construction course, march 16 – 20, 2009 in walkringen 1 site and shelter planning in emergencies...
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Construction Course, March 16 – 20, 2009 in Walkringen
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Site and Shelter Planning in emergencies and refugee
situations
Health aspectsConstruction Course,
March 16-20, 2009
Dr. J.-P. STAMM SHA
Construction Course, March 16 – 20, 2009 in Walkringen
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Objectives of the lecture
Provide general background information and reference values on health indicators in emergencies
Describe the main public health threats encountered in complex emergencies Malaria and other vector borne diseases Epidemic diarrheal diseases Air borne diseases ( ARI, measles, meningitis) HIV
What aspect should site planners consider in term of mitigating the health impact of diseases?
Construction Course, March 16 – 20, 2009 in Walkringen
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SOME REFERENCE VALUES IN HEALTH EMERGENCIES
USUAL AGE BREAKDOWN OF THE AFFECTED POPULATION
0-4 years 12,4% 5-9 years 11,7% 10-14 years 10.5% 15-19 years 9,5% 20-50 years 48,6% pregnant 2,4%
Source: WHO Health action in crisis
Construction Course, March 16 – 20, 2009 in Walkringen
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REFERENCE VALUES/ CRUDE MORTALITY RATE
1/10'000 / DAY = ACUTE EMERGENCY
2/10'000/DAY = CRITICAL
Under 5 CMR: 2/10'000/day = EMERGENCY
Under 5 CMR: 4/10'000/day= CRITICAL
Construction Course, March 16 – 20, 2009 in Walkringen
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ASSESSING THE MORTALITY IN DISPLACED POPULATION
BURRIAL SITE SURVEILLANCE
HEALTH POST RECORDS
COMMUNITY BASED REPORTING
POPULATION SURVEYS
Construction Course, March 16 – 20, 2009 in Walkringen
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GAPS IN REPORTING
WOMEN'S HEALTH: LACK OF DATAS
ORPHANS, UNACCOMPANIED CHILDREN
GENDER BASED REPORTING IS MISSING
DEATHS DUE TO DISRUPTION OF CHRONIC DISEASES TREATMENT ( TBC, AIDS, DIABETUS)
Construction Course, March 16 – 20, 2009 in Walkringen
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REFERENCE VALUES/ NUTRITION STATUS
SERIOUS MALNUTRITION: 10-14% BELOW MEDIAN OR -2 ZSCORE
CRITICAL SITUATION: > 15% OF GLOBAL MALNUTRITION
GROWTH FALTERING RATE IN UNDER 5: 30% OF MONITORED CHILDREN
LOW WEIGHT AT BIRTH ( > 2,5 KG) : % OF LIVE BIRTH
BASIC REQUIREMENTS: 2,100 KCAL/ person 10-12% of total energy by protein
Construction Course, March 16 – 20, 2009 in Walkringen
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REFERENCE VALUE/ HEALTH INFORMATION
EPI VACCINATION COVERAGE RATE
ENDEMIC/EPIDEMIC DISEASES
VECTORS
HIV PREVALENCE
Construction Course, March 16 – 20, 2009 in Walkringen
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REFERENCE VALUES
WATER : QUALITY, QUANTITIY, ACCESS , STORAGE
EXCRETAL DISPOSALS
SOAP AVAILABILITY: 250 gr/ person / month
FUEL FOR COOKING
Construction Course, March 16 – 20, 2009 in Walkringen
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THE 3 MAJOR KILLERS IN COMPLEX EMERGENCIES
ACUTE RESPIRATORY INFECTIONS: ATTACK RATE: > 10 % IN COLD MONTHS
ACUTE DIARRHEAL DISEASES: CHOLERA, SHIGELLOSES, TYPHOID FEVER > 50% / MONTH
MALARIA IN NON IMMUNE POPULATION: > 50% PER MONTH
Construction Course, March 16 – 20, 2009 in Walkringen
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Objectives of the lecture
Provide general background information and reference values on health indicators in emergencies
Describe the main public health threats encountered in complex emergencies Malaria and other vector borne diseases Epidemic diarrheal diseases Air borne diseases ( ARI, measles, meningitis) HIV
What aspect should site planners consider in term of mitigating the health impact of diseases?
