BORNO STATE GOVERNMENT Hard to Reach team providing basic health services in a community in Borno State (Photo: WHO) Northeast Nigeria Response BORNO State Health Sector Bulletin #22 31st March 2017 6.9 MILLION 5.9 MILLION 1,506,170* PEOPLE IN NEED OF TARGET BY THE HEALTH 1,891,160 IDPS IN HEALTH CARE IN; SECTOR; ADAMAWA, POLIO VACCINATED CHILDREN ADAMAWA, BORNO AND BORNO AND YOBE BORNO STATE YOBE STATES STATES HIGHLIGHTS HEALTH SECTOR Despite security challenges in Borno state, more than 19 HEALTH SECTOR PARTNERS 14,000 volunteers were deployed to vaccinate 1.9 million HEALTH FACILITIES** children under 5-years old against wild poliovirus. The 288 exercise, which is the first nationwide campaign against polio FUNCTIONING** (OF TOTAL 749 ASSESSED HEALTH FACILITIES) this year, took place from 25 to 29 March 2017. WHO and partners have trained 1,817 house-to-house, 410 fixed posts 262 FULLY DESTROYED 215 and 362 transit teams in addition to 150 health camps across PARTIALLY DAMAGED 206 wards in all local government areas (LGAs) except IDP CAMPS CUMULATIVE CONSULTATIONS Abadam and Marte due to insecurity. 119,885 MEDICAL CONSULTATIONS*** Risk of disease outbreaks looms as temperatures continue to rise over the coming weeks and months. For instance, the EARLY WARNING & ALERT RESPONSE rainy season in April will further heighten the risk of cholera 149 EWARS SENTINEL SITES 87 REPORTING SENTINEL SITES and meningitis epidemics and cases of malaria. 20 TOTAL ALERTS RAISED**** More than 84 Mobile Health Teams are operational across accessible areas in Borno state providing health services to VACCINATION the affected population. 1,891,160 POLIO According to the Cadre Harmonisé report released in March, IPV & OPV***** more than 50,000 people could experience famine-like conditions across the North-East from June to August. Food SECTOR FUNDING, HRP 2017 insecurity in the region is projected to rise to 5.2 million people in the three most affected states in the coming months. 93.8M US$ – HRP 2017 REQUIREMENTS 6.3 MILLION USD FUNDED (6.7%) 2016 UNMET REQUIREMENTS 11.8 MILLION USD FUNDED (22%) 53.1 MILLION USD REQUESTED * Total number of IDPs in Borno State by IOM DTM XIV January 2017. ** MOH/WHO HeRAMS December 2016. 1 *** Cumulative number of medical consultations at the IDP camps from 2017 Epidemiological Week 1- 12. **** The number of alerts change from week to week. *****Number of Polio vaccinated children in the Outbreak and Response campaign (IPV Inactivated Polio Vaccine & OPV Oral Polio Vaccine) as January 2017 Situation update: Boko Haram insurgency continues in the form of suicide bombings (PIED) and armed attacks resulting in casualties especially in the surrounding villages, military locations and IDPs camps in Maiduguri. As of 22 March 2017, it was reported that PBIED attack occurred at Gulumba IDP Camp in Muna Dalti. In Gulumba IDPs Camp, security sources reported that an attack likely involved PBIEDs, which detonated, causing injuries and death. There were reportedly 20 casualties, 4 dead including the PBIEDs and 14 injured. Humanitarian access remains a great challenge, and humanitarian partners are also gearing up for the upcoming rainy season to mitigate risks for response delivery. While humanitarian partners have scaled up emergency response in all sectors, gaps remain and new needs continue to emerge in outlying areas due to population movements and returns from inside the Borno sate and neighboring countries Niger, Chad and Cameroon. According to the Cadre Harmonisé report released in March, more than 50,000 people could experience famine-like conditions across the North-East from June to August. Food insecurity in the region is projected to rise to 5.2 million people in the three most affected states in the coming months. Borno state will be worst affected, with 43,066 persons expected to be in Phase 5, followed by the states of Adamawa (3,690) and Yobe (3,295). Ongoing conflict and attacks have prevented farmers from growing crops for over three consecutive years triggering severe food crisis in the largely agrarian region. The Cadre Harmonisé (CH) is the current regional framework for consensual analysis of food insecurity situations. It aims to prevent food insecurity in West and Central Africa and includes the participation of Governments, UN Agencies, NGOs and donors. Food availability is expected to decline normally towards The recommendations of the framework analysis highlight the need to scale up the emergency humanitarian assistance to improve food and nutrition security situation, save lives and protect livelihood conditions. The framework also suggests to strengthen the ongoing responses to malnutrition in the sixteen states, particularly in the three north east States before the next lean season. Improvement of food access for the poorest people especially those living in the remote areas is also a priority for the humanitarian actors. Responding to the health needs in remote areas, 84 mobile teams are operational with the support of Federal