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Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for October 12 2010)

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  • Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for October 12 2010)

    WHO, Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010 (edited)


    [Source: World Health Organization, <cite cite="http://www.who.int/hac/crises/pak/sitreps/15august2010/en/index.html">WHO | Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010</cite>. 8/16/10, edited.]

    Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010


    Highlights
    • In Khyber Pakhtunkhwa, acute diarrhoea (AD) accounted for 3 807 (17%) of the total patient visits in all age groups and is the leading cause of morbidity in the flood affected districts. Acute respiratory tract infections (both upper and lower) were recorded in 3 255 (15%) patient visits. Skin infections were reported in 4 122 (19%) of the patients.
    • In Punjab, skin diseases were reported in 6% of total patient visits and were the leading cause of morbidity among affected communities while acute diarrhoea accounted for 6% of patient consultations.
    • In Baluchistan, the leading causes of morbidity are diarrhoea, and scabies. In Sindh, Acute Respiratory Infection (ARI) was the leading cause of consultations followed by skin infection and acute diarrhoea. Suspected cases treated for malaria are rising as more areas with stagnant waters emerge.
    • Rumors of confirmed cholera cases are pouring in. In accordance with Article 9 and 10 of International Health Regulations (2005), WHO has requested the Ministry of Health for a verification of the news item reported in the international media regarding the cholera case from Mingora town of Swat district; and WHO has requested for a notification if any risk assessment has been carried out using the decision instrument and the result, as stipulated in the Annex-2 of IHR (2005).
    • Medical Emergency Relief International (Merlin) and Malteser International are conducting health interventions in response to reported cases of diarrhoea in Mingora town in Swat District.
    • International support has started to build-up through the deployment of medical teams and donations of essential medicines. Indonesia has deployed 5 medical doctors and 10 paramedics in Nowshera. On 15 August, Sri Lanka will send 7 medical doctors, 6 nurses and 2 pharmacists to Sukkur and Jordan will deploy 25 medical doctors and pharmacists in Multan. Hungary, USA and Italy are also sending medical teams to support the humanitarian work in flood affected areas.
    • The National Health Emergency Preparedness and Response Network (NHEPRN) of the Federal Ministry of Health is leading the health interventions in all affected districts. All health activities are coordinated with provincial/district departments, WHO (Health Cluster lead), UN agencies, national and international agencies.

    Situation overview and current scope of disaster

    Based on the latest data from the National Disaster Management Authority (NDMA), the affected population is over 14 million. The number of deaths has reached 1 392 while the number of injuries has reached 1 985.


    Health situation/ alerts and outbreak
    • The leading causes of morbidity in flood affected communities are: skin diseases, acute watery diarrhoea, and acute respiratory infections.
    • Rumors of confirmed cholera cases are pouring in. In accordance with Article 9 and 10 of International Health Regulations (2005), WHO has requested the Ministry of Health for a verification of the news item reported in the international media regarding the cholera case from Mingora town of Swat district; and WHO has requested for a notification if any risk assessment has been carried out using the decision instrument and the result, as stipulated in the Annex-2 of IHR (2005).
    • As response to cases of diarrhoea in Mingora, Medical Emergency Relief International (Merlin) and Malteser International are conducting health interventions in affected areas.
    • Fifty-six (56) out of 62 flood affected districts from the provinces of KPK, Punjab, Sindh and Baluchistan shared daily disease surveillance data for 11 August. One new alert (false) of suspected hemorrhagic fever was reported from CH Nawagai, district Buner in Khyber Pakhtunkhwa.
    • Cholera is endemic in Pakistan and in the current emergency situation it is anticipated that cholera cases will occur sporadically amongst the susceptible population in the affected areas. Therefore the threat of cholera in the flood affected communities remains high. In order to avoid excess mortality, it is important that all acute watery diarrhoea cases with severe dehydration have easy and rapid access to standardized treatment.

    Sindh situation
    • Sindh’s situation is getting critical. By 14 August, 300 000 people have evacuated using the road and railway. Based on reports from the ground, water is entering Shahdadkot Qamber and likely to also flood Larkana. In Karachi, 4 areas (Toll Plaza, Kimari Town, Bin Qasim and Gaddab Town) have been dedicated by city administration to host the affectees.
    • The Government is planning to establish big camps in 3 locations: Hyderabad, Jamshoro and Karachi. Furthermore, 35% of the Sindh is under water. Upper Sindh districts which where hosting the affectees from Sukkur, Khairpur, Dadu, Ghotki and Shikarpur do not have the capacity to host any more affectees.
    • Kashmore and Jacobabad are totally under water while Ghotki, Sukkur, Larkana and Qamabar Shahdadkot, Dadu, Nausehro Feroz and many others are partially flooded. In Southern Sindh only a few districts have dry land and some capacity to host the affectees.
    • The Sindh affected population has reached 2.25 million and figures and is expected to reach 3 million easily in the coming days. According to PDMA 4 Army and 2 Navy helicopters are evacuating people and thousands are still stuck in flooded districts. Around 900 000 people are on the move in the last few days. There are 200 boats currently evacuating the population.

    Khyber Pakhtunkhwa (KPK)
    • From Khyber Pakhtunkhwa, 122 health teams and static health facilities from 8 flood affected districts shared daily reports. A total of 21 813 patient consultations were reported. Acute diarrhoea (AD) accounted for 3 807 (17%) of the total patient visits in all age groups and is the leading cause of morbidity in the flood affected districts of Khyber Pakhtunkhwa. Acute respiratory tract infections (both upper and lower) were recorded in 3 255 (15%) patient visits. Skin infections were reported in 4 122 (19%) of the patients.
    • The trend of diarrhoeal disease shows an increasing number of patients expected in the period 7 – 15 days after contamination of water sources. A high number of diarrhoea cases in the districts of Charsadda, Swat, Peshawar and Nowshera are being reported. WASH interventions underway but further expansion is needed in these districts as more areas become accessible. If the clean drinking water supply is not supplied and environmental hazards are not addressed in time, it is expected that waterborne disease outbreaks will occur more frequently in the affected community.

    Punjab province
    • In Punjab province, 28 flood affected districts shared the daily disease report. From these districts, 535 health facilities including 368 mobile teams and 167 static facilities are providing health services to the affected communities in Punjab. On 11 August, a total of 143 983 patient consultations were reported. Skin diseases were reported in 6% of total patient visits as the leading cause of morbidity. Acute diarrhoea accounted for 6% of patient consultations and a high number of diarrhoea cases were reported from Muzafargarh.

    Baluchistan Province
    • In Baluchistan, 4 flood affected districts shared daily disease reports on 11August. A total of 2 238 patient visits were reported with 514 (23%) cases of diarrhea, 285 (13%) upper respiratory tract infections and 409 (18%) cases of scabies. Since 29 July, a total of 10 629 patient visits were reported from 20 health facilities in flood affected areas. Diarrhea was recorded in 2 386 (22%) patients, malaria in 2 187 (21%) patients and scabies in 2 070 (19%) patients.
    • Between 29 July and 11 August, 61 snake bites have been reported from district Naseerabad and Jaffarabad.
    • A high proportion of acute diarrhoea also has been reported in districts Jaffarabad and Naseerabad. The diarrhea cases visiting the health facilities/mobile teams are presenting with mild symptoms of diarrhea. Health hygiene education sessions are being conducted involving lady health workers (LHW) and water purification tablets have been distributed in the affected community.

    Sindh Province
    • In Sindh, daily disease surveillance reports were received from 342 health facilities (99 mobile teams and 243 fixed facilities) in 16 flood affected districts. A total of 21 493 patient visits were reported from the fixed facilities and mobile medical camps were established in the districts.
    • In Sindh, ARI was the leading cause of consultation and accounted for 17% of total visits followed by skin infection (17%) and acute diarrhoea (14%). A high numbers of diarrhoea cases are also being reported from districts Kashmor, Sukkur, Ghotki, Khairpur and Dadu. Health education in these districts is being conducted by LHWs. Strong WASH interventions are highly required in these districts.
    • Results of initial rapid assessments in flood areas show that out of 1 167 health facilities, 189 facilities have been damaged or destroyed in 4 flood affected provinces. Table below shows the damaged or destroyed facilities by district.

    Health cluster response

    Care International is supporting 4 basic health units (BHUs) in Upper Swat (Bahrain, Tirat, Miadem & Chail). It is also providing primary healthcare services through 2 mobile clinics in Upper Swat which cover the union councils of Bahrain, Bishigram, Tirat and Miadem. Since the onset of floods, Care International’s mobile teams have attended to 5 026 consultations.

    One mobile clinic of the Church World Service is providing essential medicine and consultations for patients with a special focus on women and children in Tehsil Balakot, Mansehra. On 12 August, 1 401 consultations were made and patients were given free essential medicine by the mobile health unit.

    International Medical Corps teams have provided health services to 613 people and psychosocial services to 32 people in Charsadda, Nowshera and Peshawar. Psychosocial services were provided to people with psychosomatic, psychological distress, anxiety, phobic anxiety, and depression. IMC’s medical officers and lady health volunteers are also conducting regular health education sessions and provide preventive information through health messages to individuals and families for behavior change. In addition, IMC distributed 120 hygiene kits at the Government Higher Secondary School City -1 in KPK.

    Medical Emergency Relief International (MERLIN) is continuing its provision of health services to flood affected communities in Swat, Buner and Nowshera districts. On 12 August, a total of 5 034 consultations were conducted. Merlin is providing primary health care services to flood affected communities in 3 districts through 26 static clinics located in Swat (11), in Buner (9), and in Jalozai (7) and 14 mobile teams located in Swat (6), Buner (3), and Nowshera (5). Merlin mobile teams were increased from 6 to 9 in Swat but these additional 3 teams could not be airlifted to target areas in Upper Swat due to bad weather conditions. Five of Merlin's mobile teams are now operating in Upper Swat.

    International support has started to build-up through the deployment of medical teams and donations of essential medicines. Indonesia has deployed 5 medical doctors and 10 paramedics in Nowshera. On 15 August, will send 7 medical doctors, 6 nurses, 2 pharmacists to Sukkur and Jordan will deploy 25 medical doctors and pharmacists in Multan. Hungary, USA and Italy are also sending medical teams to support the humanitarian work in flood affected areas.

    Mercy Corps will run a static clinic at Thrik-E-Islamic - Pakistan Islamic Centre near the town cemetery surrounded by schools occupied by IDP; and a mobile clinic team will serve other schools or camps nearby in Charsadda. In addition, a static clinic will be functional Pabbi Government High School which is occupied by 200 IDP families; and a mobile clinic team will serve other schools or camps nearby.

    Hygiene kits will be distributed in affected areas with partners PATTAN and Pakistan Islamic Medical Association (PIMA). Mercy Corps is also looking into the expansion of its health services to Punjab.

    The National Health Emergency Preparedness and Response Network (NHEPRN) of the Federal Ministry of Health is leading the health interventions in all affected districts. All health activities are coordinated with provincial/district departments, WHO (Health Cluster lead), UN agencies, national and international agencies.

    UNICEF is providing oral rehydration salts (ORS) and Zinc to the Lady Health Workers for community based management of diarrhoea among under-five children by LHWs in the flood affected areas of Khyber Paktoonkhwa, Punjab, Sindh, Baluchistan, AJK and Gilgit Baltistan. A total of 4.2 million sachets of ORS and 2.1 million doses of zinc are being sent through the Provincial Units of National Programme on Family Planning and Primary Health Care to the Lady Health Workers.

    As of 15 August, WHO has distributed 1521 cholera kits, 179 emergency health kits, 3 surgical kits, 700 anti-snake vials which will cover the needs of 1.8 million people in one month in flood affected areas in Balochistan, Gilgit-Biltistan, KPK, Punjab, Sindh.

    In Nowshera, 12 water tankers are supplying 1.6 million liters of chlorinated water daily to 100 000 people. In addition, 14 out of 15 tube wells of Tehsil Municipal Authority (TMA) and 57 out of 60 Public Health Engineering Department (PHED) tube wells were made functional and are currently supplying 14 million liters of water in flood affected areas of Nowshera. WHO provided 180 kilograms of chlorine disinfection to TMAs and PHEDs. In Charsadda, 25 water tankers and trucks are providing water to affected communities daily. Around 270 000 liters of chlorinated water per day are being distributed to affected communities.

    So far, 1 500 health promotion sessions were conducted by WHO and the National Program (DoH) in hosting schools.In Swat, 37 out of 53 water quality tests from tube wells, boreholes and hand pumps were found unfit for drinking. In response, water disinfection through regular chlorination is being carried out by MSF-B. In addition, 130 residual chlorine tests were conducted. In the camps, no residual chlorine was found in drinking water sources.


    For further information contact
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  • #2
    WHO, Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010 (edited)

    WHO, Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010 (edited)


    [Source: World Health Organization, <cite cite="http://www.who.int/hac/crises/pak/sitreps/16august2010/en/index.html">WHO | Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010</cite>. Edited.]

    Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010

    Highlights
    • An acute diarrhoea patient is being treated in a health facility in Muzzafargarh in the province of Punjab.
    • WHO/Syed Haider Ali - An acute diarrhoea patient is being treated in a health facility in Muzzafargarh in the province of Punjab.
    • There is an urgent need to restore health facilities damaged or destroyed by the floods. The results of initial rapid assessments in four flood-affected provinces show that out of 1167 health facilities assessed, more than 200 are damaged, including several hospitals.
    • The Pakistan Initial Floods Emergency Response Plan 2010 launched on 9 August and requesting more than 56 million for health interventions remains poorly funded.
    • The Health Cluster response strategy includes communicable disease control, provision of essential medicines, environmental health measures and support of medical teams for life-saving services.
    • The Cluster function has been rolled out in Khyber Pakhtunkhwa, Punjab and Sindh provinces. According to the WASH Cluster, less than 8% of the 15 million affected people have access to safe water supplies.
    • In flood-affected communities, the leading causes of illness are skin infections, acute watery diarrhoea and acute respiratory infections. Between the onset of the floods and 12 August, medical consultations in fixed and outreach medical centres reported 143 870 cases of skin infections, 115 922 cases of acute diarrhoea and 113 981 cases of respiratory tract infections.
    • Essential drugs and medicines were distributed to Ministry of Health (MoH) and Health Cluster partners to cover the health needs of 1.8 million people. They include 179 emergency health kits, 152 cholera kits, 700 vials of anti-snake venom and 1.8 million water purification tablets.

    Situation overview and current scope of disaster
    • According to the National Disaster Management Authority (NDMA), the number of people affected by heavy rains and floods has reached over 14 million population. So far, 1463 deaths and 2024 injuries have been reported. Around 900 000 houses were damaged by the disaster.
    • On 15 August, United Nations Secretary-General Ban Ki-Moon visited affected areas in Punjab to highlight the United Nations’ support to this crisis.
    • In Sindh and Baluchistan, floodwaters continue to rise.

    Health impact
    • In Sukkur, a WHO/UNICEF joint team conducted a field assessment in 2 relief camps in Pano Aqil on 13 August. At the Government Secondary School, there were 606 internally displaced people (IDPs), including 193 women and only 1 toilet is available for women. A similar situation was observed in the Government Girls Secondary School where five toilets are available for 304 individuals.
    • Insufficient sanitation facilities, unsafe drinking water and compromised personal hygiene are some of the major challenges faced by the Health Cluster.
    • Keeping in view the increasing trends of suspected malaria cases – accounting for 4 to 35% of all consultations (35% in Kambar) vector control activities and mosquito nets are required.
    • At Sukkur’s City Hospital, the main referral hospital of the District, inpatient wards are overloaded with IDPs, most of whom are suffering from diarrheal diseases. The hospital is also running out of medical staff as many are working in the camps. So far, there is no surveillance records for IDPs. Based on the records of the hospital, there are more than 1000 outpatient consultations per day.

    Health situation/alerts and outbreak
    • As of 15 August, 96 mobile and 250 static health posts are providing services in 16 districts of Sindh.
    • The Executive Director’s Office for Health in Swat has directed all Department of Health (DoH) staff to establish oral rehydration therapy (ORT) corners in their health facilities. WHO requested organizations working in Swat District to establish similar areas in all their assigned health facilities and mobile medical camps.
    • In Charsadda in Khyber Pakhtunkhwa Districts, 13 static teams were set up and 19 mobile teams deployed to provide health services to affected communities.
    • The leading causes of illness are skin diseases, acute watery diarrhoea and acute respiratory infections. Between the onset of the floods and 12 August, medical consultations recorded 113 045 cases of skin diseases, 86 671 cases of acute watery diarrhoea, and 83 050 cases of respiratory tract infection.
    • In Khyber Pakhtunkhwa (KPK), 124 health teams and static health facilities from 9 flood-affected districts share daily reports. On 12 August, 14 482 patient consultations were reported. Acute diarrhoea was the leading cause of illness and accounted for 2519 (17%) of these, while acute respiratory tract infections (both upper and lower) accounted for 1898 (13%) visits and skin infections for 3021 (21%).
    • In Punjab, 32 flood-affected districts share daily disease reports. In the affected districts, 532 health facilities, including 365 mobile teams and 167 static facilities, reported 264 894 patient visits on 12 August. Skin diseases were the leading cause of illness, accounting for 11% of and the visits, while acute diarrhoea accounted for 8% of patient visits.
    • In Baluchistan, 40 health facilities in 4 flood-affected districts share daily reports. Between 29 July and 12 August, 14 404 patient visits were reported with diarrhoea accounting for 3523 (24%) cases; malaria for 3380 (23%) cases and scabies for 2377 (16%).
    • In Sindh, acute respiratory infection was the leading cause of consultations followed by skin infection and acute diarrhoea. The number of suspected cases of malaria is rising in this province as more areas with stagnant waters are appearing. Daily disease surveillance reports were received from 344 health facilities (96 mobile teams and 248 fixed facilities) in 15 flood-affected districts in Sindh.

