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HEALTH CLUSTER BULLETIN PAKISTAN

North West Frontier Province Crisis

Bulletin 5

23 June 2009

Highlights

• Amid security concerns, the 4-day national polio vaccination campaign started 22 June in the North West Frontier Province (NWFP) and Federally Administered Tribal Areas (FATA). It is estimated that 5.4 million children aged under five will be vaccinated, including IDPs living in and outside camps. About 20.9 million children are being targeted throughout Pakistan.

• The risk of diarrhoeal diseases outbreak in IDP camps and hosting communities remains high. Oral rehydration therapy (ORT) corners have been established in 8 IDP camps while health partners are working on establishing Diarrhoea Treatment Centers (DTCs) in camps.

• 18 health facilities at IDP camps, nine mobile clinics and 153 public health facilities in hosting districts submitted communicable disease surveillance reports. Findings included:

- Acute diarrhoea cases registered are 10% of total consultations - 19% of consultations among children under 5 are due to acute diarrhoea - Acute respiratory inspection (ARI) is the leading cause of consultations (21% of all age group, all reported cases)

• Most common health problems facing IDPs in camps are malaria, diarrhoea, acute respiratory infection and scabies, according to Pakistan Red Crescent Society. In addition to diarrhoea and ARI, some IDPs are also suffering from heat stroke.

• 50 000 people have been displaced by new military operations in Waziristan and they are now residing in the Tank and Dera Ismail Khan districts. Immediate support is required to deliver health services.

IDPs Profile

Due to multiple registrations of displaced people, the National Database Registration Authority (NADRA) is verifying IDP registrations inside and outside camps. As of 23 June, NADRA has verified 261 749 families displaced by the crisis (25 352 inside camps and 236 397 outside). The verification of registrations is continuing.

COORDINATION

• Due to security concerns, the provincial Health Cluster meetings that were being held in Peshawar have been moved to Islamabad. This coordination meeting is regularly conducted every Thursday to consolidate actions and interventions in the field. The latest meeting was conducted in Peshawar on 18 June.

• Health Cluster meetings were conducted on 16-17 June in Islamabad to allocate among partners the US$ 3.25 million from DFID.

• A contingency planning meeting was held 19 June at OCHA. The Humanitarian Coordinator shared with the inter-agency humanitarian group the issues discussed during a teleconference with Gen. Nadeem, head of the Special Support Group including:

o The new military operations in Wazirastan have displaced approximately 50 000 people to the Tank and Dera Ismail Khan districts.

A polio vaccination team in Jalozai camp visiting tents before administering polio drops on 22 June.

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o The security situation prevents the UN from operating in these districts. Response activities will likely remain stalled for some time.

o UNHCR and the Ministry of Social Welfare are initiating the IDP registration verification process through a local implementing partner.

o Relief work may be initiated through local district response committees comprising local tribal elders, government representatives and the Pakistan Army.

o The government is considering giving Rs. 5000 monthly cash grant in lieu of food. o Immediate support is required for health, WASH and non food items service delivery and

distribution.

The meeting participants discussed the following issues: o UN agencies should consider establishing a UN hub in the neighbouring Bakkar district,

where ICRC has established a hub. o UNHCR will complete registration of IDPs in the Tank and Dera Ismail Khan districts during

the next 10-15 days. All clusters (except shelter) will be planning for a rapid assessment in both districts. OCHA will coordinate the assessments.

Who, does what, where?

• The map Who, Does, What, Where updated as of 23 June is enclosed.

HEALTH ASSESSMENT

Disease surveillance The weekly disease early warning system (DEWS) reports were received on time from 180 reporting sites showing a total of 64 793 patient consultations in IDP hosting districts in NWFP (Peshawar, Mardan, Nowshera, Charsadda and Swabi). The data were collected through 18 fixed health facilities at IDP camps, nine mobile clinics and 153 public health facilities in IDP hosting districts. The summary of the disease surveillance latest report (6-12 June 2009) is a follows:

• Acute diarrhoea comprised 6727 (10%) of total consultations in all age groups and from all IDP hosting districts;

• 19% of children aged under 5 have acute diarrhoea; • ARI is the leading cause of consultations accounting for 21% (13 479) of reported consultations.

Situation of acute diarrhoea in IDP camps The risk of diarrhoeal diseases outbreaks in IDP camps and hosting communities remains high. ORT corners have been established in the camps with diarrhoea treatment centres to efficiently handle outbreaks. Health and WASH partners are jointly working on establishing diarrhoea treatment centres (DTCs). Two alerts of acute watery diarrhoea (AWD) cases were received from Mardan medical complex and Mardan District Hospital. Case investigations, followed by comprehensive epidemiological investigations, revealed the two other affected cases, their locations and timeline of the outbreaks. Rapid response teams conducted necessary containment, including water safety measures and hygiene promotion activities. Below is the comparison of weekly percentage of consultations for acute diarrhoea in NWFP IDP camps.

