1. 1 Health Response to Floods & Landslides Nepal 2007 World Health Organization Emergency & Humanitarian Action 27 July – 23 August 2007

2. 2 Flood Preparedness Floods and landslides are annually recurring challenges in Nepal Floods and landslides are annually recurring challenges in Nepal Flood preparedness takes place at various levels every pre- monsoon season Flood preparedness takes place at various levels every pre- monsoon season Frequent Emergency Health and Nutrition Working Group coordination meetings – resource mapping and ‘who does what where’ exercise completed Frequent Emergency Health and Nutrition Working Group coordination meetings – resource mapping and ‘who does what where’ exercise completed Rapid health assessment forms printed and agreed upon with EDCD and partners in health Rapid health assessment forms printed and agreed upon with EDCD and partners in health One outcome of the SIDA-funded CAP ‘Health Action in Crisis’ was a logistic supply chain (2 containers) and pre- positioned medicine (New Emergency Health Kits and Dirreahoal Kits) One outcome of the SIDA-funded CAP ‘Health Action in Crisis’ was a logistic supply chain (2 containers) and pre- positioned medicine (New Emergency Health Kits and Dirreahoal Kits) EDCD on high alert due to cholera response from 20 May to 10 July EDCD on high alert due to cholera response from 20 May to 10 July

3. 3 Flood & Landslide Profile Localised flooding and severe landslides from 10 July Localised flooding and severe landslides from 10 July Widespread flooding from 27 July onwards Widespread flooding from 27 July onwards Flood data: Flood data: Scale of emergency not catastrophic by national standards Scale of emergency not catastrophic by national standards High level of public awareness due to international media coverage and regional flooding in India and Bangladesh High level of public awareness due to international media coverage and regional flooding in India and Bangladesh Pressure from humanitarian agencies to engage / intervene Pressure from humanitarian agencies to engage / intervene Response capacity assessed to be available in country Response capacity assessed to be available in country NRCS 23 Aug MOHA 10 Sep Deaths148185 Injured94? Displaced families 24,11616,273 Affected families 79,20069,398

4. 4 Mortality and Injuries Mortality and injuries caused by floods and landslides year 2001-2007 Source: MOHA data with 2007-data from NRCS superimposed

5. 5 Displaced Families Displacement as key public health indicator – usually not recorded by MOHA Number of displaced families caused by floods and landslides year 2002-2007 Source: Last NRCS sitrep each year

6. 6 DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWALPARASI KAPILBASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHA NUSA MAHO- TTARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI B A G L U N G TANAHU PALPA SYANGJA PARBAT ARGHAK- HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PUR P A C H E T H A R DHAN- KUTA TAPLEJUNG R A M E C H H A P OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHM SULUKHUMBU DOLAKHA SANKHUWASABHA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUTHAN ROLPA SALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG KATHMANDU LALIT BHAK India China No. of displaced families (NRCS) 1 - 100 100 - 999 1000 - Flood & landslide affected district: 28 districts Public health monitoring based on NRCS, Epidemiology and Disease Control Division, WHO and media reports, 31.07.07 Evolution of Floods Week 1

7. 7 DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWALPARASI KAPILBASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHA NUSA MAHO- TTARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI B A G L U N G TANAHU PALPA SYANGJA PARBAT ARGHAK- HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PUR P A C H E T H A R DHAN- KUTA TAPLEJUNG R A M E C H H A P OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHM SULUKHUMBU DOLAKHA SANKHUWASABHA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUTHAN ROLPA SALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG KATHMANDU LALIT BHAK India China No. of displaced families (NRCS) 1 - 100 100 - 999 1000 - Flood & landslide affected district: 33 districts Public health monitoring based on NRCS, Epidemiology and Disease Control Division, WHO and media reports, 05.08.07 Evolution of Floods Week 2