    Health Cluster Response
    • Care International is supporting 4 basic health units in Upper Swat (Bahrain, Tirat, Miadem & Chail) with 2 mobile clinics in Upper Swat (Bahrain Union Council, Bishigram UC, Tirat UC, Miadem UC). Since the onset of floods, 5424 patients have been treated, of which 1682 were women and 2495 children. Care International provided hygiene kits to 500 families in Nowshera & 250 families in Charsadda.
    • CORDAID’s community and household assessment and registration of flood-affected districts continues despite the logistics limitations.
    • International Medical Corps medical teams are providing medical treatment to in Charssada, Nowshera and Peshwar Districts. The teams’ psychologist and counsellors conducted group session on counselling, psychosocial support and phobia management. They identified 16 persons suffering from depression, aggression, psychological distress and anxiety.
    • Johanniter International provided 270 consultations through mobile clinic in Charssada district in KPK on 15 August.
    • Malteser International is working in Swat District and is providing health services through basic health units in Islampur and Meragai and the civil dispensary in Chetewar. In 2 weeks, 3674 persons have received health services. Malteser also organized 4 medical camps in 2 remote UCs as well as in Islampur UC transitional camps and Mingora Town Tahirabad quarter. So far, 1451 patients receivec care and 330 children were vaccinated (EPI protocol + influenza) by the EDO Health Office Vaccination Team. Malteser also distributed 2000 jerry-cans, 500 kg of soap, and hundreds of thousands of aqua-tabs, donated by WHO, UNICEF and Oxfam. DEWS Reports has been regularly submitted to EDO Health and WHO for further analysis.
    • Medical Emergency Relief International (MERLIN) continues to provide of health services in Swat, Buner and Nowshera Districts through 24 static clinics (11in Swat, 7 in Buner, and 6 in Jalozai) and 16 mobile teams (8 in Swat, 3 in Buner and 5 in Nowshera). Merlin has 7 mobile teams operational in Upper Swat at the moment. On 15 August 3689 consultations were conducted through static health facilities and mobile health units.
    • Médecins du Monde-France (MDM-F) has agreed to support Kohat District by establishing a diarrhoea treatment centre (DTC) in Liaqat Memorial Hospital (LMH). The DTC will have an initial capacity of up to 20 beds for severe dehydration cases that need IV fluids. Coordination with EDO-Health and Deputy of Medical Superintendent (DMS) of LMH has been made accordingly. Besides supporting Swabi, Buner and Kohat Districts, MDM-F is supporting civil dispensaries in Misri Banda (Misri Banda UC) and Mian Essa (Mughalki UC) in Nowshera District as well as Agra Payan civil dispensary and Gul Abad basic health unit in Charsada District.
    • The Pakistan Red Crescent Society (PRCS) is providing health care through 20 mobile health units in Nowsehra District and one in Peshawar. On 16 August, consultations were 780 of which 375 were female and 405 male. Skin infection was the leading cause of illness.
    • Pakistan Peoples Primary Initiatives (PPHI) mobile teams have given 55 024 outpatient consultations between 29 July and 12 August and provided free treatment and medicines to 3462 people in Nowshera, Charsadda, Peshawar, Swabi and Mardan Districts. PAIMAN has offered 25 water tankers to Department of Health and Public Health Engineering Department (PHED) for the provision of safe drinking water. They will also deliver hygiene kits in Dadu, Khair Pur & Sukkur Districts.
    • Save the Children has reach the basic health unit in Chuprial which was totally damaged by the floods. The team made it to the area by foot and stayed there with the medical officer who is a local resident of Chuprial. Two mobile medical teams are already functional under the recommendations of EDO (H) for providing primary healthcare services. Meanwhile, 5 medical teams are still working in static health facilities in Qamber basic health unit, Rangmohalla civil dispensary, Barikot civil hospital, Talang basic health unit and Dewlai rural health centre. Save the Children has provided 2 ambulances to DoH. SC is providing health services in DI Khn through 5 mobile health units. The mobile units were deployed based on the recommendations of EDO-Health.
    • SC-UK, MSF Holland and GOAL have started mobile health services in Sukkur District.
    • UNICEF is working with the Federal MoH and WHO on diarrhoea prevention and awareness and care messages and is assisting the Provincial DoH in sending these messages through the lady health workers, the Inter-religious Council network as well as radio, television and print media. UNICEF is assisting the Provincial EPI directorates to carry out measles immunization and vitamin A supplementation to flood-displaced children. In Sukkur, UNICEF has provided 600 000 ORS to the lady health workers through the National Programme.
    • WHO distributed essential drugs and medicines to the MoH and Health Cluster partners to cover the health needs of 1.8 million people. These include 179 emergency health kits, 152 cholera kits, 700 vials of anti-snake venom and 1.8 million water purification tablets. WHO as the cluster lead has rolled out the cluster at central and field levels and emergency hubs in Peshawar, Multan and Sukkur.

    Health Cluster Bulletin in PDF [pdf 541kb]

    For more information contact
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    Comment


    • #3
      Pakistan Health Cluster - Floods in Pakistan - Bulletin No 13 - 21 August 2010 (edited)

      Pakistan Health Cluster - Floods in Pakistan - Bulletin No 13 - 21 August 2010 (edited)


      [Source: World Health Organization, Full PDF Document (LINK). Edited.]

      Pakistan Health Cluster - Floods in Pakistan - Bulletin No 13 - 21 August 2010


      Highlights
      • Number of reporting disease cases is increasing. Until 18 August, 204 040 of acute diarrhoea, 263 356 cases of skin diseases and 204 647 of acute respiratory have been reported in flood-affected provinces. More than 1.5 million patient consultations have been conducted in flood-affected provinces since 29 July.
      • Daily number of reported acute diarrhoea cases, monitored since 31 July is rising, particularly in Charsadda, Nowshera and Peshawar.
      • From 16-18 August, 6 new suspected acute diarrhoea alerts reported from Khyber Pakhtunkhwa (KPK).
      • WHO establishing diarrhoeal treatment centres in flood-affected districts with government and partner support.
      • Health Cluster to have access to UNHAS flights for delivery of medical items.
      • Health Cluster coordination active in 5 hubs - Islamabad, Peshawar, Multan, Sukkur, Quetta.
      • WHO delivers large shipment of medicines to Sukkur coordination hub on 20 August.
      • In first 3 days of emergency vaccination campaign launched in Peshawar and Charsadda on 16 August, 104 640 children under 5 years were vaccinated against polio. All aged over 6 months (92 269 children) also vaccinated against measles and received vitamin A capsules.
      • As of 21 August, 39% of the US$56.2 million requested to support the health response has been funded.

      Situation overview and current scale of disaster
      • According to the National Disaster Management Authority (NDMA), more than 20 million people have been affected by the floods. Almost 1500 people have been reported killed and more than 2000 injured, while around 1 million are left homeless.
      • In the heavily-affected Sindh province city of Sukkur, flood waters have forced more than 4 million people from their homes. Many displaced are living beside roads with little food and unclean water supply.
      • More rains are expected, according to the Pakistan Meteorological Department.

      Health impact
      • In Khyber Pakhtunkhaw (KPK), an assessment conducted by the Kohistan district executive health officer reported that 11 health facilities (1 rural health centre and 10 basic health units) were damaged in the villages of Jog, Dubair Balla, Mani Khel Bela, Muj Gali, Ranolia, Kuz Paro, Thoti, Jashoi, Goshali, Peach Beal and Sheryal. Additional health facilities were unaffected and continue to function.
      • Currently, 24 health facilities are functional in Kohistan District and 17 more will be functional when damaged paths, bridges and roads are restored. 6 medical camps have been established to cover gaps where no health facilities currently exist – they are located in the rural health centres of Dassu and Pattan, the basic health units in Jijal and Jog and the civil dispensaries of Kafar Banda and Kandia Bridge.
      • Since 29 July, more than 1.5 million people have been treated for a variety of conditions in the 4 flood-affected provinces by health authorities, nongovernmental organizations, United Nations agencies and other bodies.

      Main illnesses reported between 29 July and 18 August based on patient visits in reporting health facilities in KPK, Sindh, Punjab and Baluchistan

      [Illness - Number of cases]
      • Acute diarrhoea 204 040
      • Skin diseases (including scabies) 263 356
      • Acute respiratory infections 204 647

      Khyber Pakhtunkhwa
      • The daily number of reported acute diarrhoea cases, monitored since daily reporting on priority communicable diseases began, is rising, particularly in Charsadda, Nowshera and Peshawar. Strong water and sanitation interventions, such as providing clean drinking water supply and addressing environmental hazards, are urgently needed to prevent outbreaks of waterborne diseases in these communities.
      • On 18 August, 120 health facilities (82 mobile and 38 fixed) in 9 flood-affected districts of KPK reported 15,552 patient consultations, with acute respiratory infections accounting for 17% of cases (2653), skin infections 16% (2521) and acute diarrhoea 15% (2329).
      • From 31 July-18 August, KPK health facilities have reported 318,032 patient visits.

      Punjab
      • On 18 August, 1093 health facilities (507 mobile and 586 fixed) in 24 Punjab flood-affected districts reported 314,071 patient consultations, with skin disease accounting for 23% of cases and acute diarrhoea for 14%. High numbers of diarrhoea cases were reported in Muzaffargarh, Mianwali and Jhelum. 102 snake bites were also reported.
      • From 3-18 August, Punjab health facilities have reported 958,951 patient visits.

      Baluchistan
      • On 18 August, 23 health facilities reported 2921 patient consultations, with diarrhoea accounting for 23% of cases (672), suspected malaria 18% (519), scabies 17% (506) and upper respiratory tract infections 14% (412).
      • From 29 July to 18 Aug, Baluchistan health facilities have reported conducting 26,006 patient visits, with diarrhoea accounting for 23% of cases (6063), suspected malaria 21% (5493) and scabies 16% (4232).

      Sindh
      • On 18 August, 410 health facilities (95 mobile teams and 315 fixed facilities) in 15 flood-affected districts in Sindh reported 34,042 patient visits. Skin infections were the leading cause of consultation, accounting for 19% of visits, followed by acute diarrhoea 15% and acute respiratory infections 16%. High numbers of diarrhoea cases are being reported from districts Kashmore and Shikarpur and Dadu. Strong WASH interventions are highly required in these districts. 5 snake bites also reported from Sindh province.
      • From 6-18 August, Sindh health facilities have reported 292,973 patient consultations.
      The complete daily disease surveillance reports can be downloaded from www.whopak.org


      Government response:
      • The Ministry of Health has set up a taskforce to plan and coordinate guide life saving critical interventions in wake of growing concerns of communicable diseases in affected areas. At its first meeting on 20 August, a plan was formulated to strengthen the existing government disease surveillance system in all affected districts, and the first teams were dispatched on 21 August.
      • On 20 August, the Ministry of Health launched its Health Volunteer Programme to increase the number of medical and paramedical staff available to work in affected areas. The programme aims to deploy 4-member teams for 15 days to the 50 most affected communities. Depending on needs, the number of teams deployed to the districts will range from 2 to 6. Each team will have a doctor, nurse, public health professional and paramedic.

      Khyber Pakhtunkhwa
      • As of 21 August, Pakistani health authorities had vaccinated tens of thousands of children against polio and measles in Charsadda, Peshawar and Swat districts. Polio doses were given to 66,733 children aged under 5 years in Charsadda (target population 72,071); 71,527 in Peshawar (target 72,629); and 9805 in Swat (target 10,606). Measles vaccinations have been provided to all 61,854 children aged 6 months to 5 years requiring immunization in Charsadda; 64,989 of the targeted 65,162 population in Peshawar; and 8734 of the targeted 8900 population in Swat. This Special Vaccination Campaign was conducted by the National Expanded Programme of Immunization in coordination with the National Health Emergency Preparedness and Response Network.
      • Since 11 August, the Pakistan Institute of Medical Sciences has on a daily basis deployed 5 medical teams to Nowshera district. These teams have been both expanding capacities at the 50-bed Cantonment Board Hospital in Nowshera city, and providing outreach services for flood-affected communities living outside Nowshera city.
      • In KPK's Lower Dir district, 5 mobile teams of the Executive Directors’ Office-Health (EDO-H) are providing health services to flood affected communities.
      • In KPK's DI Khan district, health authorities have deployed 21 mobile teams, while in Tank district another 4 mobile medical teams have been mobilized by district authorities.

      Punjab and Sindh provinces
      • A MoH mission is currently in Sindh to review the situation in Sukkur, Khairpur, Ghottki and other affected areas aiming to establish field hospitals in the most affected areas and to ensure other essential health services can be provided. The team had also visited flood-affected districts in southern Punjab.
      • The MoH and WHO chaired Health Cluster meetings in Sukkur and Multan, bringing together local and international health providers to identify gaps and identify response.
      • On 21 August, the Federal General Post-Graduate Medical Centre, based in Karachi, sent a 9-member medical team (doctors and nurses) to Kashmore Hospital in Sindh province to strengthen the health facility's capacity.
      • The MoH's Malaria Control Programme distributed a combined 200,000 primaquin anti-malarial tablets to the 4 flood-affected provinces. A further 40,000 insecticide-treated bed nets to KPK, Baluchistan and Sindh provinces.
      • On 21 August, two field hospitals provided by the Turkish Government arrived in Sukkur. Health authorities ordered their dispatching to Khairpur, Sindh province, and to Sibbi in Baluchistan province. Each hospital will be manned by 21 Turkish doctors.

      Health Cluster response
      • The American Refugee Committee (ARC) International is supporting 7 health facilities in Swat (the civil hospital in Barikot, the civil dispensaries in Ghalagay and Telligram and the basic health units in Barasamai, Bishband, KozaSamai and Taghma). On 18 August, 381 consultations were recorded in all 7 facilities, with acute diarrhea accounting for 18.4%, acute respiratory infections 20% and skin infections 20 %. ARC mobile camps in Shah Dehry, Takhta Band and Angora Dehry villages (all in Swat) provided 351, 135 and 164 consultations respectively. In Baluchitan, ARC started working in Sibi District, supporting the rural health centre in Talli and the basic health units in Sultan Kot, Bakhtiarabad, Chandia and Gishkori. On 18 August, the Talli facility conducted 189 consultations, Sultan Kot 122, Bakhtiarabad 148 and Gishkori 136.
      • Helping Hands is supporting 2 basic health units in the Buner district villages of Batara and Pandhir.
      • Médecins Du Monde-France is supporting 1 facility in Buner district.
      • Save the Children Alliance is operating 5 mobile medical teams in DI Khan district.
      • CARE International is supporting 4 basic health units (BHU) in Upper Swat in Bahrain, Tirat, Miadem and Chail villages, while 2 mobile clinics operating in Upper Swat. Since the onset of floods, 12 199 patients have been treated through the mobile teams and BHUs. CARE has also providing Primary Health Care services. On 18 August, 4 CARE mobile teams started providing health services via mobile clinics in district Charsada and Nowshera districts.
      • ICRC is providing clean drinking water tankers for flood-affected populations in DI Khan and Tank districts. In addition, ICRC has established a diarrhoea treatment centre at Civil Hospital Paroa for suspected acute watery diarrhoea cases. It has also provided 3 vehicles to EDO Health for emergency response.
      • Medical Emergency Relief International (Merlin) is operating 27 static health facilities and 17 mobile medical teams in KPK. These are in Swat district (11 fixed and 9 mobile), Buner (10 fixed and 3 mobile) and Nowshera district (6 fixed in Jalozai camp and 5 in all district). On 19 August, Merlin conducted 204 health promotion sessions for 2623 beneficiaries (1561 Swat, 502 Buner, 560 Nowshera). It also distributed 100 hygiene kits in the Swat capital of Mingora, water purification tablets and high energy biscuits in Nowshera, and water purification tablets, micronutrient powder and multi-micronutrient tablets in Buner. Merlin will establish three Diarrheal Treatment Centres in Nowshera, Swat and Buner. Staff are being recruited for these centres and medicines and supplies have been dispatched.
      • Muslim Aid is operating in KPK province (Nowshera and Charsadda districts), Punjab (Mianwali), Sindh (Shikarpur and Sukkur) and a team is being formed for Baluchistan (Sibbi). In Charsadda, Muslim Aid is providing facilities to flood affectees of UCs Mirza Dher, Tarnab and Agra through mobile medical camps as well as in BHU Agra providing OPD. In Nowshera, Muslim Aid will commence the renovation of BHUs Aman Kot, Pirsabaq and Mohib Banda. On 18 August, it has also started working in 5 camps (3 in Sukkur and 2 in Shikarpur) for promotion of hygiene practices and child health and nutrition.
      • Pakistan Pediatrics’ Association has provided a field ambulance service in the form of a mobile team to EDO Health for flood response in Nowshera district. PPA is also operating 1 mobile medical teams in DI Khan district.
      • UNFPA has been responding to emergency reproductive health/maternal newborn needs by deploying 7 equipped and staffed mobile units and supporting 13 existing government health facilities in 10 districts of KPK, Sindh, and Punjab provinces. UNFPA has provided emergency reproductive health medicines and 2400 women’s hygiene kits, 1200 newborn kits and 1531 clean delivery kits to 10 flood-affected districts of KPK, Punjab and Sindh provinces. UNFPA attended 2096 patients, performing 113 deliveries, 306 antenatal consultations, 74 postnatal consultations, 12 postabortion care services, 21 consultations for syndromic case management of sexually transmitted infections, and 288 cases of gastroenteritis. On 18 August, UNFPA distributed 61 women’s hygiene kits for their 1 month menstrual hygiene supplies, 55 newborn kits to the new mothers, and 42 clean delivery packets to visibly pregnant women.
      • UNICEF is providing oral rehydration salts (ORS) and zinc to lady health workers (LHWs) for community-based management of diarrhoea of children aged under five in KPK, Punjab, Sindh and Baluchistan provinces, as well as Azad Jammu Kashmir and Gilgit Baltistan. 4.2 million sachets of ORS and 2.1 million doses of zinc are being sent through the provincial units of the National Programme on Family Planning and Primary Health Care to the LHWs. UNICEF worked with the Federal Ministry of Health and the World Health Organization (WHO)to produce diarrhoea prevention and care messages relevant to the floods and is assisting the Provincial Department of Health to disseminate these messages via LHWs, network of the Inter-religious Council, radio, television and print media.
      • WHO is monitoring the AWD situation in multiple locations. It responded to alerts in Rural Health Centre Paroa in DI Khan district and the Swat district towns of Saidu Sharif, Tahir Abad and Gula Abad.
      To respond to the increasing number of diarrhoea cases, WHO will establish diarrhoea treatment centres (DTC) in each of the 84 flood-affected districts in coming days. These centres will be established in conjunction with provincial and federal health authorities.

      WHO sent a large supply of medical supplies to the humanitarian coordination hub in Sukkur, Sindh Province, on 20 August to bolster existing stocks. The materials sent include 15 emergency kits (capable of treating 90,000 people for 1 month), 20 diarrhoeal disease kits (2000 severe diarrhoea cases for 1 month or 10,000 moderate cases) and 6 interagency emergency health kits (180,000 people for 1 month). WHO conducted a health education campaign in at a temporary camp housing 100 families at Govt Girls College Pabbi in Nowshera where an AWD alert was received and responded to. The campaign was supported by UNICEF, implementing partners and lady health workers from the KPK Provincial Department of Health.

