1. “Cyclone Aila and It’s Impact on Health Care System: A Case Study on Gabura Union, Shyamnagar Upazila, Satkhira” ‘Health Centred Disaster Risk Reduction: a New Agenda for a New Era’. Dealing with Disasters Conference September 2015 Presented by : Sheikh Mohammad Abdur Rahman Deputy Director Implementation Monitoring and Evaluation Division (IMED), Ministry of Planning, The People’s Republic of Bangladesh Slide-1

2. Brief introduction of my Job Place My job place is Implementation Monitoring and Evaluation Division, Ministry of Planning. I work there as Deputy Director. The major function of this division and as well as my responsibilities are as follows: Monitoring and Evaluation of the implementation of development projects included in the Annual Development Programme. Collection and compilation of project-wise data for preparing quarterly, annual and periodical progress reports for information of the President, Prime Minister, NEC, ECNEC, Ministries and other concerned. Rendering such advisory or consultancy services to Ministries/Agencies concerned on implementation of projects as and when necessary. Field inspection of projects for on the spot verification of implementation status and such other Co-ordination works as may be necessary for the removal of implementation problems, if any, with the assistance of related Ministries/Agencies. Submission of project inspection reports to the President, Prime Minister and Ministers concerned when attention at such levels are considered necessary. Slide-

3. Geographic Location of Bangladesh Bangladesh‘s geographical location and land characteristics make it one of the most climatically vulnerable countries in the world (World Bank, 2011). With a population of 157 million people (WPDS, 2013), at least 70% of the population live in regions at risk of floods and 26% in regions at risk of cyclones (Cash et al, 2013). Slide-

4. Some Historic Events of Cyclone in Bangladesh YearType of hazardProportion (%) of total region or population affected (n) Height of storm surge (m) Deaths (n) 1970Bhola Cyclone- 6-10225000-500000 1985Cyclone1.68 million3-4.611000 1991Cyclone Gorky4.56 million6-7.6138000 2007Cyclone Sidr18.3 million4.5-6.13300 2009Cyclone Aila3.9 million 2-3190 Source: Cash et al (2013) Slide-

5. About Cyclone Aila Slide- On 23 May 2009, the category 1 cyclone Aila, took shape and hit South- Western coastal region on 25 May 2009. The sustained wind speed of the Cyclone Aila was about 65-75 mph (74 mph is the lowest threshold for Cat-1 hurricane). Affected and estimated 3.90 million people in 11 coastal districts of the Bangladesh (ActionAid et al., 2009).

6. DistrictUpazila Worst Affected Unions Most Affected Family Most Affected People Dead and Missing Household Damaged SatkhiraShyamnagar Gabura 6,007 30,03424100% Padmapukur 4,432 22,16310100% Burigoalini 4,289 26,810580% Atulia 4,621 28,879 50% Assasuni Protapnagar 3,750 15,0001100% Sreeula 2,250 9,000 80% Khazra 2,000 8,000 70% Baradal 1,875 7,500 50% KhulnaDacope Kamarkhola 3,200 16,000490% Sutarkhali 8,000 40,000 100% Tildanga 8,000 24,000 80% Banisanta 2,800 14,000 60% Koira Uttar Betkashi 4,050 8,0001100% Dakhin Betkashi 5,000 15,00047100% Moharajpur 5,000 20,500 80% Koira Sadar 6,204 25,000550% Maheshwaripur 5,000 20,000 70% Total 76,478 329,886 Massive destruction at Satkhira and Khulna districts caused by Aila Slide-3

7. Map of Gabura surrounded by Kholpetua and Kopataska rivers specifying with four mouza, health clinic, drinking water source (PSF), roads, market, canals, settlements and others Slide-5

8. Extent of the impact of Cyclone Aila in Khulna and Sathkira districts Slide-2

9. Schematic Presentation on Different Facets of Impact Caused by Aila Slide-6

10. LevelType of facilityType of service Total No. of facilities Total beds UpazillaUpazila health complex (50-bed)Hospital26813400 Upazila health complex (31-bed)Hospital1454495 Upazila health complex (20-bed)Hospital120 Upazila health complex (10-bed)Hospital11110 Subtotal of Upazila health complexes42518025 31-bed hospitalHospital5135 30-bed hospitalHospital130 Subtotal of hospitals outside health complexes6165 Trauma center (20-bed)Hospital5100 Total of upazila-level hospitals43618290 Union20-bed hospitalHospital18360 10-bed hospitalHospital13130 Subtotal of union-level hospitals31490 Union subcenterOutpatient only1275- Union health and family welfare centerOutpatient only87- Subtotal of union outpatient centers1362- Total of union level facilities1393490 WardCommunity ClinicOutpatient only12527- Grand total of hospitals (upazila and below)467- Grand total of health facilities (upazila and below) 1435618780 Primary Health Care run by Directorate General of Health Services at the upazilla level and below Slide-8

