WHO IRAQ Weekly Update 1-10 August 2003 CONTENTS: Coordination and updates Sub-sectors: Communicable Diseases Surveillance Public Health Laboratories Network Drug supply distribution system Nursing Regional overview Calendar of forthcoming activities ----------------------------------------------------------------------------------------------------------- COORDINATION AND UPDATES A Health Donors Coordination Committee (HDCC) has been established to discuss emerging health issues with stake holders and donors. It meets every Saturday under a rotating chair. Update on Oil For Food Programme WHO has procured US$ 18 million worth of drugs under SCR 1472 (2003). More than 600 metric tons of health supplies a week are shipped to Baghdad from Jordan. Hundreds of contracts (including more than 20,000 items of drugs, medical supplies and equipment, vehicles, spare parts etc) have been screened in order to identify goods that could be used for humanitarian purposes. CPA and WHO have now prioritised more than 250 health contracts that will be delivered to Iraq shortly. Update on UNDG-OCPA Needs Assessment This phase of the UN/WB Needs Assessment process has evolved into the Situation Assessment, Priority Setting, and Policy Dialogue workshop in conjunction with OCPA.. Focal points for the needs assessment continue to meet in Baghdad to exchange information on progress and to review methodologies. Ways are being sought to synchronise assessment activities and priority identification to the CPA budgeting process in order to minimise parallel planning. The UN Humanitarian Coordinator 1
emphasised that the involvement of Iraqi institutions is crucial for a correct understanding of the priorities. The Health Sector Task Manager has shared with the stakeholders a working draft of the Health Needs Assessment Report, together with sub-sectoral working papers as a basis for further discussion at the workshop scheduled to take place on 17-19 August in Baghdad. Health partners will be invited by MOH-OCPA to provide inputs in order to help prioritise the next steps for the rehabilitation and reconstruction of the Iraqi health system. SUBSECTORS Communicable Diseases Surveillance A Strengthening Disease Surveillance Workshop took place in Baghdad from 3-6 August. The participants analysed the current disease surveillance system and planned for future actions. Among other issues, it was decided that the current surveillance form will continue until the end of 2003. As of 2004, surveillance for trauma and other noncommunicable diseases will be reported in a form separate from the communicable diseases. The Workshop also discussed the computerisation of the Health Information System. This will be in the future supported by the installation of satellite phones, computers and software that will facilitate communication at the governorate and local level. The project will be piloted by Voxiva in Basra and Baghdad for 2-3 months, then assessed and refined before national implementation. The Communicable Diseases Centre in Baghdad started releasing epidemiological information on weekly basis from sentinel and routine surveillance points. This provides a forum for all stakeholders to discuss and analyse the information. Public Health Laboratories To enhance surveillance and management of communicable diseases, it is important that the public health laboratories are functioning in an effective and coordinated manner. As with other facilities, public health laboratories suffered looting and destruction in the aftermath of the war. Many of them are still lacking supplies and equipment. MOH-OCPA has convened health partners and donors to address in a comprehensive manner the rehabilitation of the Public Health Laboratory Network. ECHO has agreed to earmark Euro 5 million for rehabilitation of the Baghdad Central Public Health Laboratory (CPHL) and of a number of PH facilities in regional areas. Plans for the rehabilitation of the Radiation Protection Laboratory have already been approved. Proposals for the Drug Quality Control and the Environmental Protection laboratories in Baghdad are still under discussion. In Basrah, physical rehabilitation of the CPHL is underway. In the interim, Al Razi PHC is being assisted to perform the activities of the CPHL. Drug supply distribution system Through OFFP, around 30 truckloads of drugs and medical supplies are currently arriving in Baghdad every week. While this is alleviating drug shortages, it is also putting pressure on Kimadia (The State Company for Importation of Drugs and Medical 2
Supplies). Some of the Kimadia central warehouses in Baghdad are overloaded; others still have only limited capacity to receive drugs. WHO/Iraq is working closely with MOH and WHO Jordan to prioritise shipments according to Kimadia s needs. Inventories of drugs and supplies are to be sent in advance to Kimadia together with copies of the necessary documentation that would accompany the shipment. With regard to warehouses, MOH and WHO are working in partnership to rehabilitate Kimadia Warehouse No 2 (for intravenous fluids) which was one of the most affected by looting. A total of US$ 700,000 has been allocated for the work, which is expected to be finished in the next two months. Kimadia warehouses No. 1 (for drugs and laboratory reagents) No 7 (for distribution to the private sector) and No 13 (for medical equipment and supplies) are lacking proper cooling systems although OCPA is working on redressing the situation. Temperatures inside the premises at this time of the year are in the range of 36-39 degrees. A rapid cross-sectional survey of health facilities is being designed to evaluate