EARTHQUAKE IN Situation Report No. April 4-21, 2016

KEY INFORMATION  Seven hospitals operated by the Ministry of Public Health (MSP) and the Ecuadorian Social Security Institute (IESS) have severely damaged infrastructure and are not operational.  Health personnel in the provinces of Manabí and Esmeraldas are also affected, including some deaths. Others lost family members and homes.  There is potential risk of water-, vector-, and food-borne diseases due to limited drinking water and sanitation services, rubble and debris, and lack of proper shelter among people who have lost their homes.

7015 155 24,442 570 24 INJURED MISSING IN AFFECTED SHELTERS DEAD HEALTH FACILITIES

Source: Risk Management Department, April 20, 2016, 7:30 p.m. Ministry of Public Health, April 20, 2016

HEALTH SITUATION Status of Health Services Network According to the preliminary assessment, the earthquake has affected the infrastructure of at least 24 MSP and IESS health facilities (14 health centers and 10 hospitals) in the provinces of Manabí and Esmeraldas. Seven (7) of the 10 hospitals and six of the 14 health centers that report damage are out of service. Another three health facilities are not operating despite suffering less damage, due to a lack of personnel, some of whom are afraid to return to work.

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Table 1. Reported status of health facility infrastructure

TIPO DE PROVINCIA CANTON NOMBRE DEL ESTABLECIMIENTO INSTITUCION DAÑO PROBABLE CONDICION ESTABLECIIMENTO 1 Esmeraldas Muisne Hospital Carlos del Pozo Melga MSP Grave Inoperativo 2 Esmeraldas Rioverde Centro de Salud Resbalon MSP Leve Operativo 3 Esmeraldas Rioverde Centro de Salud Valdez MSP Leve Operativo 4 Esmeraldas Rioverde Centro de Salud Frutillo MSP Grave Inoperativo 5 Esmeraldas Rioverde Centro de Salud San Eloy MSP Leve Operativo 6 Esmeraldas Rioverde Hospital Rocafuerte MSP Leve Operativo 7 Manabi Bahía de Caraquez Hospital Bahia de Caraquez IESS Grave Inoperativo 8 Manabi Bahía de Caraquez Hospital Miguel Alcivar MSP Grave Inoperativo 9 Manabi Bolivar Hospital Básico de la Calceta MSP Leve Operativo 10 Manabi Chone Hospital Napoleo Dávila Cordova MSP Grave Inoperativo 11 Manabi Flavio Alfaro Hospital Flavio Alfaro MSP Grave Inoperativo 12 Manabi Jama Centro de Salud Jama MSP Grave Inoperativo 13 Manabi Jama Centro de Salud La Concordia Tipo C MSP Leve Operativo 14 Manabi Manta Hospital Manta IESS Grave Inoperativo 15 Manabi Manta Hospital Rodriguez Zambrano MSP Grave Inoperativo 16 Manabi Portoviejo Centro de Salud Los Angeles de Colon MSP Grave Inoperativo 17 Manabi Portoviejo Centro de Salud Portoviejo MSP Leve Operativo 18 Manabi Portoviejo Centro de Salud Nuevo Portoviejo MSP Grave Inoperativo 19 Manabi Portoviejo Centro de Salud Andres de Vera MSP Leve Inoperativo 20 Manabi Portoviejo Hospital Verdi Zevallos MSP Leve Operativo 21 Manabi Tosagua Centro de Salud Tosagu MSP Grave Inoperativo 22 Manabi Tosagua Centro de Salud Bachillero MSP Leve Operativo 23 Manabi Tosagua Centro de Salud La Estancia MSP Leve Operativo 24 Manabi Tosagua Centro de Salud Cerro Verde MSP Leve Operativo

MSP continues to assess the damages to health facilities and equipment.

Four days after the earthquake, MSP continues to mobilize personnel, medical teams, and supplies to assist affected areas. As of April 20, care had been provided to 7,015 people and 284 were referred to other health facilities.

