HIGHLIGHTS The Ministry of Health (MoH) and Health Cluster partners are preparing for a significant rise in the number of cases of malaria. The disease is being increasingly reported in all flood-affected districts; up to 2.2 million cases are expected over the next six months. In Sindh, the situation in Hyderabad is exacerbated by an acute shortage of humanitarian staff on the ground. The Executive Director of Health in the town of Dadu has asked the UN and partners for help dealing with the worsening situation, especially in the area around lake Manchar. The Pakistan Flood Emergency Response Plan (PFERP) was launched in New York on 17 September. The plan - a revision of the initial response plan (PIFERP) - proposes a comprehensive set of relief and early recovery activities. The Disease Early Warning and Surveillance (DEWS) system is functioning well: so far, the MoH and partners have managed to avert a second wave of deaths from disease. In Punjab province, Multan hub reports that between 65 and 90% of internally displaced people (IDPs) are returning home. Senior officials from WHO, UNICEF and WFP will visit affected areas from 22 to 25 September. Railway Hospital Sukkur- Photograph by Syed Haider Ali (WHO). Pakistan Health Cluster Floods in Pakistan Bulletin No 18- Focus on Malaria 20 September 2010
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Pakistan Health Cluster Floods in Pakistan Bulletin …...Railway Hospital Sukkur- Photograph by Syed Haider Ali (WHO). Pakistan Health Cluster Floods in Pakistan Bulletin No 18- Focus
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H I G H L I G H T S
The Ministry of Health (MoH) and Health Cluster partners are preparing for a significant rise in the
number of cases of malaria. The disease is being increasingly reported in all flood-affected districts;
up to 2.2 million cases are expected over the next six months.
In Sindh, the situation in Hyderabad is exacerbated by an acute shortage of humanitarian staff on the
ground. The Executive Director of Health in the town of Dadu has asked the UN and partners for help
dealing with the worsening situation, especially in the area around lake Manchar.
The Pakistan Flood Emergency Response Plan (PFERP) was launched in New York on 17 September.
The plan - a revision of the initial response plan (PIFERP) - proposes a comprehensive set of relief and
early recovery activities.
The Disease Early Warning and Surveillance (DEWS) system is functioning well: so far, the MoH and
partners have managed to avert a second wave of deaths from disease.
In Punjab province, Multan hub reports that between 65 and 90% of internally displaced people (IDPs)
are returning home.
Senior officials from WHO, UNICEF and WFP will visit affected areas from 22 to 25 September.
Railway Hospital Sukkur- Photograph by Syed Haider Ali (WHO).
Pakistan Health Cluster Floods in Pakistan Bulletin No 18- Focus on Malaria 20 September 2010
Situation overview and current scale of disaster
In Khyber Pukhtoonkhwa (KPK) and Punjab, the situation continues to stabilize. People are gradually
returning to their homes and villages. The Health Cluster coordinator in Multan reports that between
65% and 90% of IDPs in the area have returned. Nevertheless, the severe damage to infrastructure,
agriculture and homes cannot be overstated. The Health Cluster will need to begin implementing early
recovery programmes to address the needs of these returnees. In addition, outbreaks of malaria in
southern Punjab, an area with low rates of endemic malaria, are giving rise to some concern.
In northern Sindh more than half of the IDPs are returning home. Although the situation is stabilizing in
some areas, it remains critical in the south. The city of Dadu is cut off, and the Hub Coordinator in
Hyderabad reports an acute shortage of humanitarian partners on the ground. Moreover, sanitary
conditions in some IDP camps are reported to be rudimentary, with overcrowding and open defecation
within the camp area. Stagnant rain water is used to wash utensils and clothes. There is no safe drinking
water and food is cooked and eaten by IDPs in unhygienic conditions.
Security issues due to the murder of MQM party convener Dr Imran Farooq in London on 16 September
have hampered humanitarian operations in Sindh (in both Sukkur and Hyredabad), and in Karachi.
Humanitarian activities as well as general services were completely halted on 17 September, and
international staff were assigned to residence. The situation improved on 18 September; activities on
the ground are now resuming.
Health impact
Acute diarrhoea, acute respiratory infections, skin diseases and suspected malaria remain the leading causes
for seeking health care in the flood-affected areas.
Basic statistics update
• Out of 5.3 million consultations conducted up to 17 September, 708 891 (13%) were for acute
diarrhoea, 802 670 (15%) were for acute respiratory infections (ARI), 986 843 (18%) were for skin
disease and 182 762 (3%) were for suspected malaria.
• The number of suspected malaria cases is rising in Baluchistan and Sindh provinces compared to KPK
and Punjab. A total of 40 415 cases of suspected malaria were reported from 4 to 10 September.
