Current State of Knowledge of Current State of Knowledge of Flood/Post-Flood Health Situation in Flood/Post-Flood Health Situation in

Bangladesh - 2004Bangladesh - 2004‘‘UN Flash Appeal’ for Health SectorUN Flash Appeal’ for Health Sector

WHO, UNFPA, UNICEFWHO, UNFPA, UNICEF

Flood Situation as on 3Flood Situation as on 3rdrd August’04 August’04

Affected Districts: 38

Death Toll : 726

Affected Population: 30m (24% of total Popln)

Temporary Shelters: 2,710

Flood 2004(12 July-12 Sep.)

Temporary TC: 35

Flooded area of Bangladesh in different yearSource: Bangladesh Water Development Board

2004

Historical Perspectives

Flood before liberation• Frequent (1954-1970)• Affected small areas• Relief and medical care:

Govt’s role less prominent

• Role of media: Less• Health staff: Less in

number and less competent

Flood after liberation• Less frequent (1974-2004); becoming frequent• Affecting wider areas• Relief and medical care: Govt. is main player and

using electronic media extensively• Role of media: Super-active• Role of public representatives: Very active• Large number of competent health staffPeople’s coping capacity; Rx of diarrhoea-known

FloodTrapFloodTrap

Flood Impact on Health & HygieneHome goes under water

Toilets become

unprotected

Human & animal

excreta, rubbish &

contaminated soil mix with

water

Open defecation increases

Tube wells and safe water

sources are submerged

Cooking becomes difficult

People suffer from food shortage

Movement becomes difficult

Rural Area

Bathing, washing

and playing in flood water cause

disease

Flood Impact on Health & Hygiene…

Water & food-borne diseasesDiarrhea, dysentery, cholera,

jaundice, typhoid, helminthiasis

Scarcity in food supply &monotony of uncooked food

• Malnutrition of vulnerable groups (children, pregnant and lactating mothers, elderly and sick persons)

• Lower immunity > More infections

Food contaminationDue to food preparation in:

• Dirty environment• Use of unsafe water• Purchase from open food shop• Sharing with sick people• By flies and vectors• Via careless utensil handlingFood contamination causes

food borne diseases

Flood-borne Morbidities

• Water & Food-borne diseases

• Respiratory infections

• Skin diseases• Eye infections• Drowning• Snake bites• Accidents• Malnutrition

Bathing, washing, playing,

and walking in flood water

• Gastrointestinal diseases

• Respiratory infections

• Skin diseases• Eye infections• Drowning

Disease reported during and post-flood state (July 12 – Sep 12, 2004)

Name of Disease Cases Deaths CFR (%)

Acute watery Diarrhea 2,71,630 120 0.04

Water Borne Diseases 77,911 0 0.00 Pneumonia/ ARI 28,283 167 0.59

Skin, Eye & Ear Infections 72,294 0 0.00

Drowning death 247 - -

Snake-bite deaths 75 - -

*Source: DGHS Control Room and NDSC, IEDCR

Flood Impact on Health Status, effect on Infrastructure and Logistical Supplies

Loss of logistics (2004)

Medicines & Supplies

MOHFWMOHFW

Physical damage(2004)

DGHS: ~Tk. 32 crore

No. of cases of different diseases in 2004 flood215,848

19,400

51,430

931 2,418

35,5147,976

Diarrhoea Pneumonia Dysentery Jaundice Dengue Skin diseases Eye diseases

Source: DGHS, MOHFW (as of Aug 30, 2004)

No. of deaths (Flood 2004; On 12 Sep 04)

Disease No.Diarrhoea 116Pneumonia 156Snake bite 85DrowningDrowning 244244Dysentery 0Jaundice 0Skin disease 0Eye disease 0Total 601

Flood 2004

Distribution of Diarrhoea Cases and Deaths by Date 12 July - 11 Sept, 2004

883

880 1002

889 1013 1218

1007 13

73 1980

1513 20

5936

98 4163

5272

6769

6789

6338

5910

7464

7445

8221

9617 98

2385

9766

6684

79 9013

8085 8110

7136

7046

5365

6282

5926 6145

5900

5304

4578

3794

4514 48

5047

2241

5041

5029

8929

9637

13 3906

3627

3433

3258

3052

2444 30

3629

2524

90 2984

2913

1695 20

21

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2

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7

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2000

4000

6000

8000

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12-J

ul14

-Jul

16-J

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-Jul

18-J

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-Jul

20-J

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-Jul

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24-J

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-Jul

26-J

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-Jul

28-J

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-Jul

30-J

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-Jul

1-Au

g2-

Aug

3-Au

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Aug

5-Au

g6-

Aug

7-Au

g8-

Aug

9-Au

g10

-Aug

11-A

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-Aug

13-A

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-Aug

15-A

ug16

-Aug

17-A

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-Aug

19-A

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-Aug

21-A

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-Aug

23-A

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-Aug

25-A

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-Aug

27-A

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-Aug

29-A

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-Aug

31-A

ug1-

Sep

2-Se

p3-

Sep

4-Se

p5-

Sep

6-Se

p7-

Sep

8-Se

p9-

Sep

10-S

ep11

-Sep

No. o

f Cas

es

0

1

2

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4

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Cases Death

Distribution of Diarrhoea Cases and Deaths by Districts from 12 July-11 September 04

