Photo: WHO/Francisco Guerrero TYPHOON YOLANDA HEALTH CLUSTER ISSUE #4 NOVEMBER 30, 2013 HIGHLIGHTS As of 29 November 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 5 560 deaths, 26 136 injured, and 1 757 missing. A total of 10 956 460 have been affected with 3 811 370 displaced. Of the displaced, 225 911 are currently living in 1 092 evacuation centres To date the five main causes of morbidity identified across all affected regions still remain acute respiratory infection, fever, diarrhea, hypertension and skin disease. However, now there is an increase in cases of wounds as a result of clearing up debris As of 27 November more than 2000 children have received polio, measles vaccines and vitamin A supplements. The first wave of Foreign Medical Teams are phasing out. Many FMTs are scheduled to leave affected areas by 9 December making coordination and planning important to ensure transition and continuation of health services Reporting of assessments and activities from the field is improving daily but it was emphasized that additional partner reports and assessments will provide a more solid real time understanding of field situation 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 28 November 2013, the National Disaster Risk Reduction Management Council (NDRRMC) of the Philippines reported 5 560 deaths, 26136 injured, and 1 757 missing. A total of 10956 460 have been affected with 3 811 370 displaced. Of the displaced, 225911 are currently living in 1 092 evacuation centres (Table 1). Table 1: AFFECTED POPULATION (NDRRMC, 29 November 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 425 903 15.5 3 028 0.11 Region V 656 239 23.7 - - Region VI 2 805 204 39.5 2 373 134 33.41 Region VII 2 678 959 39.4 2 602 0.04 Region VIII 4 271 816 104.2 1 432 584 34.93 Region X 19 592 0.5 - - Region XI 5 040 0.1 - - Caraga 66 631 2.7 22 - Total 10 956 460 23.2 3 811 370 8.19 Humanitarian Case Load according to Flash Appeal 12 900 000 29.84% Source: Situation report # 47 NDRRMC as of 29 November, 2013 There is a still large population movements in affected areas into reception centres for the displaced. The Camp Coordination and Camp Management Cluster (CCCM) is reporting that there is an increasing trend in population movement into Davao City on Mindanao Island. The Government reports stopping of free flights from Tacloban except for people needing medical attention outside of the region. As of 29 November 2013, 1 095 evacuation centres housing 219 158 people are still in use. However, many evacuation centres are closing as people are choosing to return or relocate to non-affected family and friends. Within the remaining open evacuation centres there are fears that the limited physical capacity of sites may increase the vulnerability of evacuees to water borne illnesses. The Department of Social Welfare and Development (DSWD) is concerned with the numbers of elderly and unaccompanied children evacuees that have been abandoned in evacuation centres in Region VIII. The DSWD has deployed staff to Region VIII to address the concern. International Organization for Migration (IOM) and DSWD activated a Displacement Tracking Matrix (DMT), which is collecting data over 64 sites. This will increase the accuracy of information on population movements. DTM assessments have been completed of the 30 evacuation centres and 13 spontaneous sites in Tacloban, which house 15 668 people. Sixty four percent of these sites have management structures that need to be strengthened. The DTM has also been used to assess 8 other sites in Guiuan, 6 in Roxas, and 5 in Ormoc. The top 5 needs in sites assessed are shelter and nonfood items, food, camp management, health, and water, sanitation and hygiene. 2
PUBLIC HEALTH RISKS, NEEDS, AND GAPS General Public Health Concerns Sanitation, access to potable water and waste management as well as population movement are currently a major concern in affected areas. Lack of sanitation and overcrowding are having a negative impact on public health condition. Having largely addressed emergency and trauma needs the DOH is directing its efforts towards a public health focus. Further to this they are requesting that international teams on the ground ensure that they are working closely with local teams and integrating into the local systems with the goal of facilitating sustainability for a long-term recovery. It is strongly encouraged that all NGOs register with the DOH to strengthen coordination and that all actors are working towards common objectives. Immediate needs identified by the DOH 28 November 2013: Child health Expanded Program on Immunization (Polio and Measles vaccine, incl. syringes, freezers, cold box, vaccine carriers, ice packs, thermometers) Vitamin A and micronutrient supplementation Oral rehydration salts and zinc syrup Maternal health