8. 8 DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWALPARASI KAPILBASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHA NUSA MAHO- TTARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI B A G L U N G TANAHU PALPA SYANGJA PARBAT ARGHAK- HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PUR P A C H E T H A R DHAN- KUTA TAPLEJUNG R A M E C H H A P OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHM SULUKHUMBU DOLAKHA SANKHUWASABHA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUTHAN ROLPA SALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG KATHMANDU LALIT BHAK India China No. of displaced families (NRCS) 1 - 100 100 - 999 1000 - Flood & landslide affected district: 36 districts Public health monitoring based on NRCS, Epidemiology and Disease Control Division, WHO and media reports, 12.08.07 Evolution of Floods Week 3

9. 9 DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWALPARASI KAPILBASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHA NUSA MAHO- TTARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI B A G L U N G TANAHU PALPA SYANGJA PARBAT ARGHAK- HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PUR P A C H E T H A R DHAN- KUTA TAPLEJUNG R A M E C H H A P OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHM SULUKHUMBU DOLAKHA SANKHUWASABHA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUTHAN ROLPA SALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG KATHMANDU LALIT BHAK India China No. of displaced families (NRCS) 1 - 100 100 - 999 1000 - Flood & landslide affected district: 47 districts Public health monitoring based on NRCS, Epidemiology and Disease Control Division, WHO and media reports, 19.08.07 Evolution of Floods Week 4

10. 10 Immediate Priorities Immediate needs were shelter, food, water, sanitation and primary health care Immediate needs were shelter, food, water, sanitation and primary health care Relative few post-flood medical needs; health camps with no surprising findings Relative few post-flood medical needs; health camps with no surprising findings Public health key to successful response Public health key to successful response Provision of clean water Provision of clean water Availability of basic sanitation Availability of basic sanitation Health promotion focussing on prevention of diarrhoeal and vector-borne diseases Health promotion focussing on prevention of diarrhoeal and vector-borne diseases Strengthen public health monitoring based on multiple sources Strengthen public health monitoring based on multiple sources Strengthen disease surveillance and outbreak control Strengthen disease surveillance and outbreak control

11. 11 Health Impact Fear of epidemics was a main theme among affected population and responders from the beginning of the emergency Fear of epidemics was a main theme among affected population and responders from the beginning of the emergency No major or unexpected outbreaks have been reported from any of the flood-affected areas since 27 July No major or unexpected outbreaks have been reported from any of the flood-affected areas since 27 July Common illnesses reported: Common illnesses reported: - Fever - Respiratory infections - Diarrhoeal diseases - Skin diseases - Eye and ear infections Risk of vector-borne diseases due to wide-spread water-logging in inundated Terai districts Risk of vector-borne diseases due to wide-spread water-logging in inundated Terai districts

12. 12 DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWALPARASI KAPILBASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHA NUSA MAHO- TTARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI B A G L U N G TANAHU PALPA SYANGJA PARBAT ARGHAK- HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PUR P A C H E T H A R DHAN- KUTA TAPLEJUNG R A M E C H H A P OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHM SULUKHUMBU DOLAKHA SANKHUWASABHA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUTHAN ROLPA SALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG KATHMANDU LALIT BHAK India China No. of displaced families (NRCS) 1 - 100 100 - 999 1000 - Flood & landslide affected district: 47 districts Public health monitoring based on NRCS, Epidemiology and Disease Control Division, WHO and media reports, 19.08.07 Confirmed outbreak Unconfirmed outbreak Floods and Outbreaks

