1 Georgia Health Cluster Situation Report No. 1 13 October 2008 HIGHLIGHTS • No communicable disease outbreaks reported; • Focus on infant and children feeding in emergencies; • Relocation efforts of Internally Displaced Persons (IDPs) to their home communities and to the Gori area are ongoing; • IDP hotline (090) established by the Government to assist IDPs, including health related support; • Cluster approach was activated on 18 September 2008; • CAP/Flash Appeal revision and Joint Needs Assessment (JNA) have been finalized. WHAT IS THE GEORGIA HEALTH CLUSTER? The Health Cluster (HC), under the leadership of the World Health Organization (WHO) and in coordination with the Ministry of Labour, Health and Social Affairs (MoLHSA), is made up of national and international health organizations that have been working together after the August crisis to build partnerships and mutual understanding for common actions. The HC in Georgia is developing common approaches to improve coordination in the health sector and to enhance the effectiveness, efficiency, and accountability of health actions. The work of the HC aims to enhance: • Greater coherence in health action among the many and varied stakeholders by building partnership and common understanding; • Well-managed health information, integrated into an overall information management system that will serve all stakeholders to ensure an evidence-based health response; • Predictability and accountability in international responses, by clarifying the division of labour among organizations, and better defining their roles and responsibilities within the different sectors of the response; • A system to rapidly deploy health experts to respond to country needs. (for more information on Georgia clusters go to: http://www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=75; http://www.humanitarianreform.org/Default.aspx?tabid=700; http://www.humanitarianreform.org/Default.aspx?tabid=695) Health Cluster Coordination meetings were held on: o 23 September 2008, Gori tent camp, o 2 October 2008, Ministry of Labour, Health and Social Affairs, o 9 October 2008, Ministry of Labour, Health and Social Affairs. Mental Health and Psychosocial Support (MHPSS) subsectoral meeting was held on: o 30 September 2008, UN House. The activities (to date) of the Health Cluster partners are summarized in Annex 1. Minutes of the above meetings can be obtained through the WHO Country Office in Georgia. 1 GENERAL SITUATION UPDATE • Over 130 000 people have since the crisis commenced on 7 August been displaced and accommodated in IDP camps, collective centres and host families; • Currently 86 995 IDPs (see below table) are located in Tbilisi and 46 061 are scattered in different regions; • In Gori town there are 6 681 IDPs of which 2 250 reside in tent camps, 2 370 in host families and 2 061 in 28 collective centres (source: data received from the Ministry of Refugees and Accommodation of Georgia); Breakdown total (compiled) displacement caused by the “Georgia Crisis” (excl. South Ossetia and Abkhazia) Regions IDPs from “Georgia Crisis” [CRA; peak of 3 October 2008] Adjara 1 980 Guria 1 130 Imereti 5 716 Kakheti 4 350 Kvemo Kartli 6 523 Mtskheta-Mtianeti 3 344 Racha-Lechkhumi and Kvemo Svaneti 182 Samegrelo-Zemo Svaneti 178 Samtskhe-Javakheti 6 297 Shida Kartli 14 601 Tbilisi 86 995 Not identified 1 760 Total 133 056 Private Collective Centers Accommodation 64 374 68 682 (Source: OCHA, 2008, Civil Registry Agency and the Ministry of Refugees and Accommodation, with estimated +/- 3000 persons margin of errors) • The Government of Georgia has informed the international community about its plans to construct 4 496 houses in Gori, Mtskheta, Kaspi and Kareli for IDPs who will not return in the medium term. The construction of these housing units will partly be funded by bilateral donations. The plan is to provide 60m2 houses, each including infrastructure and internal equipment (source: http://iys.cidi.org/disaster/co m-dsr/ixl80.html webpage accessed on 12 October 2008); • The first European Union observers entered the buffer zone and South Ossetia on 1 IDPs outside Gori tent camp (Photo: MC Profili) October 2008 to begin monitoring the ceasefire between Georgia and Russia (source: http://news.bbc.co.uk/2/hi/europe/7643612.stm, webpage accessed on 8 October 2008). 