IASC Inter-Agency Standing Committee Mozambique Zambezi River floods and cyclone Favio crisis #3 17 The Mozambique emergency Health Cluster Bulletin aims to give an overview of the health activities conducted by Health Cluster partners in the areas affected by the floods and cyclone Favio. It compiles health information received from the different organizations and partners active in the area. The is issued every Friday. Health centre in Mopeia. (Picture: WHO Mozambique) Highlights 106 cholera cases have been detected in Niasa and Cabo Delgo Provinces by the provincial public health authorities. The city of Pemba has been flooded by an important tide since 21 March. Humanitarian clusters are focusing in defining possible strategies to support the resettlement process. Regarding health, the provision of health services to resettled people and people still living in accommodation centres remains key priorities as well as the rehabilitation of referral health centres. The provision of adequate water supply and sanitation system remains an issue of critical concern. The possibility to involve the private sector in rehabilitating basic lifelines is under consideration. The current epidemiological surveillance system does not cover all areas at risk of outbreaks. Particularly, data communication from some areas is still erratic. On 22 march, health authorities in Maputo reported that an explosion in a military munitions depot had killed about 72 people and wounded more than 100. The Health Cluster in collaboration with the humanitarian group is monitoring the situation. SITUATION OVERVIEW 106 cholera cases have been detected and laboratory confirmed on 22 March in Niasa and Cabo Delgo Provinces in the north of Mozambique by provincial health authorities. The Case Fatality Rate (CFR) is 2.7%, lightly above the expected (1%). However, CFR could be high at the onset of an outbreak because of late reporting and referral or lack of awareness. The fist case was found on 12 March in Niassa Province. The city of Pemba, in the north of Mozambique has been flooded by a tide since Wednesday 21 March. Cholera cases in this area are therefore increasing the population s vulnerability. WHO is following closely the situation with the Provincial Health Directors
(DPS) who certify having enough medicine, chlorine and staff to deal with the current outbreak. Health cluster members will discuss a strategy to provide support if need be. Table: Cholera cases reported on 22 March 2007 New cases Cumulative cases Case Provinces/Districts (21 to 22/03/07) Fatality Cases Deaths Cases Death Rate Lago district 2 0 44 2 4.5% Total in Niassa Province 2 0 46 2 4.3% City of Pemba 22 0 63 1 1.5% Total for Cabo Delgado 22 0 63 1 1.5% Province Total for the Country 24 0 109 3 2.7% Malaria, diarrhoeal diseases, respiratory infections, conjunctivitis and skin diseases remain the main cause of morbidity in flood and cyclone affected population. Number of cases* 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Sofala Epidemiological report from Provinces (12 to 18 March 2007) Manica Tete Vilanculos Others Scabies Conjuntivite desenteria Diarreia Respiratory Infection Malaria * Note that data collected with the kind support of Mozambique Red Cross volunteers based on simple case definition (only on symptoms). Due to the fact that different health posts reported this week it is quite difficult to have a trend, the Health cluster is working on the issue to improve data collection. Patterns of reported diseases remain normal for the seasons. Health Response to the Humanitarian Crisis 1. Assessment and monitoring Many health centres in Vilanculos, were damaged by the cyclone. A detailed assessment of the health infrastructure is still ongoing to better organize the resettlement and recovery phase. The present phase needs urgent financial contributions to allow a rapid rehabilitation 2
of health referral centres and to make sure that resettled population has access to minimum health care. WHO provided a concept paper to be discussed during the next cluster meeting. Some accommodation centres are lacking medicine and health workers. The Health Cluster is working on filling the gaps by supporting training and supplying essential medicines. Support is needed to reinforce the health posts run by the Mozambique Red Cross (MRC) in Vilanculos district where the health structure is very basic. Training is needed for basic health staff. MRC also reported that Queuene Peninsula and Benguerra Island remain isolated. These areas should be a priority for deployment of mobile heath posts. Vulnerability Assessment Committee (VAC) is organizing a new assessment between 10 and 17 April. This assessment will be done in flood and cyclone affected provinces (Inhambane, Manica, Tete Sofala Zambézia). It will do a more in-depth assessment of the impact of the disasters. While acute malnutrition seems not to be a major problem, chronic malnutrition cases might have an upward trend (from food security and nutrition clusters). 