Public Health Effects of & Public Health Efforts made for the Pakistan Floods

1. Public Health Effects of & Public Health Efforts made for the Pakistan Floods Dr. Abdul Jamil (Health & Nutrition Specialist) UNICEF Peshawar March 8, 2012

2. Background • Pakistan Floods of August 2010 were unprecedented & devastating that affected 20 million people in 78 districts • Killed 1800 individuals, destroyed 2 million homes & 514 health facilities • Prior to this crises the country already had about 4 million IDPs & Refuges in KP. • Health indicators were dismal before the flood, MMR=203 [190-280] and U5MR 89. • Most of the flooded populations comprise the lowest socioeconomic quintiles that were already facing neglect. This crisis worsened their plight

3. Damages of Floods in KP

4. Effects of Natural Disasters [Historical] • During the past two decades, natural disasters have killed millions of people, adversely affecting the lives of at least one billion more people and resulting in substantial economic damage. • Developing countries are disproportionately affected because of their lack of resources, infrastructure & disaster preparedness systems. • The potential impact of communicable diseases is often presumed to be very high in the chaos that follows natural disasters. Increases in endemic diseases and the risk of outbreaks, however, are dependent upon many factors that needs to be systematically evaluated with a comprehensive risk assessment. This allows the prioritization of interventions to reduce the impact of communicable diseases post-disaster.

5. Public Health Effects of Floods [Risk Factors] • Large scale displacements/ movements resulting overcrowding in camps or host areas. • [burden on host infrastructure] • Inadequate shelter [Infrastructure damage] • Disruption of services • HR displacements (LHWs), Effects on moral of staff • Communication disruption leading to issues of supplies, referrals & monitoring • Contamination of water & disruption of sanitation & hygiene practices • Protection is cross cutting [Kidnapping, missing/lost children & women]

6. Public Health Effects of Floods [Risk Factors] • High exposure to and/or proliferation of vectors • Incidents [snake bites, skin diseases, ARI, diarrhea] • Insufficient nutrient intake [food availability & quality] • disruption of family and cooking services [issues in BF, CF, BMS] • Insufficient vaccination coverage • Lack of and/or delay in treatment • These effects are intense in absence of contingency plans, trained/skilled HR, prepositioned supplies

7. Different Risk Factors = Different Effects

8. Which Epidemic disease should we expect and when?

10. Insufficient Food intake

11. Undernutrition and Child Mortality Malnutrition54% • Nearly 9 million children under five died in 2009, more than 2/3 of them during the first year of life, Millions more survived only to face diminished lives unable to develop to their full potential • Five diseases-pneumonia, diarrhoea, malaria, measles and AIDS – together account for half of all deaths of children under 5 years old. Undernutrition is a contributing cause of more than one third of these deaths. • The single largest common denominator in global child deaths is malnutrition • Severe wasting is an important cause of these deaths • Proportion associated with acute malnutrition often grows dramatically in emergency contexts

12. Different risk factors = different effects • From the previous slide we can immediately see that: • Malnutrition is a critical modulator of all infectious disease dynamics • Living in overcrowded camps affects the risk of the two most important routes of transmission [air-droplet, faecal-oral] • Lack of treatment can undo gains in prevention • Worst scenario = gradually declining vaccination coverage + sudden mass displacement into camps + nutritional crisis + no health services • i.e. the first 3-4 weeks of many emergencies!

13. Priority measure to reduce the impact of communicable diseases • Ensuring Safe water and sanitation • Site planning and provision of adequate shelter • Provision of adequate food • Primary healthcare services and nutrition • Establishment of surveillance/early warning system to ensure rapid control • Immunization [Especially Mass measles vaccination] • Prevention of Malaria and Dengue

14. Public Health Efforts made------ • Immediate Relief Work mainly carried out by Govt., Army, UN Agencies, bilateral donors, I/NGOs. In addition civil society, volunteers & independent teams provided support. It included: • Evacuation, IRA/McRAM • Shelter Arrangements • Camps, communities, institutions • Cooked, Ready to use Foods, Water supply, Sanitation • Health [Immunization, PHC, MCH]------Mobile & Static • Nutrition [Supp. & Therapeutic Foods, Monitoring BMS, Estab of BF corners, Hygiene promotion] • Cluster Formation/Revivals • Health, Nutrition, Shelter, WASH, Education, Protection, Agriculture

15. --------Public Health Efforts made • Capacity Building of humanitarian community and Govt. • Resource Mobilization • Flash Appeals, Humanitarian Response Appeals • Information Management [3 Ws Matrix, Pooling of Resources, Avoiding Duplication] • Surveillance and assessments [DEWS, NIS, FANS] • Recovery-Reconstruction----[PDMA]. • The threat was converted into opportunities • What was gained, this turned to be an opportunity for CB, self assessment and better planning

16. Public Health Efforts made [KP] • Around 5,000 healthcare providers and field workers were trained in emergency health and nutrition interventions [Better and coordinated Response] • Around 4 million children 5-13 years were vaccinated against measles [No measles outbreak] • Routine Immunization services were strengthened; providing routine immunization services to around 0.5 million children • Millions+++ free consultations were provided to flood affectees for PHC services [No major outbreaks of diarrhea, ARI and other diseases] • Over one million women were provided maternal health [ANC/PNC] services and >5,000 safe deliveries conducted [decreased maternal deaths]

17. Public Health Efforts made [KP] • Around 2 million children and 1 million women were assessed for acute malnutrition. Malnutrition level between 10-20%. • > half a million acute malnourished children and mothers were treated through CMAM protocols • >2 million mothers/caretakers were reached with messages on appropriate health, nutrition and hygiene messages. • >1 million children dewormed, >1 million children and women were provided mm supplements. • [Cure rate>90%, death rate<1%, default rate<10%] • Millions+++ were provided safe drinking water and sanitation services • Millions+++ were provided food and non food [hygiene] packages

18. Conclusion • Infectious diseases do not exhibit unexpected properties in crises, but crises exacerbate existing or bring about new risk factors • Higher transmission rate, probability of progression to disease and/or CFR • Excess morbidity and mortality • Think of which processes a risk factor or intervention affect: • Transmission? • Progression to disease? • CFR? • Humanitarian relief in the health sector aims to reduce excess morbidity and mortality by reducing CFR

19. THANKS