10

3

02

0

4

11

0

6

34

10 0 0

1

14

6

32

0

6

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4

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7

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6

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5000

1000015000

20000

25000

Cases

0

5

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Death

s

Comparison of month-wise diarrhoea case load in 1998 and 2004

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Y1998 Y2004 (up to Aug 30, 2004)

Distribution of Pneumonia Cases and Deaths by Date [04Aug- 11 Sep, 04]

4

12

5

2

6 6

2

6

12

6

3

0

2

7

4

1

3

9

56

4

6

3

6

2

5

10

4 4

2

5

12

5 5

21

8

0

500

1000

1500

Case

s

0

5

10

15

Death

s

Indirect Flood Impact on ServicesEPI service loss

BCG: 41,544 dosesMeasles: 41,544 dosesDPT: 1,24,632 dosesOPV: 1,24,632 dosesHepatitis B (25 dist &

5 City Corps): 4,800 dosesTT: 2,18,064 dosesEPI out-reach sessions(not held): 10,384 Nos.

NNP service loss• Programme Upazila affected: 70• Community Nutrition Centre (CNC)

did not function: 3802• Nutrition gardens damaged: 88369• Nursery damaged: 985• 1-day old chick died: 62355• Chicken died: 51807

Family planning service loss• Mother & child care• Ante-natal, natal & post-natal care• Sterilization camps• Clinic based services (IUD,

Injection, Norplant)• Home visits

Postponement of health & FP training/workshop/seminars: Many

Postponement of examinations in medical institutions: all in this period

Flood 2004

Disease Rates of Illness in 1988 Flood (n=

46,470)

Rates of Illness in 1998 Flood (n=

15,797)

Diarrhoeal Disease 34.7% 40.1%

Respiratory Disease 17.4% 20.3%

Intestinal worms 10.1% 12.2%

Skin infection 05.8% 07.4%

Eye Infection 02.2% 05.6%

Ear Infection 01.8% 04.8%

Injuries with infection 05.1% 04.3%

Fever 06.5% 03.9%

Other diseases 16.4% 01.4%

TOTAL* Source: Case Study

100% 100%

Comparison of morbidity pattern of 1988 and 1998 Flood in Bangladesh

Donor & Private Initiatives

WHOUNICEFUNFPABMA medical teams

Flood 2004

UN Flash Appeal

1. Direct intervention: Government and NGOs agencies Technical support: UN agencies (WHO, UNICEF, UNFPA).

2. Procurement of logistics/other supply materials: UN agencies.

3. Maintain and strengthen regular liaise: DGHS, NGO partners (in receiving reports of outbreaks of impending CD and carry out interventional activities as per needs)

Strategies:

Health and Nutrition Group:   

Assistance Provided by WHO, UNFPA and UNICEF Assistance Provided by WHO, UNFPA and UNICEF   Health (WHO): 

       In-house Crises Management Team formed at NDSC, IEDCR: Assistance to the DGHS

Preparing SITREP…on flood/post flood health situation        WHO provided Computer/Printer/Fax machine to DGHS Control Room.        Div. Coordinators and Dist. surveillance medical officers (SMO) from WHO are

monitoring the situation, surveillance and providing technical supports to the Civil Surgeons and sending daily reports to FCMT.

             Procurement of Medicine and supplies to the following Offices: 

1. DGHS2. BMA3. Red Crescent Society4. DPHE5. Sylhet City Corporation

WPT, Bleaching Powder, Intravenous Cholera Saline, Antibiotics syrup and tablets,

Paracetamols, Antihistamines, Anti-snake venom. Until 12 Sep. the total contribution from WHO: US $ 218,000 from Regular Budget

UNFPA support to Flood - 2004

Medicine* -  Basic medicine required for pregnant, lactating and 0 - 5 children: The following are included in each kit:

   * Medicine  to cover 8,000 clients/patients in each district   * ORS - 10,000 /each district   * Cholera Saline - 200 each district

*WFP Biscuits*: In addition to above, WFP biscuits are also being distributed by these teams. The qty per districts are as follows:

Brahmanbaria: 540 ctns (4.0 mt)Hobiganj:: 540 ctns (4.0 mt)Narhsingdi/Kishroreganj: 400 ctns.  (3 .0 mt)Bogra  540 ctns. (4.0 mt)Dhaka: 500 ctns (3.75 mt)

*UNFPA Subkit 6*: Delivery Subkit -  30 kits arrived at the airport and are under custom clearance.  We are expecting another 70 kits from HQs.*UNFPA Subkit 12:* Transfusion - 10 kits arrived at the airport and are under custom clearance.

UNICEF’s support to Flood – 2004

Procured WPT ( 5 million distributed, 5 million in pipeline)

Procured ORS for medical centers and temporary shelters (0.5 milliondelivered, 4.5 million in pipeline)

Procured IV fluid to combat diarrhea dehydration (25,000 500 ml distributedto health facilities, 150,000 500 ml and 75,000 1000 ml in pipeline)

Procuring measles vaccines (8,800 vials), AD syringes (100,000) andrecantation syringes (120,000) and safety boxes (1250) for measlesvaccination campaign in flood shelters

Procuring 100 MT blended food for infants and young children in floodshelters

Future plans

The H&N groups (WHO, UNICEF, UNFPA) is meeting for Detailed work plan Monitoring mechanism, Implementation

Composition of groups: WHO, UNICEF, UNFPA, Red Crescent has joinedOther players: ICDDR, B and/or Other NGOs

…THANK YOU…