• There are around 500 000 pregnant women among the affected population. This means that many
deliveries each month will be in an unsafe environment, without access to skilled birth attendants.
• Acute respiratory tract infections (ARI) are the leading cause of morbidity. However, the number of cases of
suspected malaria is rising fast: over the last 24 hours, the reported number of malaria cases accounted for
17% of consultations in Baluchistan province and 13% in Sindh province.
New concerns and latest needs; upcoming and recent concerns
• A total of 389 snake bites were reported in Sindh from 31 July to 14 September.
• 4 alerts of AWD and one alert of meningitis were reported and responded to from 11 to 17 September.
• Paediatric malnutrition is increasingly a concern: 30 to 50% of children arriving at health facilities show
symptoms of acute malnutrition. Before the floods, paediatric malnutrition was not foreign to Pakistan:
according to the last National Nutrition Survey, the global acute malnutrition rate was 13%. A total of 10%
of children had moderate acute malnutrition (MAM), and 5% had severe acute malnutrition (SAM).
• Around 500 000 women are pregnant among the affected population. This means that around 83 000
deliveries will take place per month, many of which will be in an unsafe environment without access to
skilled birth attendants.
Malaria Situation Focus
Malaria is endemic in 36 of the 77 flood-affected districts. The floods have favoured vector breeding, resulting
in high densities of disease-transmitting mosquitoes. This, together with the high exposure of the population
(IDPs) has greatly increased the transmission potential of the disease.
Punjab province
• Six districts located in the low-endemic province of Punjab that have reported sporadic cases in the past
have shown a decline in Slide Positivity Rate (SPR-current 20%) compared with the highest rate in the first
week of September. The number and percentage of vivax cases is disproportionately high in Southern
Punjab. The total number of reported cases from the highly endemic district of Mozaffargarh since 1
September is 1420. The data from five other districts are not available.
Sindh and Balochistan provinces
• In Sindh, except for the central districts of Karachi city, all districts are highly endemic for malaria. The
situation is deteriorating in the districts affected by floods. The situation is expected to reach epidemic
levels in coastal (Thatta, and Badin) and southern districts (Dadu, T.Muhammad Khan etc).
• In Balochistan, there have been confirmed malaria outbreaks in north-eastern districts (Zhob, Loralai,
Musakhail) that have received heavy rainfall this year. The falciparum proportion has reached 95%, and the
overall SPR is 50%, which is the highest in the country.
• The situation in districts Sibi, Naseerabad and Mastung (Balochistan) is not encouraging. Mastung has
shown a rise in falciparum cases in recent days, due to the influx of IDPs from Sindh. Information from
other districts is lacking due to the non-functioning surveillance system.
• Balochistan has the highest burden of malaria in the country. This poses challenges for the malaria control
programme when trying to cope with emerging needs.
KP Province
• The situation in KPK is stable, with normal transmission patterns.
Government Response
• On 16 September 2010, the Federal Secretary for Health and the Coordinator of the National Health
Emergency Preparedness and Response Network (NHEPRN) briefed members of the Standing Committee
on Health on the health response to the floods. The Committee requested the Ministry of Health to
continue health care services in the flood-affected areas as well as continue its efforts to contain disease
outbreaks and thus avoid epidemics.
• The third meeting of the National Steering Committee on Health Emergencies, chaired by Mr Kushnood
Lashari, Federal Secretary of Health, was held at NHEPRN Centre on 16 September 2010. The Committee,
established by the Prime Minister of Pakistan, comprises of all Provincial Secretaries, Heads of UN Agencies,
the President, CPSP, PMDC and PMA. All Provincial Secretaries present weekly reports (including needs) on
a common reporting format developed by NHEPRN.
• The committee expressed its satisfaction over improved coordination at various levels, resulting in a better
use of resources and the avoidance of duplication. A subcommittee of the MoH, WHO and UNICEF was
formed to work out the distribution of long-lasting insecticidal nets (LLINs) being donated by various
countries.
• MoH has asked the national Disaster Management Authority (NDMA) to provide water filtration plants to
the provinces through UNICEF and the Water, Sanitation and Hygiene (WASH) Cluster.
• To facilitate information-sharing, NHEPRN launched its official website on 15 September on a trial basis.
• NHEPRN is organizing the deployment of foreign field hospitals and medical teams in the provinces,
depending on the affected population and damaged health facilities. Seven field hospitals donated by the
Italian Government are being deployed at Charsaddah, Nowshera, Bhakhar, Layyiah, Mianwali, Giligit and
Balochistan.