the availability of drugs at end-user s level. The survey would be conducted through focal points in selected districts. Nursing The National Nursing Conference that took place in Baghdad in July agreed on a Nursing Action Plan that aims at upgrading and reinforcing the Nursing profession. Among other goals is the creation of a General Directorate for Nursing at MOH, the production of education and training tools and the creation of a Licensing Board at MOH. There are also plans to renovate training centres in Basrah, Kerbala and Mosul. MOH is now discussing an agenda for the implementation with USAID, WHO and other partners. REGIONAL OVERVIEW: NORTH (Dahuk, Erbil, Suleymaniyah) Security In the three northern governorates the situation is considered stable.. Communicable diseases In Suleymaniyah, stool samples of one case of Acute Flaccid Paralysis was sent to Jordan for laboratory testing. In Erbil, no changes were detected in the trends of communicable diseases. The epidemiological report for week 29 shows three cases of measles, 15 of whooping cough, and none of diphtheria and neonatal tetanus. Integrated management of communicable disease surveillance and control is on-going. Immunisation The monthly Expanded Immunisation Programme (EPI) coverage report for June, 2003 in Erbil shows that coverage rates are: BCG 108%; OPV3 97%; DPT3 95%; and 3
measles 75%. Health management As a follow up to the National Nursing Conference held in Baghdad from 15-16 July, WHO held a meeting with DOH nurses to discuss the resolutions adopted in the conference. The preparations for the Health facility Profile Survey in Erbil were finalised, to start implementation next week. CENTRE (Ninewa, Salah al-din, Tameem) Security The situation in Mosul (Nainewa) is calm but unpredictable. UNHAS humanitarian flights have been landing in Erbil instead of Mosul since 8 July. IDPs and vulnerable people In Salah al-din, a large proportion of IDPs are Arab families who fled Kirkuk and Mosul after the return of Kurdish populations from the three northern governorates to their alleged original places. Despite their living conditions, IDPs in this area identified as their priority the compensation from loss of properties and support to resettlement rather than the provision of water, health or food. World Vision conducted a child protection assessment in Nainewa in early August. Results indicate that water and sanitation facilities are poor and there is no capacity to provide aid to children with disabilities. Water and Sanitation UNICEF, UNDP-IREP and WHO programmes on solid waste, network and sewage repairs in Nainewa and Kirkuk continue. UNDP-IREP is beginning work with the Municipality and the Medical Faculty at the University of Mosul to highlight the dangers of solid waste through a public campaign. WHO and the Kirkuk and Mosul authorities are engaged in water quality control activities. Samples are obtained on a weekly basis and are tested according to WHO standards. Two hundred thirty four samples from Mosul tested on the third week of July show that 50% of the rural, 100% or the urban and 67% of the semi-urban samples failed quality control. Network damages, lack of chlorinating pumps and of trained personnel at the Water Department are among the reasons for the high level of contamination. UNICEF and WHO are providing purification materials for water treatment in Kirkuk and 25MT of chlorine gas was delivered in Mosul. UNICEF is supporting the repair of two major water treatment plants to increase water supply, particularly in rural communities. Disease surveillance and immunisation Health partners are working in the reactivation of the immunisation programme in the Centre Area. Workshops are planned to optimise surveillance and outbreak response. 4
The Mosul blood bank and the Hazim Alhafith Hospital (oncology) have reported shortage of various basic drugs and supplies. WHO is supporting MOH-OCPA in coordinating the provision of the needed items. BAGHDAD (Diyala, Anbar, Baghdad) Security A car-bomb in front of the Jordanian embassy in Baghdad that killed 11 persons and left 57 wounded is the most serious attack to civilians so far. Among the victims there were two WHO national staff, one of whom is in critical condition. The majority of anti-cf attacks and raids by the CF are concentrated in Baghdad area. The security along the road to the airport remains of deep concern due to the continuous stream of ambushes and explosive devices planted on the road. IDPs An inter-agency mission visited Ba aquba (Diyala) on 31 July, where protection of IDPs remains a concern. In some areas Arab populations continue facing expulsions by Kurdish groups who claim original ownerships of those areas. Shelter conditions are precarious and there are no alternative sites for relocation in the governorate. Given the complexity of population movements in the governorate, the newly elected governor has given the overall coordination responsibility for IDP resettlement; to one of his deputies in charge of assistance. Health infrastructure MOH and WHO are partnering to renovate Kimadia central warehouse No 2 (for intravenous fluids). WHO is contributing US$ 400,000 that will be added to the US$ 300,000 that the MOH had allocated to the project. The facility should be ready to receive supplies in around 60 days. Health management From 2 August the CPA Ministry of Health team is working full time at MOH headquarters in Baghdad. MOH began payments to former Iraqi military medical personnel that are now part of the Ministry. Over $2 million dollars will be disbursed. UPPER SOUTH (Najaf, Kerbala, Diwaniya (Qadissiayah), Hilla (Babil), Kut (Wassit) Vulnerable groups The Humanitarian Assistance Coordination Centre (HACC) in Hilla (Babil) informs that children in Diwaniyah continue to suffer from a lack of proper nutrition due to poor diets. Milk for the young and even infant formula are scarce and expensive. The HACC is looking for donations of formula and dietary supplements to improve the nutritional level in the area. 5