Emergency delivery kit Iron supplementation for pregnant and post-partum women Communicable diseases Insecticide for mosquitos to prevent dengue, malaria and other vector borne diseases Doxycycline Morbidity To date, according to ad hoc reporting, the five main causes of morbidity identified across all affected regions still remain acute respiratory infection, fever, diarrhea, hypertension and skin disease. MSF on 27 November reported post typhoon surgical wound infections as a leading reason for consults. The high prevalence of undiagnosed diabetes makes wound care more complicated. In Guiuan, Medical Teams International is reporting an increase in cases of respiratory infection. In addition there is an increase in burn patients as a result of accidents occurring while people are burning off the rubble.. Functionality of health facilities As of 25 November 2013, the DOH reported 2 280 health facilities affected in region IV-B, VI, VII and VIII. Refer to table 2 page 4. The sub national health cluster in Ormoc has reported that despite the extensive damage to the infrastructure most hospitals are functioning to some degree. For example, Ormoc District Hospital is able to conduct emergency surgery, including Obstetrics and Gynaecology. Carigara Hospital is only partially functional and has lost the ability to do essential surgical care, including caesarean sections. Ormoc Maternity and Children s hospital lacks surgical referral capacity. All hospitals have reduced admission levels due to lack of electricity and difficult conditions and one private hospital is planning to close completely for repairs. Essential health services providing free services. However, it is also noted that individuals are hesitant or unaware of health care services being provided free of charge at certain private facilities. In Guian there is concern that maternal child health and neonatal health is not being fully addressed. Health Cluster coordination The Department of Health (DOH) is the lead of the Health Cluster, with WHO as co-lead. Reporting of assessments and activities from the field is improving daily but it was emphasized that additional partner reports and assessments will provided more solid real time understanding of field situation. There are currently 5 cub national clusters active across the Philippines responding to Typhoon Yolanda; Ormoc, Roxas, Cebu, Tacloban with the Western Samar being the newest to be active. A Western Samar sub-national health cluster is now officially functioning, the first meeting on 27 November 2013with almost 30 participants. A sub national health cluster coordinator (HCC) based in Borongan will commute to Guiuan to service and resource the group. Non-communicable diseases Maintenance medications for hypertension, heart diseases and diabetes The sub national Health Cluster from Tacloban reports that all functioning health services, including private facilities, are 3
Table 1: Initial Estimates of Damaged Health Facilities in Regions IV- B, VI, VII, VIII Provinces BHS RHUs Hospitals Total No. of Health Facilities Affected Region VIII 996 Leyte Northern Samar Biliran Eastern Samar Southern Leyte Western Samar 176 56 17 97 30 11 46 9 2 165 29 12 68 23 8 249 138 57 206 99 246 202 33 11 DOH-EV Office 1 Region VII 60 Cebu 43 15 2 60 Region VI 1,216 Aklan Antique Capiz Iloilo 133 19 152 18 287 17 9 161 6 176 6 310 14 569 512 43 Region IV B 8 Culion, Palawan 7 1 8 GRAND TOTAL 1,888 292 99 2,280 4
HEALTH CLUSTER ACTION Assessment A UK Medical Team assessed smaller islands off Panay on 26 28 November 2013. In Sicogon Island, infrastructure damage was observed in the Alipata barangay. All buildings are either partially damaged or completely destroyed. There were no reports of serious injuries or deaths. The barangay hall is used as a health centre and it was destroyed by the typhoon. The nearest functioning health care services are located in Estancia, a one hour boat ride away. Post typhoon, 50% of the pipelines for pumped spring water into homes are nonfunctional. Pre-typhoon only 20% of the population had their own sanitation systems and these have since been rendered nonfunctional. Rebuilding of houses is already in progress, using debris materials as temporary structures. The elementary school is completely destroyed with no discussion of reconstruction as of yet, despite pressure to re-start schooling. Power supply to Alipata includes generators, kerosene lamps, and solar panels, all of which are partially damaged. Consultations were held 28 November 2013 with the most common presentations being soft tissue injuries and respiratory tract infections. No post-typhoon medical attention had been received previously. It was noted that underlying chronic health issues need to be addressed. In Canas and Banay islands, assessment observations showed similar