Emergency medical response teams The Medical Information and Coordination Cell (CICOM) was activated by MSP with technical support from PAHO. Twenty-two (22) national emergency medical teams and five international emergency medical teams have been deployed.

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National emergency medical teams (EMTs) deployed Type of EMT Location 1 EMT level 2 (for patient referral) , Guayas 1 EMT level 2 Chone, Manabí 1 EMT level 2 Portoviejo, Manabí 1 specialized surgical cell Manta, Manabí 1 specialized surgical cell Bahía, Manabí 1 specialized surgical cell Santo Domingo, Santo Domingo 1 EMT level 1 Pedernales, Manabí 1 EMT level 1 Manta, Manabí 1 EMT level 1 Bahía, Manabí 1 EMT level 1 Jama, Manabí 1 EMT level 1 San Vicente, Manabí 3 EMT level 1 Portoviejo, Manabí 1 EMT level 1 Esmeraldas, Esmeraldas 1 EMT level 1 Vinces, Los Ríos 1 EMT level 1 , Los Ríos 1 EMT level 1 Chone, Manabí 1 EMT level 1 Muisne, Esmeraldas

Three cells coordinate pre-hospital care

International emergency medical teams (EMTs) deployed  1 mobile EMT level 1 (Humedica, Germany) deployed in Bahía de Caraquez.  1 EMT level 2 (Samaritan Purse, USA) deployed in Chone  1 EMT level 2 (Salud, Peru) expected to arrive on April 21; assigned to Miguel Alcivar hospital in Bahia.  1 pre-hospital care cell (Red Cross, Colombia) deployed in Esmeralda  1 EMT logistic support cell (AECID, Spain) providing support to CICOM and MSP for water and sanitation and power supply.

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Wait-listed EMTs that have offered assistance: No. ORIGIN 1 Canada –Canadian Red Cross – EMT level 1 2 European Union – Emergency Response Coordination Centre –European Medical Corps 3 Venezuela – Venezuelan Paramedics Federation – Specialized pre-hospital care cell 4 United States – NYCMedic – mobile EMT level 1 5 Germany – ISAR – EMT level 2 6 Colombia 7 United States 8 United States, United Kingdom, Canada – Humanity First – EMT level 1 9 United States– Reach Out Worldwide – mobile EMT level 1

Shelters 68 shelters and refuges have been set up, housing 23,506 people.

Water and sanitation The PAHO water and sanitation expert reports that in the city of Pedernales drinking water coverage has dropped 20% from pre-earthquake levels (50%). The following sectors do not have drinking water: Brisas del Pacífico, Nuevo Amanecer, Los Palmitos, María Luisa I, II, III Etapa, and Geramime I, II, III Etapa. The city of Jama does not have regular water supply due to damage to the pumping system, and a water treatment system is in place.

IDENTIFIED RISKS  Limited operational continuity in health programs and services due to complex damage to infrastructure and equipment.  Increase in patient referrals to the hospitals closest to areas affected by the earthquake, leading to increased demand for care.

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 Possible increase in water-, food-, and vector-borne diseases due to deteriorating housing and environmental conditions.  Appearance of psychological and social problems in shelters and affected communities.

RESPONSE ACTIVITIES Ministry of Health (MSP) / health sector  MSP is continuing its response activities in the areas affected by the earthquake. Assessment teams are evaluating the damage to health facility infrastructure.  The epidemiological surveillance system is being reestablished. The situation room is operating in coordination with the Health Emergency Operations Center (COE Salud) from the National Emergency Operations Center (ECU911). MSP is taking action to strengthen epidemiological surveillance in the affected areas.  MSP has made an international call for EMTs. Level 2 EMTs have been invited to register to be selected and deployed to hospitals in Bahía de Caráquez and Flavio Alfaro in Manabí province.  MSP has indicated that there is no need for level 1 EMTs or individual volunteers, since health personnel have been mobilized to support emergency operations in the affected areas.  MSP has produced a list of essential medical devices and drugs for seismic events. Fybeca is helping to receive and organize medicines donated by individuals, while collection centers will handle donations from organizations. The two drug collection centers, one in Manta and the other in the Central Technical College, operate under the supply management system (SUMA/LSS).  The MSP collection center for drugs provided through international and national assistance is located in the Central Technical College in . It is operational and has issued a report on the availability of medicines based on MSP’s national list of medical drugs and materials.  SUMA was implemented in the IESS in order to control deliveries to health services units. IESS is using its structure to distribute supplies to the places where they are