2 HEALTH SITUATION UPDATE • A plan for rehabilitation of damaged health facilities is underway. Requests for funding will be submitted to donors; • Disease surveillance systems including water quality testing in affected areas has been set up by the National Center for Disease Control (NCDC) in Tbilisi and other regions; • As of 1 October, no outbreaks of communicable diseases among IDPs in the affected areas have been reported; Number of registered cases of communicable diseases in Georgia including cases among IDPs in August 2007 and 2008 Disease Number of cases Number of cases August 2007 August 2008 Diphtheria - 2 Pertussis 9 14 Measles 3 - Rubella 9 4 Mumps 5 1 Viral Hepatitis A 207 27 Viral Hepatitis B 25 21 Viral Hepatitis C 16 10 Diarrheal diseases 156 86 Influenza 384 247 Respiratory infections 10 945 7 973 (Source: National Center for Diseases Control, NCDC, Tbilisi – Georgia) • According to the table above, the number of cases of communicable diseases observed in August 2008 has not increased when compared to the previous year; • In Tbilisi, the NCDC has established active surveillance of the temporary IDP locations to timely detect and control emerging communicable diseases; • Teams of epidemiologists, including staff for prevention/promotion activities (disinfection, disinsection and deratization) and public health laboratories have been mobilized. Preventive and promotion activities have been conducted in parallel to inform IDPs of the ways communicable diseases are transmitted and of the methods used to avoid transmission. Disinfectants for toilets have been distributed; • In order to minimize the risk of outbreaks of communicable diseases the NCDC had recommended that overcrowding of temporary IDP locations be avoided. The NCDC continues to monitor the housing and sanitation conditions of temporary IDP locations; • In Tbilisi, as a result of close epidemiological and clinical investigations, the following cases of communicable diseases were registered among IDPs: scabies (9 cases), skin infections (7 cases); gastro-intestinal infections (4 cases of suspected viral origin) and 1 confirmed laboratory case of Salmonellosis (Salmonella enteritidis); • Outside Tbilisi, NCDC monitoring teams visited temporary IDP locations (74 places were visited once, 24 places twice, details are available from the NCDC, Tbilisi). Epidemiological and clinical investigations as well as preventive and promotion activities were conducted. Isolated cases of diarrhea were registered in the Tskaltubo district (8 cases), in the “Patriot” camp in the Bagdati district (2 cases), in Gori Kindergarten#8 (4 cases) and in the technical school in Kutaisi (3 cases). 3 GOVERNMENT OF GEORGIA RESPONSE • Georgian health authorities have announced that all IDPs in Georgia have free access to local health facilities, including referral services; • In addition, primary care providers from local health facilities are visiting all collective centres on a regular basis to provide free medical consultations, treatment and basic laboratory services; • The Government has established an IDP hotline (090) to provide advice and guidance, including on health related matters. HEALTH CLUSTER COORDINATION • WHO and MoLHSA are coordinating ongoing health activities in Georgia; • The Health Cluster matrix on Who is doing What and Where (3W) as well as a geographical mapping has been completed; • The matrix includes Nutrition and Mental Health and Psychosocial support (MHPSS) subsectors and is available through the WHO Country Office and the OCHA office in Georgia. Health Cluster partners activities (to date) are also summarized in Annex 1; • The following assessments are available and include findings on the health sector: o IMC and GCRT (Mental Health and Psychosocial Rapid Assessments of Georgian IDPs in Tbilisi August 2008) o MERLIN (Findings Gori- Tshkinvali corridor; September 2008); o European Commission (Rapid Needs Assessment related to the conflict September 2008); o UNIFEM (Rapid Needs Assessment of Internally Displaced Women, September 2008); o UNOCHA (Inter-agency Initial Rapid Assessment, Health Cluster coordination meeting (Photo: Italian Red Cross) September 2008); o UNWFP (Caucasus conflict, emergency food Security Assessment, September 2008) Partners of the Health Cluster include: ACTS, ADRA, CARITAS, CIF, CLARITAS XXI, Counterpart, GRCS, Hellenicare, IFRC, IMSS, IRD, IWA, Merlin, MdM, MSCI, MSF, OXFAM, SCF, UMCOR, WF, WVI, UNICEF, UNFPA, UNWHO, EC, EC/ECHO, USAID, WB (see Annex 2 for acronyms) Ministry of Labour, Health and Social Affairs (MoLHSA) Nutrition subsector: • UNICEF is chairing the subsector on nutrition; • The rate of exclusive breastfeeding among ID mothers continues to be very low (lower than the national average of 38% before the crisis); • Protecting, promoting and supporting breastfeeding, especially exclusive breastfeeding, in both normal and emergency situations is particularly important because: o The risks of illness are higher. Exclusive breastfeeding is therefore even more important as a protective measure; o Breastfeeding must be protected and encouraged in emergencies, which may temporarily disrupt breastfeeding or make it more difficult because