      WHO surveillance officers are receiving information for the Disease Early Warning System (DEWS) from 70 out of the 84 affected districts.

      Provincial hubs and clusters are now established and are meeting regularly. Intra-cluster coordination with WASH and Logistics Clusters.

      On 20 August, WHO trained 17 LHWs in KPK's Charsadda district on health and hygiene promotion so they could train affected people in measures such as safe hand-washing, preparing clean drinking water, and use of oral rehydration salts.


      For further information contact
      • Alfred Dube, Health Cluster Coordinator: email: dubeal@pak.emro.who.int;
      • Syed Haider Ali, Communications Officer: mobile: 0092 3004005944, email:alisy@pak.emro.who.int; focus_ali@yahoo.com;
      • Paul Garwood, Communications Officer: Mobile: +92-(0)-301-855-1459, email: garwoodp@who.int;
      • Dr Jehanzeb Khan Aurakzai, National coordinator, National Health Emergency Preparedness and Response Network, Ministry of Health, Govt. of Pakistan: email: draurakzai@gmail.com
      -
      ------

      Comment


      • #4
        Communicable Disease situation update flood affected districts, Pakistan 18 August, 2010 (WHO, edited)

        Communicable Disease situation update flood affected districts, Pakistan 18 August, 2010 (WHO, edited)


        [Source: World Health Organization, Full PDF Document (LINK). Edited.]

        Communicable Disease situation update flood affected districts, Pakistan 18 August, 2010


        Fifty-three (53) out of 73 flood affected districts in all the four provinces shared daily diseases surveillance data for 18 August, 2010. Three alerts of suspected Acute Watery Diarrhoea reported from districts Swat Peshawar and Kashmor and were responded. Health and Hygiene sessions were conducted with the help of lady health workers.


        Alerts Responded and follow-ups:

        • Swat:
          • Two suspected cases of acute diarrhoea were reported from Saidu group of teaching hospital, Swat. WHO surveillance team investigated the alert; Patients were from urban area of Saidu Shari and Tahirabad, Buner. Stool samples were taken and sent to NIH for laboratory confirmation Diarrhoea prevention activities have been reinforced in the area.
        • Peshawar:
          • An alert for suspected acute watery Diarrhoea was reported from Khyber Teaching hospital, Peshawar. Stool sample was taken and sent to NIH for laboratory confirmation. Health education session was given to the family members and aqua tabs were also provided.
        • Kashmor, Sindh:
          • An alert for increasing number of acute water diarrhoea cases and one death reported from the Taluka Head Qauarter hospital Kashmor on 16 August. The DEWS team visited the hospital on 17 August checked hospital record and that from 10 to 16 August total 3077 were attended and 1714 of the patient came with diarrhoea. On 17 August total 511 patients visited the hospital out of which 230 were having diarrhoea of which 80 with severe dehydration. There are 26 camps in the city and 15617 people are residing in these camps and majority of the patients at the hospital are coming from these camps and mostly childrn. The team also visited the IDP camps conducted field investigation. Four deaths of children less than 5 year age due to diarrhoea reported in the camps. Sanitation and environmental hygiene in these camps is extremely poor and immediate attention needed. Water samples from different camps tested for bacteriological contamination and found highly contaminated. The WHO and UNFPA, MNCH officers are also involved in the response activities and Medical teams are organized for mobile clinic in the camps. Taluka Health Officer has activated Lady Health Workers for health education and hygiene promotion in the camps.
        • Khyber Pakhtunkhwa (KPK) Province:
          • From Khyber Pakhtunkhwa 120 health teams and static health facilities from 9 floods affected districts shared daily reports. Total 15,552 patient consultations were reported high as compared to previous day. Acute Diarrhoea (AD) accounted for 2,329 (15%) of the total patient visits in all age groups and is the second leading cause of morbidity in the flood affected districts in Khyber Pakhtunkhwa. Acute Respiratory tract infections (both upper and lower) recorded in 2,653 (17%) patient visits. Skin infections reported in 2,521 (16%) of the patients. Table 1 reflects the daily number of cases reported from the flood affected districts in Khyber Pakhtunkhwa. Since 31 July to 18 August 2010 total 318,032 patient visit have been reported by health facilities mobile teams in the flood affected areas.

        Table 1: Distribution of daily patient visits by the priority diseases, in the flood affected districts Khyber Pakhtunkhwa

        [Diseases - 10‐Aug - 11‐Aug - 12‐Aug - 13‐Aug - 14‐Aug - 15‐Aug - 16‐Aug - 17‐Aug - 18‐Aug - Total (31Jul‐18Aug)]
        • AD - 3649 - 4056 - 2958 - 3296 - 2521 - 2439 - 2934 - 2869 - 2329 - 51822
        • AJS - 3 - 2 - 3 - 13 - 0 - 3 - 2 - 5 - 13 - 83
        • BD - 293 - 126 - 98 - 42 - 39 - 23 - 55 - 76 - 63 - 1578
        • S. Measles - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 2 - 2
        • S. Meningitis - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0
        • S. Mal - 250 - 119 - 102 - 150 - 39 - 97 - 151 - 144 - 137 - 2059
        • LRTI - 335 - 305 - 109 - 148 - 124 - 332 - 316 - 244 - 178 - 4133
        • URTI - 2802 - 3173 - 2245 - 2466 - 2186 - 2183 - 3260 - 2756 - 2475 - 43067
        • Skin Inf. - 3008 - 4277 - 3090 - 2873 - 2134 - 2148 - 3059 - 2497 - 2521 - 55780
        • UF - 586 - 470 - 280 - 305 - 248 - 176 - 224 - 217 - 336 - 8418
        • Injuries - 158 - 216 - 125 - 143 - 124 - 109 - 37 - 134 - 75 - 2385
        • Others - 7919 - 10284 - 7673 - 9999 - 6139 - 4790 - 8739 - 7943 - 7423 - 148705
        • Total - 19003 - 23028 - 16683 - 19435 - 13554 - 12300 - 18777 - 16885 - 15552 - 318032

        Acute Diarrhoea:

        Since beginning of the daily reporting on the priority communicable diseases from the health facilities (mobile teams and fixed facilities) the daily trend of diarrhoea is being monitored in the flood affected districts of Khyber Pakhtunkhwa. The daily trend of acute diarrhoea in the flood affected districts reflects that the proportion of patients with acute diarrhoea is high however some decline has been noted in the last three days. Higher proportion of diarrhoea cases are seen in Charsadda, Swat and Peshawar as compared to the other districts. Vigorous WASH interventions are extremely needed in these districts to prevent waterborne disease outbreaks. Figure 2 reflects the daily trend of acute diarrhoea in the flood affected districts in Khyber Pakhtunkhwa during the last 19 days.


        Punjab province:

        Twenty-four flood affected districts in Punjab shared the daily disease report. On 18th August, 2010 total 314,071 patient consultations were reported. Skin diseases were reported in 23% of total patient visits as leading cause of morbidity. Acute diarrhoea accounted for 14% of patient consultations and higher number of cases of diarrhoea reported from Muzaffargarh, Mianwali, Jhelum. Total 289 dog bites and 102 snake bite were also reported from the flood affected districts. Table 2, presenting the daily number of consultations by disease in the flood affected districts of Punjab.


        Table 2: Distribution of daily consultations by disease flood affected districts Punjab

        [Diseases - 10‐Aug - 11‐Aug - 12‐Aug - 13‐Aug - 16‐Aug - 17‐Aug - 18‐Aug - Total (3‐18Aug)]
        • ARI - 5538 - 6352 - 21833 - 8617 - 10 - 92 - 48921 - 105350
        • AD - 6167 - 9040 - 20404 - 9254 - 23 - 150 - 44359 - 99056
        • Skin Inf. - 7139 - 9146 - 29720 - 13371 - 14207 - 71296 - 151703
        • Injuries - 545 - 963 - 4619 - 899 - 0 - 12 - 7223 - 17637
        • UF - 2502 - 9826 - 30035 - 6221 - 2 - 68 - 21861 - 83240
        • ENT Cases - 992 - 2202 - 2718 - 4688 - 0 - 0 - 13556 - 25373
        • Dog Bite - 53 - 61 - 110 - 96 - 10 - 6 - 289 - 691
        • Snake Bite - 18 - 61 - 57 - 47 - 2 - 0 - 102 - 332
        • Others - 11711 - 106332 - 155380 - 40399 - 6443 - 897 - 106464 - 475569
        • Total - 34665 - 143983 - 264876 - 83592 - 6504 - 1432 - 314071 - 958951

        Table 3, presenting the number of patient visits by diseases from the flood affected districts in Punjab province on 18 August 2010.

        [District - ARI - Injuries - Skin Inf. - UF - ENT - Dog Bite - Snake Bite - AD - Others - Total]
        • Attock ‐ - ‐ - ‐ - ‐ - ‐ - 12 - 8 - ‐ - ‐ - 20
        • Bhakkar - 1,304 - ‐ - 1,356 - ‐ - 5 - ‐ - ‐ - ‐ - 2,851 - 5,516
        • B.Nagar - ‐ - ‐ - 13 - 29 - ‐ - 1 - ‐ - 811 - 118 - 972
        • Chiniot - 1,348 - 1 - 1,512 - 365 - ‐ - 3 - ‐ - 201 - 525 - 3,955
        • Faisalabad - ‐ - ‐ - ‐ - ‐ - ‐ - 1 - ‐ - ‐ - ‐ - 1
        • Hafizabad - ‐ - 93 - 268 - 196 - ‐ - ‐ - ‐ - 183 - ‐ - 740
        • Jhelum - 300 - ‐ - 2,116 - 393 - ‐ - 44 - 6 - 1,040 - 7,285 - 11,184
        • Jhang - ‐ - ‐ - 5,863 - 1,935 - ‐ - ‐ - 13 - 2,216 - 5,972 - 15,999
        • Khanewal 879 - 131 - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - 1,010
        • Khushab - 2,203 - 8 - 2,422 - 22 - 19 - ‐ - ‐ - 1,680 - ‐ - 6,354
        • Lahore - 565 - ‐ - 5 - 68 - ‐ - ‐ - ‐ - 2,222 - ‐ - 2,860
        • Layyah - 8,915 - 1,715 - 11,866 - 2,372 - 2,773 - 45 - 31 - 2,480 - 18,430 - 48,627
        • Multan - 1,814 - 363 - 2,292 - ‐ - ‐ - 6 - 1 - ‐ - 8,902 - 13,378
        • Mianwali - 7,526 - 1,786 - 13,434 - 188 - 203 - 2 - ‐ - 4,695 - 13,832 - 41,666
        • Muzafargarh - 20,806 - 2,795 - 24,529 - 9,731 - 9,071 - 66 - 26 - 25,590 - 39,173 - 131,787
        • Nankana Sb. - ‐ - ‐ - ‐ - ‐ - ‐ - 6 - 2 - 720 - ‐ - 728
        • Narowal - ‐ - ‐ - ‐ - ‐ - ‐ - 55 - 2 - ‐ - ‐ - 57
        • Rawalpindi - 574 - 28 - 139 - 104 - ‐ - 10 - 2 - 283 - 312 - 1,452
        • R.Yar Khan - 1,364 - 31 - 2,357 - 5,712 - 864 - 17 - 3 - ‐ - 6,126 - 16,474
        • Rajanpur - 871 - 272 - 2,375 - 612 - 621 - 8 - ‐ - 1,528 - ‐ - 6,287
        • Sahiwal - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - 289 - 801 - 1,090
        • Sargoda - 427 - ‐ - 740 - 56 - ‐ - ‐ - 3 - 179 - 1,909 - 3,314
        • T.T.Singh - ‐ - ‐ - ‐ - 74 - ‐ - ‐ - ‐ - 20 - 1 - 95
        • Vehari - 25 - ‐ - 9 - 4 - ‐ - 13 - 5 - 222 - 227 - 505
        • TOTAL - 48921 - 7223 - 71296 - 21861 - 13556 - 289 - 102 - 44359 - 106464 - 314,071

        Baluchistan Province:

        On August 18, 2010 a total 2921 patient visit reported with 672 (23%) cases of diarrhea, 412 (14%) Upper Respiratory Tract Infection, Scabies reported 506 (17%), while suspected malaria reported 519 (18%) of cases. Since 29th July to 18th Aug, 2010 total 26,006 patient visits were reported from the 23 health facilities in the flood affected districts, Baluchistan. The overall diarrhea recorded in 6063 (23%) patients, suspected Malaria 5493 (21%), while Scabies 4232 (16%) of patient visits were reported. Table 3 presenting the daily number of patients by disease in the four flood affected districts of Baluchistan.


        Table 4: Distribution of daily consultations by disease flood affected districts Baluchistan

        [Diseases - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - Total (29Jul‐18Aug)]
        • AD - 572 - 514 - 1321 - 604 - 87 - 139 - 357 - 497 - 672 - 6063
        • AJS - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 2 - 2
        • BD - 112 - 72 - 55 - 78 - 30 - 57 - 81 - 180 - 176 - 1138
        • S. MAL - 462 - 554 - 1193 - 585 - 99 - 134 - 303 - 473 - 519 - 5493
        • URTI - 350 - 285 - 733 - 278 - 73 - 85 - 205 - 366 - 412 - 3684
        • LRTI - 22 - 22 - 20 - 9 - 0 - 6 - 16 - 4 - 12 - 151
        • UF - 22 - 6 - 7 - 18 - 0 - 6 - 12 - 21 - 28 - 380
        • Scabies - 494 - 409 - 307 - 477 - 72 - 88 - 252 - 460 - 506 - 4232
        • Sun Stroke - 0 - 0 - 0 - 0 - 0 - 0 - 32 - 0 - 2 - 44
        • Snake Bite - 1 - 20 - 27 - 14 - 3 - 6 - 13 - 11 - 2 - 137
        • E.N.T - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 325
        • Eye Inf. - 91 - 31 - 43 - 66 - 52 - 64 - 103 - 127 - 124 - 916
        • Dog Bite - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 4 - 0 - 23
        • Others - 234 - 325 - 239 - 316 - 55 - 129 - 504 - 860 - 466 - 3418
        • Total - 2360 - 2238 - 3945 - 2445 - 471 - 714 - 1878 - 3003 - 2921 - 26006

        From 29 July to 13 August, 137 snake bites have been reported from the flood affected district in Baluchistan mainly from district Naseerabad and Jaffarabad. High proportion of acute diarrhea also has been reported in districts Jaffarabad, Naseerabad and Sibi. Health hygiene education sessions are being conducted involving LHWs and water purification tablets have been distributed in the affected community. As compared to the previous days, the proportion of acute diarrhea has increased on 18 July in flood affected areas in the reporting districts. Figure 4 reflecting the daily trend of acute diarrhea in the flood affected districts of Baluchistan.


        Sindh Province:

        Daily disease surveillance reports received from 410 health facilities (95 mobile teams and 315 fixed facilities) in fifteen flood affected districts in Sindh. Total 30,442 patient visits were reported from the fixed facilities and mobile Medical camps established in the districts. Skin infections were the leading cause of consultation accounted for 19% of total visits followed by acute diarrhoea 17%, while ARI reported 15%. High numbers of diarrhoea cases are being reported from districts Kashmore, Shikarpur and Dadu. Strong WASH interventions are highly required in these districts. Five (5) snake bites also reported from Sindh province on 18 August.


        Table: 5. Distribution of daily consultations by disease flood affected districts, Sindh

        [Disease - 10‐Aug - 11‐Aug - 12‐Aug - 13‐Aug - 14‐Aug - 15‐Aug - 16‐Aug - 17‐Aug - 18‐Aug - Total (6‐18 Aug)]
        • AD - 2904 - 3090 - 3505 - 3374 - 4285 - 4343 - 4634 - 5670 - 5802 - 47103
        • BD - 507 - 709 - 461 - 774 - 715 - 748 - 903 - 995 - 1113 - 8553
        • ARI - 3479 - 3693 - 3303 - 3837 - 3766 - 3660 - 4918 - 5671 - 4957 - 48262
        • Malaria - 2055 - 2355 - 1976 - 2782 - 2459 - 2326 - 3431 - 4129 - 3463 - 31654
        • Skin Inf. - 3061 - 3722 - 3753 - 4281 - 4415 - 3887 - 5681 - 6332 - 6430 - 51641
        • Snake bite - 49 - 20 - 18 - 13 - 15 - 9 - 6 - 21 - 5 - 200
        • Others - 4892 - 7904 - 7144 - 7947 - 9641 - 9071 - 10869 - 12186 - 12272 - 105560
        • Total - 16947 - 21493 - 20160 - 23008 - 25296 - 24044 - 30442 - 35004 - 34042 - 292973
        -
        -----

        Comment


        • #5
          Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 1 Monday 23 August 2010 (WHO, edited)

          Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 1 Monday 23 August 2010 (WHO, edited)


          [Source: World Health Organization, Complete PDF Document (LINK). Extracts, edited.]

          Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 1 Monday 23 August 2010

          This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan and World Health Organization (WHO), Pakistan . For Correspondence: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int. or eic.nih@gmail.com


          Highlights
          • Epidemiological week no 33 (14-20 August 2010)
            • Fifty-six out of the seventy-three flood affected districts in four provinces are now reporting surveillance data to the DEWS;
            • 597 fixed health centers and 361 mobile medical outreach centers have reported to the Disease Early Warning System (DEWS) during the last reporting period (Week no-33: 16-20 August 2010);
            • 1,253,495 patients’ consultations were reported during the last epidemiological week (week no-33) which shows an increase by 25% over the preceding week;
            • The number of populations currently under surveillance by the Disease Early Warning System (DEWS) in the flood affected districts is close to 8.5 million;
            • Acute diarrhea, acute respiratory infections, skin diseases and suspected malaria remain the major causes of seeking health care in the flood affected districts
            • Acute watery diarrhoea has been reported from a number of foci in KPK, Sindh and Punjab provinces.

