North West Frontier Province Crisis

HEALTH CLUSTER BULLETIN

Bulletin 5
PAKISTAN
23 June 2009

Highlights
• Amid security concerns, the 4-day national polio
vaccination campaign started 22 June in the
North West Frontier Province (NWFP) and
Federally Administered Tribal Areas (FATA). It is
estimated that 5.4 million children aged under
five will be vaccinated, including IDPs living in
and outside camps. About 20.9 million children
are being targeted throughout Pakistan.
• The risk of diarrhoeal diseases outbreak in IDP
camps and hosting communities remains high.
Oral rehydration therapy (ORT) corners have
been established in 8 IDP camps while health
partners are working on establishing Diarrhoea
Treatment Centers (DTCs) in camps. A polio vaccination team in Jalozai camp visiting tents before
• 18 health facilities at IDP camps, nine mobile administering polio drops on 22 June.
clinics and 153 public health facilities in hosting
districts submitted communicable disease surveillance reports. Findings included:
- Acute diarrhoea cases registered are 10% of total consultations
- 19% of consultations among children under 5 are due to acute diarrhoea
- Acute respiratory inspection (ARI) is the leading cause of consultations (21% of all age group, all
reported cases)
• Most common health problems facing IDPs in camps are malaria, diarrhoea, acute respiratory infection
and scabies, according to Pakistan Red Crescent Society. In addition to diarrhoea and ARI, some IDPs
are also suffering from heat stroke.
• 50 000 people have been displaced by new military operations in Waziristan and they are now residing in
the Tank and Dera Ismail Khan districts. Immediate support is required to deliver health services.

IDPs Profile
Due to multiple registrations of displaced people, the National Database Registration Authority (NADRA) is
verifying IDP registrations inside and outside camps. As of 23 June, NADRA has verified 261 749 families
displaced by the crisis (25 352 inside camps and 236 397 outside). The verification of registrations is
continuing.

COORDINATION
• Due to security concerns, the provincial Health Cluster meetings that were being held in Peshawar have
been moved to Islamabad. This coordination meeting is regularly conducted every Thursday to
consolidate actions and interventions in the field. The latest meeting was conducted in Peshawar on 18
June.
• Health Cluster meetings were conducted on 16-17 June in Islamabad to allocate among partners the
US$ 3.25 million from DFID.
• A contingency planning meeting was held 19 June at OCHA. The Humanitarian Coordinator shared with
the inter-agency humanitarian group the issues discussed during a teleconference with Gen. Nadeem,
head of the Special Support Group including:
o The new military operations in Wazirastan have displaced approximately 50 000 people to
the Tank and Dera Ismail Khan districts.

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 o The security situation prevents the UN from operating in these districts. Response activities
will likely remain stalled for some time.
o UNHCR and the Ministry of Social Welfare are initiating the IDP registration verification
process through a local implementing partner.
o Relief work may be initiated through local district response committees comprising local tribal
elders, government representatives and the Pakistan Army.
o The government is considering giving Rs. 5000 monthly cash grant in lieu of food.
o Immediate support is required for health, WASH and non food items service delivery and
distribution.

The meeting participants discussed the following issues:

o UN agencies should consider establishing a UN hub in the neighbouring Bakkar district,
where ICRC has established a hub.
o UNHCR will complete registration of IDPs in the Tank and Dera Ismail Khan districts during
the next 10-15 days. All clusters (except shelter) will be planning for a rapid assessment in
both districts. OCHA will coordinate the assessments.
Who, does what, where?
• The map Who, Does, What, Where updated as of 23 June is enclosed.
HEALTH ASSESSMENT
Disease surveillance
The weekly disease early warning system (DEWS) reports were received on time from 180 reporting sites
showing a total of 64 793 patient consultations in IDP hosting districts in NWFP (Peshawar, Mardan,
Nowshera, Charsadda and Swabi). The data were collected through 18 fixed health facilities at IDP camps,
nine mobile clinics and 153 public health facilities in IDP hosting districts. The summary of the disease
surveillance latest report (6-12 June 2009) is a follows:
• Acute diarrhoea comprised 6727 (10%) of total consultations in all age groups and from all IDP
hosting districts;
• 19% of children aged under 5 have acute diarrhoea;
• ARI is the leading cause of consultations accounting for 21% (13 479) of reported consultations.

Situation of acute diarrhoea in IDP camps

The risk of diarrhoeal diseases outbreaks in IDP camps and hosting communities remains high. ORT
corners have been established in the camps with diarrhoea treatment centres to efficiently handle
outbreaks. Health and WASH partners are jointly working on establishing diarrhoea treatment centres
(DTCs).

Two alerts of acute watery diarrhoea (AWD) cases were received from Mardan medical complex and
Mardan District Hospital. Case investigations, followed by comprehensive epidemiological investigations,
revealed the two other affected cases, their locations and timeline of the outbreaks. Rapid response teams
conducted necessary containment, including water safety measures and hygiene promotion activities.

