1

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN

ISSUE # 1 NOVEMBER 20, 2013

HIGHGLIGHTS

As of 19 November 2013, the National Disaster Risk Reduction and Manage-ment Council (NDRRMC) reported 3 982 deaths, 18 266 injured, and 1 602 missing. A total of 10 047 652 have been af-fected including 3 997 129 displaced. Of the displaced, 418 988 are currently living in 1 595 evacuation cen-tres.

Immediate health priorities

include trauma care for the wounded including preven-tion for tetanus; provision of essential medicines and supplies; re-establishment of essential primary and secondary care, including for medical, surgical and obstetric emergencies; management of dead bod-ies; measles and polio vac-cinations in the affected ar-

eas; and re-establishment of early warning disease surveillance for rapid detec-tion and response to poten-tial outbreaks.

As of 8 am 19 November

2013, there are 22 Foreign Medical Teams deployed to the affected areas, com-posed of 546 medical staff. Sixteen of the field hospitals established are type 1 (basic) while five are type 2 (advanced). Ten additional foreign medical teams com-posed of 213 staff are cur-rently being deployed. In addition, 45 local medical teams composed of 504 staff are deployed by the DOH.

A national level health clus-

ter mechanism has been established in Manila and three sub-national health

cluster coordination mecha-nisms in Tacloban City, Ce-bu and Roxas. Daily Health Cluster meetings are being held to coordinate response actions through establish-ment of common priorities and goals, identification of needs and gaps.

Photo

: W

HO

/Fra

ncis

co G

uerr

ero

Inside this bulletin:

Affected population and areas

Context

Main public health concerns

Morbidity data

Health cluster priorities

Health needs, gaps and con-straints

Health cluster action

Funding status of action plan

Health cluster meeting partici-pants

2

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

AFFECTED POPULATION AND AREAS

Forty-four provinces out of a total of 81 have been affected in regions IV-A, IV-B, V, VI, VII, VIII, X, XI, and Caraga (map). As the typhoon moved from east to west, the eastern re-gions were the hardest hit. Alt-hough assessments are still on-going, it is estimated that Re-gions VI, VII and VIII were the most affected, currently ac-counting for 90% of the total affected population (table 1). As of 19 November 2013, the National Disaster Risk Reduc-tion Management Council (NDRRMC) reported 3 982 deaths,18 266 injured, and 1 602 missing. A total of 10 047 652 have been affected with 3 997 129 displaced. Of the dis-placed, 418 988 are currently living in 1 595 evacuation cen-tres.

Table 1 AFFECTED POPULATION

(NDRRMC, 19 November 2013) Number % of total popula-

tion of the area* Total affected 10 047 652 21.2

Region IV A 27 076 0.2 Region IV B 401 207 14.6 Region V 696 581 25.1 Region VI 2 766 816 39.0 Region VII 2 603 700 38.3 Region VIII 3 482 442 84.9 Region X 19 592 0.5 Region XI 5 175 0.1 Caraga 45 063 1.9

IDPs 3 97 129 9.2

Region IV A 888 0.01 Region IV B 2 795 0.1 Region V - - Region VI 2 156 041 30.4 Region VII 508 557 7.5 Region VIII 1 328 657 32.4 Region X 185 - Region XI - -

Caraga 6 - Humanitarian Case Load ac-cording to Flash Appeal

12 900 000

* 2010 Census, Philippines National Statistics Coordination Board

3

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

CONTEXT

Current event Haiyan, a category 5 typhoon, locally named Yolanda, made landfall on 8 November 2013 at 0440 am in the Guiuan mu-nicipality, Eastern Samar province, moving steadily north into the province of Northern Cebu, with maximum winds of 235 km/hr and se-vere gusts of 275 km/hr. The typhoon made subsequent landfalls in Tolosa municipality south of Tacloban City, Leyte province, Daanbantayan and Bantayan Island, Cebu prov-ince, and Conception, Iloilo province. The typhoon also affected the city of Roxas in Capiz province and the tour-ism centre of Borocay in Aklan province. Subsequent storm surges caused widespread flooding in coastal areas.

Background information Due to its location in the Pacif-ic Ring of Fire, The Philip-pines is especially prone to natural disasters. According to the latest World Risk Index report, Philippines ranks third out of 173 coun-tries for disaster risk, based on susceptibility, coping ca-pacities and adaptive capaci-ties. The country experiences an average of 20 typhoons annu-ally during the rainy season. Flooding and landslides are also common. In 2013 alone, the Philippines had already experienced three major cri-ses prior to Typhoon Hayian resulting in humanitarian needs. In August 2013, mon-soon rains aggravated by Tropical Storm Trami caused flooding and landslides in 11 provinces including Metro Ma-

nila and Luzon Islands. This was followed by a 7.2 magni-tude earthquake in Bohol state in the south of the coun-try resulting in 223 deaths and affecting 3.2 million people. Additional humanitarian needs exist in Mindanao where an internal conflict has been on-going for over 40 years as the minority Muslim group, known as the Moros, fight for self-determination. More than 150 000 persons have died from the conflict since 2000 and it has displaced nearly 3 million people. In September 2013, a new wave of violence be-tween the Moro Islamic Liber-ation Front rebels and the Fili-pino armed forces in Zambo-anga City affected 170 000 people, of whom 75690 peo-ple still remain displaced.