          Epidemic prone diseases under surveillance in the flood affected areas
          • Acute flaccid paralysis
          • Cholera/Acute Watery Diarrhoea
          • Bloody Diarrhoea
          • Dengue
          • Malaria
          • Measles
          • Viral Hepatitis/ Acute Jaundice Syndrome
          • Acute Respiratory Infections
          • Viral haemorrhagic fever

          Cumulative number of selected health events reported from the flood affected districts (29 Jul-20 Aug)

          [Disease - Number - % of total consultations]
          • Acute Diarrhoea (AD) - 314,814 - 13%
          • ARI - 317,450 - 13%
          • Skin Diseases - 421,198 - 18%
          • Suspected malaria - 53,707 - 2%

          Major health events reported during the week (14-20 Aug)

          [Disease - Number - % of total consultations]
          • Acute Diarrhoea (AD) - 180,872 - 14%
          • ARI - 183,562 - 15%
          • Skin Diseases - 244,365 - 19%
          • Suspected malaria - 27,439 - 2%

          Surveillance sites

          [Province - Fixed centers - Mobile outreach]
          • Balochistan - 10 - 11
          • KPK - 43 - 50
          • Punjab - 228 - 185
          • Sindh - 316 - 115
          • Total - 597 - 361

          Selected health events: KPK Province, Week-33 (14-20 Aug):

          [Health events - Case counts - (%)]
          • Acute diarrhea (AD) - 15,502 - (16%)
          • Acute respiratory tract infection (ARTI) - 17,101 - (18%)
          • Skin infections (SI) - 15,305 - (16%)
          • Unexplained fever (UF) - 1308 - (1%)
          • Suspected malaria (S. Mal) - 846 - (1%)
          • Injuries (Inj) - 439 - (<1%)

          Selected health events: Punjab Province, Week-33 (14-20 Aug):

          [Health events - Case counts - (%)]
          • Acute diarrhea (AD) - 125,646 - (13%)
          • Acute respiratory tract infection (ARI) - 135,369 - (14%)
          • Skin infections (SI) - 197,862 - (21%)
          • Unexplained fever (UF) - 81,774 - (9%)
          • Injuries (Inj) - 18,845 - (2%)
          • Others (OTH) - 348,601 - (37%)

          Selected health events: Sindh Province, Week 33 (14-20 Aug)

          [Health events - Case counts - (%)]
          • Acute diarrhea (AD) - 37,014 - (17%)
          • Suspected malaria (S. Mal) - 23,811 - (11%)
          • Acute respiratory tract infection (ARI) - 33,072 - (15%)
          • Skin infections (SI) - 41,746 - (19%)
          • Bloody diarrhoea (BD) - 6,488 - (3%)
          • Others (OTH) - 75,206 - (35%)

          Selected health events: Balochistan Province, Week 33 (14-20 Aug)

          [Health events - Case counts - (%)]
          • Acute diarrhea (AD) - 2904 - (19%)
          • Suspected malaria (S. Mal) - 2594 - (17%)
          • Acute respiratory tract infection (ARI) - 2074 - (13%)
          • Skin infections (SI) - 2184 - (14%)
          • Bloody diarrhoea (BD) - 944 - (6%)
          • Others (OTH) - 4172 - (27%)

          Patient consultations

          Since the beginning of flood, approximately 2,394,492 patients consultations have been reported to the DEWS from the four flood affected provinces in Pakistan. Starting from 213 patients’ consultations reported on 29 July , the number of patients seeking health care from both the fixed and mobile outreach centers are increasing– a sign of increasing health facility utilization by the flood affected communities. During the last week rs (Figure-1), a total of 101,925 patients consultations were reported from 597 fixed and 361 mobile health centers.

          This represents an increase by over 25% compared to the preceding day.


          Leading causes of morbidity

          The major causes for seeking health care by the affected communities in almost all the flood affected provinces are from the commonly prevalent infectious diseases like diarrhoeal diseases, acute respiratory infections, skin diseases and suspected malaria. While in the province of Balochistan and Sindh, the risk of increasing case load from malaria are unfolding (Figure-7), the provinces of Punjab, KPK and Sindh are showing increasing trend of skin diseases, diarrhoeal disease and acute respiratory infections. The number of diarrhoeal diseases reported from the flood affected provinces are on the rise (Figure-7) and a perceptible increasing trend has been observed in each of the affected areas compared to the same corresponding reporting period in the past. As seen in the figure-8, the diarrhoeal diseases, reported from the IDP crisis and hosting districts of KPK province after the flood, as a percentage of total patients consultations, clearly exceeds the number reported during the same corresponding period in 2009

          Alert/Alarm thresholds

          A total of thirty-eight (38) alerts were raised during the last reporting period (Week no 33: 14-20 August 2010). Out of these, 37 alerts were flagged for suspected acute watery diarrhea and the remaining alert was for Bloody Diarrhoea. The maximum number of alerts for AWD was raised from KPK (31) followed by Sindh (3), Punjab (2) and Balochistan (1) province. The alert for Bloody Diarrhoea was raised from the KPK province. No alert was raised for any other epidemic prone disease during the last reporting period. Following the field investigation, samples were collected from the suspected cases and sent to the National Institute of Health (NIH) for laboratory confirmation. As part of the field investigations, the community at risk has been educated on safe hygiene and behavioural practices as well.

          All alerts are monitored and assessed closely in accordance with the alert thresholds set for each of the epidemic prone diseases currently under surveillance for disease early warning system (DEWS).


          Epidemic Watch

          As the emergency health interventions scale up in the flood affected areas, the surveillance system has been geared up to early detect any potential outbreak. Since the beginning of the flood, the epidemic prone diseases are being closely monitored. The progression of these epidemic prone diseases are under close vigilance through daily analysis of surveillance data as well as, whenever possible, through comparison with past historical trend.

          Any alerts for an outbreak, whenever flagged, are rapidly investigated and biological samples collected for laboratory diagnosis and verification.

          So far, 66 outbreak alerts have been flagged since the beginning of the flood out of which 61 (92%) were from Acute Watery Diarrhoea. 3 alerts were raised for Measles and 1 alert, each, was raised for malaria and dengue fever. Majority of the alerts (Over 70% ) were raised from the province of Khyber Pakhtunkhwa (KPK).

          All these outbreak alerts were verified through field investigation and clinical specimens were collected and sent to the National Reference Laboratory for confirmation. The rapid analysis of surveillance data, almost on a daily basis, field investigation for verification of any unusual health event that represent a threat to public health and use of epidemic intelligence data are the central basis of this early warning system for any potential outbreak in the flood affected areas of Pakistan


          Outbreak Alert and Verification

          [Diseases - Number - Number investigated]
          • AWD - 61 - 61
          • Dengue Fever - 1 - 1
          • Malaria - 1 - 1
          • Measles - 3 - 3
          • Total - 66 - 66

          The objective of this weekly epidemiological bulletin is to provide a snap shot on the health events occurring amongst the affected communities displaced by the current flood in Pakistan. It is built upon the daily surveillance data received from over 490 fixed and 554 mobile outreach centers which are currently operational in the 73 flood affected districts of four provinces (Balochistan, KPK, Punjab and Sindh). While every attempt is made to show and analyse the weekly trend of the epidemic prone diseases amongst the flood‐hit communities, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin doesn’t provide any health information on areas not currently accessible or covered by the emergency health response operations of MoH, Pakistan and WHO.

          For further information and feed-back
          • Epidemic Investigation Cell, National Institute of Health, Chak Shahzad, Islamabd, Paksitan. : eic.nih@gmail.com
          • World Health Organization, Pakistan : wr@emro.who.int
          -
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          Comment


          • #6
            Pakistan Health Cluster - Floods in Pakistan - Bulletin No 14 - 25 August 2010 (WHO, edited)

            Pakistan Health Cluster - Floods in Pakistan - Bulletin No 14 - 25 August 2010 (WHO, edited)


            [Source: World Health Organization, Full PDF Document (LINK). Edited.]

            Pakistan Health Cluster - Floods in Pakistan - Bulletin No 14 - 25 August 2010


            Highlights
            • Government of Pakistan announces on 24 August measures to strengthen coordination and activities, including disease surveillance, to respond to health impacts of flood emergency.
            • Increasing numbers of cases of diarrhoeal disease, acute respiratory infections, skin diseases and malaria are being reported, with growing concerns about the overall situation in Sindh and Punjab provinces.
            • At least 380 health facilities damaged or destroyed by flooding.
            • 21 diarrhoeal disease centres operating, through USAID/OFDA funding, in affected districts of KPK, Punjab and Sindh provinces, with more being set up.
            • Health Cluster coordination active in 5 hubs - Islamabad, Peshawar, Multan, Sukkur, Quetta.
            • 39% of the US$56.2 million requested to support the health response has been funded, according to OCHA as of 23 August.
            • On 23 August, 101,925 patient were treated in flood affected districts. Of these consultations, 25,476 cases of skin infections (24% of total), 16,469 cases of acute respiratory infections (16%), 14,008 cases of acute diarrhoea (14%) and 4966 cases of suspected malaria (5%) were reported.

            Situation overview and current scale of disaster
            • According to OCHA, 17.2 million people have been affected by the floods, with Pakistan officials stating number of affected could be upwards of 20 million. 1539 people have been reported killed and more than 2000 injured, while around 1 million are left homeless. Some 160,000 square kilometers of land has been affected.
            • The situation in Sindh has continued to deteriorate, with evacuations reported from Thatta and Shahdadkot districts in recent days as the second wave of flooding moves into province's south. Provision of clean drinking water and related WASH support in Sindh and Punjab are of increasingly critical importance.

            Health impact
            • At least 380 hospitals and clinics have been totally destroyed or partially damaged in each of the provinces, according to WHO.
            • During the last 24 hours, a total of 101,925 patients’ consultations were reported from the flood-affected districts. Of these consultations, 25,476 cases of skin infections (24%), 16,469 cases of acute respiratory infections (16%), 14,008 cases of acute diarrhoea (14%) and 4,966 cases of suspected malaria (5%) were reported.
            • Between 29 July to 21 August, a total of 2,394,492 patients’ consultations were reported from the affected districts. Of these consultations, 314,814 cases of acute diarrhoea (13% of total consultations), 317,450 cases of Acute Respiratory Infection (13% of total consultations), 421,198 cases of skin infections (18% of total consultations) and 53,707 cases of suspected malaria (2% of total consultations) were reported from the flood-affected districts.
            • The number of cases of suspected malaria is rising in Baluchistan and Sindh provinces compared to KPK and Punjab. During the last 24 hours, the number of cases reported from suspected malaria comprised 17% of patients’ consultations in Baluchistan province and 11% in Sindh.
            • WHO on 24 August has launched a new weekly disease surveillance document, the full reports can be downloaded from (LINK)

            Government response
            • The Government of Pakistan announced on 24 August the creation of a new national steering committee to intensify and streamline the overall health response to the impacts of the flood crisis. The committee be headed by the Federal Secretary of Health and will include all provincial health secretaries plus the representatives of WHO, UNICEF and UNFPA.
            • The aim of the committee is to ensure better coordination between districts, provinces and the Federal level in terms of improving access to information. Focal points will be appointed at district and provincial level with the responsibility to actively gather and share information so to improve coordination, identify gaps, and reduce duplication of health activities.
            • There was also a decision to intensify disease early warning and surveillance systems flood-affected areas, ensuring that an "active" system of surveillance is in place, rather than a "passive" one. This will involve making health facilities responsible for actively reporting disease surveillance data to district, provincial and Federal levels.
            • A further measure taken at the 24 August meeting was the decision to better coordinate and monitor medical resources (supplies and staff) so they are best used in the emergency response. For Health Cluster partners, this would mean providing greater clarity as to where their services are needed.
            • Since its 20 August launch, the Ministry of Health's National Health Volunteer Programme has seen 840 volunteer doctors, nurses, public health professionals and paramedics register with the scheme. Volunteers will form 4-member teams and work for 15 days in the communities most affected by the floods.
            • The Ministry of Health-led taskforce on communicable diseases has issued new guidelines on responding to cholera and acute watery diarrhoea cases. These guidelines were revised with the support of WHO. The new guidance, issued in response to the growing disease concerns in flood-affected provinces, have been sent to district and provincial health officials and will be disseminated widely.
            • Hundreds of thousands of children have be immunized against a range of diseases during vaccination campaigns conducted in the 4 provinces between 4-20 August. The campaign was coordinated by MoH's National Health Emergency Preparedness and Response Centre and implemented by the national Expanded Programme of Immunization.
            • Children were vaccinated against polio, measles, tuberculosis, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, and Haemophilus influenza type b (often known as Hib) which causes some severe forms of pneumonia and meningitis, and given Vitamin A supplements. Pregnant women were also vaccinated against tetanus and neonatal tetanus.

            Health Cluster response
            • UNFPA provides emergency reproductive health/maternal newborn responds through deploying 23 fully equipped and staffed mobile service units and supporting 13 existing govt. health facilities in 14 districts of KPK, Sindh and Punjab provinces. UNFPA has provided emergency reproductive health medicines to cover 510,000 people for one month, women’s hygiene kits for 3300 families,1800 newborn kits, Interagency clean delivery packets were distributed among pregnant women to in flood affected districts of KPK, Punjab and Sindh provinces. During 21-22 August, UNFPA staff consulted around 4700 patients, including 187 deliveries, 980 antenatal consultations, 132 postnatal consultations, 18 post-abortion care, 30 consultations for syndromic case management of sexually transmitted infections and 500 cases of gastroenteritis. In the same period, UNFPA distributed women’s hygiene kits to cater for 240 families for one month and 187 newborn kits were distributed to newly delivering mothers.
            • Helping Hands for Relief and Development (HHRD) is operating more than 150 health facilities in Punjab, KPK and Sindh provinces, and, on 23 August its medical staff treated more than 33,000 people for a range of conditions, including diarrhoea, skin infections, respiratory infections and malaria.
            • World Health Organization is planning to establish 69 diarrhoea treatment centres in 47 priority affected districts in the 4 provinces after receiving funding support from USAID. 21 have already been established, 17 are in the process of being set up and the remainder are under discussion. The centres will be run by implementing partners and health authorities. 11 of 15 centres being established in KPK are operational; 9 of the 11 planned for Punjab have been established; 4 of the 16 planned for Sindh are being established, 4 of the 8 for Punjab are being set up.

            Khyber Pakhtunkhwa
            • Medical Emergency Relief International (MERLIN): Merlin is scaling up operations and mobilizing 682 medical, health and logistics support staff. Merlin has also distributed 50,000 Aqua-Tabs, 90,000 water purification sachets (enough to purify 1 million litres of water) and 10,000 hygiene kits, throughout 3 of KPK's worst-affected areas. Primary health care services are being provided alongside waterborne disease control, blanket distribution of oral rehydration salts. Since 5 August 2010, Merlin has conducted around 90,000 consultations (average 6000 per day). In Nowshera, Merlin is providing health and nutrition services through 5 mobile team in 6 Nowshera union councils and 6 static clinics in Jalozai that provide 24-hour coverage. On 23 August, 1570 consultations were conducted, and 235 water purification tablets, 245 Multi Micronutrients Tablets, 230 high energy biscuits and 700 plumpy nuts were distributed. 23 health promotion sessions were conducted for 410 people. A diarrhoea treatment centre started functioning 21 August and has treated 104 patients to date. Merlin is covering an approximate catchment population of 153,034 in Nowshera.
            • In Swat, Merlin is providing health services through 9 mobile teams (8 in Upper Swat, 1 in Lower Swat) and 11 fixed health facilities. On 23 August, 3300 consultations were conducted, as were 116 health promotion sessions for 1455 people. A diarrhoea treatment centre is being established at tehsil headquarters Matta. Merlin is covering an approximate catchment population of 590,036 in Swat. A mobile camp was conducted in response to a suspected AWD case in Battai Bunn area,. Hygiene kits and aqua tabs were distributed. In addition, 110 Hygiene Kits were also distributed in Mingora and Bahrain.
            • In Buner, Merlin is providing comprehensive PHC, reproductive healthcare and disease early warning systems in Buner district through 10 fixed health facilities and 3 mobile teams. On 23 August, 60 health promotion sessions were conducted for 627 people. Merlin is covering an approximate catchment population of 337,808. A diarrhoea treatment centre is being established at tehsil headquarters Pachakalay.
            • The Pakistan Red Crescent Society continues operations at 7 basic health units in Kohistan and Shangla disitricts of KPK province. On 22 August, the basic health units in the Shangla towns of Damorai and Olandar conducted multiple around 180 consultations.
            • CARE has treated more than 14,000 patients during the emergency in Upper Swat via 2 mobile teams and 4 basic health units. It has also conducted 7 mobile clinics in Charsada district, providing almost 1200 patients with primary health care, including approximately 300 women & 300 children on 22-23 August. On 23 August in Upper Swat, CARE health facilities treated 1272 patients. In Nowshera, CARE conducted 10 mobile clinics in Nowshera district, treating over 1300 patients, including 370 women and 470 children on 22-23 August.
            • Doctors Worldwide has rehabilitated and reequipped the Pir Sabaq basic health unit and is working out of the facility since 9 August, with permission from health authorities in Peshawar. Local and international volunteers are staffing the facility. Doctors Worldwide is also establishing a 6-patient inpatient facility at the same centre, and intends to replicate its activities at 4 more basic health units (Ganderi, Misri Banda, Shaidu, Jehangira).
            • International Medical Corps has deployed 14 medical teams to flood-affected areas of Charsadda, Peshawar and Nowshera. On 22 August, IMC medical teams provided medical treatment to 1300 patients, including 164 cases of acute diarrhoea, 214 cases of acute respiratory infection, and 147 cases of scabies.
            • Relief International has established 2 medical camps, one at the border of union council Bahrain in Upper Swat, and one in bordering Lower Dir district's Khan union council. On 24 August, its teams conducted 206 patient consultations in Swat and 47 in Lower Dir. There was a reported increase of diarrhoeal cases among the consultations and acute upper respiratory infections, while cases of scabies are also being reported. In recent days, Relief International conducted 3 infant and young child feeding education sessions for 91 pregnant women and lactating mothers, while 7 education sessions were conducted on water-borne diseases. RI workers distributed 400 water purification tablets and demonstrated their use, registered 15 pregnant women antenatal check up, distributed Energy-5 Biscuits for under five children, and Multi micronutrient tablets and sachets to children and women.
            • IHH-Turkey has been sent a medical team to support health activities in Nowshera, with a second team expected to arrive 25 August. IHH-Turkey plans to support Shelter and WASH cluster activities as well.
            • UNICEF is providing 4.2 million sachets of oral rehydration salts and 2.1 million Zinc doses to lady health workers for community-based management of diarrhoea in children aged under 5 in flood-affected areas of Khyber Paktoonkhwa, Punjab, Sindh, Baluchistan, AJK and Gilgit Baltistan.
            • UNICEF and WHO are assisting the Provincial Expanded Programme of Immunization efforts to immunize children against measles and provide vitamin A supplementation. The campaigns are targeting schools, camps and floodaffected areas in Peshawar, Charsadda, Nowshera.
            • A UNICEF-supported measles campaign started in Swat on 19 Aug. 381 teams have been deployed throughout Swat, Charsadda and Peshawar to conduct the campaign in these 3 districts. These teams have vaccinated 205,520 children aged under 5 against polio, 185,140 children (6-59 months) received measles vaccine and 184,801 children (6-59 months) received Vit A supplementation. 6 UNICEF mobile medical teams have been operating in Charsadda, Nowshera and Swat, providing consultations for 1,626 patients, including 722 children and 571 women. 77 women received antenatal, postnatal care and 32 high risk pregnant women and 2 seriously ill children were provided with referrals through these teams. The teams distributed 270 hygiene kits and 921 soap bars, plus delivered health and hygiene messages to 297 people.
            • UNICEF supported 5 district health authority medical teams in D.I. Khan that have treated more than 1000 people, including over 500 women and 200 children. These teams have resumed providing services through health facilities. UNICEF supported specialized paediatric services at D.I. Khan districts headquarters hospital, treating 459 children.
            • A mobile team in D.I. Khan has treated 466 patients, including 296 children and 147 women.
            • Mother Child Days, supported by UNICEF, have been conducted in 6 Swat union councils. Health teams served 1261 households (11,848 people), providing oral rehydration salts, aqua tab strips, jerry cans, and water purification tablets. Pregnant women received antenatal care and were vaccinated against tetanus. Children were vaccinated against measles, received de-worming and were given multi-micronutrient sachets. Medical teams provided health, hygiene and breastfeeding-related messages. UNICEF distributed 10,000 sachets of ORS and other medical materials to support mobile medical services in Kohistan.
            • International Catholic Migration Mission operates a health facility Charsadda district's Prang union council, where on 23 August its health staff conducted 96 consultations, numerous of which were for diarrhoeal diseases, respiratory tract infections and scabies.
            • Malteser International has treated, up until 21 August, 5236 patients at fixed health facilities within the Swat district union councils of Islampur, Chetewar and Meragai, as well as through 7 medical camps. The average number of patients being treated at the 3 fixed health facilities is 65 per day. Each Malteser mobile team has its own ambulancetype referral capacity.
            • Malteser has supported vaccination efforts and is providing intensive hygiene awareness campaigns in the area with suspected acute watery diarrhoea, including in Barikot, Margazal and Ahunbaba in Islampur, and Mingora Town. During the previous week, several hundred families were registered by Malteser, and printed hygiene materials, aquatabs, soap and ORS sachets were distributed.
            • Malteser will be procuring, using CERF funds acquired by WHO, additional health supplies and equipment for operating 2 diarrhoea treatment centres in northern Swat with a combined 100 patient capacity. With its own funds and funds from the German government, Malteser will purchase 1000 hygiene/household family kits for Swat, and a further 600 for Kohistan. Malteser International, which is operating in Swat and Kohistan districts of KPK, notes its major challenges are access to people in affected areas, and ensuring access to health facilities.
            • American Rescue Committee International is working through 7 health facilities in Swat district. On 23 August, ARC staff treated 604 patients, with diarrhoea representing 17.7% of cases, respiratory tract infections 22.6%, and scabies 6.9%. 104 women received antenatal care consultations, and 24 received postnatal care consultations. 41 health education sessions were conducted, 18 sessions for psychosocial counseling and 19 delivery kits were distributed. Mobile health camps have been established in Swat, with more than 600 patients treated in 3 villages of Shah Dehry, Takhta Band Angora Dehry.
            • Church World Service is operating mobile teams in remote areas of 3 KPK districts - Swat, Manshera and Kohistan - where they provide essential medicines and consultations for patients with a focus on women and children. As of 24 August, the teams had conducted 2446 consultations, while a lady health worker had examined 44 antenatal and 6 postnatal clients. 398 children were examined by the teams. The mobile teams use their own ambulance to transfer patients needing urgent referral to secondary or tertiary level health care facilities.
            • Church World Service is planning to further expand mobile health units in Kohistan and Shangla Districts.