2. Health coordination During the latest Health Cluster meeting, the Health cluster under the leadership of the MOH agreed to speed up the implementation of training activities. In addition to the dignity (hygienic items for women) kits delivered by UNFPA and NGOs, UNFPA is working on the possibility to deliver delivery kits (items for safe and clean delivery) trough NGOs. The next Health Cluster meeting will take place Monday on 26 March, 14:00 at the MoH. Joint household cooking seems to be not really adopted by the population. The Health Cluster has not endorsed this strategy since there could be health problem related to poor hygiene. Health Cluster was recommended by the Humanitarian country team to continue attending the CENOE meeting despite the reduction of the emergency phase to orange. For Health cluster members it was recommended to attend the social service working group. Health Cluster is discussing the action needed in the upcoming resettlement phase. Health priorities would be providing health services to resettled people and strengthening the surveillance system as gaps in water and sanitation area are believed to continue. In the cyclone affected areas, the priority would be to rehabilitate referral health centres which have been damaged. OCHA Expert for Early recovery is expected in Mozambique to support the country team. A Real Time Evaluation (RTE) is planned. Cluster members have been asked to support the RTE team. The evaluation will start on 30 March and will last for 3 weeks. Clusters added their input to its Terms of Reference. The Humanitarian country team also recommended to the Health Cluster to establish a link with the AIDS Council to seize the opportunity of people being in accommodation centres to disseminate AIDS messages. 3. Filling health gaps Norwegian-Canadian Red Cross BHC unit in Vilanculos is receiving an average of 300 patients a day. This includes paediatric/adult consultations, and Mother and Child Health (MCH) activities. Delivery room is fully operational. An average of 5 babies is delivered every day; 20 were born last week. In Zambezia province, the MRC has opened 6 new health posts. A total of 89 volunteers were trained in: Noere, Nhacatundo, Namirere, Nzanza, Calangane and Braz. In Sofala one more health centre was open increasing the total number of health posts in this province to 10. In Vilankulo 31 volunteers were trained and another 30 as well in Tete province. Medicus do Mondu Portugal, Provided medical items and malaria drugs to the health centre in Morrumbala, Zambezi province, in addition soaps and food items. 3
UNICEF is continuing to work with partners to distribute Insecticide-treated mosquito nets (ITNs) in flood affected provinces. To date, UNICEF and partners have distributed approximately 77,000 ITNs, nearly reaching the target of 80 000 set by the Instituto Nacional de Gestão de Calamidades (INGC). The majority of affected districts have now been reached, with two ITNs being distributed to each family. With support from UNICEF, child to child radio programmes and broadcasts by community radios on cholera prevention are being broadcast in Portuguese and local languages in all affected provinces until 31 March. In response to reports by the Ministry of Health of cholera cases in Niassa province, UNICEF is scaling up its communication programme and community mobilization activities in the area of cholera prevention in districts on the northern banks of the River Zambezi. 4. Capacity building Health worker trainings on diseases case management, surveillance and health promotion supported by WHO, UNICEF, Mozambique Red Cross (MRC) and other NGOs have started last week in Tete Province jointly. This week Norwegian-Canadian Red Cross in collaboration with MRC conducted a 5-day health education training for 40 MRC volunteers. 5- Interview of the week Ernestina Goerge Jama, health national coordinator of the Mozambique Red Cross answered the following questions: 1- What are you doing in the field and how many volunteers do you have? A total number of 770 volunteers are fully active to assist the population affected by the cyclone and floods. They are active in 37 health posts and all the accommodation centres except for Murrombala. Our volunteers provide first aid, health promotion and assisting health authorities in vaccination campaigns. We have two groups of volunteers. The first group treat common diseases such as conjunctives, malaria, injuries, and intestinal infections. Also they assist the health staff in detecting malnutrition cases. They refer complicated cases to health facilities. The second group go from tent to tent, and house to house to disseminate hygiene and water and sanitation practises. They follow up as well on the vaccination calendars of babies and prenatal consultation. 2- As the resettlement phase is due to start soon, what s your priorities? Our main priority is to train our volunteers to deal with the resettlement phase needs. For instance, we are expecting support from the health cluster to incorporate the Community Based Health Care in the volunteers training. This means including delivery, HIV/AIDS, immunization, nutrition, basic treatment to common diseases among others. We are strongly appealing to partners to speed up the process of training. The volunteers are already in the camps. We can start training them there before they leave when the emergency will stop. We urge the health cluster to speed up the process. 3- How many people are you assisting? Do you need additional volunteers? Our goal during the resettlement phase is to assist 23 500 families. Each volunteer will work with 50 families. No need to recruit more volunteers but there is an urging need to train them. For the 4
resettlement phase, we launched an appeal to build 10 health posts at the resettlement premises. We will work under the umbrella the MOH. 4- What kind of support are you expecting from the Health cluster and donors? We need training for our volunteers mainly for health promotion, epidemiological surveillance, and communication techniques. We need health education materials, incentives, equipment such as megaphones, loud speakers, bicycle to reach the people, caps to protect the volunteers from the sun and t-shirts. Interview done by WHO communication team on behalf of the Health cluster. For further information, please contact: crisis@mz.afro.who.int 5