Photo: WHO/Alan Esquillon TYPHOON YOLANDA HEALTH CLUSTER ISSUE #6 DECEMBER 6, 2013 HIGHGLIGHTS As of 6 December 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 5 786 deaths, 26 233 injured, and 1 786 missing. A total of 11 241 237 people have been affected, 4 006 747 displaced, and 94 310 are in 385 evacuation centers Vaccination efforts have moved to Region VI, from which immunization operations in Palo, Tanauan, Dulag and other highly affected coastal areas will be supported. In Tacloban the Australian Field Hospital will discontinue operations at the airport, with MSF- France s field hospital absorbing their patient load. Inside this bulletin: Affected population and areas Health cluster action Main public health concerns Next steps Public health risks, needs, and gaps Funding status of action plan 1
AFFECTED POPULATION AND AREAS As of 6 December 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 5 786 deaths, 26 233 injured, and 1 786 missing. A total of 11 241 237 people have been affected, 4 006 747 displaced, and 94 310 are in 385 evacuation centers (Table 1). Table 1: AFFECTED POPULATION (NDRRMC, 6 December 2013) Number of affected population % of total population of the area* Number of Displaced Population % of internally displaced Region IV A 27 076 0.2 - - Region IV B 467 050 17 1 960 0.07 Region V 656 239 23.7 - - Region VI 2 829 806 39.8 2 414 276 33.83 Region VII 2 898 027 42.6 258 484 4.30 Region VIII 4 271 816 104.2 1 340 381 31.93 Region X 19 592 0.5 - - Region XI 5 000 0.1 - - Caraga 66 631 2.7 22 - Total 11 241 237 23.8 4 006 747 9.27 Humanitarian Case Load according to Flash Appeal 12 900 000 29.84% Source: Situation report #54 NDRRMC as of 6 December, 2013 The International Organization of Migration (IOM) has deployed 8 Displacement Tracking Matrix (DTM) teams in Region VIII where they are gathering data in all 143 municipalities. Other teams have begun gathering data in Regions VI and VII. Evacation centers continue to close, making the assessment of displaced people outside institutions increasingly important. Biliran and Northern Samar provinces no longer have any displacement sites. Many institutional sites lack resources and management. IOM and the Department of Social Welfare and Development (DSWD) are working with WHO to seek information via people s electronic footprint in cooperation with a national cellphone provider. Information collected by the DMT, including sector break downs is available through the Camp Coordination and Camp Management s PUBLIC HEALTH RISKS, NEEDS, AND GAPS Public Health Concerns Re-establishment of routine services is critical, especially regarding routine vaccination programmes and treatment for preestablished conditions such as TB and diabetes. For example, MSF field hospital in Tacloban reports having to amputate limbs for patients who lost access to diabetic medicines. Morbidity In Tacloban the Australian field hospital has had clinical cases test positive to dengue with rapid kits at Eastern Visaya Regional Medical Centre (EVRMC). Health facilities To date, 1 068 of 9 297 health facilities in the affected regions have been assessed. Among the assessed facilities substantial damage has been observed. OCHA has reported intermittent power and communication in Eastern Samar and Capiz. website: http://cccmphilippines.iom.int/ Cebu sub national cluster reported that 3 evacuation centers housing people from Leyte and Samar are to be relocated to a tent facility at South Road Properties. Red Cross will assist with site set up. Eastern Samar sub national health cluster meeting highlighted that the Balangiga hospital requires rebuilding but has so far received very little support. The hospital mainly runs out patient department (OPD) services. Inpatients facilities are inadequate. The hospital has inadequate funds for fuel for the ambulance. 2
Cebu sub national health cluster reported that health facilities in Bogo City and Daanbantayan are still in need of repair. EVRMC has ordered but not yet received health care wastermanagement supplies. HEALTH CLUSTER ACTION Health Cluster coordination There are currently 5 sub national cluster hubs in Ormoc, Roxas, Cebu, Tacloban and Eastern Samar Guiuan and Borongan. A full list of the health cluster partners has been complied at is accessible on: http://www.wpro.who.int/philippines/ typhoon_haiyan/partners/en/ Information for the health cluster bulletin from partners need to be submitted by lunch time Mondays for the first weekly bulletin and lunch time Thursdays for the second. The curfew in Tacloban has been removed as of 5 December 2013. However, it is advised that staff members remain cautious. Local sources in Iloilo are reporting that some militant (left-wing) organizations are planning to hold mass protests in Iloilo (Western Visayas) against the government on environmental issues. Assessment Silad Island was assessed by UK Naval Ship HMS ILLUSTRIOUS team on the 3 December 13. They reported that there were no deaths, missing persons, or