            Punjab province
            • CARE International is providing primary health care services in southern Punjab province via a mobile clinic in Muzzafargarh, which has treated 213 patients including 30 women and 107 children.
            • WHO, from the Multan Health Cluster hub, is preparing to sent a consignment of medical supplies to DG Khan and Rajanpur on 24 August, by air asap.
            • A WHO team visited 2 formal IDP camps near Multan, noting that safe drinking water was available and sanitation conditions were satisfactory. Medicines are available in sufficient quantities. An adequate patient referral system exists from the camps to Nishter Hospital.

            Sindh province
            • CARE International is providing services in Sindh province via 10 mobile clinics. The teams have provided primary health care services to 2105 patients via 10 mobile clinics Sukkur and Shikarpur districts, including 774 women and 845 children. CARE has also provided PHC services to 403 patients via 03 Mobile clinics including 94 women & 183 children in district Sukkur & Shikarpur of Sind province.
            • WHO is expected to open a new diarrhoea treatment centre on 25 August in Kankhot, near Sukkar, which will be operated by the Health and Nutrition Development Society (HANDS) and district health authorities. Another centre is operating in Khairpur town, near Sukkar, at and by the Gambat Institute of Medical Sciences.
            • WHO, from the Health Cluster bug in Sukkar, is planning to airlift medicines, including for the treatment of diarrhoeal diseases, to communities inaccessible by road due to flooding.

            Baluchistan province
            • Medical services are being provided to displaced people in 6 districts of Baluchistan, with support being provided by health authorities, Muslim Hands, WHO and community organizations.
            • Relief International established on 23 August a static emergency PHC services centre in union council Dhadar of Kachi district, Baluchistan, where there are 23,000 displaced people living. The team working at the centre comprises 2 medical officers, 2 lady health volunteers, 2 health educators and 2 dispensers. On its first day, the team conducted 147 consultations, 5 antenatal checkups, 2 health education sessions on diarrhoeal disease prevention and nutritional anthropometry of 14 children.
            • Johanniter International will commence providing health services in Bolan and the district health facility in Naseerabad. Johanniter will provide medical services at the basic health units in Mitri, Hajio Seher, Chandar, Killi Shahbaz, Masoo and the Chalgri rural health centre.
            • WHO has provided medicines to the Baluchistan health department, which has distributed the materials 10 health facilities serving flood affected people, including items for treating diarrhoeal diseases.
            • American Refugee Committee International is working at the rural health centres in Talli and Lehri, and the basic health units at Sultan Kot, Bakhtiarabad, Chandia and Gishkori. More than 930 patients were treated at the different facilities on 23 August.

            Inter-cluster coordination
            • WASH-HEALTH:
              • WHO is working with UNICEF, as WASH cluster lead, which is coordinating the WASH cluster response to reach safe drinking water, hygiene and sanitation supplies to flood-affected communities. In Multan, WHO briefed at the WASH Cluster meeting on 24 August, presenting current disease patterns, and statistics on the damage to health facilities. WHO also briefed on malaria prevention strategies undertaken by the Punjab Health Department. WHO is leading the sub-cluster on health and hygiene within the WASH Cluster in Multan. A WHO environmental health consultant presented the matrix of an action plan for flood-affected areas.
            • LOGISTICS-HEALTH:
              • Logistics cluster receiving 3 helicopters to be based in Multan and they are awaiting partners, including Health Cluster, to provide distribution plan to deliver supplies to areas not accessible by road. The Health Cluster is in constant coordination with the Logistics Cluster to capitalise on opportunities to delivery medical supplies offered by air support.

            For further information contact: health_cluster_bulletin@pak.emro.who.int
            Please submit your organization's activities by 5pm daily using the above email address.
            -
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            Comment


            • #7
              Floods in Pakistan - Bulletin No 15 - 29 August 2010 (WHO, Pakistan Health Cluster, 8/30/10, edited)

              Floods in Pakistan - Bulletin No 15 - 29 August 2010 (WHO, Pakistan Health Cluster, 8/30/10, edited)


              [Source: World Health Organization, full PDF Document (LINK). Edited.]

              Pakistan Health Cluster

              Floods in Pakistan - Bulletin No 15 - 29 August 2010


              Highlights
              • Australia, Bangladesh, China, Indonesia, Iran, Japan, Jordan, occupied Palestinian territories, Saudi Arabia, Spain, Sri Lanka, Turkey and UAE have sent medical teams to support medical relief efforts in affected areas.
              • 43% of the US$56.2 million requested to support the health response has been funded, according to OCHA as of 26 August.
              • Increasing numbers of suspected malaria cases being recorded in Sindh and Baluchistan provinces.
              • On 24 August, 110,062 patients were recorded as having been treated in flood affected districts. Of these consultations, 21,400 cases of skin diseases (19% of total), 16,557 cases of acute respiratory infections (15%), 18,562 cases of acute diarrhoea (17%) and 7399 cases of suspected malaria (7%) were reported.
              • Health Cluster coordination active in 5 hubs - Islamabad, Peshawar, Multan, Sukkur, Quetta.

              Situation overview and current scale of disaster
              • According to OCHA, 17.2 million people have been affected by the floods, with Pakistan officials stating number of affected could be upwards of 20 million. 1600 people have been reported killed and more than 2366 injured, while 1.2 million homes have been destroyed, as of 27 August. Floodwaters in Punjab are reportedly receding. Monsoon activity is expected to be subdued during next 3-4 days. Further OCHA information, go to: (LINK)

              Health impact
              • Health needs remain great as relief efforts strive to cope with the scale of the challenges. Large numbers of people continue being treated for diarrhoeal disease cases, skin diseases, acute respiratory and increasingly, malaria.
              • 402 of more than 1000 health facilities in flood-affected districts have been damaged or destroyed by the flooding.
              • Latest epidemiological data released by WHO, as of 27 August, shows that on 26 August, 133,684 patients were recorded as having been treated in flood affected districts. Of these consultations, 28,815 cases of skin diseases (22% of total), 22,902 cases of acute respiratory infections (17%), 19,178 cases of acute diarrhoea (14%) and 7973 cases of suspected malaria (6%) were reported.
              • In all, 3.7 million people are reported to have been treated from 29 July to, and including, 23 August. Of these, there were 500,635 cases of acute diarrhoea (13% of total consultations), 517,929 cases of acute respiratory infection (14% of total consultations), 693,114 cases of skin infections (19% of total consultations) and 94,186 cases of suspected malaria (3% of total consultations) were reported from flood-affected districts.
              • The number of cases of suspected malaria is rising in Baluchistan and Sindh provinces compared to KPK and Punjab. During the last 24 hours, the number of cases reported from suspected malaria comprised 27% of patients’ consultations in both Baluchistan and Sindh provinces.
              • WHO's weekly disease surveillance document id as: (LINK)

              Government response
              • On 28 August, the Government of Pakistan's National Steering Committee on Health Emergency Preparedness and Response (HEPR) met in Islamabad with all provincial health secretaries and representatives from WHO, UNICEF and UNFPA, formulating plans to receive more rapid and complete health surveillance data from district and provincial levels.
              • The Ministry of Health is working with partners on plan to provide incentives to have lady health workers return to duties, as at least 20,000 have been affected by the flooding, many of whom are not working.
              • Foreign medical teams have been arriving in Pakistan to support health relief efforts, and their activities are being coordinated by the HEPR.

              Foreign medical teams supporting Pakistan flood relief effort (not complete)

              [Country - Arrived - Capacities - Where operating]
              • China - 26-Aug - 38 member hospital multi-disciplinary team, including mobile field hospital, medical equipment, doctors, nurses, surgeons, cardiologists. - Thattar district, Sindh province.
              • Australia - Approx 26-Aug - 72-member army medical corps multidisciplinary team including mobile field hospital - Kotaddu district, Punjab province
              • Saudi Arabia - 25-Aug - 2100-bed field hospitals with 70 staff each. - Rajanpour, Punjab province and Thatta, Sindh province.
              • Saudi Arabia - 25-Aug - Medical team with 18 specialists, medicines - District Headquarters hospital, Nowshera district, KPK province.
              • Indonesia - 26-Aug - 6-member team supporting Pakistan Institute of Medical Sciences. - Charsadda district, KPK
              • Spain - 26-Aug - 8-member medical team, provided 13 tons of medicines to the Ministry of Health - Sukkur district, Sindh province.
              • Physicians Across Continents - 26-Aug - Multidisciplinary team that has provided planeload of equipment, water filtration plants. - Nowshera and Charsadda.
              • Jordan - 16-Aug - Medical team - Multan

              Health Cluster response

              (Inputs received before 4PM Thursday 28 August through health_cluster_bulletin@pak.emro.who.int)
              • UNFPA is delivering health care in Sindh, Punjab and KPK provinces is through 23 mobile service units for outreach services and 14 government health facilities for emergency reproductive health care services. UNFPA is also providing primary health care services including 8605 consultations for gastroenteritis, 5556 scabies, 5273 for acute respiratory tract infections, 5686 consultations for fever and 9971 other minor out-patient services for psychosomatic and general medical services.
              • World Health Organization providing medicines and related supplies to all Health Cluster partners, delivering items that can treat more than 3.4 million people for one month. More than 20 international staff, including public health specialists, epidemiologists and logisticians, been deployed from throughout the WHO network to different locations in Pakistan to support the flood response. WHO is supporting the establishment of diarrhoea treatment centres in affected districts. As of 28 August, more than 60 had been established or where in the process of being set up to provide diarrhoea treatment services for people affected by the flooding.

              Khyber Pakhtunkhwa
              • American Refugee Committee (ARC) International treated 859 children, women and men on 24-25 August at 7 health facilities it supports in Swat district. On 24 August, a medical camp was established in Dardyal town, Swat, where 1590 patients received consultations mainly for acute respiratory infection, diarrhoea, scabies and eye infections.
              • CARE International operates 2 mobile teams and 4 basic health units in Upper Swat, treating on 25-27 August 568 patients (including more than 100 women on 26-27 August). CARE conducted 7 mobile clinics Charsadda district on the same days, providing primary health care services to 963 patients including 313 women and 278 children, and 12 mobile clinics in Nowshera district, treating 1829 patients including 515 women and 901 children.
              • Church World Service (CWS) operates 3 mobile health units in Mansehra, Kohistan and Swat districts, delivering consultations to 3189 patients on 26 August. A lady health visitor examined 62 antenatal and 6 postnatal clients and gave them essential medicine. The medical team examined 531 children aged under 5 years. CWS is planning to further expand mobile health units in Kohistan and Shangla districts to provide more free consultations, free essential medicine and maternal and child health services. CWS ambulances transfer patients needing urgent referral to secondary or tertiary level health care facilities.
              • International Catholic Migration Commission mobile teams on 27 August treated 66 flood affected people staying at the Prang Primary School in Utmanzai Union council in KPK's Charsadda district.
              • International Medical Corps (IMC) medical teams are delivering emergency health services in Nowshera and Charsadda districts. IMC and WHO are working together to operate a diarrhoea treatment centre at the Nowshera district headquarters hospital. IMC medical teams treated more than 6353 patients from 25-28 August, with acute diarrhoea, acute respiratory infections and scabies being the main conditions. Health education and hygiene promotion sessions were given to 4200 people. The team from the Dagai basic health unit at Nowshera moved to the Khair Abad rural health centre and started functioning 28 August. A female psychologist has joined the 6-member psychosocial support team, which operates in Peshawar, Nowshera and Charsadda. The team has provided services to 461 people on 25-28 August, including for depression, anxiety and distress.
              • MERCY Malaysia is collaborating with the Pakistan Islamic Medical Association to operate static clinic for floodaffected people in KPK and a mobile medical team is providing health services in Charsadda district. MERCY Malaysia will help establish a static clinic at Pabbi Government High School which is occupied by 200 families; and a mobile team to support displaced people living nearby. MERCY is delivering hygiene kits and conducting hygiene promotion activities in KPK.
              • Medical Emergency Relief International (MERLIN) is operational in Swat, Buner, and Nowshera districts, covering an approximate catchment population of 1 million people, and is starting interventions in Charsadda. Merlin currently provides health services through 27 static clinics (11 Swat, 10 Buner, 6 Jalozai) and 17 mobile teams (9 Swat, 3 Buner, 5 Nowshera), while 1 diarrhoea treatment centre is functional at the Satellite Hospital in Nowshera's Pabbi town, and 1 in Matta town, Swat. 2 centres are also being established at Pacha Kaly in Buner district and Charsadda district. Merlin is conducting an average of 4955 daily consultations and has conducted around 121,000 consultations from 5-27 August. Services include primary health care, referrals to tertiary level facilities, distribution of hygiene kits, water purification tablets, maternal and newborn health.
              • The Pakistan Red Crescent Society and the German Red Cross are conducting joint activities Nowshera district, providing treatment for water-borne diseases, acute respiratory infections and a wide range of other conditions. Routine healthcare is also being delivered, including for hypertension and the delivery of babies. From 31 July-24 August, 8763 people have been treated (4897 males, 3866 females). On 26 August, PCRS teams treated around 400 people in Mana Khel town and Pirpayi station.
              • Relief International medical staff has treated 518 people at the Madyan medical camp in Swat district for a range of conditions from 25-27 August, with the main health conditions being acute diarrhoea and respiratory infections. Relief International conducted health education sessions on diarrhoeal disease prevention and child immunization, while pregnant and lactating women have received education on the importance of breast feeding and complementary feeding. Hundreds of water purification tablets were distributed among the community. In Lower Dir, Relief International is using a mobile unit to better reach affected communities, with 480 patients being treated. Main health conditions were acute diarrhoea, respiratory infections and scabies. A health education session was conducted on diarrhoeal disease control and prevention.
              • Sawera Development is running a medical camp in D.I. Khan and conducting disease early warning and surveillance. Sawera is providing medicines, consultations, checkups and health education sessions to raise awareness on communicable diseases and measures to protect public health.
              • UNICEF is supporting routine expanded programme of immunization activities in Peshawar, Charsadda, Nowshera and D.I. Khan districts, completing a campaign on 28 August that vaccinated 285,154 children aged under 5 against polio, 253,511 children (6-59 months) against measles and providing 257,561 children with Vitamin A supplements.
              • 5 UNICEF-supported mobile medical teams are operating in Charsadda, Nowshera and Swat districts, providing primary health care services, distributing health-related materials including hygiene kits and delivering health and hygiene messages. UNICEF is supporting specialized paediatric services at the D.I. Khan district headquarters hospital.

