Torrential rains in Djibouti on 11-14 April 2004 resulted in flash floods in many areas, predominantly affecting the Ambouli River Oued (banks). It is estimated that approximately 300 people died; 600 houses were destroyed and another 100 inundated; 3,000 persons were made homeless; and the lives of a total of 100,000 persons were affected.
Search and rescue operations were carried out quickly. Main roads and rail tracks were cleared. The repair of key services (water, telephone and electricity) was initiated and services were partially resumed within a week. Sanitation problems continue, with many destroyed and clogged sewage pipes and water stagnating in "lakes".
National and health sector coordination meetings are being held daily. Assessments highlight the need for urgent stocks of medicines and supplies to ensure resumption of health services in damaged centres and to be ready for possible outbreaks of cholera and malaria. Four health centres, serving the most affected population, had their equipment, medicine stocks and files washed away. It was imperative to re-establish services as soon as possible. An active surveillance system has been established and support to health centres with newly graduated nurses was provided to carry out surveillance activities and to support medical care.
A contingency plan for a possible outbreak of cholera has been initiated and additional stocks of medicines and medical supplies have been requested.
At this stage, the health sector's main concern is to prevent, detect as early as possible and respond quickly to any outbreak. The UN system is planning to review this experience and undertake a UN lessons learnt exercise. Discussions with the government disaster focal points have also underlined the importance of reviewing the national disaster management plan and the National Committee for Disaster Management. From a health perspective, besides evaluating the surveillance system and improving it, there is a need to discuss the preparedness and mitigation of the health sector, including the mitigation of the impact of natural disasters on health facilities.
Nature of the emergency
The torrential rains that struck Djibouti in April 2004 occurred after a long dry period. The country faces yearly torrential rains and occasional (usually limited) flooding. The last important flood occurred in 1994 and left 100 people dead, displaced populations, and resulted in aggravated epidemics of cholera and malaria.
During the night of 13 April, more than 100 centimetres of water fell (half of the yearly average in a good year). Flooding occurred suddenly, while people were sleeping. The floods swept away children and/or their parents, trees, debris, and even rocks. Survivors climbed to the top of their houses. Rescue operations were immediately launched with the police and national, French and US army helicopters and teams.
The affected area
Djibouti is a country of 23,200 square meters divided into five districts: Ali Sabieh, Dikhil, Djibouti, Obock and Tadjoura. The population is estimated at 500,000 persons, of which more than two-thirds live in the capital Djibouti. The vegetation is arid and semi-desert, and there is little arable land. The riverbed and banks of the Ambouli River Oued provide fertile soil for farming and raising livestock. For this reason, many people live in the immediate vicinity of the river, and it is probable that they will return to living near the river in the aftermath of the floods.
Most districts have suffered from the torrential rains and-with the exception of the Ambouli and Djibouti town-damages have been limited to the destruction of roads in Ali sabieh and rail tracks between Jupto and Chebeili. In Holl Holl and Jupto, damages to rooftops were reported. In Ali adei, damages to farms and to the refugee camps in Ali adeih and Ar aoussa were reported.
In Ambouli, the roads were damaged and small streets immediately covered with more than three meters of water. The bridge over Ambouli River partly collapsed. Water covered most areas of the capital and inundated residential areas including Ambouli, Jebel, Cite Progres, Engueila, and Arhiba. Roads in the town were covered with water, mud and debris from trees and rocks. Many areas were not accessible except by helicopter. The train coming from Ethiopia with fruits and vegetables had to stop in Ali Sabieh with the collapse of a bridge close to Wea. The National 1 main road in Dikhil province was cut.
The affected population
In the immediate aftermath of the disaster, 56 bodies of mostly women and children were transported to the morgue of the only referral hospital, Peltier. Twenty-four wounded were admitted to the hospital. Thirty-six people were reported missing. The unofficial number of dead was cited as 300. The overall affected population by the flooding is 100,000 persons. The vulnerability of population living in the Ambouli River Oued area is heightened by the general conditions of economic hardship, unemployment and by drought.
