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Highlights Health Sector HEALTH CLUSTER BULLETIN # 2 Preparation of medical camp kits 11May 2015 Photo: WHO/J.Swan (MCKs) in Bharatpur Nepal Earthquake Health Cluster Bulletin No. 5 28 May – 3 June 2015 5.6 MLLION 2.8 MILLION 0 22,220 8699 AFFECTED DISPLACED REFUGEES INJURED DEATHS HIGHLIGHTS HEALTH SECTOR Five weeks into the emergency response 170 HEALTH CLUSTER PARTNERS following 25 April and 12 May earthquakes, the 5.6M TARGETED POPULATION health cluster response is transitioning towards MEDICINES & SUPPLIES revitalization of primary health care services in the affected districts in early recovery and >20 TONNES OF MEDICINE DISTRIBUTED TONNES OF MEDICINE IN IN- rehabilitation framework. >28 The Ministry of Health and Population’s (MoHP) COUNTRY STORAGE Early Warning and Response System for epidemic-prone diseases (EWARS) show a PUBLIC HEALTH FACILITIES generally stabilizing trend in numbers of 439 COMPLETED DAMAGED outbreak prone diseases in the 14 highly 564 PARTIALLY DAMAGED affected districts. HEALTH ACTION On 28 May, tuberculosis sub-cluster was established under the health cluster to priorities 103686 CASES TREATED joint planning preparedness and response 31707 ADMISSIONS related to post earthquake care to TB patients including continued medication and rehabilitation EWARN support to Multi-drug Resistant (MDR) patients in 14 highly affected districts. 32 - 40 SENTINEL SITES Health cluster contingency plan for flood and landslides was jointly developed with WASH FUNDING $US cluster to ensure the timely preparation for the 43.1 % FUNDED response to upcoming monsoon season. With heavy heart we report that four medical aid workers were killed in a helicopter crash in $41.8 M REQUESTED Sindhupalchok district on 2 June 2015. *Availability of accurate information on health facilities’ status from seriously affected sites is a major challenge for the MoHP PAGE 1 Situation update The Government reported a total of 505,745 houses destroyed and 279,330 damaged by the 7.8 magnitude earthquake on 25 April and the 7.3 quake on 12 May. The public health consequences of the earthquake have been significant as more then 22, 000 people injured in earthquake and a total 1003 health facilities, mostly village health post often serving the population in hard to reach area of the highly affected 14 districts have been damaged and rendered non-functional. A total of 18 health workers, including 10 Female Community Health Volunteers (FCHVs) lost their lives and other 68 health workers injured. A total of 2778 have undergone major surgery out of which more than 1500 injured have an on-going nursing and rehabilitation needs. As the emergency response transitions into the recovery phase, the health cluster priority activities target to revitalize health service delivery with focus on restoration of Primary Health Care services, through the provision of medical supplies, tents and rehabilitation support ensuring that priorities such as reproductive health, mental health, and child health are coordinated and addressed. Strengthening the communicable disease control and surveillance system, particularly in view of approaching monsoon season remains the key priority for the immediate future. The Ministry of Health and Population’s (MoHP) Early Warning and Response System for epidemic- prone diseases (EWARS) show a generally stabilizing trend in numbers of outbreak prone diseases in the 14 severely affected districts. No major outbreaks have been reported to date. District Public Health Offices (DPHOs) continue to gather information on rumours or other alerts of potential disease outbreaks in the 14 most highly affected districts. The MOHP has been finalizing the Post Disaster Need Assessment (PDNA) and district planning process. PDNA exercise mainly focused on assessing the status of health services and health commodities, infrastructure, governance and risks at the district level. The exercise will help the MoHP and health cluster partners including the external development partners to identify the post disaster needs in order to target the support to districts in implementing the district recovery plan. Forty seven National Medical Teams with diverse skills and expertise including surgical, medical, orthopaedics, gynaecologists, obstetrics, psychiatrists and psychosocial counsellors have been deployed to the affected district in order to support the management of post trauma rehabilitation and mental health problem arising from the earthquakes. In addition, 25 FMTs comprising of 463 persons including 135 doctors and 145 nurses are currently working in the earthquake-affected districts. Table below taken from MOHP sitrep (2 June 2015) provides a snapshot of casualties per districts. PAGE 2 Districts in the spotlight Each week, the health cluster bulletin will zoom in on needs and health action in the most affected districts. The current issue will take a closer look at the situation