major injuries. Houses were mainly intact, most still having roofs. General health status on the island was fair, with no observations of malnutrition. There are no healthcare services on the island, the nearest doctor is located in Conception, a 6-8 hour boat ride away. Hypertension was observed to be a chronic problem. Post typhoon no medical assistance had been provided prior to the ships arrival. Most children are vaccinated for measles, diphtheria/ Essential health services Tacloban sub national health cluster reported that the EVRMC laboratory, supported by the Japanese University, has rapid tests for rotavirus, norovirus, cholera, typhoid, hepatitis A, leptospirosis, dengue, TB and RSV. pertussis/tetanus, BCG. One case of TB presented at clinic provided by the team, treatment was arranged via contact the team made with the DOH. The Eastern Samar sub national health cluster indicated that the 2 Hospitals and 2 Rural Health Units (RHU) in Guiuan and 1 RHU in Hernani are heavily damaged but still are offering some services. MSF also warned that Inapulangan and Bagan in Guiuan Municipality are extremely difficult to reach. International Medical Corps (IMC) performed assessments on the difficult to reach areas of Panitan, Mumuosao, and Cuartero, in Capiz province. Damage to infrastructure and services is extensive, including no electricity and inadequate water and supplies. Acute respiratory infection and wounds are the most common reasons for medical visits in all three locations. Other areas assessed by IMC were Aklan and Antique provinces. Consistent with pre-typhoon conditions, much of the population in this area has limited access to healthcare. In Aklan, damage is predominantly concentrated east of Kalibo City. Forty of the 161 health facilities were assessed, 1 was completely destroyed, 21 partially damaged and the remaining 18 intact. Notable challenges faced by health staff working in health centers include electricity limited to daytime resulting in deliveries in the dark at night. Low stocks of medication were also of high concern in Aklan, along with sanitation concerns due to nonfunctioning sanitation systems. In Antique, damage was concentrated in northern municipalities, where electricity and communications are still intermittent. None of Cebu sub national health cluster reported that electrisity in town centers have been restored except in Medellin and Madridejos. San Remegio needs Tetanus Immunoglobulin. the RHUs have generators. Of the health facilities assessed, 3 BHS were totally damaged, 25 were partially damaged but functional, 8 RHUs were partially damaged but functional and 4 hospitals were partially damaged. The most common reasons for visits are ARI and wounds, and an increase in diarrhea in some areas was noted. Response Health Care Services 65 registered Foreign Medical Teams (FMTs) and 116 local medical teams were in the affected areas as of 5 December (refer to maps). Fifty-six of the teams are functioning with basic type 1 services, 6 teams functioning with more sophisticated type 2 services and 2 teams with specialty type 3 services. Currently the FMTs are predominately working in Region VIII with 51 FMTs based there. According to the DOH some FMTs have been requested to extend their missions. Protocols are also being established by the DOH for handover to local medical teams. Discussions are also underway to establish a system to donate medical goods/equipment the FMTs leave. According to the DOH some FMTs have been requested to extend their missions. Protocols are also being established by the DOH for handover to local medical teams. Discussions are also underway to establish a system to donate medical goods/equipment the FMTs leave. The DOH intends to release an end of assignment reporting template for FMTs to fill out before they exit the country. 3
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MSF are supplying the RHU in Coron in Region IVb with medical supplies every couple of weeks and so far the province has reported no shortage in medical supplies. Medical Team International (MTI) donated large tents to Balangiga district hospital in Eastern Samar. In Tacloban the Australian Field Hospital will discontinue operations at the airport, with MSF- France s field hospital absorbing their patient load. The facility was initially identified for referral and medical evacuation. An alternative health facility, Remedios Trinidad Romualdez (RTR), is also available for referral and medical evacuation. RTR is partially functional and is staffed by international and local doctors. RTR has access to an ambulance and three helicopters on standby for medical evacuations to Cebu. However, the sub national health cluster partners in Tacloban have expressed concern that the closure of the Australian Field Hospital will put extra pressure on the remaining health services as it is not functioning at full capacity. EVRMC now has a 24 hour functional isolation ward for TB patients with simple x-ray capabilities, 4 operating