Around 460 families were made homeless and 700 persons took shelter in the school Balbala 2. Other families went to stay with relatives and are now back to clean their houses. To allow resumption of the school activities, displaced persons in the school were subsequently asked to move to an area called PK12, twelve kilometres away from the town centre, based on the national authorities' intention to provide each family with a land parcel to build new houses. It is important to highlight the situation in which these families were living in the first days after their arrival to PK12. Families were sheltered in 97 tents (donated by UNHCR) in a semi-arid area with limited access to water. The Desk Officer from WHO/HQ participated in an assessment mission with the Ministry of Health to the PK12 camp. There is one health centre nearby, manned by community health workers, and with very limited equipment and medicine supplies. The assessment mission found that water supply at this area is insufficient and latrines are absent.
This new area has also attracted those hoping to get a free land parcel but not necessarily affected by the recent floods. Aware of this difficult situation, the government asked the homeless to return to their original place, where food, shelter and other assistance will be directly provided.
The direct impact: reasons for alert
The direct impact of the flood on the health of the population has been limited until now. However, there are reasons for alert:
- Cholera and diarrhoeal diseases are
endemic in Djibouti. The last cholera epidemic was in 2002; 1,828 cases
were declared with 32 deaths.
- Tuberculosis is seeing a recrudescence
and malaria is also endemic.
- Over the past two-three weeks, respiratory
infections were the most reported diagnosis.
- An increasing number of patients with
undefined fever are feared to have dengue; a medical source indicates that
a significant proportion of some samples collected in one of the hospitals
were positive by IGM testing.
- Malnutrition is common in Djibouti,
with 17.9% and 26.8% of children under five suffering from acute and chronic
malnutrition respectively, rates having increased with the economic hardship.
- Scabies seems to be also on the increase.
- The suddenness of the event and the traumatic experiences lived by thousands have left many still in shock.
What is feared now is an outbreak of cholera. Several cases of diarrhoea have been reported but have not yet exceeded the threshold. A surveillance system exists that collects weekly information on the list of reportable diseases. However, there are many areas to be strengthened in the quality and completeness of the system. Laboratory capacity for cholera tests exists but does not cover all districts; it needs reinforcement.
Indirect health impact (e.g., damage to water plants, other vital infrastructures or lifelines)
Extensive damage to water pipes and sanitation system has occurred as a result of the floods. One week after the floods, water and electricity have been partially restored. The sewage system presents many problems with the accumulation of waste water, the clogging of pipes with debris and full pits. There are many pools of stagnant water in the city, and difficulties are experienced in pumping it. In this regard, the floods are an environmental disaster and pose environmental health risks to the affected population.
Most importantly, four Level lI Community Health Centres (all in the capital Djibouti) were flooded and mud destroyed equipment, medicines, files, and furniture. These centres-Farahad, Ibrahim Balala, Ambouli and Arhiba-serve a population of 91,000. Their medicines and supplies were all washed away, as were the vaccine stocks and the cold chain equipment. Before the flood, the centres suffered from shortage of qualified staff. This situation was worsened when, in the immediate aftermath of the floods, many staff could not come to work as their homes had been affected by the floods.
The main cause for concern is the probability of an outbreak of cholera, especially given the damage to the water and sewage systems as well as poor hygiene awareness by the population. In addition, and since it is the malaria season, the many pools of stagnant water are potential breeding places for the anopheles mosquito.
Meeting the vital needs of the affected population in the immediate aftermath of the floods was done-above all else-through local mobilization and solidarity between the population and the private sector. It is worth highlighting that the first direct support to victims was sent by the private sector to the Union of Djiboutian Women (UNFD).
The current situation
Water: The pre-flood system has been restored. Chlorination has been increased from 0.1 to 0.3. However, several reports mention it is still incomplete.
Excreta disposal: Still inadequate; needs to be fully addressed.
Food: Distribution of food is being carried out to 300 families, predominantly by civil society organizations, NGOs, and local suppliers.
Shelter and environment on site: Initially two schools were used as shelter by only a small number of those rendered homeless by the flood. Many families hosted their relatives who had lost their houses and all of their belongings.
Others vital needs (e.g., clothing and blankets): Items have been distributed to the displaced populations.
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