levels of damage to those found in Sicogon, with reconstruction also underway. There was high level of concern for livestock loss and damage to fishing boats which are the main source of livelihood. Clinics conducted in these locations revealed primary health care needs to be most prevalent, including lower respiratory tract infection, urinary tract infection, cough/flu symptoms and back pain. On Banay island, a general practitioner and paramedic are seeing patients in the local government office. A water purification unit was brought to Banay island by Global Medics and bottled water was provided to Canas by the government. Other sources of drinking water, namely wells, have been compromised by storm surge. The oil spill in Iloilo has seriously compounded the issue of displacement in the Estancia evacuation centre. There was an assessment of the area conducted and as of 27 November 2013, the Iloilo regional authorities and the Estancia local authority have relocated the population due to their original proximity to the oil spill site. The new site is connected to the city supply of water via stand pipes giving access to potable water. The camp has temporary latrines but they are not a satisfactory long term option. MSF and Iloilo health authorities have established a 24 hour clinic on the site with a cold chain system in place. As of 29 November 2013, measles immunization, vitamin A supplements and nutritional assessments for children at the site commenced. Relief items in the southern parts of Panay Island are noted to be slowing down despite the continued need. Response Health Care Services A total number of 58 registered Foreign Medical Teams (FMTs) are in the affected areas as of 28 November 2013 (map). There are an additional 12 medical teams that have not yet registered. 50 of the teams are functioning with type 1 services. There are 6 teams functioning with type 2 services and 2 teams with type 3 services. An additional 117 national and local medical teams have also been deployed to the affected areas. Refer to maps on pages 6 and 7 for further details. The first wave of FMTs are phasing out. Many FMTs are scheduled to leave affected areas by 9 December making coordination and planning important to ensure transition. As of 28 November 2013, 13 FMTs have been demobilised. All FMTs are required to be completely self-sufficient for the duration of their stay as resources are limited. Provision of fuel remains the main challenge. A guidance note has been issued by the DOH on the entry and exit strategy of FMTs in light of a shifting of priorities from immediate trauma care to primary and public health issues. As of 26 November MSF reported establishment of tented facility along side Filipino staff in Guiuan near the destroyed Rural Health Unit. The facility includes an inpatient department, a delivery room, a maternity unit, an isolation room and a unit for sterilising equipment. The team is making 5-6 deliveries per day and around 40 minor surgeries, mainly for wounds. The unit carries out 300 consultations per day. A team of three MSF psychologists are continuing to raise awareness about mental health issues and providing health education. A Chinese hospital ship arrived in Tacloban this week. The ship has a capacity of 300 beds and can receive referrals and offers services, such as neurosurgery, ophthalmology, and dentistry that are not currently provided by others. A referral system has been established through Eastern Visaya Regional Medical Centre and 2 liaison officers from the hospital ship are based there. 5
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Vaccination and cold chain In Tacloban vaccines and equipment are being received at sites where mass vaccination programs are occurring. Twentythree nurses from the Manila are assisting to the vaccination campaign. As of 27 November more than 2000 children have received polio, measles vaccines and vitamin A supplements. However, the vaccination campaign is facing some challenges including other competing activities being carried out at the same time (such as food distribution) and the loss of access to many children who have already moved out of the affected areas. Efforts are on-going to address the challenges through enhancing social mobilization and community awareness. The tracking of mobile communities (DTM) will also be used to track children from the affected areas. Vector control In Tacloban, a vector fumigation campaign has started assisted by the Japan Self-Defence Force (JSDF). Fumigation campaign has started assisted by the JSDF. Fumigation of the Astrodomed, the main evacuation center, completed and the aim is to fumigate Eastern Visaya Regional Medical Centre and several other hospitals as well as evacuation centres by the end of the week. Essential drugs and supplies DOH has