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Health Action in Crises Monthly Report Jun 2004

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DISCLAIMER: The following is a non-exhaustive selection of health-related events and WHO actions undertaken during the stated period in specific countries in which populations are experiencing crisis conditions. This has been compiled by WHO/Health Action in Crises (HAC/HQ) in Geneva, in consultation with relevant Country and Regional Offices. If you are a WHO staff member and wish to contribute to this update, please write crises@who.int.
For a list of acronyms, please see the last page of this update.

AFRO West Africa Sub-Region

Cameroon

Events

A cholera outbreak that began in January 2004 has started again with the onset of the rainy season in the Littoral and West regions. The Ministry of Health (MoH) reported 2,924 cases and 46 deaths as of 9 June. Since then, the number has risen to 4,032 cases and 65 deaths. .. The MoH is working with other Ministries to carry out control measures. Physicians have been sent from the capital to Douala, at the centre of the outbreak, to support cholera treatment centres.

WHO Interventions

WHO met with the MoH, members of the donor community, NGOs and international agencies to decide on a common strategy to combat the outbreak. WHO contributed drugs and supplies, case management guidelines, and chlorine. .. Specific technical support, comprising an epidemiologist and a social mobilization expert, have been provided by the WHO Regional Office for Africa. A water and sanitation engineer provided by the French Government joined this team. .. WHO/HAC/HQ is providing funds for emergency medicines, and Médecins sans Frontières has engaged in drilling wells and chlorinating water supplies.

Cote d'Ivoire

Events

On 30 June, an agreement was signed on the work of the UN in Côte d'Ivoire. The measure authorized a one-year peacekeeping operation and mandated 7,000 UN personnel to monitor the ceasefire agreement.

World Food Programme (WFP) and the Ivorian Red Cross are collaborating on a pilot project targeting people affected by HIV/AIDS in the western town of Daloa. Food aid will complement medical care and psychological counseling.

WHO Interventions

WHO is charged with coordinating the health sector projects submitted for funding to the ONUCI (the UN peacekeeping operation in Cote d'Ivoire). Preparations are underway for a series of meetings in July, during which a committee will meet to review the proposed projects. WHO is working closely with the MoH and ONUCI in this regard.

Guinea

Events

According to the mid-term Consolidated Appeals Process (CAP) review, the humanitarian context in Guinea is characterised by: the burden of a considerable refugee and returnee caseload; widespread high levels of mortality, morbidity and malnutrition; very limited access to basic life-saving social services; increasing vulnerability and loss of coping mechanisms; social discontent, and a galloping spread of HIV/AIDS. The combined effects of these factors could easily lead to an acute humanitarian crisis if adequate, integrated and targeted assistance is not provided to the most vulnerable populations on time. (Source: OCHA) .. The health situation has deteriorated as a result of continuous population movements and the cross-border areas of the sub-region are especially at risk and in need of access to basic health care services and disease surveillance. According to the Mid-Term CAP Review, if measures are not taken, large outbreaks may occur. Disease surveillance is essential. (Source: WHO N'Zérékoré) .. Preparations are underway for a CAP Workshop in Conakry, Guinea, on 13 and 14 July 2004.

WHO Interventions

WHO-in conjunction with the Direction Régional de la Santé (DRS), Direction Préfectorale de la Santé (DPS), and NGOs-has included the project "Health Preparedness and response to epidemics in cross-border areas of Guinea Forestière" in the mid-term review of the CAP. The project, to be conducted in the June-December 2004 period, would: .. Enhance health workers' capacity to respond to epidemics. .. Ensure emergency stocks of vaccines and drugs. .. Create a network of laboratories for epidemic preparedness and response. .. Allow for cross-border disease surveillance and information sharing. .. Make more effective the coordination of emergency public health activities. .. Put in place a surveillance system capable of early detection and confirmation.

Liberia

Events

The cholera outbreak that began 18 May in Harper is under control. Over 96 cases and five deaths were reported in the last few weeks.

The Liberian MoH reported more than 8,000 cases of malaria, 1,022 cases of acute watery diarrhoea, 181 cases of acute bloody diarrhoea and nine cases of measles throughout the country during the 14 to 19 June period.

A measles immunization campaign targeting 70,000 children aged six to 59 months will begin shortly with the support of UNICEF and country health teams. The successful implementation of measles vaccination in Gbarpolu and Sinoe Counties will mean measles vaccination has reached all 15 counties of the country (Source: OCHA).

Liberia signed the Framework Convention for Tobacco Control (FCTC) Protocol.

Reactivation and rehabilitation of a 24-hour running water system for Tubmanburg hospital is in progress.

Phebe Hospital resumed operations at its premises in Phebe, Bong County, on 2 June after being dislodged several times during the last round of fighting in Liberia. The facilities of the hospital were severely looted and vandalized during fighting last year. The return of the hospital is made possible through a Danish grant of US$ 250,000.

Health workers confirmed cases of Lassa fever in Nimba. For several weeks now, fears have increased that communities in Liberia would be threatened with Lassa fever because of an epidemic in Sierra Leone and the return of hundreds of Liberian refugees.

The Deputy Special Representative of the Secretary-General in Liberia and Humanitarian Coordinator for Liberia, Mr Abou Moussa, opened a two-week training workshop on HIV/AIDS counseling for UNMIL peacekeepers in Monrovia on 23 June. (Source: UNMIL)

Preparation is ongoing for local chlorine production and emergency surveillance and response assessment.

Capacity building is ongoing for MoH personnel.