13. 13 Health Response EDCD / DHS immediately deployed three response teams to different parts of the country. These teams worked together with DHOs / DPHOs and RRTs in the affected districts to provide public health guidance and epidemiological support EDCD / DHS immediately deployed three response teams to different parts of the country. These teams worked together with DHOs / DPHOs and RRTs in the affected districts to provide public health guidance and epidemiological support Supply of essential medicines to 33 districts and 5 regional stores; including emergency supplies from WHO Supply of essential medicines to 33 districts and 5 regional stores; including emergency supplies from WHO Daily rumour verification and situation updates from DHOs / DPHOs; including weekly WHO sitreps Daily rumour verification and situation updates from DHOs / DPHOs; including weekly WHO sitreps EDCD opened a hotline for Rapid Response Teams to call and inform urgent health updates EDCD opened a hotline for Rapid Response Teams to call and inform urgent health updates An MOHP high-level committee established six health teams to coordinate field response and provide emergency medical care and public health guidance. These teams, headed by senior DHS officials, covered 17 districts An MOHP high-level committee established six health teams to coordinate field response and provide emergency medical care and public health guidance. These teams, headed by senior DHS officials, covered 17 districts

14. 14 WHO Response After 27 July, WHO mobilized the IPD SMOs in the field to conduct assessments, assist DHOs / DPHOs and provide public health guidance After 27 July, WHO mobilized the IPD SMOs in the field to conduct assessments, assist DHOs / DPHOs and provide public health guidance On 2 August, WHO called an Emergency Health and Nutrition Working Group meeting to discuss the flood situation in the country and facilitate coordination and operational planning On 2 August, WHO called an Emergency Health and Nutrition Working Group meeting to discuss the flood situation in the country and facilitate coordination and operational planning On 3 August, WHO delivered emergency medicine to five MOHP teams On 3 August, WHO delivered emergency medicine to five MOHP teams On 14 August, two additional diarrhoeal kits were pre- positioned in Banke district On 14 August, two additional diarrhoeal kits were pre- positioned in Banke district On 15 August, one diarrhoeal kit was airlifted to Kalikot district to contain the surge in diarrhoeal cases On 15 August, one diarrhoeal kit was airlifted to Kalikot district to contain the surge in diarrhoeal cases Weekly WHO sitreps including district-specific health data Weekly WHO sitreps including district-specific health data Disease surveillance is being strengthened in collaboration with EDCD and DHOs / DPHOs Disease surveillance is being strengthened in collaboration with EDCD and DHOs / DPHOs

15. 15 Provision of Medical Supplies

16. 16 Learning Experiences Past disaster statistics helped to identify the appropriate response level and not being ruled by subjective factors Past disaster statistics helped to identify the appropriate response level and not being ruled by subjective factors Pressure from international agencies and the ‘South Asia flood affect’ to substitute rather than support national response efforts was resisted Pressure from international agencies and the ‘South Asia flood affect’ to substitute rather than support national response efforts was resisted The magnitude of the emergency was appropriate for the country to test and enhance response mechanisms The magnitude of the emergency was appropriate for the country to test and enhance response mechanisms Emergency preparedness, pre-positioned medicine and close collaboration with EDCD played an important role for our flood and landslide response Emergency preparedness, pre-positioned medicine and close collaboration with EDCD played an important role for our flood and landslide response Recent WFP / UNICEF assessment of the flood response in 19 districts concluded that the health response was impressive and no major shortcomings were identified Recent WFP / UNICEF assessment of the flood response in 19 districts concluded that the health response was impressive and no major shortcomings were identified

17. 17 Recommendations Continue regular efforts to strengthen the disaster management section in EDCD Continue regular efforts to strengthen the disaster management section in EDCD Stronger efforts to coordinate with MOHP and align with health policies to systematically introduce response preparedness and risk management in health sector policies and practices Stronger efforts to coordinate with MOHP and align with health policies to systematically introduce response preparedness and risk management in health sector policies and practices Maintain the logistic pipeline introduced last year and re- stock international medical kits Maintain the logistic pipeline introduced last year and re- stock international medical kits Develop cost-effective local medical kits specifically designed to meet field needs in Nepal; invest in packaging and labelling Develop cost-effective local medical kits specifically designed to meet field needs in Nepal; invest in packaging and labelling Decentralize the health sector’s emergency preparedness further; pre-positioning at district level and focus on training and capacity building at peripheral levels Decentralize the health sector’s emergency preparedness further; pre-positioning at district level and focus on training and capacity building at peripheral levels

18. 18 Thank You