established a registration system for receiving drug to with a focus on limiting duplications, ensuring appropriate expiry date and donation of medicines in the essential medicines list / national drug formulary. Reproductive Health Working Group There is an increase in the number of partners contributing to the reproductive health working group. Discussions lately have expanded to include related issues on child health. The group is currently in the process of developing the strategic plan for response and recovery. Key needs that are currently being highlighted include the following: Need to familiarize implementing partners with the DOH guideline on newborn health Integration of family planning in emergency response in a culturally sensitive way Integration of prenatal tetanus into mass vaccination programs Dead Body Management The National Bureau of Investigation (NBI) have taken the lead in Dead Body Management (DBM). WHO has been providing advise. 7
Surveillance and communicable disease control Teams with access to communications network are able to contribute information through Surveillance in Post Extreme Emergency and Disasters (SPEED). Since 25 November, there has been a large increase in SPEED reporting from regions VI, VII and VIII. Reports have been received from northern Cebu, Cebu city, Roxas City, but information is still lacking from Tacloban, Ormoc, Eastern and Western Samar. Foreign medical teams are requested to input into SPEED as their information would provide good coverage of the affected population. Eastern and Western Samar. Foreign medical teams are requested to input into SPEED as their information would provide good coverage of the affected population Table 2: Summary of SPEED Reporting in Typhoon Yolanda affected Areas 22-29 Nov (Table 3) Region Provinces (#) Municipalities (#) Health Facilities and Reporting Sites (#) VI 4 30 36 VII 1 10 23 VIII 1 10 21 Water, Sanitation and Hygiene (WASH) and Environmental Health The WASH cluster partners are providing water purification mechanisms for many parts of Guiuan. Pompiers de l Urgence Internationale (PUI) donated a water purification unit to the Guiuan municipality authorities. Four municipal staff were trained on its use and maintenance. Sanitation concerns in Guiuan have been acknowledged and interventions are currently being implemented to address them. Mental Health and Psychosocial Mental health and psychosocial wellbeing is an increasing concern. In Tacloban there is a growing need for psychosocial support. This was identified through anecdotal reports from community health workers regarding increased attempts of suicide and self harm in the community. Coordination discussions for mental health response have been occurring between WHO and the National Institute of Mental Health. Planning The Health Sector Response Strategy is currently in its final stages of development. The strategy will include a dynamic plan that will include partner inputs and is in line with the response and recovery plan of DOH. NEXT STEPS Assessments, tracking and mapping will be continue to: Estimate amount of infrastructure damage and health service availability in detail Better define affected populations and needs, including for pregnant and lactating women and patients with chronic disease, evacuee locations and needs of displaced people for longer term relief and recovery in the next 6 to 12 Evaluate resources currently months available and what will be required in the short to mid term Consolidate planning: Refine understanding of health partners location and activities Coordination with the DOH including availability of and Health Cluster partners to fi- logistics and supplies nalise strategic plan Better understand the needs 8
FUNDING STATUS OF ACTION PLAN As of 28 November 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 Save the Children Save the Children 570 310 0 0% 1 926 000 800 000 42% Ensuring Access to Reproductive Health Services for IDPS affected by Typhoon Haiyan Provision of emergency health services to Typhoon affected populations UNFPA 3 000 000 4 092 077 136% WHO 15 000 000 8 816 481 59% 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) Save the Children ACF- Spain 1 070 000 0 0% 3 000 000 0 0% Provision of life-saving interventions for UNICEF 13 500 000 182 041 1% health to children 0-59 months affected by Typhoon Haiyan (Yolanda) emergency TOTAL 38 066 310 10 597 211 28% http://fts.unocha.org/reports/daily/ocha_r32_a1043 28_November_2013_(03_00).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). 9
Health Cluster Partners National- Manila: Sub-national- Cebu: AECID, Americares, Australian Aid, CDN- DART, CFSI, Child- Fund, DFID, DOH, FPOP, Handicap International, 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 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 10