MAIN PUBLIC HEALTH CONCERNS

In view of the public health profile of the Philippines as well as the risks associated with typhoons and flooding, the main public health concerns are as follows:

Injuries as a direct result of the storm, or associated with post-event flooding

Lack of food, water, sanitation and hygiene facilities, and related food and water-borne illnesses

Reproductive health especially for pregnant women Respiratory infections associated with overcrowding, es-

pecially acute respiratory infections in children Measles, and potentially polio due to importation Malnutrition, especially among infants and young children Mental health and psychosocial problems Leptospirosis from direct exposure to rodent excreta or

contaminated water Vector-borne diseases, especially dengue and chikungu-

nya Sexually transmitted diseases

MORBIDITY DATA

The disease surveillance system in the affected areas has been disrupted by the typhoon as many of the reporting sites have been destroyed. As a conse-quence the morbidity data re-mains sparse. Some facilities in 5 areas including Tacloban and Ormoc cities in Region VIII and Aklon, Antique, Capiz, and Iloilo in Region V have provided some reports of the main reasons for consultation. The main health concern reported to date is trau-ma including wounds and bruis-es. Cases of respiratory tract in-fection, fever, acute gastro-enteritis, skin disease and hyper-tension have also been reported.

4

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

HEALTH CLUSTER PRIORITIES

The immediate priorities for the cluster currently remain the management of the direct ef-fects of the disaster including trauma care for the wounded, essential primary and second-ary care, including for medical, surgical and obstetric emergen-cies and management of dead bodies. Prevention and detection of out-breaks such as measles and diarrhoeal disease is also a pri-ority especially in view of the disrupted surveillance system and difficult living conditions, compounded by the lack of safe drinking water and sanitation which needs to be addressed urgently. As the emergency moves into the next phase, the needs will change from acute trauma-related issues to those needing primary health care including mental health and psychosocial support, and treatment of chronic conditions such as hy-pertension and diabetes. Reha-

bilitation and re-surgery needs will arise, as well as a more ro-bust surgical capacity that can provide emergency obstetric care (e.g. caesarian sections). In addition, the increased bur-den on the health care services in the host communities follow-ing mass internal migration will also need to be addressed.

Immediate priorities Trauma care for the wound-

ed including prevention for tetanus

Provision of medicines and medical supplies

Establishment of emergen-cy primary and secondary care for medical, surgical and obstetric emergencies

Risk communication to the public

Management of dead bod-ies including identification of victims

Measles polio vaccinations in the affected areas

Establishment of an early warning system for early detection and response to outbreaks

Infection control in healthcare units including safe blood transfusion and medical waste manage-ment, as well as sufficient water supply and sanitation

Management of acute mal-nutrition including cases with medical complications

Continuity of treatment for chronic diseases and chron-ic infections such as tuber-culosis

Short term priorities Re-establishment of essen-

tial health care services (primary, secondary and tertiary care including refer-ral)

Mental health and psycho-social support

Waste management includ-ing medical waste

HEALTH NEEDS, GAPS AND CONSTRAINTS

Functionality of health facilities Due to difficulties in accessing some of the affected areas, da-ta on the functionality of health services in the affected area remains largely incomplete. The Department of Health (DoH) has provided preliminary infor-mation on some of the health facilities in 9 provinces in re-gions IVB, VI, VII and VIII. To date, information on the func-tionality of 41% of the hospitals in the affected area have been received and from 47% of rural health units (RHU). Only 27% of the barangays health services (BHS) in the affected area have provided information. Figures 1-2 show that infor-mation is still sparse in Cebu

and Leyte for hospitals and RHU compared to other prov-inces. Information for BHS is still lacking in many provinces with substantial data available only from IloIlo (figure 3). Note that facilities can still be func-tional even if damaged. In Tacloban, there is a need to set up primary and referral health care services in the are-as that to date have not been well covered by medical teams. Damage assessments show that hospitals in Ormoc, Baybay and Carigara need support. Currently there is insufficient laboratory capacity. In Cebu, the increasing number of inter-nally displaced persons is be-ginning to put a strain on the local health services. On 19 November alone 650 persons

moved to Cebu city with an ad-ditional 240 going to Lapu-Lapu city. In Capiz, preliminary assess-ments show RHUs in the prov-ince to be functional but the BHSs are mostly destroyed and non-functional. Very little information is availa-ble on health facilities in small islands affected by the typhoon. An estimated 235 245 pregnant and 156 830 lactating women will be in need of pre and post natal medical care (DSWD DROMIC Report of 6am, 16 November 2013) as well as child health, health promotion and family planning services. Type 2 field hospitals are espe-cially needed for ceasarian sec-tions.