Water Lack of potable drinking water is a persistent problem in the Upper South. According to HACC several rural villages in Hilla would need Compact Water Treatment Units to alleviate the situation. LOWER SOUTH (Muthanna, Thi Qar, Basrah, Missan) Communicable diseases During the reporting period three cases of Acute Flaccid Paralysis, were reported. Samples were sent to Baghdad for viral isolation. On 3 August 2003, a cluster of 150 whooping cough cases were reported from one facility in Samawa District (Muthana). A WHO mission travelled to Muhanna to validate the information. It was found that the outbreak had been over-reported probably due to a wrong use of the reporting forms. However, doctors in the area confirmed that whooping cough incidence is high. This could be due to, among other reasons, the lack of vaccination services in the last months. There are plans to accelerate the vaccination campaign. A laboratory confirmed case of diphtheria was reported from Muthana governorate on 3 August, 2003. During July the following cases of visceral leishmaniasis were reported: Thiqar 93 cases (total to date: 567); Muthana 20 (total to date: 60); Basrah 14 cases (total to date: 120); the total number of cases reported in Missan until the end of July is 162. Disease surveillance Upgrading reporting and laboratory capacity are crucial for the effectiveness of the disease surveillance system. The Communicable Diseases Task Force in Lower South decided to expand training on disease surveillance to improve case definitions and disease diagnosis. The Health Sector Coordination Group briefed on the situation of vaccine preventable diseases, especially of whooping cough in the area. A committee composed of MOH, UNICEF and WHO are planning to accelerate the immunization campaign. Coalition Forces and Save the Children will be involved. Water During the reporting period, sixteen water samples were collected from Misan and Muthana to be tested for Vibrio cholerae by the CPA. Drugs and medical supplies There is a shortage of dipsticks for leishmaniasis testing, culture media for whooping cough and transport media for pertussis. To address the shortage of medical oxygen in the south, MOH will purchase an oxygen synthesiser with a daily production of 3,000 cylinders. MOH, WHO, Premiere Urgence, 6
ICRC and an Italian NGO have formed a committee to set up to work on the interim way of providing oxygen to the hospitals through locally manufactured ones. Basrah received drugs and supplies for two months that are being distributed to 211 Private Pharmacies and 65 Public Clinic Pharmacies in the three southern governorates of Basrah, Nissan, and Thiqar. Two hundred vials of Pentostam (for treatment of leishmaniasis) and Fentanyl injections (anaesthetic) were provided to Thiqar governorates from Kimadia warehouse in Basrah. Medical supplies such as needles and syringes (all sizes), IV given sets for adult, all sizes of canula, X-ray films among others in the lower south governorates are running out. Contacts are being made with WHO and Kimadia warehouse in Baghdad to accelerate their dispatch. MSF has procured laboratory supplies and equipment for some hospitals in Missan and Basrah governorates. WHO will assist MSF in their distribution. Health infrastructure The interim Basrah Central Public Health Laboratory (in Al Razy health centre) is now functioning, having received considerable amounts of media and reagents from Kimadia, and IMC. IMC is procuring additional equipment and reagents. As at present, the laboratory has capacity to perform some microbiological assays for water, food and some clinical samples, including stools for cholera. It is also performing rapid smear screening for blood parasites. Due to space limitations, the laboratory cannot expand activities. Renovation of the serum bank in Basrah will also start soon by IMC. IOM reported that physical rehabilitation of the permanent CPHL compound has started. It is expected that rehabilitation will be completed by 1 November. IOM will only perform physical rehabilitation of the building. Equipment and furniture will need to be provided. UNDP provided Health Sector partners an update on the supplied generators to different health facilities. UNDP, DOH and WHO are coordinating needs for the provision and maintenance of generators for health facilities. The Health Facilities Database was updated and copies were distributed. NGOs were requested to provide updates, especially for Thi-Qar, Missan and Muthanna Governorates. IOM started physical rehabilitation of the Burns Unit at Basrah General Hospital. It is expected that work will finish by 1 October. Medical Equipment for the unit still needs to be provided. Health management The shortage of fuel has become a pressing problem in the South. MOH Basra informed that if not solved, some hospitals may have to close within days. CPA informed the participants that patient fees will be introduced in the health facilities from 15 August 2003 CALENDAR OF FORTHCOMING ACTIVITIES 7
7 August: Kimadia management planning meeting. Topics for discussion: customer service, ordering procedures and transition plans for the phase out of the OFFP. 17-19 August: Health Priority Setting Round Table 21 August: National Vaccine Day 8