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Current State of Knowledge of Flood/Post-Flood Health Situation in Bangladesh - 2004 ‘UN Flash Current State of Knowledge of Flood/Post-Flood Health Situation in Bangladesh - 2004 ‘UN Flash Appeal’ for Health Sector WHO, UNFPA, UNICEF

 Flood Situation as on 3 rd August’ 04 Flood 2004 (12 July-12 Sep. Flood Situation as on 3 rd August’ 04 Flood 2004 (12 July-12 Sep. ) v Affected Districts: 38 v Death Toll : 726 v Affected Population: 30 m (24% of total Popln) v Temporary Shelters: 2, 710 v Temporary TC: 35

Historical Perspectives 2004 Flood before Flood after liberation • Less frequent (1974 -2004); becoming Historical Perspectives 2004 Flood before Flood after liberation • Less frequent (1974 -2004); becoming • Frequent (1954 frequent 1970) • Affecting wider areas • Affected small areas • Relief and medical care: Govt. is main • Relief and medical player and using electronic media care: Govt’s role extensively less prominent • Role of media: Super-active • Role of media: Less • Role of public representatives: Very active • Health staff: Less in • Large number of competent health staff number and less • People’s coping capacity; Rx of Flooded area of Bangladesh in different year competent Source: Bangladesh Water Development Board diarrhoea-known

Flood Impact on Health & Hygiene Movement becomes difficult People suffer from food shortage Flood Impact on Health & Hygiene Movement becomes difficult People suffer from food shortage Cookin g becom es difficult Tube wells and safe water sources are submerged Bathin g, washin g and playing in flood water cause disease Open defecation increases Home goes under water Flood Trap Rura l Area Toilets become unprotecte d Human & animal excreta, rubbish & contaminat ed soil mix with water

Flood Impact on Health & Hygiene… Floodborne Morbidities • Water & Foodborne diseases • Flood Impact on Health & Hygiene… Floodborne Morbidities • Water & Foodborne diseases • Respiratory infections • Skin diseases • Eye infections • Drowning • Snake bites • Accidents • Malnutrition Water & food-borne diseases Diarrhea, dysentery, cholera, jaundice, typhoid, helminthiasis Bathing, Food contamination washing, Due to food preparation playing, and in: walking in • Dirty environment flood water • Use of unsafe water • Gastrointestinal • Purchase from open food diseases shop • Respiratory • Sharing with sick people infections • By flies and vectors • Skin diseases • Via careless utensil handling • Eye infections Food contamination • Drowning Scarcity in food supply & causes monotony of uncooked food borne diseases • Malnutrition of vulnerable groups (children, pregnant and lactating mothers, elderly and sick persons) • Lower immunity > More infections

 Disease reported during and post-flood state (July 12 – Sep 12, 2004) Name 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 Snake-bite deaths *Source: DGHS Control Room and NDSC, IEDCR 247 -- 75 --

Flood Impact on Health Status, effect on Infrastructure and Logistical Supplies MO HF W Flood Impact on Health Status, effect on Infrastructure and Logistical Supplies MO HF W Flood 2004 Physical damage (2004) No. of deaths (Flood 2004; On 12 Sep 04) Disease Diarrhoea Pneumonia Snake bite Drowning Dysentery Jaundice Skin disease Eye disease Total No. 116 156 85 244 0 0 601 Loss of logistics (2004) Medicines & Supplies DGHS: ~Tk. 32 crore Source: DGHS, MOHFW (as of Aug 30, 2004)

Flood 2004 Indirect Flood Impact on Services EPI service loss BCG: 41, 544 doses Flood 2004 Indirect Flood Impact on Services EPI service loss BCG: 41, 544 doses Measles: Family planning service loss • Mother & child care • Ante-natal, natal & post-natal 41, 544 doses care DPT: 1, 24, 632 doses • Sterilization camps OPV: 1, 24, 632 doses • Clinic based services (IUD, Injection, Norplant) Hepatitis B (25 dist & NNP service loss • Home visits 5 City Corps): 4, 800 doses • Programme Upazila affected: TT: 2, 18, 064 doses 70 EPI out-reach sessions (not held): Postponement of health & FP • Community Nutrition Centre (CNC) did not function: 3802 training/workshop/seminars: • Nutrition gardens damaged: 10, 384 Nos. Man 88369 P y ostponement of • Nursery damaged: 985 examinations in medical • 1 -day old chick died: 62355 institutions: all in this period • Chicken died: 51807

Comparison of morbidity pattern of 1988 and 1998 Flood in Bangladesh Disease Rates of Comparison of morbidity pattern of 1988 and 1998 Flood in Bangladesh 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%

Donor & Private Initiatives Flood 2004 WHO UNICEF UNFPA BMA medical teams UN Flash Donor & Private Initiatives Flood 2004 WHO UNICEF UNFPA BMA medical teams UN Flash Appeal

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

Health and Nutrition Group: Assistance Provided by WHO, UNFPA and UNICEF Health (WHO): · Health and Nutrition Group: 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 Civi Surgeons and sending daily reports to FCMT. · · Procurement of Medicine and supplies to the following Offices: 1. DGHS 2. BMA 3. Red Crescent Society 4. DPHE 5. 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 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 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 million delivered, 4. 5 million in pipeline) Procured IV fluid to combat diarrhea dehydration (25, 000 500 ml distributed to health facilities, 150, 000 500 ml and 75, 000 1000 ml in pipeline) Procuring measles vaccines (8, 800 vials), AD syringes (100, 000) and recantation syringes (120, 000) and safety boxes (1250) for measles vaccination campaign in flood shelters Procuring 100 MT blended food for infants and young children in flood shelters

Future plans The H&N groups (WHO, UNICEF, UNFPA) is meeting for Ø Detailed work Future plans The H&N groups (WHO, UNICEF, UNFPA) is meeting for Ø Detailed work plan Ø Monitoring mechanism, Ø Implementation Composition of groups: WHO, UNICEF, UNFPA, Red Crescent has joined Other players: ICDDR, B and/or Other NGOs

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