Construction Course, March 16 – 20, 2009 in Walkringen
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MALARIA IN COMPLEX EMERGENCIES
30% OF GLOBAL MALARIA MORTALITY OCCURS IN COUNTRIES AFFECTED BY COMPEX EMERGENCIES
INCREASED MALARIA BURDEN DUE TO: Population movements and displacement: immunity Malnutrition and concurrent infections: vulnerability Environemental deterioration: vector breeding Poor or absent housing: exposure Ongoing conflict: access Collapse of health and prevention services (chronic diseases) Poor co-ordination among health agencies
Construction Course, March 16 – 20, 2009 in Walkringen
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MALARIA
VECTOR: ANOPHELES
PARASITES: PLASMODIUM SPECIES
Plasmodium Falciparum
Plasmodium Vivax Plasmodium Ovale Plasmodium Malariae
Construction Course, March 16 – 20, 2009 in Walkringen
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REDUCING THE BURDEN OF MALARIA
Rapid and correct diagnosis
Correct treatment
Chemoprophylaxis
Individual protection against vector
Environmental vector control measures
Construction Course, March 16 – 20, 2009 in Walkringen
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MALARIA: INDIVUDUAL PROTECTION
TREATED BEDNETS
Need > 60% coverage to be considered as a community
control measure
PERMETHRIN TREATED CLOTHING AND BEDDING
COILS, CURTAINS, MATS
Construction Course, March 16 – 20, 2009 in Walkringen
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MALARIA VECTOR CONTROL
INDOOR RESIDUAL SPRAYING
EFFECTIVE COMMUNITY TOOL IF > 85% OF
DWELLINGS ARE TREATED BUT:
HIGHLY DEPENDANT ON OPERATIONAL
FACTORS, PLANNING, STAFF...
Construction Course, March 16 – 20, 2009 in Walkringen
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MALARIA VECTOR CONTROL : NEW TOOLS
INSECTICIDE TREATED PLASTIC SHEETING
INSECTICIDES BLANKETS, PILLOWS
Construction Course, March 16 – 20, 2009 in Walkringen
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MALARIA: WHAT THE SITE PLANNERS SHOULD KNOW
DO NOT SELECT A SITE CLOSE TO A STAGNANT WATER SOURCE: RIVER, PONDS, LAKE
OTHER VECTOR NEED SMALLER WATER SOURCES FOR REPRODUCTION: AEDES VECTOR OF DENGUE FEVER Old tires, tins, garbages
Importance of proper waste disposal
Construction Course, March 16 – 20, 2009 in Walkringen
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EPIDEMIC DIARRHEAL DISEASES
CHOLERA
TYPHOID FEVER
SHIGELLOSIS
OTHERS ( HEPATITIS, INTESTINAL PARASITES)
Construction Course, March 16 – 20, 2009 in Walkringen
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THE IMPORTANCE OF WATER AND DISEASE TRANSMISSION
DIARRHEAL DISEASES
DERMATOLOGICAL DISEASES (PEDICULOSIS, SCABIES)
EYES DISEASES: CONJONCTIVITIS, TRACHOMA)
TYPHUS ( LOUSE TRANSMISSION)
Construction Course, March 16 – 20, 2009 in Walkringen
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Living conditions• Over-crowding• Sanitation• Water supply• Unsafe food
External Conditions• Gatherings• Crowded places • Forced migration• Environment
Climatic conditions• Seasonal rains• Floods• Dry season
DiarrhoealOutbreak
Many different factors can lead to an outbreak
Culture• Behaviour (e.g. funerals)• Poverty
Construction Course, March 16 – 20, 2009 in Walkringen
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BEFORE THE OUTBREAK
PREPAREDNESS:
EMERGENCIES STOCKS LABORATORY TRAINING COMMUNITY AWARENESS
CHOLERA TREATMENT CENTER CHLORINE BIOLOGICAL AND HOSPITAL WASTE DISPOSAL
Construction Course, March 16 – 20, 2009 in Walkringen
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CHOLERA TREATMENT CENTERS
Plan for a cholera treatment center if cholera is endemic or ingredients are present
3 major concepts: ISOLATION / SUPPLIES HYGIENE
4 different areas
Construction Course, March 16 – 20, 2009 in Walkringen
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TREATMENT CENTERS
NUMBER OF BEDS ACCORDING TO ESTIMATED ATTACK RATE
FULL BOARD INCLUDED !