11. Types of facility from national to the ward level, with managerial hierarchy Slide-9

12. Objectives of the study To make a clear comparison about health care system of Gabura union before and after Aila; to analyze the situation of the villagers of Gabura in times of disaster and the needs and problems that arose due to the disaster; to examine the weakness of the health care services provided by both GOs and NGOs agencies working for affected villagers of Gabura and To push forward some recommendations so that remedial as well as rehabilitative measures in terms of health and education could be initiated to redress the vulnerability of the affected people. Slide-10

13. Materials and Methods Slide-11 Study Design: The Schematic Presentation of Different Steps Followed Data Collection Data analysis, appraisal and assessment Study Output Collection of secondary data from different issues of the daily, monthly and quarterly newspapers, published and unpublished research reports, articles and various relevant web site. Supported by : Focus Group Discussion & Case Study Supported by : Focus Group Discussion & Case Study Collection of primary data through personal interview with the Aila affected inhabitants, traditional birth attendants, village doctors, community leaders, NGO officials, Shyamnagar upazila statistics and health officer.

14. A view of FGD session conducted in an indigenous way by the researcher with Aila affected male inhabitants in front of Maddho Khalishabunia mosque (situated at Maddho Khalishabunia village) Slide-13

15. Findings of the study. House of a permanent residenceJhupri of the migrants’ family living on the embankment Slide-17 Affected hand of the victims by the tiger Tiger victims with the researcher

16. Slide-21 Findings of the study In terms of magnitude diseases placed Gabura in the following ranks: Water-borne diseases- 1st Position (100%) Cardiovascular diseases- 2nd Position (68%) Kidney problem - 3rd Position (54%) High blood pressure/Hypertension- 4th Position (43%) Gynecological problem- 5th Position (36%) Eclampsia- 6th Position (32%) Researcher at village doctor (VD) chamber Researcher with Kabiraj Proshanto

17. Slide-25 Water sealed toilet of a permanent residence Non-sanitary toilet of a migrated residence

18. Slide-27 Homemade harvested rain water tank Piped water system PSF water system Homemade harvested rain water tank A harvested rain water tank seen to be functioning Water point of a Piped water system

19. Findings of the study In order to ensure remedy of the diseases the facts are as follows: The doctor is available only once a week only for a couple of hour. Bad road infrastructure due to Aila it is difficult on the part of the local people to rush for medical services provided by the four Community Clinics (CCs) specially at the rainy season. The villagers usually take basic health care services from 38 village doctors or paramedics of Gabura. Village Doctors have their own medicine shop with low quality medicines. Respondents are taking services from Untrained Traditional Birth Attendants and Kabirajs’ even knowing that they are not qualified enough to prescribe any scientific treatment. No health and nutrition related education or campaigning found in the study area. Slide-23

20. Front view of Friendship water purification system Partial image of Friendship water purification system PSF system installed by OXFAM seen to be non-functioning Front view of Friendship water purification system Partial image of Friendship water purification system A harvested rain water tank seen to be non-functioning Slide-29

21. Embankment are rebuilt for last five years within this way Damaged portion of the embankment which is still in risk Embankment and river are almost on the same height in this location Only pond that was full of pure water even after more than one year of Aila Slide-31

22. Signboard of some NGO’s which are exists only in the signboard Slide-33

23. Concluding Remarks This particular study was confined to a union only. The scope for the study was very much limited. The findings of this study should, at best, be considered as indicative rather than exhaustive. This micro study will pave the way to take many macro studies in this particular area. With this study and future research, a nation-wide programs of action could be commissioned aiming at complete rehabilitation of the people (suffering from natural disaster like Aila on regular interval specially health, nutrition and relevant education) living in coastal regions would be viable and sustainable. Slide-34

24. Researcher with ‘Sheikh Ameer Hossain’ who helps a lot to discover Aila affected Gabura union and assist to communicate all through the respondents Slide-35

25. Thanks for your patience hearing Do you have any query? Please………………. Contact: Sheikh Mohammad Abdur Rahman Deputy Director Implementation Monitoring and Evaluation Division (IMED), Ministry of Planning, The People’s Republic of Bangladesh Cell No. +8801819260139 E-mail: tinturet@gmail.com Slide-36