WHO update on health situation in Bam, Iran

Main Category: Mental Health
Article Date: 03 Jan 2004 - 0:00 PDT

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Highlights

- No outbreak of communicable diseases, to date.

- Surveillance system established.

- Assessment of health facilities and recovery needs ongoing.

- Health services provision in field hospitals organized, mapping underway.

- Mental health programmes started.

- Health component of the UN Appeal being developed.

- Overall health sector coordination mechanisms established.

1) General

a) The search and rescue operation is winding down with, over the past two days, very few survivors found.

b) The estimated number of dead has risen to more than 30,000.

c) The estimated surviving population in the city is 30,000, being assisted by 10,000 people. The erection of camps and their locations is in discussion. People will move to these locations once tractors start removing the rubble. Now people reside near their destroyed houses, or have left to stay with relatives in other cities.

d) Concern was expressed about the potential contamination of freshly prepared food during transportation and distribution. Therefore, it was advised that this intervention be delayed for another four to five days. Until then, the supply of canned food will be continued. In the case that fresh food is distributed in the interim, transportation time and distance between the central store/point and consumption site should be kept minimal. This advice was accepted by the organization responsible for the preparation and distribution of food.

2) Environmental health

a) Bam has been divided into 12 health zones, each falling within the responsibility of a university of medical sciences.

b) Approximately 12,000 field toilets and 1,000-1,500 field showers are needed.

c) Approximately 50 trailers and 50 tractors are needed for the collection of solid waste.

The following measures are being taken to ensure environmental health:

a) Water reservoirs are tested for chlorine residual content two to three times daily.

b) Decontamination of the area is being done for any possible infection.

c) The Ministry of Health and Medical Education (MOHME) is responsible for technical advice and for the dissemination of community public health education messages including those on environmental health issues. Meanwhile, municipal authorities are installing field toilets and showers.

3) Disease surveillance

a) There are no reports of communicable disease outbreaks, to date.

b) The surveillance system has been put in place. Priorities for reporting are: diarrhoeal diseases, upper respiratory infections, meningitis, measles, polio, tetanus, leishmaniasis, malaria, animal bites, hepatitis, malnutrition, and PTSD.

c) There is a need for unified case definition, formats and treatment protocols. Health coordination is vital to ensure the successful prevention and control of any outbreak.

d) There have been seven cases of diarrhoea, which are being investigated. There is no evidence of shigellosis or cholera. One case of suspected pneumonia was reported and is being investigated.

e) All hospitals have been requested to watch for diarrhoea and immediately report cases to the MOHME. There is a mobile surveillance officer moving between NGO hospitals to collect information. Other highly communicable diseases are to be reported by telephone.

f) Active disease surveillance for 17 priority diseases is ongoing in all 12 zones of the city and surrounding area. Each zone is managed by a neighbouring university of medical sciences and health services.

g) A coordination meeting is being held every day at 18:00-attended by the heads of each of the 12 zones-during which daily interventions are reported to the MOHME. The meetings are chaired by the Deputy Minister for Health and Medical Education. The heads of the zones coordinate with international NGOs working in their area on disease surveillance.

4) Mental health

a) A coordination meeting was held on 1 January 2004 on mental health and psychosocial issues upon the invitation of Director-General of Youth and Mental Health, MOHME. Attendees included representatives from the Welfare Organization, universities of medical sciences and health services, the Tehran Psychiatric Institute, Red Crescent, the National Center for Medical Research, a number of national NGOs, and UNICEF.

b) During this meeting, a summary of the current situation was delivered by the responsible officers from the MOHME. This was followed by brief presentations by attending institutions on their abilities, activities underway and needs.

c) A comprehensive plan prepared by the MOHME based on experiences during the earthquakes of Ardabil and Qazwin was discussed. A workplan and full package of interventions will be finalized. These will contain elements on training, integrated interventions in Bam and other places where refugees and the injured are stationed, children, chronic patients and issues related to drug dependants and suicide prevention. The plan will also include:

- A campaign for collecting information about affected people.

- Case findings, including PTSD cases and their referral.

- Addressing the needs of people with substance abuse problems.

- Addressing the needs of children who have lost their parents.

d) All elements of the plan will include monitoring, evaluation, follow-up and documentation. According to a report from Bam, certain mental health-related conditions like epilepsy, psychosis, depression and PTSD will be included in the disease surveillance plans.

e) Thirty psychiatrists and 100 psychologists from the Islamic Republic of Iran have been mobilized. UNICEF, IFRC, IRCS, Samariter bund (Germany), and MSF France will contribute to mental health activities. PTSD is highly prevalent. Symptoms will appear later. Active surveillance of PTSD is ongoing in the 12 operational zones.