in Kathmandu Valley districts – Bhaktapur, Kathmandu and Lalitpur. Health risks, priorities, needs and gaps The public health consequences of the earthquake remained worrisome in Kathmandu valley districts with a high number of casualties and damage of infrastructure. The summary of the total casualties and damage in three districts is presented below: Districts Number Number House damaged Health facilities damage of of deaths injured completely partially completely partially functional Bhaktapur 333 2101 18900 9090 8 9 5 Kathmandu 1222 7864 36973 50753 7 45 21 Lalitpur 174 3052 17444 8064 10 22 12 The central level referral hospitals have also sustained significant damage. A total of 400 beds of Bir Hospital and 300 beds of Maternity Hospital and were rendered non-functional due to the severe damage. Some clinical blocks of Patan hospital and the residential block and store of Sukraraj Tropical hospital and the older block of Bhaktapur hospital were damaged according to the Ministry of Health and Population report dated 10 May 2015. In Majority of the hospitals, services have been continued in the extended spaces managed by tents. In Bhaktapur hospital, in patients treatments continue in tents. MOHP identifies 429 patients in Bhaktapur, Kathmandu and Lalitpur are in need of longer term treatment support and more than 250 need longer term rehabilitation support. PAGE 3 People displaced from Sindhupalchok district due to the damage of their house and the increased landslides risk have been staying in three larger camps in Bhaktapur i.e. Nilbarahi (1104 people), Maheshwory (< 800 people) and Kamalbinayak(<900 people). Monitoring of four syndromic diseases namely acute respiratory infections, acute watery diarrhea, acute bloody diarrhea, and fever of unknown origin continued, presenting generally stabilizing trend in Kathmandu valley. Number of acute watery diarrhoea cases, Kathmandu Valley 120 100 80 60 40 5 and over 20 number of cases of number Under 5 0 30-04-2015 02-05-2015 04-05-2015 06-05-2015 08-05-2015 10-05-2015 12-05-2015 14-05-2015 16-05-2015 18-05-2015 20-05-2015 22-05-2015 24-05-2015 26-05-2015 28-05-2015 31-05-2015 01-06-2015 26-04-2015 Number of bloody diarrhoea cases, Kathmandu Valley 30 25 20 15 10 5 and over 5 number of cases of number Under 5 0 30-04-2015 02-05-2015 04-05-2015 06-05-2015 08-05-2015 10-05-2015 12-05-2015 14-05-2015 16-05-2015 18-05-2015 20-05-2015 22-05-2015 24-05-2015 26-05-2015 28-05-2015 31-05-2015 01-06-2015 26-04-2015 Number of fever cases, Kathmandu Valley 120 100 80 60 40 5 and over 20 number of cases of number Under 5 0 08-05-2015 26-04-2015 30-04-2015 02-05-2015 04-05-2015 06-05-2015 10-05-2015 12-05-2015 14-05-2015 16-05-2015 18-05-2015 20-05-2015 22-05-2015 24-05-2015 26-05-2015 28-05-2015 31-05-2015 01-06-2015 PAGE 4 Number of acute respiratory infection cases, Kathmandu Valley 120 100 80 60 40 5 and over 20 numberof cases under 5 0 26-05-2015 30-04-2015 02-05-2015 04-05-2015 06-05-2015 08-05-2015 10-05-2015 12-05-2015 14-05-2015 16-05-2015 18-05-2015 20-05-2015 22-05-2015 24-05-2015 28-05-2015 31-05-2015 01-06-2015 26-04-2015 Health Cluster Action The health cluster mechanisms have been established in the Kathmandu valley districts. The cluster operations are led by the DPHO with co-leadership from WHO. As of 3 June 2015 a total of 24 health cluster partners in Bhaktapur, 40 in Kathmandu and 18 in Lalitpur district have been involved in the health cluster response (based on 4Ws information) The field hospitals established by FMTs have completed the initial services of mass casualty management and now services are being covered by the normal hospital services, except the Cuban Medical Team (CMT) in Kirtipur. The Injury Rehabilitation sub-cluster has identified a number of large step-down facilities with rehabilitation and nursing services available in the Kathmandu Valley. The main centres include: Cuban FMT at Kirtipur, Anandaban TLM Hospital (Laltipur), Spinal Injury Rehabilitation Centre (Sanga), Nepal Youth Foundation and Patanjali Yogpeeth. These facilities have a capacity of total of 315 beds. The National Tuberculosis Centre jointly with the cluster partners has been working to ensure the post-earthquake care for the TB patients including the tracing and continuity of medication. The MOHP has confirmed that free follow up services will be provided in public hospitals in Kathmandu and the district hospitals in the 14 affected districts for one year. Hospitals in Kathmandu include TUTH, Bir, Patan, Army Hospital, Civil Hospital, Police Hospital, Dulikhel and Nepal Orthopedic Hospital. PAGE 5 Public health risks, priorities, needs and gaps Communicable diseases There is concern about the risk of outbreaks of communicable diseases, including water-borne diseases, vector-borne diseases and acute respiratory infections, in areas of overcrowding and where water, hygiene and sanitation (WASH) systems have been disrupted.
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