5

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

Essential drugs, vaccines and supplies The DoH has identified basic

medical supplies as the main

priority including cold chain for

vaccines. Equipment such as

self-powered refrigerators,

freezers, ice packs and cold

boxes are also needed. Trans-

portation remains the biggest

challenge as access to the

affected areas remains lim-

ited.

Figure 1

Figure 2

6

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

HEALTH CLUSTER ACTION

Health Cluster coordination The Department of Health is the lead of the Health Cluster, with WHO as co-lead. In addition to the national Health Cluster in Manila, sub-national Health Cluster Coor-dination teams have been es-tablished for coordinating health response in the follow-ing areas:

Tacloban City in re-gion VIII

Cebu city in region VII Roxas City in region VI

Health cluster partners at each site are listed at the end of the bulletin. Daily Health Cluster meetings are being held to coordinate response actions through es-tablishment of common priori-ties and goals, identification of needs and gaps and avoiding duplication in geographical coverage of assessments and services.

At national level, 6 technical sub-working groups for repro-ductive health, mental health, vaccination and cold chain, health services planning, and communicable disease/surveillance, have been formed under the health clus-ter for more detailed discus-sions and targeted action. A packet of relevant global and national guidelines in spe-cific public health areas has been put together and distrib-uted to partners on the ground. The packet can also be accessed via the health cluster website. A Who is doing What Where and When (4Ws) is on-going to map and track health clus-ter activities in the affected area.

Needs assessment Needs assessments by health cluster partners are on-going but the process is hampered by impassable routes, insecu-rity and shortage of food, wa-ter and fuel. As of 18 November, several health cluster partners are present in the provinces of Cebu, Leyte (including Tacloban city and Ormoc city), Samar (specifically eastern and northern Samar), Capiz, Iloilo and Palawan, conducting rapid assessments to identify immediate needs, and some are providing medical ser-vices. Further in depth assessments of health facilities is planned as more of the affected areas become accessible to assess long-term needs.

Figure 3

7

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

The DoH has planned in-depth assessments of health facilities in the 66 most affect-ed municipalities of region VIII. Assessments in 11 mu-nicipalities in Leyte and Samar have been conducted and re-sults are currently being ana-lysed. A Multi-Cluster Initial Rapid Assessment, coordinated by OCHA, is due to take place this week. Response Health services As of 19 November 2013 (NDRRMC), a total of 45 local medical teams from CHDs X, CARAGA, VII, V, IV-B, Bicol Medical Center, Vicente Sotto Medical Center and Metro Ma-nila Hospitals were deployed to the affected areas.

As of 19 November 2013, there are 22 Foreign Medical Teams (FMTs) in the affected areas, composed of 546 medi-cal staff (map). Sixteen of the field hospitals established are type 1 while five are type 2. MSF did not implement a type 3 field hospital after an as-sessment showing no need for it. A further 10 FMTs, composed of 213 staff are underway for deployment. All FMTs are required to be completely self-sufficient (food, water and fuel) for the duration of their stay as re-sources a limited. Provision of fuel remains the main chal-lenge. In Tacloban, a referral system is being put in place. The Health Cluster Coordination

team is requesting that East-ern Visayas Regional Medical Centre continues to be sup-ported and remain the key ref-erence hospital for the region. Airlifting of patients is ongoing especially for patients with Spinal injuries. In Cebu, FMTs and national medical teams are providing temporary medical services but additional resources are needed to provide health care for the migrant population in other cities. In Capiz, emergency health care teams have been estab-lished but surgical services remain limited due to electrical outages and lack of re-sources.

8

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

Essential drugs and supplies The Department of Health has established hubs for medical supplies and personnel in Tacloban, Cebu, and Catbalo-gan Cities, with Cebu as the main hub for medical supplies. A ‘One Stop Shop’ has been activated in Tacloban and Cebu ports to expedite and release donated relief items. Currently enough measles vaccines, vita-min A and vaccination supplies are available to start the planned measles vaccination campaign in region VIII. WHO in support of DOH is de-veloping a logistics tracking and monitoring mechanism to identi-fy available supplies and gaps. Vaccination and cold chain A campaign for mass vaccina-tion against measles (6-59 months) and polio (0-59 months) is planned to start this

week in Region VIII. Vitamin A will also be distributed. In Tacloban, measles vaccination and vitamin A distribution has already begun in some of the evacuation centres. Mid Upper Arm Circumference measure-ments were also taken to moni-tor for cases of malnutrition. Surveillance The Surveillance in Post Ex-treme Emergencies and Disas-ters (SPEED) system has been activated by the Department of Health but its implementation has been limited in several are-as due to interruption of com-munication systems as the sys-tem is primarily based on SMS reporting. The lack of capacity for implementing SPEED is also an issue as many of the trained health workers have been af-fected by the typhoon.

