Chad + 8 more

Health Action in Crises - Highlights No. 230, 13 to 19 Oct 2008


Each week, the World Health Organization Health Action in Crises in Geneva produces information highlights on critical health-related activities in countries where there are humanitarian crises. Drawing on the various WHO programmes, contributions cover activities from field and country offices and the support provided by WHO regional offices and headquarters. The mandate of the WHO departments specifically concerned with Emergency and Humanitarian Action in Crises is to increase the effectiveness of the WHO contribution to crisis preparedness and response, transition and recovery. This note, which is not exhaustive, is designed for internal use and does not reflect any official position of the WHO Secretariat.


- As the emergency phase is now considered over, Health Cluster weekly meetings are being replaced by monthly sectoral reunions.

- The UN Security Council has extended the MINUSTAH mandate until October 2009.

- A donor conference to aid the country has been called.

Assessments and Events

- As of 13 October, no outbreak is reported, but cases of severe malnutrition call attention to the poverty and extreme vulnerability of the population.

- Roads are being repaired, allowing the delivery of fuel and medical supplies to all hospitals and most health centres. Several health centres in Artibonite, South and South-East departments still need some rehabilitation.

- Overall health care provision is comparable to pre-crisis levels. However, after a period in which emergency health services were provided free of charge by humanitarian organizations, access to care is now difficult for the poor due to the users fees.

- Access to safe drinking water is poor to non-existent in Artibonite, Nippes, South and South-East departments.

- Many of the displaced are not able to return to their homes yet and remain very vulnerable to the ongoing hurricane season. In Gonaives, water, sanitation and environmental interventions are critical to allow these returns.

- The main health priorities are financial access to health care, nutritional surveillance and referral, safe drinking water and vector-control measures.


- WHO/PAHO leads the Health Cluster. The MoH participates in the meetings and the number of partners has been growing steadily.

- WHO/PAHO is using the US$ 1 million received under the Flash Appeal to coordinate the health response, implement epidemiological surveillance, early warning and vector control measures and support access to health care.

- WHO/PAHO and UNICEF helped re-establish the cold chain. WHO/PAHO, the Center for Disease Control and the MoH are replenishing supplies for epidemiological surveillance in Gonaives and in the national laboratory.

- Health partners supported the provision of care in urban centres by setting up field and mobile clinics and providing staff and equipment. WHO/PAHO and Terre des Hommes recently distributed medical kits and water purification equipment to Tiburon, in South department, and to Môle and Port-de-Paix, in North-West department.

- Health Cluster partners are assisted by two WHO logisticians. A WHO outstation in Gonaives supports local coordination, sanitation engineering and logistics. A sanitation engineer will join the WHO Country Office for 2 to 6 months to oversee the provision of potable water.

- WHO/PAHO's emergency activities have been funded by the CERF and Sweden.


- OCHA has prepared a Who Does What Where map of the response.

Assessments and Events

- Since the beginning of the cholera outbreak on 5 May, 10 872 cases and 185 deaths (CFR 1.7%) have been confirmed, with Bissau reporting 7427, followed by Biombo with 1451 cases and Bijajos islands with 500 cases.

- Overall case fatality varies greatly, ranging from 0.8% and 1% in Biombo, the most affected regions, to 8.7% in Bafata (127 cases and 11 deaths) and 10.1% in Quinara (276 cases and 28 deaths).

- The number of cases notified between 6 and 12 October has reduced by nearly 30%, but remains high, at 1046. It is not clear yet whether the epidemic has reached its peak despite the end of the rainy season.

- Across the country, public sector workers, nurses and doctors are striking over salary arrears, and basic services are running at minimum capacity.


- The Government, WHO and humanitarian counterparts are still fully absorbed in efforts to contain the outbreak.

- The General Directorate of Public Health, WHO, UNICEF, MSF-Spain, MDM and the National Red Cross are assessing the remaining the stock of medicine and materials available in the Central Drug Store.

- WHO has initiated an analysis of this and past outbreaks to help authorities develop a comprehensive cholera prevention and control preparedness plan.

- OCHA regional in Dakar has contacted WHO offering support to control the outbreak.

- WHO's emergency work is supported by Italy and the CERF.