Lucas Molfino, MSF Mozambique MSF emergency intervention Limpopo River floods in Mozambique January-March 2013 “ There was water up to your knees and people started coming to look for their ART” Health care worker at Chokwe Carmelo Hospital ART registers and patient files from a flooded clinic drying in the sun Lucas Molfino, MSF Mozambique

Context Heavy rains caused floods in 24 districts in different areas of Mozambique. More than 175.000 affected people by Limpopo floods. The hardest-hit District were Chokwe and Guija in Gaza Province: HIV prevalence of 25,1% in age group 15-49 years in Gaza Province – Insida 2009 150.000 people temporally allocated in 15 displacement sites. Widespread disruption of Health & support services Health facilities severely damaged Lost of equipment, drugs stock and patients files The National Disaster Management Institute (INGC) Led the coordination & Provided initial emergency response. The Humanitarian Country Team Working Group (HCTWG) Tightened coordination with government sectors Deployed more staff and essential relief to support the local structures.

MSF Responses In partnership with MoH and Carmelo Hospital authorities, MSF launch an intervention based in Chokwe city and temporary shelters around the city To re-establish health care services Ensuring continuum of HIV care and treatment. Main activities: Emergency Care & OPD- including HIV package in Carmelo Hospital, main HIV Treatment center with the largest patient cohort in the area. Mobile clinics System of reference for severe patients Set up a epidemiological surveillance system Monitor the environmental health (Water & sanitation) Support the re-opening of Chokwe Rural Hospital Duration of intervention: 8 weeks

Total consultations: 23.401 (8217 HIV consultations & pick up ART) Results (1) Total consultations: 23.401 (8217 HIV consultations & pick up ART) (965 TB consultations & pick up TB drugs) Morbidity: Wounds & skin conditions -first stage- Malaria, diarrhea and RTI. -second stage Referrals: 353 referrals to Main hospitals in a early stage of intervention Malaria, Malnutrition, complicate deliveries Hospital care: 223 admissions after re-opening of Chokwe Rural Hospital. - HIV/AIDS – 30% mortality-

ART treatment interruption Results (2) ART treatment interruption Estimations based on the number of PLWHA enrolled in care pre-floods and numbers receiving drugs in all facilities during and post-floods, more than 50% of the PLWHA experienced treatment interruption during the floods only in Chokwe district.

Challenges for HIV care during Limpopo floods Uncertainty about where to access to ART refills Fear to leave houses and belongings unattended Patients not fully aware of Type ART regimen that they were taking. ART provision was not seen as a priority by emergency teams Stock-outs of ART 2nd Line, ART pediatrics, PMTCT and OI drugs. Sexual and gender-based violence & lack of access to PEP kit in the displacement sites. Medical management of complex cases (malnourished HIV patients) Use of ARV drugs affected by the floods?

Conclusion & lessons learned (1) Despite considerable challenges, the local health authorities, with the support of partners, were able to keep medical services and provision of ART treatment functioning in Chokwe city after the floods Develop of a contingency plan for emergencies that includes the basic elements of the HIV program to ensure continuity of ART care in determinate areas. This should include discussions with MoH agencies and other partners Develop a communication structure with close ties with the community Use of a “patient card" outlining current and previous ART regimens, side effects and any recent laboratory results, so care can be obtained at alternative sites.

Conclusion & lessons learned (2) Develop patient empowerment through treatment literacy & prepare then for eventual treatment interruptions. In determinate period of time or high risk setting, consider extending the ART supply for patients (3 months refill) or the buffer stock of ART & OI medications in the health centers. Develop a safe storage from floods for the medical files & pharmacy. Develop a robust paper based emergency data management system that contend essential information for on-going care Ongoing work between partners and MSF is assessing attrition rates and the longer-term impact of this natural catastrophe.

Acknowledgments Provincial & Districts Health authorities of Gaza province. Patients & Staff of Carmelo Hospital MSF emergency team