Highlights
- WHO teams are continuing their assessments in the accessible areas round Mansehra and Muzaffarabad and will target Bagh in the coming two days.
- WHO is investigating reported cases of diarrhoea in Balakhot.
- WHO is supporting the MOH in the mobilization of 40 teams of surgeons and public health/environmental specialists.
- An estimated 3.3 million people have lost their homes, 38,000 their lives and there are over 65,000 injured.
- There is an urgent need for generators to ensure an unbroken cold chain system for vaccines.
Health impact
- Lack of shelter (tents and blankets) and warm clothes for the affected population as well as for health workers continues to be an acute problem. The weather is becoming rainy and very cold, with sharp drops in temperature at nightfall. The situation is compounded by limited quantities of food, lack of clean drinking water and an appalling sanitary situation. This exposure of the wounded and the survivors to a multitude of health risks gives cause for great concern. The health system in most areas has yet to be expanded beyond basic trauma and surgery care.
- Medical and surgical field teams report 2 000 patients are being treated daily in Muzaffarabad The first three days after the earthquake, most patients were treated for trauma injuries. Currently, only around 40% of patients are treated for trauma; the remainder being largely acute respiratory infections. The large number of injured continues to overwhelm current capacity. Many of those injured may not be treated on time, resulting in unnecessary deaths and disabilities.
- The Pakistan Institute for Medical Sciences (PIMS) in Islamabad is receiving up to 300 patients daily and is sending stabilized patients to other public hospitals around the country in order to admit the seriously injured. The hospital has put up tents in the hospital grounds for families of patients.
- Because of the harsh geographical characteristics of the area, it is very difficult to find suitable sites to set up field hospitals and camps for displaced populations.
- There is heightened concern about potential epidemics of diarrhoeal disease, typhoid and other waterborne diseases due to lack of clean drinking water and the dearth of sanitation facilities. .
- ICRC and the Pakistan Red Crescent are asking aid workers to contact them whenever unaccompanied children are identified to prevent possibilities of child abuse.
- The Pakistan Armed Forces has set up a field hospital at Islamabad airport.
Preliminary Assessment of damages to health facilities in Muzaffarabad and initial response :
- Muzaffarabad, a district of 600,000, has been massively damaged. 50% of the population has no access to any kind of services.
- The Combined Military Hospital (CMH) in Muzaffarabad, the mainstay of higher level health services in the district, has been extensively damaged and is non-functional.
- The infrastructure of the other main hospital, the Abbas Institute of Medical Sciences, is intact, but the hospital is not functioning.
- Information about peripheral health units is scant. However, given the amount of damage and destruction it seems unlikely that these units would be operational.
- The Department of Health has effectively ceased to function as most staff are direct or indirect victims of the disaster and are not reporting for duty
Initial Response : Abbas Institute of Medical Sciences (AIMS)
- Surgical services made operational, 4 operation theatres functional (general and orthopaedic surgeons), approximately 100 surgeries carried out daily;
- AIMS has been designated as the principal hospital in Muzaffarabad. The military has agreed to transfer its resources to this hospital.
- AIMS OPD is now operational and has established a vaccination service.
- A dialysis unit is being set up at AIMS to prevent renal complications of crush injuries. The unit will be fully functional in two days.
- Three vaccination centres and mobile teams have been established in Muzaffarabad (in the central camp, Stadium Refugee Camp, and Neelum Stadium).
- Two sentinel surveillance sites will be established at Muzaffarabad
Preliminary Assessment of damages in Bagh
- Bagh is a district with a population of 400,000. The estimated population of the city of Bagh is approximately 100,000. The city and surrounding district suffered massive damage in the earthquake.
- All civil and military health facilities have been destroyed. Apparently, there is not a single building in the city that could be used to establish a makeshift hospital.
- Health services are being provided through NGOs and the armed forces, with a team from Mayo Hospital in Lahore. The district health system has ceased to function. Information from peripheral areas is not available, however, it seems that most primary health care facilities are non-functional.
- The focus of services is on emergency surgery. There is no attention being given to preventive services or to accessing the remoter areas.
- The District Health Office was non-functional. The environmental conditions in which health care was being provided were unacceptably poor.
Initial Response:
- In addition to undertaking a preliminary assessment of the situation, the WHO team assisted in organizing a coordination meeting among the staff of DHQ hospital, the new commandant of the military hospital and the NGOs providing emergency care.
- A coordination committee was set up to monitor health interventions.