WHO Interventions

From 11 to 16 June, WHO led an MoH joint assessment task force for the cholera outbreak in Harper. The most affected communities were visited and the task force assisted the Country Health Team in developing an intervention action plan. WHO provided technical support for case management, surveillance, information management and community action. WHO also supplied 50 kilograms of chlorine for 170 wells and provided chlorination guidelines.

WHO is supervising and monitoring the screening of all ex-combatants in all of the four cantonment sites of the Disarmament, Demobilization, Repatriation, Reintegration, and Resettlement (DDRRR) process in Liberia. As of 16 June, 41,698 ex-combatants were screened; 72.3 per cent (30,136) of which received treatment for minor illnesses and injuries. Five per cent were referred to hospitals.

To support the provision of basic health services to the civilian population, WHO provided emergency health and trauma kits for use by the Pakistani Battalion in Tubmanburg, Bomi County and Voinjama, Lofa County.

WHO facilitated the process that led the Minister of Foreign Affairs, on behalf of the Government of Liberia, to sign the Framework Convention for Tobacco Control (FCTC) Protocol on 18 June 2004.

Grants from the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) totalling more than US$ 24 million have been signed for implementation in Liberia. The Liberian MoH has requested that WHO chair the Technical Coordinating committee that will manage the Global Fund. During the period of 4 to 18 June 2004, WHO provided two consultants to work with the National Malaria Control Programme and United Nations Development Programme (UNDP) to produce a detailed activity-driven work plan to ensure WHO involvement in the implementation activities.

WHO is currently developing its Country Cooperation Strategy for Liberia in coordination with the MoH. A draft document is being prepared. A follow-up mission to finalize the strategy will take place in October.

WHO headed a team to carry out facility- and community-based assessments of Lassa Fever in Internally Displaced Persons (IDPs) Camps and specifically to: a) establish the mode of transmission for the index cases; b) trace contacts; and c) collect specimens for investigations. WHO is intensifying efforts in advocating for and coordinating the initiation of a National Lassa Fever Control Programme in collaboration with the MoH, UN Agencies, United Nations Mission in Liberia (UNMIL) and NGOs. WHO is also monitoring the Lassa Fever situation as the suspected case in Bong county was confirmed positive by laboratory diagnosis. In preparedness, WHO encouraged the MoH to request assistance from the government of Sierra Leone for Ribavirin.

Through the WHO/AFRO Regional Director's development fund, WHO is currently rehabilitating the water and sanitation system for Tubmanburg Hospital, Bomi County. This activity comprises the drilling of one production borehole; the laying of a new pipe line; the construction of an elevated water storage facility; the rehabilitation of the reticulation system within the hospital; the rehabilitation of the sewer conduits, septic tanks and soak-away pit; the rehabilitation of the toilets and bathrooms and rehabilitation and construction of facilities for hospital wastes.

WHO, in collaboration with WHO/EMRO and other partners, has completed the preparatory phase for establishing a local chlorine production and distribution system for the country. This activity involves the local production of chlorine for chlorination of community wells, household chlorination and sterilization of health facility equipment.

WHO has completed the preparatory phase for the assessment of the Emergency surveillance and response system.

WHO is leading health sector partners in developing a Synchronized National Immunization Day (NID) implementation plan. The NID is scheduled for October and November 2004.

WHO is leading health sector partners in developing a programme for implementing, monitoring and evaluating the plan for basic social services (Cluster 6) sector and is participating in the development of the same for IDPs, refugees and returnees (Cluster 3).

WHO Country Office, together with UNICEF, UNDP, UNHCR, MoH and a number of local and international NGOs), is implementing a water quality improvement project. The principal strategy is to make water safe through disinfection and safe storage at the household level (the disinfectant-sodium hypochlorite is produced locally from salt and water using an electrolytic cell). Behavior change techniques, increased community mobilization and education on the link between consumption of contaminated water and disease and the benefits of safe water make this approach an effective intervention system if the routine cycle is to be broken. The generated sodium hypochlorite could also be used in sterilization of surgical equipment.

WHO, in collaboration with UNICEF, reactivated the Interagency Coordinating Committee (ICC) and Technical Coordinating Committee for Expanded Programme of Immunisation (EPI).

WHO also supported: two Ministry of Health and Social Welfare (MoHSW) professionals to attend an Integrated Management of Childhood Illnesses (IMCI) training workshop in Nairobi, Kenya; another participant from MoHSW for a fellowship in communication and behavioral science in Accra, Ghana; and the MoH Emergency officer for training in emergency preparedness and response in Geneva, Switzerland.

Sierra Leone

Events

Health services have improved from a capacity level of five to ten per cent during the conflict to 40 to 50 per cent at present. Despite this progress, the provision of health services continues to face capacity constraints, including inadequate staffing and resources. There are still significant areas of the country without adequate access to basic services. (Source: OCHA Mid-term CAP Review)

The Special Court for Sierra Leone ruled that recruitment or use of children under age 15 in hostilities is a war crime under customary international law. An estimated 6,000 children were demobilized at the end of the civil war in Sierra Leone. These children were subjected to extreme brutality - including physical torture, sexual violence and rape. (Source: UNICEF)

WHO Interventions

WHO, United Nations Population Fund (UNFPA) and UNICEF have relied on core and alternative funding to support the restoration of community health services.

WHO is in the process of rehabilitating four Peripheral Heath Units (PHUs) in Kambia, Pujehun and Bombali.

WHO is working closely with the Ministry of Health and Sanitation (MoHS), UN agencies and NGOs to review malaria protocols, response strategies for Lassa and Yellow Fevers and monitor diseases such as polio, Yellow Fever, neonatal tetanus and measles.

Contact: Dr K.E. Siamevi, siamevik@afro.who.int

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