200 BEDS = 150 PERSONAL !
Construction Course, March 16 – 20, 2009 in Walkringen
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DISINFECTION / CHLORINE
0,05% FOR SKIN, CLOTHES, HANDS
0,2% FOR BEDS, SURFACES, INSTRUMENTS
2% FOR EXCRETAS, VOMITING, DEAD BODIES
DRINKING WATER: SOL 1%: 3 DROPS
Construction Course, March 16 – 20, 2009 in Walkringen
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DISINFECTION
FLEES CONTROL
PEOPLE COMING IN AND OUT
SURFACES
Construction Course, March 16 – 20, 2009 in Walkringen
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BIOLOGICAL WASTE
INCINERATE
DIG A PIT
SUN DISINFECTION
CHLORINE DISINFECTION
Construction Course, March 16 – 20, 2009 in Walkringen
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EFFECTIVE CONTROL MEASURES
WATER
FOOD HYGIENE
SANITATION (1 LATRINE/ 25)
SOAP DISTRIBUTION
COMMUNITY AWARENESS
Construction Course, March 16 – 20, 2009 in Walkringen
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AIR BORNE DISEASES
Acute respiratory infections
Measles
Meningitis
Construction Course, March 16 – 20, 2009 in Walkringen
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Epidemic meningococcal disease in Africa
700 000 cases in the past 10 years
10-50 % lethality 10-20 % of survivors suffer
permanent brain damage
Construction Course, March 16 – 20, 2009 in Walkringen
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Meningococcal meningitis
• Bacterial infection affecting the brain and the spinal cord
• Neisseria meningitidis
• serogroups: A, B, C, W135, X, Y, Z, 29E..
Construction Course, March 16 – 20, 2009 in Walkringen
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MEASLES
COMMON HEALTH HAZARD IN EMERGENCIES
COMPLICATIONS
HIGH LETALITY
VACCINATION
Construction Course, March 16 – 20, 2009 in Walkringen
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HIV /AIDS IN COMPLEX EMERGENCIES
OVER 40 MIO SEROPOSITIVE IN THE WORLD
PREVALENCE IN SOME SOUTHERN AFRICAN COUNTRIES OVER 25%
RISK FACTORS RAPES COMMERCIAL SEX SEX FOR FOOD OR WORK UNSAFE BLOOD TRANSFUSION AND INJECTIONS
Construction Course, March 16 – 20, 2009 in Walkringen
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HIV/AIDS IN EMERGENCIES
SIDE EFFECTS OF EMERGENCIES:
BREAKDOWN OF SERVICES: SHORTAGE OF ARV MEDIC SHORTAGE OF LAB REAGENS: INCREASED TRANSMISSION LACK OF COMPETENT HEALTH WORKERS
INCREASED TRANSMISSION
DEVELOPMENT OF RESISTANCE
Construction Course, March 16 – 20, 2009 in Walkringen
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MINIMAL INTERVENTIONS FOR HIV PREVENTION IN EMERGENCIES ( UNHCR, WHO, UNAIDS)
PROTECTION SEXUAL VIOLENCE/ WOMEN/ ORPHANS PROVIDE CONDOM ACCESS TO MILITARY FORCES, PEACE
KEEPING AND HUMANITARIAN WORKERS
FOOD SECURITY ADEQUATE/SUPPLEMENTARY FEEDING TO HIV AFFECTED
COMMUNITIES/FAMILIES/ ORPHANS
SITE PLANNING
ADEQUATE AND SAFE SHELTER HEALTH
SAFE BLOOD SUPPLY + UNEVERSAL PRECAUTIONS SYNDROMIC TREAMENT OF STD
Construction Course, March 16 – 20, 2009 in Walkringen
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HIV MINIMAL INTERVENTIONS
• FREE DISTRIBUTION OF CONDOMS AND HEALTH EDUCATION ( PEER TO PEER)
• RISK REDUCTION ACTIVITIES AMONG DRUG USERS IN THE CAMPS
• VOLONTARY TESTING
• REPRODUCTIVE HEALTH COUNSELLING AND PRACTICE
• PMTCT
EDUCATION/ HEALTH INFORMATION
MAINSTREAMING HIV/ AIDS AT THE WORK PLACE
Construction Course, March 16 – 20, 2009 in Walkringen
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SOME OTHER TIPS
DEAD BODIES
HAZARDOUS HEALTH WASTES
ZOONOSIS ( INTERACTION MAN / LIVESTOCK)
Construction Course, March 16 – 20, 2009 in Walkringen
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DEAD BODIES
MYTH: DEAD BODIES ARE A CAUSE OF EPIDEMICS
Construction Course, March 16 – 20, 2009 in Walkringen
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DEAD BODIES/ WHAT TO DO, WHAT NOT TO DO
INFORM PUBLIC AND MEDIAS OF LOW RISK OF EPIDEMICS ORGANISE IDENTIFICATION AND TAGGING OF CADAVERS
AND DEATH CERTIFICATES DELIVER BODIES TO FAMILIES RESPECTING THEIR WISH
AND LOCAL CUSTOMS
BURIAL IS USUALLY THE SIMPLEST AND RITUALLY ACCEPTED METHOD
NO MASS GRAVES, MASS CREMATION
Construction Course, March 16 – 20, 2009 in Walkringen
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WHERE TO BURRY DEAD BODIES ?