              Punjab province
              • CARE International mobile clinics operating in Muzzafargarh district of southern Punjab province on 25-27 August, delivering primary health care services to 1402 patients, including 351 women and 688 children.
              • Cordaid has scaled up its health response, operating 5 mobile medical teams in Shangla, and 2 more teams are scheduled to start in Kohat shortly. Cordaid may conduct medical camps in Kohistan. Cordaid Team A is working in Shangla's most affected areas with mobile and fixed health services in Barkana, Kuzana, Karora, Damorai, Olandar and Shapur. Mule carriages are moving medicines on mountain roads, along with Cordaid vehicles and public transport. The Cordaid-supported basic health unit in Kuzana is delivering healthcare. A lady health volunteer is travelling from Kuzana to Shapur delivering health services to females. Cordaid is also coordinating the Shangla district WASH Cluster working group.
              • Integrated Health Services (IHS Pakistan) is operating mobile medical teams in Muzzafargarh and DG Khan districts since 12 August.
              • MERCY Malaysia conducted joint assessment with Pakistan Islamic Medical Association to Punjab for the opportunity to expand health services in Southern Punjab.
              • Medical Emergency Relief International (MERLIN) is starting interventions in Muzzafargarh in Punjab province, including through the establishment of a diarrhoea treatment centre at the Muzzafargarh district headquarters hospital.
              • UNICEF is delivering medical and nutritional supplies to 7 Punjab districts of Mianawali, Bhakkar, DG Khan, M. Garh, Layyah, Rajan Pur, RY Khan, Khushab, Multan. Health education sessions are being conducted in displaced people's camps in RY Khan and UNICEF-supported medical officers, lady health volunteers and vaccinators are providing health care services in all Punjab displaced people's camps.
              • UNHCR is providing health support to Afghan refugees in Pakistan affected by the flooding. In Mianwali, Punjab province, where 18,000 people are located, UNHCR and implementing partners are providing health services to Afghan refugees and locals through makeshift tent health points. Bed nets have also been provided.

              Sindh province
              • CARE International provided primary health care services via 9 mobile clinics to 1282 patients in Sukkur and Shikarpur districts, including 524 women and 446 children, on 25-27 August.
              • Helping Hand for Relief and Development (HHRD) is supporting 184 medical camps in flood-affected areas and provided medicines to treat 43,000 people. launched a hygiene promotion project in Sukkur district, Sindh province, and will conduct health and hygiene awareness sessions and distribute hygiene kits to 500 families (35 00 people). Clean drinking water will also be provided.
              • Mercy Corps is operating 2 mobile health teams in Sindh province's Sukkur, Rohri and Pannu Aqil districts, delivering primary health care and maternal, newborn and child health services. The mobile teams contain ambulances, medicines, and health and hygiene kits. Mercy Corps health teams deliver health and hygiene sessions and provide clean delivery kits to pregnant women. Mercy Corps is also supporting water and sanitation activities. Mercy Corps is planning to replicate the same services in Jacobabad, Shikarpur and Jaffarabad.
              • The UNFPA humanitarian team conducted a joint reproductive health assessment mission with national and the Sindh provincial maternal newborn and child health department in the districts of Sukkur, Shikarpur and Khairpur.
              • UNICEF is supporting childhood vaccination campaigns in camps providing shelter for flood-affected people, with continuing vaccinations planned for areas where people have moved to, including Karachi. More than 2000 patients have been treated at UNICEF-supported medical facilities in Sindh, while messages on safe motherhood, breastfeeding, clean drinking water, hand washing and immunization are being provided.
              • World Health Organization conducted disease early warning system training for 36 district health management staff, polio team members and Health Cluster partners on 28 August in 9 flood-affected districts of Sindh to strengthen disease surveillance activities.

              Baluchistan province
              • The American Rescue Committee International is supporting the rural health centre in Talli town, Sibi district, where 214 people were treated (158 men and 80 women) on 25-26 August. At the ARC-supported basic health unit in Chandia, 95 patients were treated on 25 August (58 women and 37 men) mainly for diarrhoea, bloody diarrhoea, upper acute respiratory infections, lower acute respiratory infections, scabies and injuries.
              • Relief International is working in Dhadar town of Kachi district, conducting 515 consultations between 25-27 August. Main conditions reported include acute respiratory infections and acute watery diarrhoea. Health education sessions have been conducted for mothers and male members of the community, as well as for use of oral rehydration solution. Water purification tablets have been distributed.
              • UNICEF-supported health services are operating in Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Harnai districts of Baluchistan, treating 9400 patients on 24-25 August, including for diarrhoea (21% of cases), clinical malaria (23%) and scabies /skin diseases (135). UNICEF is conducting polio, measles, turberculosis and tetanus in Baluchistana's 6 most affected districts (Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Kachhi) and a relief camp at Eastern bypass Quetta. UNICEF is supporting malaria control activities being conducted by health authorities in Sibi, Naseerabad and Jaffarabad districts.
              • World Health Organization is planning to send a 20-bed inflatable hospital to the severely flood-affected Sindh province town of Thul.

              Azad Jammu and Kashmir (AJK)
              • UNICEF is delivering zinc tablets and oral rehydration solution to health authorities and planning measles vaccinations campaigns for flood-affected people.

              Gilgit Baltistan
              • UNICEF is providing emergency medical supplies, zinc tablets and oral rehydration solution to health authorities and is planning measles vaccinations in Ganche, Skardu, Ghizer and Gilgit districts.

              Coordination
              • REPRODUCTIVE HEALTH:
                • The first reproductive health task force meeting of Health Cluster partners was held 24 August to ensure implementation of Minimum Initial Service Package protocols through the Health cluster response.
              • WASH-HEALTH:
                • WHO is working with UNICEF, as WASH cluster lead, which is coordinating the WASH cluster response to reach safe drinking water, hygiene and sanitation supplies to flood-affected communities. UNICEF and WHO launched an appeal on 25 August for more support for water and sanitation activities. (LINK)
              • LOGISTICS-HEALTH:
                • WHO/Health Cluster working closely with the Logistics Cluster to plan deliveries of medicines to flood-affected communities.

              Gaps/challenges
              • Cordaid International reports that Sharpur town, in KPK's Shangla district, has no operational health facility, and the nearby Karora Rural Hospital is badly damaged and non- operational. Critical shortages of medicines reported in Sharpur and Damorai markets. Increased hygiene promotion needed in Sharpur and Towa towns, Shangla district in KPK.
              • According to UNFPA, more female health care providers (especially gynecologists) in flood-affected districts are needed due lack of access to reproductive health services and limited funds.
              • Overall funding of the health sector's emergency response projects had reached 43% of the US$56.2 million requested as of 28 August, according to OCHA.
              For further information contact: health_cluster_bulletin@pak.emro.who.int
              Please submit your organization's activities by 5pm daily using the above email address.
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              Comment


              • #8
                Diarrhoeal treatment capacity increasing in Pakistan, but sustained support needed (WHO/EMRO, edited)

                Diarrhoeal treatment capacity increasing in Pakistan, but sustained support needed (WHO/EMRO, edited)


                [Source: World Health Organization, Regional Office for Eastern Mediterranean (EMRO), full PDF Document (LINK). Edited.]

                Press Release 10
                30 August 2010

                Diarrhoeal treatment capacity increasing in Pakistan, but sustained support needed

                30 August, 2010 ¦ ISLAMABAD


                The World Health Organization is establishing diarrhoeal treatment centres throughout flood-ravaged Pakistan, a key intervention by the humanitarian health sector as it strives to protect people against epidemic-prone acute water-borne diseases, reduce excess deaths and restore routine health care services.

                According to new data issued 29 August, 500,635 people are recorded to have been treated have been treated for the various forms of diarrhoeal disease, ranging from acute watery diarrhoea, bloody diarrhoea (shigella) and milder variations including. This number represents 13% of the 3.7 million people recorded to have been treated between 29 July and 26 August. On 26 August alone, 19,178 cases of acute diarrhoea were reported.

                Dr Hussein Gezairy, WHO Regional Director for the Eastern Mediterranean has warned against the increased risk of diarrhoeal diseases in the floods-striken areas, pointing that this increase is due to there being no, or a lack of, access to safe water for flood- affected people, as well as poor sanitation and compromised hygiene and living conditions that millions displaced by the floods are forced to live in.

                “More than 60 diarrhoeal treatment centres (DTCs) are operational or are in the process of being established in 46 of the most affected districts. USAID and the Office of US Foreign Disaster Assistance is funding the establishment of these centres, which are being operated by nongovernmental organization partners and Pakistani health authorities”. He added "The terrible scale of this disaster has shocked the entire world, and the increasing trend of diarrhoeal diseases remains a grave concern to the humanitarian community ," says Dr Guido Sabatinelli, WHO's representative to Pakistan. "The current situation remains a major threat to public health. If the current poor environmental and hygiene situation in affected areas does not improve, coupled with limited availability of safe drinking water and the need for better access to health services, the risk is we may see more potentially fatal diarrhoeal and other acute waterborne diseases cases in coming days."

                Diarrhoeal diseases are not the only public health risks facing Pakistan's flood-affected people.

                Acute respiratory infections, hepatitis A and E, malaria and skin infections are among multiple health threats that have already sickened hundreds of thousands of people.

                The combination of challenges preventing many people reaching healthcare is worrisome, requiring health providers to intensify efforts both to deliver health services directly to those who need it and find alternative means, such as by air, to reach communities isolated by floodwaters.

                "More than 400 hospitals and clinics have been damaged by this disaster, destroying in the blink of an eye services that have been built up over 60 years. And the worst is not over yet," Dr Sabatinelli says. "The waters could remain for weeks, and the damage caused will remain even longer. The humanitarian community has a monumental task to protect the health of so many vulnerable people. And this will require sustained international support."

                WHO and Health Cluster partners have sought US$56.2 million to conduct life-saving health programmes in the Pakistan Initial Floods Emergency Response Plan 2010 launched 9 August.

                So far, just 43% has been covered by pledges or commitments for the plan, which covers relief efforts for the first 90 days of the emergency. WHO has delivered to healthcare providers supplies capable of treating 2.6 million people since the crisis started to treat a range of illnesses, including diarrhoea.

                "More funding is urgently needed to deliver health services to extremely vulnerable communities now, and sustained support will be needed in the months ahead as well as Pakistan tries to rebuild its health system for the future," Dr Sabatinelli says.


                For more information, go to (LINK)

                Contacts:
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                Comment


                • #9
                  Daily Epidemiological Update - Flood Response in Pakistan - 1 September 2010 (WHO, edited)

                  Daily Epidemiological Update - Flood Response in Pakistan - 1 September 2010 (WHO, edited)


                  [Source: World Health Organization, full PDF Document (LINK). Edited.]

                  Daily Epidemiological Update - Flood Response in Pakistan - 1 September 2010

                  This daily epidemiological update is published jointly by the Federal Ministry of Health, Government of Pakistan and World Health Organization (WHO), Pakistan. For correspondence: Tel: +92-051-9255184-5; fax: +92-051-9255083; E-mail: wr@pak.emro.who.int; eic.nih@gmail.com


                  Highlights

                  Date received on 30 August 2010
                  • 47 out of the 73 flood affected districts in four provinces have reported over the last 24 hours compared to 37 districts reported on 29 August 2010.
                  • 932 fixed health centers and 526 mobile medical outreach centers have reported to the Disease Early Warning System (DEWS) over the last 24 hours;
                  • 264,329 patients’ consultations were reported over the last 24 hours compared to 157,058 patients’ consultations reported on 29 August 2010
                  • Acute diarrhoea, acute respiratory infections, skin diseases and malaria remain the leading causes of seeking health care in the flood affected districts;
                  • In Balochistan and Sindh province, higher number of suspected malaria cases were reported compared to either KPK or Punjab provinces;
                  • Sporadic cases of acute watery diarrhoea, laboratory confirmed as Vibrio Cholera 01 Ogawa, have been reported from multiple foci in KPK, Sindh and Punjab province.

                  Alerts received over last 24 hours

                  [Province - District/Place - Disease - No of alerts]
                  • KPK - DI. Khan/Village Chaudwan; Mahra; UC Nai - AWD - 3
                  • Sindh - No Alert
                  • Balochistan - No Alert
                  • Punjab - No Alert
                  • AJK - No Alert

                  Cumulative number of selected health events reported from the flood affected districts (29 Jul-30 Aug)

                  [Disease - Number - % of total consultations]
                  • Acute Diarrhoea - 559,021 - 13%
                  • ARI - 627,303 - 15%
                  • Skin Diseases - 823,281 - 19%
                  • Suspected malaria - 112,406 - 3%
                  • Total consultation - 4,251,900

                  Major health events reported during the epi-week -34 (21-27 Aug)

                  [Disease - Number - % of total consultations]
                  • Acute Diarrhoea - 198,793 - 14%
                  • ARI - 215,619 - 15%
                  • Skin Diseases - 295,193 - 21%
                  • Suspected malaria - 45,459 - 3%
                  • Total consultations - 1,413,980

                  Major health events reported during last 24 hours (30 August 2010)

                  [Disease - Number - % of total consultations[
                  • Acute Diarrhoea - 18,623 - 7%
                  • ARI - 73,867 - 28%
                  • Skin Diseases - 87,087 - 33%
                  • Suspected malaria - 6,664 - 3%
                  • Total consultations - 264,329

                  Selected health events: KPK Province, 30 Aug 2010: Case counts and proportional %

                  [Health events - Case counts (%)]
                  • Acute diarrhea (AD) - 1,662 (10%)
                  • Bloody diarrhoea - 52 (0.32%)
                  • Acute respiratory tract infection (ARTI) - 2,031 (13%)
                  • Skin infections (SI) - 1,451 (9%)
                  • Unexplained fever (UF) - 132 (1%)
                  • Suspected malaria (S. Mal) - 135(1%)
                  • Total Consultation 16,062

                  Selected health events: Punjab Province, 30Aug 2010: Case counts and proportional %

                  [Health events - Case counts (%)]
                  • Acute diarrhea (AD) - 9,058 (5%)
                  • Acute respiratory tract infection (ARI) - 56,115 (28%)
                  • Skin infections (SI) - 76,853 (38%)
                  • Ear Infection (Ear Inf.) - 8,170 (4%)
                  • Unexplained fever (UF) - 13,310 (7%)
                  • Others (OTH) - 33,642 (17%)
                  • Total Consultation - 199,864

                  Selected health events: Sindh Province, 30 Aug 2010: Case counts and proportional %

                  [Health events - Case counts (%)]
                  • Acute diarrhea (AD) - 7,055 (16%)
                  • Suspected malaria (S. MAL) - 5,378 (12%)
                  • Acute respiratory tract infection (ARI) - 7,463 (17%)
                  • Skin infections (SI) - 8,138 (19%)
                  • Bloody diarrhoea (BD) - 1,143 (3%)
                  • Others (OTH) - 11,597 (27%)
                  • Total Consultation - 43,594

                  Selected health events: Balochistan Province, 30 Aug 2010: Case counts and proportional %

                  [Health events - Case counts (%)]
                  • Acute diarrhea (AD) - 848 (18%)
                  • Suspected malaria (S. MAL) - 1,151 (24%)
                  • Acute respiratory tract infection (ARI) - 419 (9%)
                  • Unexplained fever (UF) - 218 (5%)
                  • Bloody diarrhoea (BD) - 216 (4%)
                  • Others (OTH) - 1,163 (24%)
                  • Total Consultation - 4,809
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                  Comment


                  • #10
                    Pakistan Health Cluster - Floods in Pakistan - Bulletin No 16 - Focus on Sindh (WHO, edited)

                    Pakistan Health Cluster - Floods in Pakistan - Bulletin No 16 - Focus on Sindh (WHO, edited)


                    [Source: World Health Organization, full PDF Document (LINK). Edited.]

                    Pakistan Health Cluster - Floods in Pakistan - Bulletin No 16 - Focus on Sindh

                    3 September 2010


                    Highlights
                    • Poor hygiene and sanitation conditions represent major risk factor for large numbers of flood-affected people living in informal and organised settlements in Sindh province.
                    • Roll-out of diarrhoea treatment centres continuing and efforts need to be intensified.
                    • Almost 4.6 million people received medical treatment in flood-affected areas from 29 July-31 August, with main health conditions reported being acute diarrhoea, acute respiratory infections, skin diseases, and suspected malaria.
                    • Health partners treating people with stress.
                    • Sixth Health Cluster response and coordination hub established in Hyderabad on 31 August, following Islamabad, Sukkur, Multan, Peshawar and Quetta.
                    • 47% of the US$56.2 million requested to support the health response has been funded, according to OCHA as of 1 September.

                    Situation overview and current scale of disaster
                    • According to OCHA, over 18 million people have been affected by the floods.
                    • Waters are receding in parts of northern Sindh, Punjab and Khyber Pakhtunkhwa (KPK), while severe flooding continues in southern districts including Dadu, Larkana, Qambar Shahdadkot and Thatta.
                    • In Thatta, the full extent of the disaster is undetermined but 823,000 people in 436 villages are estimated to have been affected. Further OCHA information, go to: (LINK)

                    Health impact
                    • Health needs remain great as relief efforts strive to cope with the scale of the challenges. Large numbers of people continue being treated for diarrhoeal disease cases, skin diseases, acute respiratory and increasingly, malaria.
                    • OCHA Sukkur office reports that due to poor health and hygiene situations in camp settings, authorities want people to leave temporary settlements to move to more organized camps, but waiting for enough shelter to accommodate them.
                    • At least 452 of the 2957 health facilities in 33 flood-affected districts have been damaged or destroyed.
                    • Latest epidemiological data released by WHO, as of 3 September, shows that on 1 September, 135,719 patients were recorded as having been treated in flood-affected districts. Of these consultations, 18,539 cases of skin diseases (14% of total), 24,738 cases of acute respiratory infections (18%), 18,202 cases of acute diarrhoea (13%) and 6549 cases of suspected malaria (5%) were reported.
                    • In all, almost 4.6 million people are reported to have been treated from 29 July to, and including, 1 September. Of these, there were 610,606 cases of acute diarrhoea (13% of total consultations), 671,476 cases of acute respiratory infection (15% of total consultations), 861,986 cases of skin disease (19% of total consultations) and 126,683 cases of suspected malaria (3% of total consultations) were reported from flood-affected districts.
                    • The number of cases of suspected malaria is rising faster in Baluchistan and Sindh provinces. During the last 24 hours, the number of cases reported from suspected malaria comprised 20% of patients’ consultations in Baluchistan province and 12% in Sindh provinces.
                    WHO's weekly disease surveillance document id as: (LINK)


                    Government response
                    • The Federal Ministry of Heath has positioned medical teams in Kashmore and Khairpur districts of northern Sindh province, Sibi district of Baluchistan, and Nowshera district of KPK.
                    • Federal mobile teams are active in multiple districts treating patients including in:
                      • Punjab province: D.G. Khan district (17 days treated 3598 patients), Rahim Yar Khan (17 days treated 3241 districts); Jhang district (17 days treated 6795 patients); Rajanpour district's Kot Mithan area (16 days treated 4108 patients) and Jampur (16 days treated 4490 patients); Muzaffargarh district's Yadgar Chowk (7 days treated 3408 patients.)
                      • Sindh province: a 10-member mobile medical team operating in Khairpur (in 4 days treated 835 patients) and Kashmore (3 days treated 345 patients) districts; a 10-member team is operating in Khandkot and a 7-member team deployed to Sanghar.
                      • Baluchistan province: 10-memebr mobile team operating in Sibi district.
                      • KPK: 5 10-member teams deployed to Charsadda and Alizai, 6 8-member teams deployed to Nowshera district. 8 medical teams of 4-8 volunteer health workers deployed 3 September to Nowshera and Charsadda.
                    • District health authorities throughout Sindh are serving affected communities, including:
                      • Hyderabad: 5 mobile medical teams and 29 fixed medical stations are serving 58 relief camps for 33,414 people.
                      • Thatta: 23 mobile medical teams and 84 fixed medical stations are serving 823,000 people in 436 villages.
                      • Jamshoro: 9 mobile medical teams and 66 fixed medical stations are serving 94 relief camps. The University Hospital laboratory is also supporting the camps. An estimated 178,000 people in 130 villages have been affected.
                      • Badin: 4 mobile medical teams and 36 fixed medical stations are serving 9724 persons who have moved to Badin from other districts.
                      • Tando Mohamad Khan: 2 mobile medical teams and 8 fixed medical stations are serving 44 camps for 7185 people.
                      • Shaheed Benazirabad (Nawab Shah): 5 mobile medical teams and 2 fixed medical stations are serving 54 camps for 8550 people. Peoples Medical College is also serving affected people.
                      • Matiari: mobile medical teams and 37 fixed medical stations are serving 30 camps for 5137 people. A total of 23,456 persons from 31 villages have been affected.
                      • Sukkur: Health care team from the National Institute of Child Health has established in-patient services with emphasis on pediatric patients at the Railway Hospital, Sukkur district.
                    • The Pakistan Army Medical Corps is providing large-scale support across the country. A detailed breakdown in table form is found below in Annex 1.
                    • Medical teams from multiple countries are also supporting relief efforts, in coordination with Pakistani authorities, and a table indicating some of the support obtained to date is found below in Annex 2.

