Location of operation: INDONESIA
Amount of Decision: EUR 367,000
Decision reference number: ECHO/IDN/BUD/2006/01000
Explanatory Memorandum
1 - Rationale, needs and target population:
On April 25th, an outbreak of diarrhea was reported to have killed 58 residents within a few weeks(1), in three highland districts of Papua, Indonesia (Jayawijaya, Yakuhimo and Tolikara). A few days later the health authorities, based on tests from three laboratories(2), confirmed that the outbreak was due to cholera (Vibrio Cholerae Type Ogawa), although some(3) fatal diarrhea cases are believed to have a different, unidentified origin. As of May 6th 4,015 cases and 160 deaths had been reported(4). The number of casualties is however believed to be grossly under-estimated, as some cases in remote areas were not reported. The reported cases are distributed as follows:
|
Sub-District
|
# of cases
|
# of deaths
|
| Wamena |
67
| |
| Asologaima |
557
|
32
|
| Kurulu |
1,540
|
67
|
| Bolakme |
50
|
4
|
| Welelagama |
307
|
2
|
| Asolokobal |
153
|
3
|
| Musalfak |
155
|
18
|
| Hubikosi |
734
|
21
|
| Hom-hom |
180
|
1
|
| Wamena Hospital |
272
|
12
|
|
Total
|
4,015
|
160
|
The above table shows that cholera cases have quickly spread over a large area. 133,787 persons are estimated to be at risk by the local health authorities in the nine sub-districts in which cases have appeared(5).
The situation is further complicated by the poor response capacity of the health system in the affected districts. At Wamena hospital, the hospital of reference for the outbreak, cholera patients are not isolated from other patients, water is not safe to drink and sanitary conditions are deplorable. In addition, the hospital counts only four medical doctors and 190 beds, and medical supplies and basic equipment are lacking.
The affected districts are located in under-developed and isolated areas of the highlands of Papua, which is one of the least developed provinces of Indonesia and counts only minimal infrastructure. As a consequence, access to the affected areas is difficult and limits the effectiveness of the response to the outbreak.
Local authorities and humanitarian agencies have reacted to the outbreak, but they have so far failed to contain the spread of the disease. Local authorities have increased the resources allocated to the crisis. Three teams of 4-6 nurses have been mobilised to do case findings in the villages. The Health Department in Jakarta has sent a team of six experts, and authorities radio-broadcast health and hygiene prevention messages.
There are only three humanitarian organizations currently addressing the outbreak: OXFAM United Kingdom (OXFAM UK), Medecins Sans Frontieres Belgium (MSF-B), and the United Nations Children's Fund (UNICEF). UNICEF is supporting the local health authorities in distributing Oral Re-hydration Salt (ORS) and jerry cans. After conducting a medical assessment in April-May, MSF Belgium plans to get involved in patient treatment and the construction of a Cholera Treatment Center. OXFAM UK began working on water, sanitation and hygiene issues with the deployment of a team of nine staff on May 8th.
The present cholera outbreak follows a previous severe diarrhea outbreak that caused an estimated 300 deaths in September - December 2006 in Yahukimo district, also located in the province of Papua. The emergency humanitarian aid proposed in this Decision is needed to avoid further deaths in the affected sub-districts and to contain the outbreak before it spreads to neighboring areas, causing further casualties.
Notes:
(1) The outbreak is thought, with no certainty, to have originated from the non-hygienic food served during a tribal ritual on March 16th.
(2) 28 of March. Referral Health Laboratory of Surabaya, Java. Six samples out of eight received on the 24 of March resulted positive to Vibrio Cholerae Type Ogawa
7 of April. Referral Health Laboratory of Surabaya, Java. Two samples out of seven received on the 4 of April resulted positive to Vibrio Cholerae Type Ogawa
25 of April. Provincial Health Laboratory of Jayapura, Papua. Two samples out of thirteen received on the 11 of April resulted positive to Vibrio Cholerae Type Ogawa
3 of May. Central Referral Health Laboratory of Jakarta, Java. Seven samples out of eight received on the 1st of May resulted positive to Vibrio Cholerae Ogawa.
(3) Source: Oxfam UK
(4) Exact breakdown of casualties caused by cholera and casualties caused by bloody or another type of diarrhoea is unknown, since local laboratories do not have the capacity to test all cases.
(5) Source: Papua Health Crisis Centre