1. Emergency Capacity Building Project Health in Emergencies

3.  Understand the health impact of disasters  Orientation to SPHERE minimum standards in health response  Understand priority health interventions in emergencies

4.  The primary goal of Emergency Health response is to prevent excess mortality  Excess Mortality is prevented by providing evidence based health interventions to the greatest number of people (high coverage and utilization) and designed to ensure the greatest health impact (decrease mortality).

6. Health Impact ComplexEarthquakeHigh winds Without flooding Floods DeathsMany FewMany InjuryVariesManyModerateVaries Diseases outbreak HighLow Varies Food Scarcity CommonRare Common

7. Major Causes of Death in Refugee Populations <5 Years Sudan: Wad Kowli Camp February, 1985 Somalia: Gedo Region, 7 Camps January, 1980 Source: Centers for Disease Control and Prevention, Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues. MMWR, 1992;41(No. RR-13):8. Measles ARI Malaria Diarrhea Other

8.  Dead bodies pose an immediate threat in emergencies.  Large numbers of Expatriate health workers are essential in emergencies following a natural disaster.  Drug Donations are always good

9.  Crude Mortality Rate, under 5yr Mortality Rate, and acute malnutrition level have traditionally been used to classify the severity of a crisis, monitor trend, and evaluate the impact of the humanitarian intervention  Mortality rates in emergencies are calculated as deaths per 10,000 persons per day, per day because situations may rapidly change

10. (Source: adapted from OFDA FOD) Crude Mortality Rate = deaths/10,000 people/day Mortality rate for under 5yr (U5yr) age group = U5yr deaths/10, 000 U5yr children/day <1 = Under control >1 = Serious condition >2 = Out of control >4 = Major catastrophe 1 = Normal in a developing country <2 = Emergency phase: under control >2 = Emergency phase: in serious trouble >3 = Emergency phase: out of control

11. CMR = Total number of deaths x 10,000 /No of days Total population U5yrMR = Total number of deaths <5yr X 10,000/No of days Total number of children U5yr

12. Camp bravo has a total mid-period population of 36,000, and in the last 10 days 90 people have died and been reported to the health unit registrar. The crude mortality rate (CMR) will be calculated as follows  CMR = Total number of deaths x 10,000 / number of days Total population Total number of deaths reported = 90 Total population = 36,000 Number of days = 10 Thus  Crude Mortality Rate = 90 X 10,000 / 10 36,000 = 2.5 deaths / 10,000 / day

13.  Measles vaccination coverage among children aged 6-59 months is > 95%  Vitamin A supplementation coverage among children aged 6-59 months is > 95%  Case Fatality Rate <1%  Crude Mortality Rate <1/10000/day or less than double the baseline Crude Mortality Rate  Under 5yr Mortality Rate < 2/10000U5yr/day or less than double the baseline Under 5yr Mortality Rate  1 basic health unit/10000 people

14. 1. Rapid Health Assessment 2. Prevention and Control of Disease Outbreaks  Measles  Cholera/Acute Watery Diarrhea  Hygiene Promotion 3. Emergency Health Care

15. 1. Rapid Health Assessment

16.  The purpose of a Rapid Health Assessment is to gather key health information in a short period of time for immediate action  Need to determine: Is it really an emergency? How many persons are affected? What are the immediate needs? What local resources are available? What external resources needed?  Need to develop a plan of action

17.  Background; social, political, economic  Affected population size and demographics  Background health (affected population + host)  Vital health information Morbidity Mortality rates Access to health services Anticipate potential disease outbreaks  Measles?  Cholera?  Environmental conditions – water, shelter, sanitation

19.  Outbreak: is the occurrence of a number of cases of a diseases that is unusually large or unexpected for a given place and time.  The goal - is to detect an outbreak as early as possible so as to control the spread of disease and reduce death due to the disease and its complications among the population at risk.  Common causes of disease outbreak in humanitarian emergencies are: cholera, measles, malaria, meningitis, dysentery