rooms, neonatal intensive care units and two further intensive care units. The center is now functioning around the clock. IOM s adopt-a-rural health center program is providing medicines, supplies, temporary repairs and additional staff to support and augment activities in RHUs in Pilar and Pontevedra, Capiz including referral. Cebu sub national health cluster meeting highlighted that foreign and local medical teams are still welcome in Tabogon, Bantayan, Daanbantayan and Santa Fe. The Japan Self-defence Force (JSDF) plans to exit Cebu and transfer all their operations to Tacloban by 7 Dec. Essential drugs and supplies Cebu reported on 3 December that San Remegio, Medellin and Santa Fe need medicines and medical supplies. San Remegio also needs Tetanus Immunoglobulin. Rabisin in Northen Iloilo was destroyed except in the municipality of San Rafael. All Rabisin stocks in the Iloilo Provincial Veterinary Office is intact. In Capiz Province most stock was destroyed. All Rabisin stocks in the Capiz Provincial Veterinary Office are intact. Aklan Province is currently consolidating information about the damage to their stock. Two municipalities in Antique Province have lost Rabisin, however the stock at the provincial Veterinary Office is intact. Vaccination and cold chain The mass vaccination program reached 8 962 children for measles, 8 537 children for Polio and administered Vitamin A to 6 908 children. These numbers are corrected from higher numbers previously reported. Vaccination efforts have moved to Region VI, from which immunization operations in Palo, Tanauan, Dulag and other highly affected coastal areas will be supported. Twelve solar fridges will be distributed and installed this week around Tacloban. On 4 December it was reported that cold chain assessment is still required in Eastern Samar. 5
Surveillance and communicable disease control While there is an increase in the number of sites reporting, the frequency is decreasing. There appears to be confusion amongst reporting sites on what and when reporting should occur. There are currently no reported outbreaks of measles in any of the affected areas, however, there are reports of rashes accompanied with fevers occurring. Practitioners are encouraged to collect samples at the time of consultation and arrange for further testing. IOM is supporting sub national health clusters and the DOH with collection of SPEED forms from health facilities without reporting capacity through its DTM mobile teams. IOM is working on incorporating DTM and SPEED data to better target gaps and interventions. The Eastern Samar sub national health cluster reported on the 30 November that SPEED is still not functioning properly and that not all FMT s are reporting regularly. On 4 December at the Tacloban sub national health cluster meeting it was reported that partners are willing to participate in the collection of SPEED data and routine vaccination but there are no cards available and there are not sufficient vaccines. Table 2: Summary of SPEED Reporting in Typhoon Yolanda affected Areas 2 6 Dec 2013 (Table 2) Region Provinces (#) Municipalities (#) Health Facilities and Reporting Sites (#) VI 45 45 52 VII 1 9 19 VII 2 13 14 Reproductive Health The reproductive health working group is developing a guidance note to address the concerns around using chlorhexidine in deliveries. The WHO Western Pacific Regional Office reproductive health technical group does not endorse the use of the product anywhere in the region, stating, that it does not replace hand washing practises and maintaining sterile environments and equipment. The DOH also states that the use chlorhexidine during deliveries is not endorsed in the Philippines. However, these guidelines do not include exceptional circumstances, which is why the working group is reviewing the issue. If usage is approved, it will only be as a temporary measure. Eastern Samar sub national health cluster reported that PLAN is establishing neonatal and newborn health care services health facilities without these services through out the affected areas. Dead Body Management According to the National Bureau of Investigation equipping of three temporary mortuaries is almost completed. A location for the establishment of the first mortuary has been chosen at Suhi, which is about 15km outside of Tacloban. Enquiries are still being made to see who is responsible for collecting ante-mortem data from the families of those who have died to assist identification of victims. Water, Sanitation and Hygiene (WASH) and Environmental Health Most of the water sources in the affected areas are not functional due to lack of electricity. Alternate water sources, such as, open dug wells, hand pumps, bottled water, water trucking and a refilling station have been established. However, there is a concern about the quality of most of the alternate water sources. Water quality testing in and around Tacloban this week showed that the majority to be positive for coliform bacteria and with inadequate chlorine levels. Mental Health and Psychosocial Support (MHPSS) On 5 December in Manila the WHO provided training of trainers on psychological first aid to key national stakeholders. Representatives were invited from the DOH, DSWD, Psychological Association, Philippine Psychiatric association, Child Protection Working Group and Citizens Network for Psychosocial Response The DOH, WHO and MHPSS.NET have started collecting data on 4Ws (who does where, what until when) on MHPSS in the affected areas. The aim is to increase coordination, collaboration and referral. It was also raised at the Cebu sub national health cluster that Madredejos is still in need of psychosocial support services. 6