                    Health Cluster response

                    (Inputs received before 4PM Thursday 28 August through health_cluster_bulletin@pak.emro.who.int)
                    • UNFPA is delivering health care in Sindh, Punjab and KPK provinces through 23 mobile units for outreach services and 14 government health facilities for emergency reproductive health care services. Up until 1 September, UNFPA has provided 59,664 patients with reproductive and primary health care services. So far 1222 deliveries have been conducted, 7395 antenatal and 1636 post-natal consultations, delivered 250 post-abortion care services, 92 referrals for cesarean section, 548 syndromic case management of sexually transmitted infections and 638 family planning consultations.
                    • World Health Organization is providing medicines and related supplies to all Health Cluster partners. Until 1 September, it had delivered items that can treat more than 3.6 million people for one month. WHO is supporting the establishment of diarrhea treatment centres in affected districts. 33 diarrhoea treatment centres have been established and are operational in flood-affected districts within the four provinces. More than 20 are in the process of being established. Through support from IOM and the Office of US Foreign Disaster Assistance, WHO is receiving 7 inflatable boats that can be used to deliver mobile health care to isolated communities. The boats are for the hubs in Sukkur, Hyderabad and Multan.

                    Sindh province
                    • CARE International provided primary health care services via 9 mobile clinics to 1477 patients in Sukkur and Shikarpur districts, including 722 women and 420 children, on 28-31 August.
                    • Helping Hand for Relief and Development (HHRD) launched a hygiene promotion project in Sukkur district, will conduct health and hygiene awareness sessions, and distribute hygiene kits to 500 families (35 00 people). Clean drinking water will also be provided.
                    • Mercy Corps is operating 2 mobile health teams in Sindh province's Sukkur, Rohri and Pannu Aqil districts, delivering primary health care and maternal, newborn and child health services. The mobile teams contain ambulances, medicines, and health and hygiene kits. Mercy Corps health teams deliver health and hygiene sessions and provide clean delivery kits to pregnant women. Mercy Corps is also supporting water and sanitation activities. Mercy Corps is planning to replicate the same services in Jacobabad, Shikarpur and Jaffarabad.
                    • Save the Children is working in Jacobobad and Shikarpur, supporting 30 fixed health and 12 mobile teams, providing water and sanitation items in Thul, purification sachets, buckets, and can establish a diarrhoeal treatment centre in Thul. Save the Children is also willing to handle Thul district level health coordination, feeding into the overall northern Sindh Health Cluster coordination network.
                    • UNICEF is supporting childhood vaccination campaigns in camps providing shelter for flood-affected people, with continuing vaccinations planned for areas where people have moved to, including Karachi. More then 164,500 vaccinations were conducted in flood-affected districts of Sindh. The Expanded Programme of Immunization vaccinated 46,880 children against measles, 51,599 against polio and 41,401 children received Vitamin A supplements. More than 10,000 patients have been treated at UNICEF-supported medical facilities in Sindh, while messages on safe motherhood, breastfeeding, clean drinking water, hand washing and immunization are being provided.
                    • UNICEF/WASH Cluster is focussing on how to have highest impact for health, which is hygiene and sanitation.
                    • WASH and government clean water capacity is covering 10-15% of needs in Sindh, and no extra capacity. On 31 August, a new strategy was launched agreeing to revise Sphere standards to 3.5 litres per day per person (standard 15 litres) and 1 toilet for 100 people (standard 1 per 20 people), but we are still reaching only 20%. Need to scale up digging of defecation trenches, but it depends on the public covering waste. Vector control needs to be scaled up.
                    • World Vision: Sending medical teams to Shakarpur district and Khaipur district's Subaiduru area (6000 households) here it is delivering primary health care services. World Vision will also set up a diarrhoeal treatment centre in Subaiduru and Gombut areas.
                    • The World Health Organization has established a new hub in Hyderabad to coordinated health response activities in southern Sindh province.
                    • WHO Conducted Diseases Early Warning System (DEWS) training of trainers in Sukkur and Hyderabad to health care workers and district government officers during 25- 31 August. Health Cluster partners participated in these trainings.
                    • WHO is also planning to send a 20-bed inflatable hospital to the severely flood-affected Sindh province town of Thul.

                    Punjab province
                    • CARE International mobile clinics operating in Muzaffargarh district of southern Punjab province on 28-31 August delivered primary health care services to 1712 patients, including 581 women and 739 children.
                    • Cordaid has scaled up its health response, operating 5 mobile medical teams in Shangla, and 2 more teams are scheduled to start in Kohat shortly. Cordaid Team A is working in Shangla's most affected areas with mobile and fixed health services in Barkana, Kuzana, Karora, Damorai, Olandar and Shapur. The Cordaidsupported basic health unit in Kuzana is delivering healthcare. A lady health volunteer is travelling from Kuzana to Shapur delivering health services to females.
                    • NAGE-Pakistan is providing health services through a static and mobile medical camp at Chakar Dari union council, Pattal number 4 of Tehsil Kot Adu, in Muzaffargarh distrct. The mobile camp treated 700 patients (334 female and 100 male and 266 children under five) during 27-28 August. Skin infections, diarrhea and acute respiratory tract infections were the main causes of morbidity.
                    • Helping Hand for Relief and Development (HHRD) has conducted 13,992 consultations through 53 mobile camps in Layyah, Mianwali, Muzaffargarh and DG Khan.
                    • Islamic Relief Pakistan plans to operate 3 more mobile health clinics for Muzaffargarh by 4 September.
                    • MERCY Malaysia conducted joint assessment with Pakistan Islamic Medical Association to Punjab for theopportunity to expand health services in southern Punjab.
                    • Medical Emergency Relief International (MERLIN) is establishing a diarrhoea treatment centre at the Muzaffargarh district headquarters hospital, and its teams are already delivering health services there. The centre's first consultations are expected to occur this week.
                    • UNICEF is delivering medical and nutritional supplies to 7 Punjab districts of Mianawali, Bhakkar, DG Khan, M. Garh, Layyah, Rajan Pur, RY Khan, Khushab and Multan. Health education sessions are being conducted in displaced people's camps in RY Khan. UNICEF-supported medical officers, lady health volunteers and vaccinators are providing health care services in all Punjab displaced people's camps. Some 9287 children were vaccinated for measles and 6300 children were given Vitamin A supplements.
                    • The World Health Organization conducted Diseases Early Warning System (DEWS) training of trainers in Multan for health care workers and district government officers during 25- 31 August. Health Cluster partners participated in these trainings.

                    Khyber Pakhtunkhwa
                    • American Refugee Committee (ARC) International treated 3490 children, women and men on 30-31 August at 7 health facilities it supports in Swat district. Common fever was the leading cause of morbidity (34%) followed by respiratory tracct infection.
                    • CARE International operates 2 mobile teams and 4 basic health units in Upper Swat and treated on 30-31 August 654 patients (including 269 women and 385 children). CARE conducted 7 mobile clinics Charsadda district on the same days, providing primary health care services to 846 patients including 309 women and 268 children, and 12 mobile clinics in Nowshera district, treating 1293 patients including 334 women and 595 children. Altogether 58 health and hygiene sessions were conducted in KPK benefiting 1125 persons.
                    • Church World Service (CWS) operates 3 mobile health units in Mansehra, Kohistan and Swat districts, delivering consultations to 4618 patients on 31 August. Lady health visitors examined 124 antenatal and 12 postnatal clients and provided essential medicine. The medical team examined 747 children aged under 5 years.
                    • International Catholic Migration Commission mobile teams on 27 August treated 66 flood-affected people staying at the Prang Primary School in Utmanzai Union council in KPK's Charsadda district.
                    • International Medical Corps (IMC) medical teams are delivering emergency health services in Nowshera and Charsadda districts. IMC and WHO are working together to operate a diarrhoea treatment centre at the Nowshera district headquarters hospital. IMC medical teams treated more than 1066 patients from 28-31 August, with acute diarrhoea, acute respiratory infections and scabies being the main conditions. Its psychosocial support team conducted 49 sessions in the Peshawar, Nowsehra and Charssada districts and identified 12 cases of complex stress related issues for further care and referral other than common cases of depression, anxiety and distress.
                    • Helping Hand for Relief and Development (HHRD) has conducted 37,298 consultations through 199 mobile camps in Charsadda, Dir, Swat, Nowshera and Buner.
                    • Doctors Worldwide has completed basic refurbishment of Pir Sabaq basic health unit in Nowshera district. Clinical activities ongoing and on average more than 200 patients a day are given medical treatment, including short stay observations and treatment, plus transfer of critically ill patients. The organization is also supporting the Ganderi basic health unit in Nowshera, where approximately 600 patients were treated during 29-31 August.
                    • MERCY Malaysia is collaborating with the Pakistan Islamic Medical Association to operate static clinics for floodaffected people in KPK. A mobile medical team is providing health services in Charsadda district. MERCY Malaysia will help establish a static clinic at Pabbi Government High School, which is occupied by 200 displaced families; and a mobile team is supporting displaced people living nearby. MERCY is delivering hygiene kits and conducting hygiene promotion activities in KPK.
                    • Medical Emergency Relief International (MERLIN) is operational in Swat, Buner, and Nowshera districts, covering an approximate catchment population of 1 million people, and is starting interventions in Charsadda. Merlin currently provides health services through 27 static clinics (11 Swat, 10 Buner, 6 Jalozai) and 17 mobile teams (9 Swat, 3 Buner, 5 Nowshera), while 1 diarrhoea treatment centre is functional at the Satellite Hospital in Nowshera's Pabbi town, and 1 in Matta town, Swat. 2 centres are also being established at Pacha Kaly in Buner district and Charsadda district. Merlin is conducting an average of 6042 daily consultations and has conducted around 121,396 consultations from 5-31 August. Services include primary health care, referrals to tertiary level facilities, distribution of hygiene kits, water purification tablets, maternal and newborn health.
                    • The Pakistan Red Crescent Society and the German Red Cross are conducting joint activities in Nowshera district, providing treatment for water-borne diseases, acute respiratory infections and a wide range of other conditions. Routinehealthcare is also being delivered, including for hypertension and the delivery of babies. The organization provided health support to more than 1000 people from 25-28 August. From 31 July-28 August, 9899 people were treated (5281 males, 4158 females).
                    • Islamic Relief Pakistan established two mobile health clinics last week for the flood-affected communities in four union councils of Nowshera and Charsada districts. As of 31 August, 2410 consultations have been conducted. Skin problems, acute respiratory infections and eye diseases are the top three health concerns.
                    • Relief International medical staff have treated 615 people at the Madyan medical camp in Swat district from 28-31 August, with the main health conditions being acute diarrhoea and respiratory infections. It distributed water purification tablets among the community. In Lower Dir, Relief International is using a mobile unit to reach affected communities, treating 535 patients. A health education session was conducted on diarrhoeal disease control and prevention.
                    • UNICEF is supporting routine expanded programme of immunization activities in Peshawar, Charsadda, Nowshera and D.I. Khan districts, completing a campaign on 30 August that vaccinated 15,029 children aged under 5 against polio, 21,089 children (6-59 months) against measles and providing 449 children with Vitamin A supplements. So far 285,154 under five children have been vaccinated for polio, 253,511 (6-59 months) for measles and 257,561 children were given vitamen A supplements.
                    • UNICEF-supported mobile medical teams are operating in Charsadda, Nowshera, Swat, D.I. Khan and Kohistan districts, providing primary health care services to 29,767 persons. The organization is distributing health-related materials including hygiene kits and delivering health and hygiene messages. UNICEF is supporting specialized pediatric services are provided at D.I. Khan district headquarters hospital benefiting 699 children and 474 children through mobile services in the district. The first round of mother and child days have been completed in 6 union councils of Swat benefiting 12,818 people.

                    Baluchistan province
                    • American Rescue Committee International is supporting the rural health centre in Talli town, Sibi district, where 221people were treated (93 men and 128 women) on 28-30 August. At the ARC-supported basic health unit in Chandia, 89 patients were treated on 30 August (56 women and 33 men) mainly for diarrhoea, bloody diarrhoea, upper acute respiratory infections, lower acute respiratory infections, scabies and injuries.
                    • Relief International is working in Dhadar town of Kachi district, conducting 535 consultations between 28-31 August. Main conditions reported include acute respiratory infections and acute watery diarrhoea. Health education sessions have been conducted for mothers and male members of the community, as well as for use of oral rehydration solution. Water purification tablets have been distributed.
                    • UNICEF-supported health services are operating in Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Harnai districts of Baluchistan, treating 9400 patients on 24-25 August, including for diarrhoea (21% of cases), clinical malaria (23%) and scabies/skin diseases (135). UNICEF is conducting polio, measles, tuberculosis and tetanus vaccination campaigns in Baluchistan's 6 most affected districts (Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Kachhi) and a relief camp at Eastern Bypass in Quetta. UNICEF is supporting malaria control activities that are being conducted by health authorities in Sibi, Naseerabad and Jaffarabad districts. 500,000 Aquatabs were sent to Naseerabad, Jaffarabad, Sibi, Kohlu and Barkhan districts, which were sufficient to treat 2.5 million litres of drinking water. 4000 extended family hygiene kits, jerry cans and buckets (500 each) were distributed in five districts (Barkhan, Kohlu, Sibi, Naseerabad and Jaffarabad) benefiting 28,000 people.

                    Azad Jammu and Kashmir (AJK)
                    • UNICEF provided 1 IEHK, 5430 packs (100 each) of dispersible zinc tablets and 1086 cartons of oral rehydration solution were sent to the Department of Health.

                    Gilgit Baltistan
                    • UNICEF provided 1 Inter Agency Emergency Health Kit, 3714 packs of zinc tablets and 3714 cartons of oral rehydration solution dispatched to Department of Health.

                    Coordination
                    • GOVERNMENT COORDINATION: On 4 September, Federal, provincial and district authorities, along with WHO, UNICEF and UNFPA representatives, will meet to plan on malaria control, diarrhoeal treatment and reproductive health interventions. Needs of provinces in these 3 areas will be identified with a view to understanding resources needs to fill gaps.
                    • NEW HYDERABAD HUB: An additional coordination hub has been established in Hyderabad to provide relief to an estimated 500,000 severely affected population in southern Sindh. The Health Cluster has established an office inside the OCHA coordination hub in the Revenue Building, Hyderabad. The first Health Cluster Coordination meeting chaired by the coordinator for the Hyderabad Hub was held on 1 September and the email address for health partners to share information with the cluster is whohyderabad@gmail.com
                    • WASH-HEALTH: WHO is working with and WASH Cluster lead UNICEF to reach safe drinking water, hygiene and sanitation supplies to flood-affected communities. The first joint Health and WASH cluster meeting was held in Islamabad on 31 August. A Sukkur-level coordination meeting was held 31 August during which revised strategy for provision of drinking water was announced. Limited capacities and access to water has resulted in the Sphere standard of 15 litres of safe drinking water per person reducing to 3.5 litres. MSF Netherlands is providing safe drinking water that WHO can distribute in a tanker to Sukkur city's Railway Hospital, which has limited water supplies.
                    • DIARRHOEAL DISEASE: An emergency meeting of the Sukker Health Cluster was held 1 September to plan for response to acute watery diarrhoea cases and map gaps. Key action points included.
                      • Identify focal points for different groups of interventions to control acute watery diarrhoea.
                      • Appoint focal points to provide situation analysis with gaps and strategy for immediate gap filling.
                    • UNICEF and IOM working together to support social mobilization, with backing of cluster partners, to do grass roots health education and messaging with social mobilization officers. Production of materials.

                    Gaps/challenges
                    • There is an unequal distribution of health partners in southern Sindh districts, exacerbating healthcare delivery gaps.
                    • Throughout affected districts, particularly in Sindh and Punjab provinces, poor standards of hygiene and sanitation continue to pose major health risks.
                    • In northern Sindh, district authorities reported on 28 August reported that diarrhoea treatment centres of Kashmore, Khairpur, Shikarpur, Kambar/Shahdad Kot, Larkana, Jacobabad, Ghotki and Nowsheroferoz are requiring either medical staff or additional medicines.
                    For further information contact: health_cluster_bulletin@pak.emro.who.int
                    Please submit your organization's activities by 5pm daily using the above email address.


