WHO RELIEF MISSION TO GUJARAT (INDIA) EARTHQUAKE Update March 12th March 23rd 2001

1.

General Highlights With the end of the acute emergency phase, the number of national and international organizations working in the earthquake areas is declining. Only agencies involved in restoration and rehabilitation continue to be present. Field level Health sector coordination mechanism are established in Bhuj, Bachau and Anjar under leadership of health sector nodal officers from Government of Gujarat, and facilitated by WHO officials. The 271 Health Sub Centers, 37 Primary Health Centers, 37 Dispensary and Five Community Health Centers deliver Primary Health Care Services. The Red Cross Hospital in Bhuj has started the hand-over process of Hospital to local health authorities. Plans for a prefabricated hospital is under development. The Private health sector has been included in the disease surveillance network with approximately 40 Private practitioners and 12 laboratories in the towns of Bhuj, Anjar, Mandvi and Ghandidham Jaundice cases (suspected Hepatitis A) have been reported from the towns of Bhuj, Anjar, Ghandidham and Adipur Human waste & solid waste disposal, sanitation and health promotion still remain the area of concern. Shelter still remains the prime concern for common people. There are ongoing training of engineers and masons on earth-quake resistant houses for permanent use. Emphasize is put on capacity-building of local inhabitants and community participation. The WHO SEARO adviser on Health & Behavior has visited Bhuj and Anjar, to assess the needs for psycho-social support in relation to mental health,

2. A.

WHO activities in the earthquake affected areas of Gujarat Health Sector Coordination Health Sector Coordination and health-sector subgroups meeting are held on weekly bases in Bhuj, Bachau and Anjar. Several organizations have started initiatives on mental health / psycho-social support as: counseling training of key-staff within the education and health sector. The objective will be to support communities in improving coping mechanisms to increase wellbeing and to be able to identify referral cases. IFRC is lead agency for Hospital sub-group. The group will change its agenda and continue as a Hospital take over group OXFAM is lead agency for Health Promotion sub-group. IEC material, especially on water and sanitation will be ready for field testing this week. SCF is providing weekly lists on development of Restoration and Rehabilitation of Health Infrastructure. A plan for Primary Health Sub Centers has been approved. The GoG has distributed lists on standard equipment for health facilities UNICEF will supply prefabricated structures for 113 Anganwadi sites in Bhuj and 64 in Anjar. IFRC, Save the Children, OXFAM and World Food Program have carried out a nutritional survey in Kutch District. The global level of acute malnutrition was found to be 20,5 % where 17,7 % of the sampled children were found to have a moderate acute malnutrition and 2,8 % severe acute malnutrition. The national survey during the drought in 2000 showed a level of 29,5 % of global acute malnutrition. Disease Surveillance All PHCs, CHCs, Govt. Hospitals and Field Mobile Teams continue to report on daily basis. Currently there are 90 mobile teams and it is foreseen that approximately 30-40 would remain attached to PHCs and the worst affected urban areas. Reporting compliance was 92%. Private health sector in Bhuj, Gandhidham and Mandvi has started reporting on a weekly basis. Initial response is encouraging. Five WHO Surveillance Officers are supporting and supervising the Taluka Nodal Officers to strengthen the surveillance network. The Disease Surveillance Unit (DSU) is functioning at the District Head Quarter to support all the surveillance related networks.

A.