1,5 METER DEPTH
IN PERIPHERY OF THE CAMP ( APPROX 800 M)
AWAY FROM WATER SOURCES, AND ON A SURELEVATED PLACE
PROVIDE TOOLS AND SHROUD
BEWARE GRAVES ARE NOT SCATTERED IN THE CAMP
Construction Course, March 16 – 20, 2009 in Walkringen
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HAZARDOUS HEALTH WASTES
SHARPS ( NEEDLES, CUTTERS, SURGICAL, IV DRIPS)
BODY FLUIDS OF HIGHLY CONTAGIOUS DISEASES
Construction Course, March 16 – 20, 2009 in Walkringen
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INJECTION OVERUSE
A CULTURAL PATTERN
THE VICIOUS CIRCLE PERCEPTION
SOME INCENTIVES
A REAL RISK OF HBV HCV TRANSMISSION
Construction Course, March 16 – 20, 2009 in Walkringen
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INCINERATION
THE MOST APPROPRIATE
THE HIGHEST THE TEMPERATURE THE BEST
ENVIRONMENAL ISSUES
Construction Course, March 16 – 20, 2009 in Walkringen
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LIVESTOCK
WHAT PROXIMITY TO THE CAMPS / TENTS
INCREASES MALARIA TRASMISSION IN SOUTH EAST ASIA
Construction Course, March 16 – 20, 2009 in Walkringen
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ZOONOSIS
WILD ANIMALS, DOGS, CATS : OFTEN A RESERVOIR OF DISEAES AND A THREAT OF DISEASE TRANSMISSION
RABIES RICKETTSIOSE PLAGUE HEMMORAGIC FEVERS ETC
Construction Course, March 16 – 20, 2009 in Walkringen
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TAKE HOME MESSAGES
MALARIA, ACUTE RESPIRATORY INFECTIONS, DIARRHEA ACCOUNT FOR MORE THAN 80 OF UNDER 5 DEATHS IN IN EMERGENCIES
ASSESS THE VULNERABILITY OF THE DISPLACED POPULATION IN TERM OF HEALTH
ASSESS THE PUBLIC HEALTH THREATS PRESENT AT THE SITE OF THE PLANNED CAMP AND PLAN THE SITE ACCORDINGLY
Construction Course, March 16 – 20, 2009 in Walkringen
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TAKE HOME MESSAGES
DESIGN ENOUGH SPACE NEAR HEALTH POSTS TO BUILD EMERGENCY TREATMENT CENTERS OR ISOLATION WARDS IN CASE OF EPIDEMICS
CROWDING IS A MAJOR RISK FACTOR FOR AIR TRANSMITTED DISEASES, FOR SKIN DISEASES
MAINSTREAM HIV/AIDS PREVENTION AND AWARENESS AT ANY STEP OF YOUR ACTIVITIES
Construction Course, March 16 – 20, 2009 in Walkringen
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TAKE HOME MESSAGES
ENVIRONMENTAL ASPECTS LIKE WATER, SANITATION, VECTOR CONTROL WILL BE CRUCIAL ELEMENTS FOR THE HEALTH OF THE DISPLACED POPULATION
ORGANIZE A SAFE AND EFFECTIVE HOSPITAL AND GENERAL WASTE COLLECTION AND DISPOSAL SYSTEM
VECTOR CONTROL, AND PERSONAL PROTECTION CAN REDUCE BY 2/3 THE LETALITY OF MALARIA
A SHORT DISTANCE TO A MAJOR REFERENCE HEALTH STRUCTURE MAY REDUCE THE MORTALITY OF SEVERE HEALTH CONDITIONS