                    Annex 1

                    Pakistan military medical support to flood-affected communities (3 Sept)

                    [Province - Mobile teams - Field hospitals - Districts operating]
                    • Sindh - 30 - ... - Ghotki, Larkana, Shahdadkot, Danglalcha, Jacobobad, Kashmore, Khandhkot, Sukkur, Shikarpur, Khairpur, Nowshero Feroz, Nawab Shah, Jamshoro, Kotri Barrage, Thatta, Dadu, T.M. Khan, Matiari, Hyderabad, Latifabad.
                    • Punjab - 15 - ... - Rajanpour, Kot Addu, Lyia, Muzaffargarh, Tonsa Sharif, Alipur, Multan (Sultan Colony), D.G. Khan, Bahawalpur, Chathra Sharif, Icha Bunglaw, Jammaldin Wali, Rahwari.
                    • KPK - ... - 5 - Nowshera, D.I. Khan, Kalan, Charsadda, Jalozai.
                    • Baluchistan - 3 - ... - Khandkot, Bakhpiarabad, Jhalnagsi.
                    • Total - 48 - 5 - 43

                    Annex 2

                    Foreign medical teams supporting Pakistan flood relief effort (not complete)

                    [Country - Arrived - Capacities - Where operating]
                    • China - 26-Aug - 55 member hospital multi-disciplinary team, including mobile field hospital, medical equipment, doctors, nurses, surgeons, cardiologists. - Thattar district, Sindh province.
                    • Australia - Approx 26-Aug - 72-member army medical corps multidisciplinary team with mobile field hospital - Kotaddu district, Punjab province
                    • Saudi Arabia - 25-Aug - 2 100-bed field hospitals with 70 staff each. - Rajanpour, Punjab province and Thatta, Sindh province.
                    • Saudi Arabia - 25-Aug - Medical team with 18 specialists, medicines - District Headquarters hospital, Nowshera, KPK province.
                    • Indonesia - 26-Aug - 6-member team supporting Pakistan Institute of Medical Sciences. - Charsadda district, KPK
                    • Spain - 26-Aug - 8-member medical team, provided 13 tons of medicines to the Ministry of Health - Sukkur district, Sindh province.
                    • Physicians Across Continents - 26-Aug - Multidisciplinary team that has provided planeload of equipment, water filtration plants. - Nowshera and Charsadda.
                    • Jordan - 16-Aug - Medical team - Multan
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                    Comment


                    • #11
                      Re: Pakistan Health Cluster - Floods in Pakistan - Bulletin No 16 - Focus on Sindh (WHO, edited)

                      WHO steps in to prevent outbreak of malaria in camps
                      ISLAMABAD: The World Health Organisation (WHO) will provide ambulances, vans and bed nets to the internally displaced people to protect them from outbreak of malaria in the makeshift camps, WHO Regional Director Dr Hussain A Gezairy said on Tuesday.

                      Talking to reporters, he said his organisation had already provided essential medicines, including malaria and diarrhoea kits, to the medical teams working in the flood-affected areas.

                      Earlier, Gezairy called on Federal Health Minister Makhdoom Shahabuddin, along with two other WHO officials, Dr Guido Sabatinelli and Dr Farah Shadoul, and discussed health issues concerning the flood affectees.

                      The minister welcomed the WHO regional director and thanked him for talking interest in undertaking visits to various flood-affected areas in Pakistan. staff reporthttp://www.dailytimes.com.pk/default...-9-2010_pg7_22
                      CSI:WORLD http://swineflumagazine.blogspot.com/

                      treyfish2004@yahoo.com

                      Comment


                      • #12
                        WHO's regional director inspects flood-affected southern Pakistan, visits diarrhoea treatment centre (9/08/10, edited)

                        WHO's regional director inspects flood-affected southern Pakistan, visits diarrhoea treatment centre (9/08/10, edited)


                        [Source: World Health Organization, full PDF Document (LINK). Edited.]

                        WHO's regional director inspects flood-affected southern Pakistan, visits diarrhoea treatment centre


                        5 September, 2010 ¦ MULTAN -- The World Health Organization's top official for the Eastern Mediterranean region visited areas in southern Punjab today affected by Pakistan's devastating floods, meeting with senior health officials and assessing one of the health facilities dedicated to treating diarrhoeal disease cases.

                        Dr. Hussein Gezairy praised the work of Punjab's provincial health authorities in their response to this unprecedented crisis, which has left millions of people vulnerable to water-borne diseases and destroyed and damaged hospitals and clinics.

                        Accompanying Dr Gezairy were Chief Minister of Punjab, Mr. Mian Mohammed Shahbaz Sharif, Federal Secretary of Health, Mr Khushnnod Lashari, and Dr. Jehanzeb Aurakzai, the coordinator of Pakistan's Health Emergency Preparedness and Response Network.

                        Dr Gezairy was flown by helicopter to survey the impact of the flooding in the Punjab districts of Muzaffargarh, Rahim Yar Khan, Dera Dhin Panah, Rajanpur and Layyah.

                        Later, Dr Gezairy helped open the WHO-supported 25-bed diarrhoea treatment centre, run by Save the Children, in Multan city's Fatima Hospital. More than 10 medical staff operate the centre around the clock. The centre is one of several operating in southern Punjab, along with the 47-bed facility run by UK NGO, the Medical Emergency Relief International (MERLIN).

                        Since the flood crisis started in late July, more than 3 million people have received medical consultations in Punjab, including 361,718 for acute diarrhoea, 618,165 for skin diseases, 444,193 for acute respiratory infections and 374 suspected malaria cases. At least 242 health facilities were damaged or destroyed in the province.

                        In response, WHO has distributed medicines to partners to cover the potential health needs of 703,000 people in Punjab, including 57 emergency health kits, 63 diarrhoea disease kits and 150 vials of anti-snake venom.


                        For more information:

                        WHO Pakistan, Gul Afridi, Media & Advocacy Officer: Mob: +92-300-501-0640, Off: +92-51-8432486, afridig@pak.emro.who.int

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                        Comment


                        • #13
                          Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 8 2010)

                          This thread contains some of the reports about health situation in Pakistan compiled by WHO headquarters and regional office.

                          Comment


                          • #14
                            Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 8 2010)

                            Pakistan: Health Clinics on the Move to Save Lives Across the Country (Relief Web, via WHO website, edited)


                            [Source: ReliefWeb, via WHO Website, <cite cite="http://www.reliefweb.int/rw/rwb.nsf/db900sid/MMAO-893BV8?OpenDocument&RSS20&RSS20=FS">ReliefWeb » Document » Pakistan: Health Clinics on the Move to Save Lives Across the Country</cite>. Edited.]

                            Pakistan: Health Clinics on the Move to Save Lives Across the Country

                            Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA)
                            Date: 06 Sep 2010
                            (New York / Geneva / Islamabad: 06 September 2010):


                            The World Health Organization (WHO), Pakistani health authorities, and partners, are currently operating almost 1,200 mobile health teams in flood-affected areas of the country.

                            "During this crisis, these mobile clinics are very effective. For many people, these are the only places where they can receive health care", said Dr. Guido Sabatinelli, WHO's Representative to Pakistan.

                            Dr. Hussein Gezairy, WHO's Regional Director of its Eastern Mediterranean office, said: "When these clinics enter affected areas, they provide basic emergency health care services, which include medical consultations, vaccinations, maternal and child care, management of non-communicable diseases, and health education. The whole mobile mechanism is a key component of the overall emergency health response strategy, and the delivery of outreach medical services".

                            So far, more than two million people have received medical care through this system. The most frequent health conditions observed are acute respiratory infections, skin and eye diseases, and diarrhoeal diseases.

                            More than 1,200 health volunteers, recruited through a drive called by the Government of Pakistan, have been enrolled in a programme of mobile health teams in affected districts in support of residual health services.

                            Non-governmental organizations (NGOs) and Pakistani health authorities are key partners in this endeavour in flood-affected provinces. These include the International Medical Corps, Medical Emergency Relief International (MERLIN), Médecins du Monde – France (MDM-F), Centre of Excellence for Rural Development, Sahara, Friend Foundation, Muslim Aid Pakistan, National Rural Support Program, Swat Participatory Council, Islamic Relief, Family Planning Association of Pakistan, the Tahliq Foundation, the Initiative for Development and Empowerment Axis (IDEA), and the Health and Nutrition Development Society (HANDS).

                            Pakistani Federal and Provincial authorities, along with the country's military medical corps, have mobilized hundreds of medical teams to support flood health relief efforts.Merlin was among the first NGOs to respond with mobile clinics in the country's most severely flood-affected areas including the remote north-western Swat Valley in the Khyber Pakhtunkhwa Province (KPK). This NGO has been providing essential health care and supporting the Pakistan health system for five years, when the Emergency Response Team arrived to assist in the earthquake relief effort.

                            "Merlin has mobilized health teams, logistics experts and medical staff for an immediate and effective response to the devastating floods of July 2010", said Jacqueline Koch, Communications Officer of the NGO, "In many cases our teams walk for six hours, carrying up to 20 kg of medical supplies on their back, to reach those in need". Merlin teams are currently working in Buner, Charsadda, Nowshera, and Swat in KPK, and Muzaffargarh in Punjab.

                            For further information, please call: OCHA Islamabad: Maurizio Giuliano,+92 300 8502397 giuliano@un.org; Stacey Winston, +92 300 8502690, winston@un.org; OCHA New York: Nicholas Reader, +1 212 963 4961, mobile +1 646 752 3117, reader@un.org; OCHA Geneva: Elisabeth Byrs, +41 22 917 2653, mobile +41 79 473 4570, byrs@un.org

                            For specific information on health, please contact: WHO Islamabad: Gul Afridi, +92 300 5010640, afridig@pak.emro.who.int - OCHA press releases are available at http://ochaonline.un.org or www.reliefweb.int
                            -
                            ------<cite cite="http://www.reliefweb.int/rw/rwb.nsf/db900sid/MMAO-893BV8?OpenDocument&RSS20&RSS20=FS"></cite>

                            Comment


                            • #15
                              Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 8 2010)

                              Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 4 Monday 13 September 2010 (edited)


                              [Source: World Health Organization, full PDF Document (LINK). Extracts, edited.]

                              This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan and World Health Organization (WHO), Pakistan . For Correspondence: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int. or eic.nih@gmail.com

                              Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 4 Monday 13 September 2010


                              Highlights
                              • Epidemiological week no 36 (4 - 10 September 2010)
                                • 48 out of the 79 flood affected districts (61%) in four provinces are now reporting surveillance data to the Disease Early Warning System (DEWS)
                                • 903 fixed health centers and 417 mobile medical outreach centers reported to DEWS
                                • 533,169 patient consultations were reported, a decrease from the previous reporting period
                                • Acute diarrhea, acute respiratory infections, skin diseases and suspected malaria were the major causes of seeking health care in the flood affected districts
                                • Laboratory confirmed cases of Vibrio Cholera 01 have been reported sporadically from a number of foci in KPK, Sindh and Punjab provinces.

                              Epidemic prone diseases under surveillance in the flood affected areas
                              • Acute flaccid paralysis
                              • Acute Respiratory Infections
                              • Bloody Diarrhoea
                              • Cholera/Acute Watery Diarrhoea
                              • Dengue
                              • Malaria
                              • Measles
                              • Viral Hepatitis/ Acute Jaundice Syndrome

                              Major health events reported during the week-36 (4-10 September)

                              [Disease - Number - % of total consultations]
                              • Acute Diarrhoea - 65,913 - 12%
                              • ARI - 92,087 - 17%
                              • Skin Diseases - 86,930 - 16%
                              • Suspected malaria - 40,415 - 8%
                              • Total consultations - 533,169

                              Cumulative number of selected health events reported from the flood affected districts (29 Jul-10 Sept)

                              [Disease under surveillance - Number of consultations - Percentage of total consultations]
                              • Acute Diarrhoea - 708,891 - 13%
                              • ARI - 802,670 - 15%
                              • Skin Diseases - 986,843 - 18%
                              • Suspected malaria - 182,762 - 3%
                              • Total consultations - 5,335,581

                              Surveillance sites

                              [Province - Fixed centers - Mobile outreach]
                              • Balochistan - 36 - 12
                              • KPK - 87 - 72
                              • Punjab - 312 - 176
                              • Sindh - 468 - 157
                              • Total - 903 - 417

                              Selected health events: KPK Province, Week-36 (4 to 10 Sept):

                              [Health events - Case counts (%)]
                              • Acute diarrhea (AD) - 7,417 (10%)
                              • Acute respiratory tract infection (ARI) - 10,234 (13%)
                              • Skin infections (SI) - 7,287 (9%)
                              • Unexplained fever (UF) - 712 (1%)
                              • Suspected malaria (S. Mal) - 809 (1%)
                              • Bloody diarrhoea - 145 (0.18%)
                              • Total consultation 77,965

                              Selected health events: Punjab Province, Week-36 (4 to 10 Sept):

                              [Health events - Case counts (%)]
                              • Acute diarrhea (AD) - 13,748 (9%)
                              • Acute respiratory tract infection (ARI) - 30,696 (20%)
                              • Skin infections (SI) - 30,193 (19%)
                              • Unexplained fever (UF) - 20,283 (13%)
                              • Injuries (Inj) - 3,766 (2%)
                              • Ear Infections (Ear Inf) - 9,712 (6%)
                              • Total consultation - 155,716

                              Selected health events: Sindh Province, Week-36 (4 to 10 Sept):

                              [Health events - Case counts (%)]
                              • Acute diarrhea (AD) - 40,996 (15%)
                              • Suspected malaria (S. Mal) - 34,579 (13%)
                              • Acute respiratory tract infection (ARI) - 48,237 (18%)
                              • Skin infections (SI) - 46,098 (17%)
                              • Bloody diarrhoea (BD) - 8,065 (3%)
                              • Total consultation - 274,362

                              Selected health events: Balochistan Province, Week-36 (4 to 10 Sept):

                              [Health events - Case counts (%)]
                              • Acute diarrhea (AD) - 3,752 (15%)
                              • Suspected malaria (S. Mal) - 4,978 (20%)
                              • Acute respiratory tract infection (ARI) - 2,920 (12%)
                              • Skin infections (SI) - 3,352 (13%)
                              • Bloody diarrhoea (BD) - 1,009 (4%)
                              • Total consultation - 25,126

                              Patient consultations

                              Since July 29, approximately 5,335,581 patient consultations have been reported to the DEWS from the four flood affected provinces in Pakistan. This may partially be attributed to the increase in reporting sites as well as increase in health facility utilization.

                              Reports were received from 903 fixed and 417 mobile health centers. However, this is a decrease compared to the preceding week (possibly due to Eid holidays).


                              Leading causes of morbidity

                              The major causes for seeking health care by the affected communities in almost all of the flood affected provinces were diarrhoeal diseases, acute respiratory infections, skin diseases and suspected malaria.

                              Increasing cases of suspected malaria were reported in Balochistan and Sindh, while unexplained fever has increased in Punjab (Figure-2).

                              The number of cases of diarrhoeal diseases continue to rise in KPK (Figure-7 and 8 ) and is proportionally higher compared to the corresponding reporting period from 2009.


                              Alert/Alarm thresholds

                              A total of seven alerts were raised during this last reporting period. Out of these, six alerts were flagged for suspected acute watery diarrhea (3 from Sindh, 2 from KPK, 1 from Punjab) and one alert was for measles (Sindh). In the Sindh province, alerts were reported from Kashmore, Jacobabad and Umerkot districts. In the KPK province, one alert for AWD was reported from DI Khan and Nowshera districts, respectively. One alert for suspected measles was reported from Kashmore district in Sindh province.

                              Laboratory samples were collected from all sites, as necessary, and sent to National Institute of Health (NIH) for laboratory confirmation.

                              Relevant public health actions were initiated in the field to arrest a potential outbreak.


                              Outbreak Alerts reported during the current reporting week

                              [Event - Place - District - Province - Action taken]
                              • AWD - RHC Parora - DI Khan - KPK - Lab. Test negative
                              • AWD - Pabbi, Jalozai camp, and Kurwai village - Nowshera - KPK - Sample collected and test under process
                              • AWD - THQ Alipur - Muzaffarabad - Punjab - Lab. test Negative
                              • AWD - Khahi Village - Kashmore - Sindh - Sample collected and test under process
                              • AWD - UC Thull - Jacoabad - Sindh - Sample collected and test under process
                              • AWD - Gamoori Palli Village - Umerkot - Sindh - Sample collected and test under process
                              • Measles - Khahi Village - Kashmore - Sindh - Sample collected and test under process

                              Epidemic Watch

                              Laboratory confirmed cases of both Vibrio Cholera 01 Ogawa and Inaba have been reported sporadically from 16 of the 79 flood affected districts in the country. Cases were localized and reported from multiple foci within these districts. Fiftyseven confirmed cases have been identified (50 tested positive for Vibrio Cholera 01 Ogawa, 1 for 01 Inaba, and six for non 01). Stool samples were tested at the NIH. The districts reporting laboratory confirmed cases of Vibrio Cholera include 10 districts in KPK province, 4 districts in Sindh, 1 district in Punjab and 1 district in AJK province (Please see the map)

                              Until now, no major cholera outbreak has been reported from any of the districts reporting Vibrio Cholera cases. The transmission of Vibrio Cholera remains localized, and the geographic spread seems to be limited. There are higher number of cases in some foci, however, these reporting sites also have stronger surveillance system in place. Health education, personal hygiene promotion and risk communication campaigns have been scaled up in the affected communities using both formal and nonformal means. Other control measures such as chlorination, soap and ORS distribution at the household levels are ongoing.

                              The surveillance for Vibrio Cholera cases have been geared up in these areas to detect any evolving outbreak.

                              Since the beginning of the flood, all other epidemic prone diseases are being closely monitored. The progression of these epidemic prone diseases are under close surveillance through daily data analysis of surveillance data and, where possible, through comparison with past trends.

                              Apart from Vibrio Cholera , no other epidemic diseases have either been reported or been laboratory confirmed so far. All alerts reported during the last epidemiological week were investigated and samples (wherever necessary) were collected and tested. The result of most of these laboratory samples is negative signifying no presence of any epidemic disease in the flood affected areas.


                              The objective of this weekly epidemiological bulletin is to provide a snap shot on the health events occurring amongst the affected communities displaced by the current flood in Pakistan. It is built upon the daily surveillance data received from over 490 fixed and 554 mobile outreach centers which are currently operational in the 73 flood affected districts of four provinces (Balochistan, KPK, Punjab and Sindh). While every attempt is made to show and analyse the weekly trend of the epidemic prone diseases amongst the flood‐hit communities, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin doesn’t provide any health information on areas not currently accessible or covered by the emergency health response operations of MoH, Pakistan and WHO.

                              For further information and feed-back
                              Epidemic Investigation Cell, National Institute of Health, Chak Shahzad, Islamabd, Paksitan. : eic.nih@gmail.com
                              World Health Organization, Pakistan : wr@pak.emro.who.int

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