Planning Projects developed by partners to support the implementation of the strategic response plan, which is aligned with the Government s plan. An analysis of the projects by locations, objectives and priorities. Government priority area are shown in the map below: 7
FUNDING STATUS OF ACTION PLAN As of 6 December 2013, the action plan is 28% funded for the health sector (table 4). Table 4 FUNDING STATUS OF ACTION PLAN FOR HEALTH (US$) Project Appealing Agency Amount Required Funding % Covered Saving Pregnant Women and Newborn lives and support to Super Typhoon Haiyan affected provinces of Leyte, Capiz, Iloilo and Aklan Adolescent and Sexual Reproductive Health in Emergency Services and Support to typhoon Haiyan affected provinces of Leyte, Samar, Iloilo, Aklan and Capiz Ensuring Access to Reproductive Health Services for IDPS affected by Typhoon Haiyan Provision of emergency health services to Typhoon affected populations Emergency Health for Children and Families Affected by Super Typhoon Haiyan in the Philippines Providing Mental Health and Psychosocial support to children and pregnant and lactating women and Primary Health Care Interventions in population affected by Typhoon Haiyan (Yolanda) Provision of life-saving interventions for health to children 0-59 months affected by Typhoon Haiyan (Yolanda) emergency Save the Children Save the Children 570 310 0 0% 1 926 000 800 000 42% UNFPA 3 000 000 5 920 077 20% WHO 15 000 000 8 934 721 60% Save the Children 1 070 000 0 0% ACF-Spain 3 000 000 0 0% UNICEF 13 500 000 182 041 1% TOTAL 38 066 310 10 597 211 28% http://fts.unocha.org/reports/daily/ocha_r32_a1043 2_December_2013_(12_54).pdf Major WHO donors: Australia, Canada, Norway, Japan, the United Kingdom and the UN Central Emergency Response Fund (CERF), Russian Federation, Sweden and the United States of America, and from the European Commission Humanitarian Aid and Civil Protection (ECHO). 8
Health Cluster Partners National- Manila: AECID, Americares, Australian Aid, CDN- DART, CFSI, Child- Fund, DFID, DOH, FPOP, Handicap International, Hospitals for Humanity, HuMa, IFRC, IHP-UK, ILO, IMC, IOM, IRC, ISAR- Germany, JICA,MERLIN, MDM, MSF, National Bureau of Investigation, PHE, Philippines Red Cross, Relief International, Plan International, Project Hope, PU- AMI, SCI, UNFPA, UNICEF, USAid, US Forces, WHO, World Vision. Sub-national- Tacloban: AECID, ACF, ACTED, Action PompiersUzgenceInlanaVionus, ARC, ASEAN, ASYA SAR/KYM, B-FAST, AUs, BomberosUnidos SP, Care, Christian Aid, DFID, DOH, ECHO, Emergency.LU, Ericsson Response, EUCPT, First Relief Fund, First Response Radio, Fuel Relief Fund, German Embassy, German Red Cross, Globalmedic, GOAL, Good Neighbours Intl., Good People Intl., HUMEDICA,IFRC, International Disaster Relief, Internews, IOM, IsraAid, JICA, KIHI, KOICA, Leger Foundation, Miral Welfare Foundation, MSF/F, OCHA, Oxfam, Philippine Red Cross, PompiersHumanitaires France, PUI France, Samaritan 119 Korea, SC, SCDN, Solidarities International, Spanish Red Cross, TGCFI, RTR hospital, UNDAC, UNDP, UNFPA, UNICEF, USAID, US OFDA, Vodafone foundation, WFP, WHO, WISAR, World Vision. Sub-national- Cebu: AmeriCares, ASB Germany, Canadian Emergency Response Unit, Canadian Medical Assistance Teams, CFSI, ChildFund, DOH, Embassy of Israel, Eversly Child Sanitarium, GOAL, ICRC, IFRC, International Medical Corps, JICA, MDM, Med Japan, Merlin, MSF, NYC Medics, PNA, Samaritan Purse, SC, SCI, Spanish Red Cross, Saint Anthony Mother and Child Hospital, Talisay District Hospital, UNICEF; Vicente Sotto Memorial Medical Centre, WHO Sub-national- Roxas: ACF, Action Aid International, Canada DFAT, Child Fund, CRWRC, DoH, GOAL, IOM, Japan Heart Foundation, Philippine Rural Reconstruction Movement, MSF-Swiss, NETHOPE, Save the Children, UNDAC, UNICEF, Welt Hunger Hilfe, WFP, WHO, World Vision International Sub-national Guian / Borangan: IOM, Medical Team International, DOH, Plan, PHTO, Norwegian Church aid, Radio Bakdaw Health Cluster Contacts National- Manila: haiyanhccmanila@wpro.who.int Sub-national- Tacloban: haiyanhcctacloban@wpro.who.int; hcctacloban@gmail.com Sub-national- Cebu: haiyanhcccebu@wpro.who.int Health Cluster Website:http://www.wpro.who.int/philippines/typhoon_haiyan/en/ Please send any information on potential disease outbreaks to: haiyanops@wpro.who.int 9