Mental health Department of Health has de-ployed a team of 55 people to provide psychosocial support in Tacoblan City. There is good expertise on mental health in country. Reproductive health Ten thousand dignity and hy-giene kits for pregnant and breastfeeding women are being moved to Tacloban City and Eastern Samar. RH kits, includ-ing equipment, supplies and medicines for temporary birth-ing facilities have been pro-cured and will be deployed for restoration of maternal and newborn care. Clean delivery kits have been procured for women unable to reach a birth-ing facility.

9

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

NEXT STEPS

Assessments, tracking and mapping will continue to:

Estimate amount of infrastructure damage and health service availability Better define affected populations and needs, including for pregnant and lactating women

and patients with chronic disease, evacuee locations and needs of displaced people Evaluate resources currently available and what will be required in the short to mid term Refine understanding of location and activities of health partners

FUNDING STATUS OF ACTION PLAN

As of 18 November 2013, the action plan is 27% funded for the health sector (table 2).

Table 2 FUNDING STATUS OF ACTION PLAN FOR HEALTH (US$) Project Appealing

Agency Amount Re-quired

Funding % covered

Saving Pregnant Women and Newborn lives and support to Super Typhoon Hai-yan affected provinces of Leyte, Capiz, Iloilo and Aklan

Save the Children

570 310 0 0%

Adolescent and Sexual Reproductive Health in Emergency Services and Support to typhoon Haiyan affected provinces of Leyte, Samar, Iloilo, Aklan and Capiz

Save the Children

1 926 000 0 0%

Ensuring Access to Reproductive Health Services for IDPS affected by Typhoon Haiyan

UNFPA 3 000 000 592 077 20%

Provision of emergency health services to Typhoon affected populations

WHO 15 000 000 5 051 663 34%

Emergency Health for Children and Fami-lies Affected by Super Typhoon Haiyan in the Philippines

Save the Children

1 070 000 206 612 19%

TOTAL 21 566 310 5 850 352 27%

Source: http://fts.unocha.org/reports/daily/ocha_R32_A1043___18_November_2013_(03_01).pdf

As of 18 November WHO received firm commitments from Australia, Norway and the UN Central Emergency Response Fund (CERF) for a total of US$5 million. Japan has also pledged support. Rapid deployment of staff and medical supplies in the first two weeks of the emergency has been made possible thanks to contributions made earlier in 2013 to enhance WHO’s surge capacity for acute emergencies from the governments of the Russian Federation, Sweden, the United States of America, and the European Commission Humanitarian Aid and Civil Protection (ECHO) .

10

TYPHOON YOLANDA HEALTH CLUSTER BULLETIN # 1 November 20, 2013

Health Cluster Meeting Participants

Health Cluster Contacts National- Manila: haiyanhccmanila@wpro.who.int Sub-national- Tacloban: haiyanhcctacloban@wpro.who.int; hcctacloban@gmail.com Sub-national- Cebu: haiyanhcccebu@wpro.who.int

Health Cluster Website:http://www.wpro.who.int/philippines/typhoon_haiyan/en/

Please send any information on potential disease outbreaks to: haiyanops@wpro.who.int

National- Manila: AECID, Americares, Australian Aid, CDN- DART, CFSI, ChildFund, DFID, DOH, FPOP, Handicap International, HuMa, IFRC, ILO, IRC, IOM, ISAR-Germany, JICA,MERLIN, MDM, MSF, National Bureau of Investigation , PHE, Philippines Red Cross, Project Hope, PU-AMI, SCI, UNFPA, UNICEF, USAid, US Forces, WHO, World Vision. Sub-national- Tacloban: AECID, ACF, AUs, Bomberos Unidos SP, DOH, HUMEDICA, JICA, KOICA, MSF/F, SC, RTR hospital, UNICEF, WHO. Sub-national- Cebu: AmeriCares, ASB Germany, Canadian Emer-gency Response Unit, Canadian Medical Assis-tance Teams, CFSI, ChildFund, DOH, Embassy of Israel, Eversly Child Sanitarium, GOAL, IFRC, International Medical Corps, JICA, MDM, Med Japan, Merlin, MSF, NYC Medics, PNA, Samaritan Purse, SC, SCI, Spanish Red Cross, Saint Anthony Mother and Child Hospital, Tali-say District Hospital, UNICEF; Vicente Sotto Memorial Medical Center, WHO.