20.  Cholera: is an acute diarrheal illness caused by the bacterium Vibrio Cholerae  Approximately 1 in 20 infected person has severe disease characterized by: profuse watery diarrhea and vomiting  Rapid loss of body fluids lead to dehydration and shock, death can occur within hours without treatment  A person can get cholera by drinking water or eating food contaminated with the cholera bacterium, the source of contamination is usually the feces of an infected person  A report of one case – in emergency contexts is the threshold to reporting an outbreak by World Health organization

21. 1. Health care – treatment of cases  Active case finding  Setup Cholera treatment units, oral rehydration corners at village level  Train all health staff on case management 2. Environmental Intervention – control disease spread  Water treatment – chlorination, boiling, covered water container  Use latrines, safe disposal of children excreta  Safe burial of dead people 3. Hygiene promotion  Safe food preparation  Go to Health Clinic Immediately if you have diarrhea  Wash your hands before cooking, before eating, and after using the toilet 4. Coordinate work with Cholera task force and the community

22.  Measles is a viral infection that is highly contagious.  It is spread by airborne droplets (circulating as a result of coughing and sneezing), close personal contact or direct contact with nasal or throat secretions of infected persons.  Whenever there are crowded emergency settings, large population displacements there is always high risk of a measles outbreak  Almost all non-immune children contract measles if exposed to the virus

23.  Vaccinate all children 6month – 15yrs by vaccination campaign  Provide Vitamin A supplementation to all children 6-59month  Establish vaccination of 9-month-old children to ensure the maintenance of the minimum 95% coverage.  For mobile or displaced populations, an ongoing system is established to ensure that at least 95% of newcomers aged between 6 months and 15 years receive vaccination

24. 3) Emergency Health Care

25. Access to health services is usually disrupted in the initial phase of emergencies due to several reasons including: a) the health service is for fee and the community can no more afford the price; b) travelling to the health facilities is impossible or dangerous ; road block, health clinic destroyed, insecurity c) health personnel have fled from the area; d) the health facility does not have adequate supplies to provide care for the population; e) there is language barrier/ or cultural barrier e.g. absence of a female health staff in a conservative Muslim community could lead to limited access to health care for females

26.  Basic health Unit (BHU)/Clinic: this could be setup in IDP or refugee camps, if non-camp situation supporting existing facilities would be preferred strategy. The minimum standard is 1 BHU for 10,000 people.  Mobile Clinic: mainly in situations where the population size is less than 10,000, the area is inaccessible; or if the area is insecure to have staff full time working in the location  Community Health: can be provided by community health workers, outreach workers, traditional birth attendants

27.  Supply chain system for drugs and medical materials need to be established. The interagency emergency health kit (IEHK) formerly known as the WHO health kit for 10,000 people for 3 months is handy be used to start up program.  Drug donations At times shortage of drugs at clinic level is due to lack of proper supply chain or drug management system, and not necessarily lack of drugs in country.  Medical staff recruitment all efforts should be taken to ensure recruitment of local staff, international staff are only needed to provide technical assistance. Ensure that there are female medical personnel in each clinic

28.  Service should be available to all people in the coverage area; IDPs, refugees, local population. Local tension and insecurity could arise if service is discriminately addressing the need of only refugees or IDPs  Health information system: data collection, analysis, dissemination is crucial for program quality improvement, prioritization, and resource allocation

29. Case Study

30.  Country Omega had heavy rains and flooding. An estimated 100, 000 people have been displaced from the main capital city Bravo.  Rapid assessment done by your agency reports that the sanitary conditions are extremely poor and access to safe water is low.  There is reported increase in number of children with diarrhea, the local authorities and World Health  Organization are concerned about the situation and have sent an assessment team

31. Q1. The first case of cholera (confirmed) was reported on the 9 th of Feb. what do you think are the priority activities to do: - Declare a cholera outbreak - Convene meeting with your team to discuss what the role of your agency would be - Concentrate on school education program you are doing

32. Cholera case confirmed

33.  Water chlorination  Setting up village level Acute watery diarrhea treatment centers, and oral rehydration points  Hygiene promotion  Latrine construction  Digging water-wells  Ordering diarrhea treatment kits  Mosquito net distribution  Coordinate with Acute Watery Diarrhea task force and the community

34. In this situation would you recommend cholera vaccination?