Ministry of Health, WHO and Health Sector Partners in Borno state. The teams are regularly working in communities and health facilities delivering essential health care including treatment of minor ailments, safe deliveries, nutrition screening, and health promotion across 23 accessible LGAs. Some of the health partners have started their interventions in the rehabilitation or renovation of health facilities where the health facilities are non-functional due to damages to the infrastructure and assets. Population displacement and return are ongoing as for the last few weeks there is a continuous daily influx of IDPs in Dikwa LGA due to which the total population caseload has reached to 150,000 people in both camps and host community. The influx is from Bama, Ngala and surrounding villages of Dikwa LGA. Like other services health services are also overstretched. People are living in congested environment in camps and some host communities which create public health risk in terms of disease outbreak. Disease surveillance and monitoring of health situation is an urgent priority. WHO surveillance team is in touch with the state MoH to improve disease surveillance and reporting from Dikwa. Shelter and CCCM sectors are struggling to provide additional shelter support to the new arrivals and improve the living condition of people specially in the camps. ICRC, UNICEF, WHO, FHI-360 and Federal government mobile medical teams are providing health services in Dikwa. UNICEF is supporting three PHC centers including one MCH center in host community and two health clinics in IDP camps. WHO has deployed a Hard to Reach team providing health services in the surrounding host communities. The referral services are not enough to cater the needs of additional caseload of IDPs. 2 Public Health Risks and Needs 6.9 million people are in need of humanitarian health services including more than 1.7 million internally displaced people living in more than 100 IDP camps across Adamawa, Borno and Yobe states. Cholera and meningitis, Viral Haemorrhagic Fever (VHF) such as Lassa fever, outbreaks are an increasing threat; full preparedness and response plans are ongoing. Active surveillance for Polio and Acute Flaccid Paralysis remain extremely active. Measles outbreaks continues to be a challenging to be contained. The need for food assistance is likely to increase even further in the coming weeks. Qualified health human resources, essential medicines and the destruction of medical facilities continues to hamper the delivery of lifesavings health interventions Surveillance and communicable disease control . Polio: No new cases of polio have been reported. A nationwide immunization plus days against polio took place between 25th -29th March, 2017 in 25 LGAs out 27 in Borno state. Early Warning Alert and Response System (EWARS): In Epidemiological Week 12 - 2017, a total of 87 out of the 149 reporting sites (including 20 IDP camps) in 13 LGAs submitted their weekly reports. Completeness of reporting was 58% and timeliness was 74% (target 80% respectively). Twenty indicator- based alerts were received and 90% were verified. Malaria: Between Epi Weeks 34-2016 to Week 12-2017, a total of 181,753 suspected cases and 108,293 confirmed cases (18% of morbidity) of malaria were reported. In Epidemiological Week 12, 2853 cases of confirmed malaria were reported with two malaria deaths at 400 Housing estate Gubio road IDP camp clinic A, Konduga, and Federal Training Centre Dalori camp clinic A, Jere. 8000 6000 4000 Number 2000 0 Weekly trend of malaria cases reported through EWARS in Borno State from Week 34-2016 to Week 12-2017 . Acute Watery Diarrhoea (AWD): In Epidemiological Week 12, 1108 cases of AWD were reported with no deaths. The below figure shows the trends of AWD cases in Borno State between Epi Weeks 34-2016 to Week 12-2017. 3 Weekly trend of AWD cases reported through EWARS in Borno State from Week 34-2016 to Week 12-2017 . Measles: Between Epi Weeks 34-2016 and Week 12-2017, a total of 2,717 suspected cases of measles were reported from EWARS reporting sites in 13 LGAs. In Epi Week 12, 40 suspected cases were reported with 90% of the cases occurring in children below 5 years. They include 7 cases from Gusi clinic Kwaya Kusar, 5 cases from State Specialist Hospital MMC, and 4 cases from Madinatu IDP camp clinic. There was no reported death due to measles. 200 160 120 80 Number 40 0 W1 2017 W2 2017 W3 2017 W4 2017 W5 2017 W6 2017 W7 2017 W8 2017 W9 2017 W43 2016 W44 2016 W35 2016 W36 2016 W37 2016 W38 2016 W39 2016 W40 2016 W41 2016 W42 2016 W45 2016 W46 2016 W47 2016 W48 2016 W49 2016 W50 2016 W51 2016 W52 2016 W10 2017 W11 2017 W12 2017 W34 2016 Weekly trend of Measles cases reported through EWARS in Borno State from Week 34-2016 to Week 12-2017 Maternal death: In Epidemiological Week 12, no maternal death was reported Neonatal death: In Epidemiological Week 12, there were 4 reported neonatal deaths in Garubula MCH Biu (20), Guwal clinic Kwaya Kusar (1), and State Specialist Hospital MMC (1).