Disputed Area Swat Rani Zai F.A . T. A . China/India China Malakand PA PUNJAB Mansehra Baizo Kharki Mardan BALOCHISTAN

Kohi Barmol Ikram Pura Biazo Kharki Iran (Islamic Republic of) India Sam Rani Zai SINDH

Qasmi Mian Khan Daggar Buner Miangano Killi Alo Mansehra Babuzai

Shamozai Babuzai Mian Issa Dheri Lakpani Shergarh Lund Khwar v Lund Khwar Lund Khwar The following are he worst affected Union councils Aman Kot Hathian having approximately 500 houses damaged affecting Zor Abad Palo Dheri Rustam 35,000 people: Katlang Palo Dheri Kati Garhi Jalala v Tangi Pir Saddo Rustam Ghazi Takht Bhai Jamal Garhi Ismaila in Swabi district Pir Saddo Kata Khat Char Guli NARANJI Machi Garyala and Shahbaz Garhi in Mardan district Ta kht Bha i Mardan Haripur Kot Jungara BAHADAR ABAD(PARMOLI) Mian Killi Takkar Akbar Abad Parkho Dheri Less affected Union councils are as follows: Sawal Dher Gujrat Mardan Khair Abad Mardan

Bakhshali Kalo khan, Adena in Swabi district Kodinaka Fathma UTLA GANI KOT Seri Behlol Galyara Mohib banda, Bala garhi in Mardan district Jamra Garyala !( !( GANI CHATRA GABASANI FS Mill Takht Bhai SHEWA SHEWA Bala Garhi !( Charbanda Shahbaz Garhi CHANAI Shahbaz Garhi ISMAILA !( Gujar garhi Adena SHEIKH JANA Baghicha Dheri Kalo Khan MANGOLCHAI ADINA Check Mardan NAWAN KILLI Kass Korona KALU KHAN TURLANDl !( Bughdada Mohib Banda Kot Ismailzai Ismaila v Mardan Sikandar Korona CHECK NODEH Sheikh Yousaf Garhi Ismailzai KALU KHAN Legend Manga Par Hoti Mardan KAB GANAI Bijligar Korona Guli Bagh Mohib Banda YAR HUSSA1N TARAKAI v Mardan Type of health facilities Mayar SALIM KHAN Charsadda DAGAI Khazan Dheri PS Mill MArdan MIAN KILLI BADA YAQOOBAI !( DHOBIAN MALIK ABAD DHQ Charsadda Sharif Abad Sheikh Maltoon Mardan To ru !( BACHAI JANDA Shiek Maltoon BARAKI No.1 Gumbat Mardan Muhabat Abad Qasam GANADAF TOPI SADRI JAD1D BARAKI No.2 SWABI THQ FPHC GANDAF CAMP Ghala Dher !( SWABI v !( BAJA MAINI QADRA SWABI SWABI GANDAF v Bago Banda Shamat Pur FAZAL ABAD SWABI GADOON IND. STAT CH SARD CHINA BAMKHELA !( !( Swabi RHC KOTTA MARGHUZ TOPI RBC COLONY SHAH MANSOOR TANDO KOHI v GIK UNIVERSITY TOPI AMBAR KUNDA Zaida Swabi BHU PEHORE LAHORE Lahor LAHORE EAST ZAIDA !( LAHORE!( EAST !( JALSAI DISP LAHORE PORAY BETA KARA MANKI ZAROBI JALBAI MCH DHER1 ZAKRIA

BEKA TORDHER Union council boundary Worst affected Nowshera Nowshera JEHANGIRA Ghazi Haripur Haripur Less affected Tehsil boundary Attock Attock District boundary Hasan Abdal Province boundary Rawalpindi Neighbour country

Produced by: Information Management Unit, WHO-Pakistan Date created: August 18, 2009 WHO Map Num: WHO-Flood-321

GIS data dource: HIC, WHO 0369121.5 Scale: 1:344,644 Kilometers The boundaries, names and the designation used on this map do not imply official endorsement or Data source: WHO, OCHA 1 inch equals 9 kilometers acceptance by the United Nations. Dated: 18 August, 2009 . World Health Organization, Chak Shehzad, NIH Premises, Park Road, Islamabad. Email: [email protected] Website: http://www.whopak.org