As surveillance network expands, mortality and morbidity data is expected to rise, and existing baseline population and prevalence/incidence data would be considered for disease trend analysis. Support to the available laboratories (IMA General Hospital, National Institute for Communicable Diseases and the Red cross Hospital) is being considered until the new Public Health Laboratory is set up to support the Surveillance System. Aggregate Kutch District data reveal 25,316 presentations in the reporting period. Proportional morbidity of recognized syndromes are: conjunctivitis 8 %, acute respiratory infections 8 %, fever of unknown origin 5 %, infected wounds 5 % and uncomplicated diarrhoea 4%. Conjunctivitis and ARI has slightly decreased during last week Acute Jaundice Syndrome (Suspected Viral Hepatitis A) has increased during the last two weeks. Cases are reported mainly from the private sector in Gandhidham, Bhuj, Adipar and Mandvi. The health authorities are investigating the cases from epidemiological perspective and control measures are being taken to ensure adequate chlorinating of water and proper health promotion & education. Cold chain is restored in most of the affected PHCs and CHCs and routine immunization services are established. A special campaign of TT and distribution of Iron-Folic Acid has started. Reproductive health and child health services will restart in urban areas and all Block Extension Educators (BEEs) and Health Visitors (HVs) have been called for meetings. Blood smears are examined from all fever (suspected malaria) cases at all level and current data suggest no increase of malaria. Water, Sanitation and Environmental Health Fly nuisance control measures are been taken seriously by Government of Gujarat and the National Institute for Communicable Diseases. Measures are including fly-insecticide susceptibility tests but garbage collection/disposal and hygiene promotion, remain the ultimate choice. The WHO support to the Gujarat Water Supply and Sewerage Board in restoring laboratory capabilities and a comprehensive program of water quality surveillance in Kutch District is under progress. Sanitation in urban areas of Bhuj is a problem, as the sewerage system has been damaged and the problem is compounded by poor municipal trash collection. The Water and sanitation team of WHO has submitted a proposal for sanitation and garbage collection at temporary campsites. Approval from H.O. is awaited.

B.

Various proposals for improvement of rural sanitation in worst affected Talucas of Kutch district are under consideration and has been discussed in Dehli during the week. Due to an increase in Jaundice cases, WHO has facilitated meetings between the health and water sector to discuss and plan remedial measures. Decisions were made to check residual chlorine in water supply. A team comprising of four members from: District Health Department, Gujarat Water Board, State Water Quality Laboratory and WHO visited affected places. Water storage at hotels and restaurants showed poor results for which immediate action has been taken by authorities. Chloroscopes have been distributed to all the water supply sources visited by WHO. Simple guidelines regarding chlorinating of water has been translated into local language, and made available by WHO experts WHO Water and Sanitation team has visited areas of Bhuj to assess water and sanitation situation and identify gaps. NGO:s and the local municipality has been contacted and provided support according to basic standards. WHO is assisting Bhuj Civil Hospital authorities in installing a line water purifier and water storage tank.

RECOMMENDATIONS 1. Facilitate initiatives, which support health promotion and education, in rural and urban areas as preparing and disseminate public information on personal hygiene through available mass media and mobile speakers in villages. 2. Encourage systematic collection and disposal of solid waste particularly in urban areas. 3. Ensure adequate sanitation facilities in urban areas through prompt reestablishment of existing sewerage systems or provision of temporary latrines as bridging solution. 4. Continue verification of water chlorinating at end user level through provision of Chloroscopes and instructions to surveillance medical officers and sanitary staff on mobile health teams and private medical doctors 5. Support the restoration of the Kutch District Health Laboratory. 6. Intensity epidemic preparedness with dissemination of case management guidelines for communicable diseases with epidemic potential, as well as outbreak investigation protocol. 7. Reestablish routine communicable disease control programs especially for malaria and TB and a continuos immunization program.

8. Conduct refresher training on standardized case management of common illnesses for PHC staff. 9. Provide a health coordinator to support the District Health Office for the next six months. 10. Follow up assessments and programs of psychosocial support/mental health needs among disaster survivors proposed by IFRC and WHO Regional Adviser on Health & Behavior 11. Continue development of state capacity for material resources management with attention to commodity warehousing and medical logistics. 12. Compile lessons learned from Orissa cyclone and Kutch earthquake in support of state surveillance capacity building. 13. Assign a disaster epidemiologist to strengthen communication links with local and state health authorities in support of future contingency planning. 14. Emphasize affordable earthquake-resistant building standards during reconstruction of health facilities. 15. Encourage inter-sector disaster preparedness within state government.