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most needed, and is identifying availability in its units. Rapid work is underway to prepare a daily report and overview of the distribution of supplies.  An MSP team with SUMA training was sent to Manta to set up a reception and distribution center for medical supplies.  59 ambulances have been mobilized for patient referral.  12 multidisciplinary teams (epidemiology, risk management, health services, and infrastructure assessment) have been deployed in Portoviejo, Pedernales, Manta, and Muisne.  21 EMTs made up of specialists in trauma and emergency medicine, as well as surgeons, nurses, and psychologists are providing care in Portoviejo, Manta, and Muisne. Also, 135 volunteer health workers are being coordinated by MSP in Manta.

PAHO/WHO • PAHO/WHO response teams continue working with MSP to evaluate damages in health facilities, communities, and water and sanitation systems. • Coordination with humanitarian health group on response activities and review of Flash Appeal proposal. • Panama has provided 200 body bags at the request of the Ecuadorian government. • Support for EOC operations. • Implementation of SUMA/LSS in coordination with MSP at the first collection center. • PAHO will deploy two international experts on water and sanitation, and will support structural evaluations of hospitals. • One expert in communications has been deployed to MSP and the PAHO office in Ecuador.

Other actors  PMA is distributing food kits to hospital workers in Manta and Pedernales, covering a 15-day period.

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 UNFPA is working with MSP to estimate the need for sexual and reproductive health kits in the affected areas.  Action Against Hunger plans to mobilize 183,000 Euros to implement a health care strategy for mothers and breastfeeding infants.  A UNICEF charter flight arrived with tents, medicines, mosquito netting, and humanitarian assistance items. These will be delivered to national organizations, among them MSP.  UNICEF will be implementing a “Back to Happiness” strategy (Retorno a la Alegría) as part of a mental health intervention aimed at children under 5 years of age.

NEEDS • Reestablish health care capacity in the hospital network through provisional strategies, repair and cleanup of treatment areas, purchase of water tanks, electric power generators, and other equipment. • Reorganize the patient referral and counter-referral system, prioritizing the strengthening of the primary health care network. • Timely detection of outbreaks in shelters and affected communities by reestablishing the epidemiological and environmental surveillance system, and by strengthening the public health laboratories. • Psychological and social care and protection for health workers, people in shelters, and communities in the affected areas. • Develop healthy practices in the population for disease prevention. • It is estimated that at least 500 wheelchairs and crutches are needed to replace those lost by persons with disabilities and for others with serious injuries who may need them. • Implementation of SUMA/LSS in support of technical group 4 on Humanitarian Aid and Supplies (MIES ECU911) in the National Crisis Room for control of national-level distribution of assistance. This will require workers trained in the deployment of logistical support operations.

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Information sources: • Ministry of Public Health, National Situation Room, Ecuador • Risk Management Department, Ecuador • Office of the Attorney General, Ecuador • PAHO/WHO Representative Office, Ecuador (field reports from staff members) • Ministry of Foreign Affairs

FOR MORE INFORMATION For more information, please contact: PAHO Ecuador: Dr. Alejandro Santander: [email protected] PAHO Washington D.C.: Dr. Alex Camacho: [email protected]

For more information, please visit: www.paho.org www.paho.org/ecu/

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