Weekly pattern of Acute Diarrhoea in IDP camps, NWFP

0

5

10

15

20

25

30

B. Complex

Jalozai-I

Jalozai-II

Jalozai-III

Jalozai-IV

Jalozai-V

Jalozai-VI

Jalozai-VII

KG-I

KG-II

Palosa-I

Palosa-II

Jalala

S.Shahzad

S.Yaseen

Mazdoorabad

Larama

Shah

Mansoor

Yar Hussain

Charsadda

Sugar Mill

Percentage

Wk21 Wk22 Wk23 Wk24

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Distribution of all reported consultations in the IDP hosting districts by Diseases

FILLING GAPS

After the influx of conflict affected IDPs to Abbottabad and Mansehra, the Church World Service-Pakistan/Afghanistan (CWS-P/A) has been assisting IDPs through a mobile health unit since April 2009. The mobile health unit provides basic health services with a special focus on women and children, along with free basic medicines. So far, the unit has conducted 733 consultations for various diseases in these areas and provided antenatal care to pregnant women. Helping Hand for Relief & Development is running eight health clinics to support health needs of IDPs living outside camps in Talash Shamsi, GC College Temrgra, Samar Bagh union councils in Dir One; Totalai in Buner; and the mobile clinics in Tarnole and Bara Kahu. The Islamic International Medical and Dental College and Allied Hospital has been supporting mobile clinics managed by HHRD in Mardan, which serve IDPs in 38 village ‘host communities.’ During the second week of June, Malteser International deployed two mobile medical teams and were given use of the Executive District Officer’s (EDO) Health Office in Mardan. Each time includes a:

•• Medical officer for curative health care, including minor surgery;

•• Lady health volunteer, dispenser and site mobiliser/hygiene promoter;

•• Health worker, in-charge of basic maternal and child health services and emergency obstetric and neonatal care (EmONC)

Malteser is covering part of the IDP population accommodated in 55 schools and one residing with host communities in five Union Councils of Mardan district, namely: Toru, Mayar, and Khandar, southeast from Mardan town. During the first six days of interventions, Malteser’s mobile team treated 1343 patients. Merlin conducted 15,491 consultations in camps and host communities in Peshawar, Mardan and Nowshera during epidemiological week 25 (13-19 June). In addition, 3951 children and Pregnant & Lactating Women (PLW) were screened for nutritional status. Service provision in Jalozai 4 IDP camp has been started on 22 June. During the past week, Merlin has conducted a rapid needs assessment in three Tehsils and 4 health facilities in district Buner. They have sent emergency medicines and supplies to the DHQ hospital Buner. WHO is conducting a needs-based assessment survey to assess the prevalence of persons with disabilities in IDP camps as well as their needs in terms of health and rehabilitation services. Several meetings were conducted by the Nutrition Cluster to establish a nutrition surveillance system. The preliminary questionnaire was shared with Nutrition Cluster partners. It was discussed and agreed that data collected from camps and host communities will be submitted to WHO for analysis and production of a monthly report.

Cause of consultation No. of consultations Percentage

Acute diarrhoea 6727 10 Acute jaundice syndrome 36 - Bloody diarrhoea 744 1

Lower respiratory tract infection 1629 3

Upper respiratory tract infection 11 850 18 Suspected malaria 1028 2 Others (causes of consultation other than communicable diseases) 36 734 57 Scabies 3234 5 Unidentified fever 2811 4 Total 64 793

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UNICEF and Save the Children USA conducted several meetings to establish therapeutic feeding /stabilization centres in Mardan, Swabi and Charsadda, where training sessions on hospital management of severe acute malnutrition are being arranged. The Pakistan Red Crescent Society (PRCS) is providing psychosocial support to help displaced people recover from traumatic experiences and cope with the current situation. The psychosocial support programme has reached 3266 beneficiaries. The psychosocial team is organizing sports competitions among IDPs, including cricket, badminton and football. • PRCS health teams have attended 77 029 patients in all camps, where health awareness sessions are

being conducted. • Based on a PRCS health teams’ report, heat stroke, malaria, diarrhoea, ARI and scabies are the most

common health problems being faced by IDPs in camps. The PRCS, supported by ICRC, is conducting medical consultations in five IDP sites: Sher Mansur in Swabi district, Rangmala and Pokhut in Malakand district, and Khungi and Degree College in Lower Dir district. No particular health problems were encountered in these camps during the last seven days. ICRC teams conducted assessments in the Buner, Swat and Upper Dir districts. In Swat, the situation remains precarious. Daggar Hospital was provided by ICRC with dressing kits, basic health kits to restart OPD. Generator fuel has been delivered. With Ministry of Health’s drug donations, the hospital has resumed services for displaced people. 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 Contacts: For further information please contact: WHO Pakistan Country Office Dr Khalif Bile Mohamud WHO Country Representative to Pakistan e-mail: wr@pak.emro.who.int WHO Regional Office for the Eastern Mediterranean Dr. Irshad Shaikh EHA Regional Adviser e-mail: shaikhi@emro.who.int 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: garwoodp@who.int tel. +41 22 791 3462 mobile: +41 79 475 5546 www.who.int/disasters

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Acronyms AWD: Acute Watery Diarrhoea 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 Salt 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: Women Medical Officer