WHO Response
- The Early Warning and Response Surveillance system (EWARN) is ready for immediate activation. Training of surveillance officers is ongoing. All health partners (surgical teams, medical teams, field hospitals, etc.) will be asked to provide EWARN with updated information on the number and type of cases treated.
- WHO has initiated health coordination in Bagh, Muzaffarabad and Mansehra and will be setting up a field office in Muzaffarabad.
- WHO, together with the MOH, UNICEF and other partners, has launched a measles vaccination campaign. The vaccine is being given to children between 9 months and 15 years old. Vitamin A is also being provided. The vaccination campaign has started in areas where people have congregated at medical sites or tent clusters for vaccination. 25 teams are already in the field and 20 more will be there by Tuesday. There are some constraints with ensuring the cold chain in many areas.
- WHO, together with the Ministry of Health, is mobilizing 40 teams of surgeons and public health/environmental specialists, some from the Institute of Public Health in Lahore and the rest from the Health Services Academy Islamabad on Monday. They will be briefed on Monday
afternoon/ evening and will leave for the affected areas on Tuesday. Another group of 100 students and 30 epidemiologists from Aga Khan University is also targeted for mobilization and training for ensuring the surveillance system.
- WHO is representing UNDAC in Manshera.
- A broad range of health messages, varying from the fact that dead bodies do not transmit disease, the importance of personal hygiene, use of latrines, and so on, will be transmitted as of tomorrow to the affected population from a local radio station, Power 99.
- 40 national public health experts have been recruited to go to the affected regions next Monday. Another 200 physicians from Karachi and Punjab are available for immediate mobilization.
- WHO has set up a website to facilitate information exchange between all health partners at www.whopak.org
Other UN agencies' and health partners' response
- IOM has distributed 15,000 tents to the affected population, with another 67,000 still to come.
- UNICEF has purchased additional health emergency kits.
- Doctors worldwide have treated 3 000 patients up till now.
- Assessments are being done in Dhanni and Balakot. More teams are coming in.
- IMC treated over 100 patients in Balakot.
- MDM is running a mobile clinic in Balakot, focusing on family health care.
- Caritas Pakistan has set up 15 medical camps in Balakot.
- More field hospitals will be installed soon:
- Johanniter aims to install a field hospital in Kashmir next Monday.
- A Canadian Disaster Response Team mobilized by CIDA will be initiating activities soon in Muzaffarabad.
- IOM and the Pakistan Medical Associations of Rawalpindi and Islamabad will be setting up an operation theatre and hospital facility for 60 patients requiring minor surgery in the Rawalpindi building.
- Caritas Germany aims set up four additional field hospitals within the next two weeks.
- ARC International will send a medical and surgical team with a capacity to treat 15,000 people per month to the villages of Ratnoi, Khwaja, Mahaldara and Kotla. Supplies of tents, blankets, clothing and hygiene kits will be distributed
Urgent needs
- Ensure that a stock of Tetanus toxoid and Tetanus Immune Globulin is procured
- Initiate the EWARN system in order to monitor, detect and respond to any rumours or threat of outbreaks.
- Generators are needed urgently to ensure the cold chain system for vaccines
- It is critical to start establishing temporary health centres as soon as possible for delivering essential basic health services and preventive interventions. Teams of doctors, nurses and counsellors, mobilized from other regions, will need to be moved to the more rural parts of the affected provinces
- All health facilities need to have a sustainable source of clean drinking water.
- The urgency for winterized tents and blankets is increasing with the onset of winter.
- Setting up of health supporting facilities such as blood banks and basic laboratories should be planned.
- WHO hubs in Muzaffarabad and Manshera will be functioning today. 4 warehouses in Manshera and 5 in Muzaffarabad will be established with cold chain facility.
Donations
- The British Government has donated US$252,951 for WHO support to the disaster response
- The Swiss Government has donated US$100,000 for WHO support to the disaster response
- The Norwegian Government has donated US$250,000 for WHO support to the disaster resonse
- The Principality of Monaco has donated Euro 100,000 for WHO support to the disaster response
- The Government of Italy has donated EURO 250,000 for WHO support to the disaster response plus in-kind donation of 5 Trauma kits A, 5 Trauma kits B, 5 New Emergency Health Kits and transport
- The Government of Australia has donated US$ 1,899,696
- The Government of Ireland has donated EURO 100,000 for WHO support to the disaster response
- The Government of Sweden has donated US$1,928,020 against the Flash Appeal
- The Government of the United States has donated US$2,000,000 against the Flash Appeal
- The Government of Canada has donated CDN 1,750,000.