5) Health service delivery

a) The Deputy Minister of Heath and Medical Education conveyed that 95 (out of 96) health houses were destroyed completely or affected (partially destroyed or cracked). This is in addition to all 23 health centres (10 urban and 13 rural) and two out of the three hospitals (around 250 beds). He stated that the rehabilitation costs are estimated to be US$40,000 per health house, US$200,000 per health centre, and US$60,000 per hospital bed. He invited donor countries and NGOs to adopt one centre each and stressed the psychologically positive effect of the presence of international actors.

b) The first mapping of secondary and tertiary medical services, provided by the international community in the form of day clinics, referral and field hospitals, has been completed.

c) The first hospital coordination meeting was held on the IFRC premises on 1 January 2004. WHO and MOHME will attend this meeting on daily basis. Outcomes of the first meeting include the following:

- MSF kidney dialysis in Kerman is functioning.

- A mental health clinic will be established soon in Bam.

- Italian Civil Service Clinics are discussing handing-over to national authorities.

- THW-Germany is considering the establishment of a Health Purification Installation in Imam Hospital.

- MDM Spain has established a field hospital in collaboration with IRCS in Kerman.

- The France team is leaving in one week.

- The US team arrived and will leave in four weeks.

- IFRC is erecting a 150-200 bed hospital-expected to be operational in three days-with the help of Norway, Finland, French, Austria, Spain and Japan. The hospital will remain for one year and will replace Imam Hospital. Its hand-over to the Iranian authorities will begin in three to four months.

- Other hospitals are requested not to leave without coordinating with IFRC and the MOHME.

- The Jordanian hospital has commenced work. It contains twenty beds, two operating theatres, and all emergency services. It will need some equipment and x-ray developing materials.

6) UN assistance/ Health sector coordination

a) The Minister of Foreign Affairs, in a meeting with health sector staff on 31 December 2003, paid tribute to the international/UN agencies for their support.

b) A meeting of the representatives from MOHME, the WHO Representative for the Islamic Republic of Iran, and staff from other UN agencies and NGOs operating in the health sector was held to coordinate health sector activities. The following issues were discussed and agreed upon:

- Health sector meetings should routinely be held at 5:00 o'clock in the OCHA tent everyday until further notice.

- A list of participants for the above-proposed meeting and their contact numbers shall be distributed.

- A comprehensive list of different teams, classified by sector and hospital, will also be made available soon.

- Environmental health issues, including water and sanitation, need to be immediately addressed.

c) WHO participated in the donor meeting organized by the Resident Coordinator Office. In this meeting, the following issues were discussed: immediate needs for medicines, environmental health, and improved coordination. It was decided that the areas to be covered by the Flash Appeal would be as follows:

- Food and logistics (WFP)

- Water and sanitation (UNICEF)

- Health and nutrition (WHO)

- Protection of children and women education (UNICEF and UNESCO)

- Coordination, security, telecommunication, information, monitoring and evaluation (Resident Coordinator Office)

- Recovery, rehabilitation and reconstruction; shelter and cultural heritage (UNDP and UNESCO)

The team expected to prepare the Flash Appeal by Tuesday, 7 January. In the process of preparing the Flash Appeal, UNDP will lead a field trip 4-6 January. The WHO team in Bam will join this mission.

d) UNSECOORD will conduct a security assessment of the area on 4 January. It was decided that the agencies would continue to rely on local law enforcement officials for now. UNSECOORD is looking into the possibility of hiring a security coordinator for the area.

7) Other issues

Water and sanitation

a) The MOHME is establishing 10,000 toilets in the entire area. Medical Aid Committee (France) and the German THW, among others, are assisting.

b) Approximately 1,000-1,500 showers are needed.

c) Sixty per cent of the water network in the city has been re-established.

d) International organizations that are going to install field hospitals have brought facilities for the production of safe drinking water with the capacity of up to 700 cubic meters per day.

e) Some donors have indicated support for the water supply with the provision of laboratory test kits.

Electricity

a) Electricity has been restored for the major parts of the city.

Waste collection, transfer and disposal

a) Fifty tractors and trailers will soon serve this purpose. Hospital waste management is being addressed.

Food

a) Regular canned food distribution by IRCS and other actors for all Internally Displaced Persons (IDPs) continues. Per the recommendation of the MOHME, the distribution of hot food has been postponed for another couple of days.

Shelter

a) Tent provision has been adequate.

Personal sanitary supplies (soap, toothbrush, toothpaste, sanitary napkins, etc.)

a) Supplies are not adequate.

8) Logistics support

a) Three A trauma kits, three B trauma kits, and five burn dressing kits- purchased by WHO (total cost: US$41,985)-were received in Kerman by national health authorities.

b) A tent in the UN compound is dedicated to the International Relations Department of the MOHME, allowing for close liaison with UNOCC and other international organizations. Efforts are underway to further strengthen the coordination between MOHME and IRCS. The International Relations Department will also coordinate all mental health facilities. Resources of external support organizations and agencies will be incorporated into the mental health programme of the MOHME for the affected area.

c) Facilities are available at the communication centers. Mobile communications are facilitated. There is no Internet access. Fax facilities are hardly available.
Written communication between the WHO team in Bam and the WHO Country Office for the Islamic Republic of Iran has been extremely difficult.

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