Health Cluster Response
CARE
Update from 8 to 14 September: KPK
A total of 807 patients have been treated via four BHUs in Upper Swat (KPK) including 285 women and
368 children. CARE has conducted 15 Mobile clinics (via three mobile teams) in the district of Charsadda,
treating 2556 patients including 761 women and 1042 children. CARE also held 36 health and hygiene
sessions for 742 people.
CARE operated four mobile clinics (via four mobile teams) in the district of Nowshera (KPK) and treated
1580 patients including 481 women and 692 children. It also held 23 health and hygiene sessions for 796
persons.
Punjab
Primary health care (PHC) services were provided via 10 mobile clinics in Rajanpur (South Punjab). A
total of 2866 patients including 979 women and 1388 children were treated.
Sindh
CARE provided PHC services to 837 patients including 258 women and 422 children via mobile medical
camps in districts Sukkur, Kasmore and Shikarpur.
CHURCH WORLD SERVICE – CWS P/A
KPK
Three mobile health units (MHUs) are operating in districts of Mansehra, Kohistan District and Swat,
especially in remote areas where these MHUs are providing essential medicines and consultations for
patients, with a special focus on women and children. A total of 7855 consultations were made. Lady
health visitors (LHVs) examined 156 ante- and 32 postnatal clients, who were registered and given
medicines. A total of 1252 children under five years of age were examined.
CWS-P/A teams conducted 208 health education sessions on common health issues including personal
CITIZENS' COMMISSION FOR HUMAN DEVELOPMENT (CCHD) CCHD has begun work ensuring that health and sanitations needs are met, plus other daily necessities.
CCHD is 1) providing direct services (medical camps, food items, clothing etc), 2) coordinating among
local organizations and the government, and 3) facilitating the availability of doctors and other medical
staff to local organizations. CCHD has also treated 5500 patients. It operates eight medical camps, each
staffed by a doctor and paramedical staff. A total of 1500 children suffering from diarrhoea have been
provided with mineral water and oral rehydration salts (ORS). Over 150 families have been given food
items. CCHD collaborates with other organizations in providing services. Twenty tents have been
provided to widows, and over 800 new dresses and other items of clothing have been donated to
children, women and men for Eid. CCHD is monitoring cases of epidemics, and common diseases and
infections.0300 8
IDEA KPK
Wooden frames for 35 latrines have been completed, of which 15 have been installed successfully. Work
is in progress on another 20 latrines being installed in Khema Basti Nawa Kili of District Nowshera. Five
water tanks have also been installed. Stickers and banners with hygiene messages have been pasted on
latrines.
In mobile medical camps, 5760 water purification sachets have been distributed, which benefited 480
families (30 sachets per family) of District Nowshera. Another 7689 sachets were distributed in Upper
Swat. IDEA conducted 20 mobile medical camps in the target Union Councils of District Nowshera. Total
consultations reported in the week are 6455, out of which 1855 are male, 2945 are female and 1665 are
children. IDEA also held 301 health and hygiene sessions for 3570 people (1530 female, 1389 male and
651 children).
A water purification plant was installed in District, Nowshera, UC kheshkai payan, with funding from
CARE International.
IDEA received 13 small water purifier plants from GEO TV Network and Rotary Club Peshawar. It has
installed the plants in selected UCs.
INTERNATIONAL MEDICAL CORPS (IMC) KPK
As of 17 September, the organization has conducted 39 946 health consultations in 14 static units in
three districts (Peshawar, Charsadda, Nowshera). In addition, IMC has opened diarrhoea treatment
centres at DHQ Nowshera and Mardan Medical Complex. All IMC's psychosocial support members will
be attending psychosocial support training for three days: there will be no health statistics kept for
these three days.
ISLAMIC RELIEF PAKISTAN KPK
Islamic Relief Pakistan is running two static health camps with outreach capacity at two civil dispensaries
in Union Councils Nissata and Zandu Banda in districts Charsadda and Nowshera respectively. A total of
6663 consultations have been undertaken since 25 August. During this period 46 cases of suspected
malaria have been seen and treated. Skin problems and acute respiratory infection are the two main
health concerns, followed by eye infections and acute diarrhoea cases. Islamic Relief has also distributed
4003 hygiene kits to the most affected population in the area.
Punjab
In Muzaffargarh Islamic Relief has one mobile health clinic working since 5 September in four Union
Councils. A total of 1934 consultations have been undertaken so far. A total of 253 cases of suspected
malaria have been treated in these four UCs. Islamic Relief has also distributed 1479 hygiene kits to the
most affected population in the area.
HELPING HAND FOR RELIEF AND DEVELOPMENT-HHRD
• Since the floods began in Pakistan, HHRD provided free consultations and medicines to flood
affectees by organizing medical camps
• Till 19 September, HHRD held 396 medical camps in 13 districts including Charsada, Nowshehra,