Below is the comparison of weekly percentage of consultations for acute diarrhoea in NWFP IDP camps.
Weekly pattern of Acute Diarrhoea in IDP camps , NWFP
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Wk21 Wk22 Wk23 Wk24
25

20
Percentage

15

10

0
Jalozai-IV

Jalozai-V

Jalala

Larama

Charsadda
Yar Hussain
S.Shahzad

S.Yaseen

Mazdoorabad
B. Complex

Jalozai-I

Jalozai-II

Jalozai-III

Jalozai-VI

Jalozai-VII

KG-I

KG-II

Palosa-I

Palosa-II

Mansoor

Sugar Mill
Shah

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 Distribution of all reported consultations in the IDP hosting districts by Diseases
Cause of consultation  No. of consultations  Percentage 
Acute diarrhoea 6727 10
Acute jaundice syndrome 36 -
Bloody diarrhoea 744 1
Lower respiratory tract infection 1629 3
Upper respiratory tract infection 11 850 18
Suspected malaria 1028 2
Others (causes of consultation other
than communicable diseases) 36 734 57
Scabies 3234 5
Unidentified fever 2811 4
Total  64 793

FILLING GAPS

After the influx of conflict affected IDPs to Abbottabad and Mansehra, the Church World Service-
Pakistan/Afghanistan (CWS-P/A) has been assisting IDPs through a mobile health unit since April 2009.
The mobile health unit provides basic health services with a special focus on women and children, along
with free basic medicines. So far, the unit has conducted 733 consultations for various diseases in these
areas and provided antenatal care to pregnant women.

Helping Hand for Relief & Development is running eight health clinics to support health needs of IDPs
living outside camps in Talash Shamsi, GC College Temrgra, Samar Bagh union councils in Dir One; Totalai
in Buner; and the mobile clinics in Tarnole and Bara Kahu. The Islamic International Medical and Dental
College and Allied Hospital has been supporting mobile clinics managed by HHRD in Mardan, which
serve IDPs in 38 village ‘host communities.’

During the second week of June, Malteser International deployed two mobile medical teams and were
given use of the Executive District Officer’s (EDO) Health Office in Mardan. Each time includes a:
• Medical officer for curative health care, including minor surgery;
• Lady health volunteer, dispenser and site mobiliser/hygiene promoter;
• Health worker, in-charge of basic maternal and child health services and emergency obstetric and
neonatal care (EmONC)

Malteser is covering part of the IDP population accommodated in 55 schools and one residing with host
communities in five Union Councils of Mardan district, namely: Toru, Mayar, and Khandar, southeast from
Mardan town. During the first six days of interventions, Malteser’s mobile team treated 1343 patients.

Merlin conducted 15,491 consultations in camps and host communities in Peshawar, Mardan and
Nowshera during epidemiological week 25 (13-19 June). In addition, 3951 children and Pregnant &
Lactating Women (PLW) were screened for nutritional status. Service provision in Jalozai 4 IDP camp has
been started on 22 June.

During the past week, Merlin has conducted a rapid needs assessment in three Tehsils and 4 health
facilities in district Buner. They have sent emergency medicines and supplies to the DHQ hospital Buner.

WHO is conducting a needs-based assessment survey to assess the prevalence of persons with disabilities
in IDP camps as well as their needs in terms of health and rehabilitation services.

Several meetings were conducted by the Nutrition Cluster to establish a nutrition surveillance system. The
preliminary questionnaire was shared with Nutrition Cluster partners. It was discussed and agreed that data
collected from camps and host communities will be submitted to WHO for analysis and production of a
monthly report.

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UNICEF and Save the Children USA conducted several meetings to establish therapeutic feeding
/stabilization centres in Mardan, Swabi and Charsadda, where training sessions on hospital management of
severe acute malnutrition are being arranged.

The Pakistan Red Crescent Society (PRCS) is providing psychosocial support to help displaced people
recover from traumatic experiences and cope with the current situation. The psychosocial support
programme has reached 3266 beneficiaries. The psychosocial team is organizing sports competitions
among IDPs, including cricket, badminton and football.
• PRCS health teams have attended 77 029 patients in all camps, where health awareness sessions are
being conducted.
• Based on a PRCS health teams’ report, heat stroke, malaria, diarrhoea, ARI and scabies are the most
common health problems being faced by IDPs in camps.

The PRCS, supported by ICRC, is conducting medical consultations in five IDP sites: Sher Mansur in Swabi
district, Rangmala and Pokhut in Malakand district, and Khungi and Degree College in Lower Dir district. No
particular health problems were encountered in these camps during the last seven days.

ICRC teams conducted assessments in the Buner, Swat and Upper Dir districts. In Swat, the situation
remains precarious. Daggar Hospital was provided by ICRC with dressing kits, basic health kits to restart
OPD. Generator fuel has been delivered. With Ministry of Health’s drug donations, the hospital has resumed
services for displaced people.

Web links:

• WHO HQ: http://www.who.int/hac/crises/pak/en/index.html

• Health Cluster Pakistan: http://www.whopak.org/idps
• Provincial Relief Commissionerate: http://www.helpidp.org
• Pakistan MoH: http://www.health.gov.pk
• WHO EMRO: http://www.emro.who.int/eha/pakistan

Contacts:
For further information please contact:

WHO Pakistan Country Office

Dr Khalif Bile Mohamud
WHO Country Representative to Pakistan
e-mail: wr@pak.emro.who.int

WHO Regional Office for the Eastern Mediterranean

Dr. Irshad Shaikh
EHA Regional Adviser
e-mail: shaikhi@emro.who.int
tel.: + (202) 2276 5525
mobile: + (201) 01733924
http://www.emro.who.int/eha/

WHO Headquarters
Mr Paul Garwood
Communications Officer
Health Action in Crises
e-mail: garwoodp@who.int
tel. +41 22 791 3462
mobile: +41 79 475 5546
www.who.int/disasters

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Acronyms

AWD: Acute Watery Diarrhoea

BHU: Basic Health Unit
CD: Civil Dispensary
CERD: Centre for Excellence for Rural Development
DART: Disaster Assistance Response Team
DEWS: Disease Early Warring System
DHQ: District Headquarter
DTC: Diarrhoea Treatment Centre
DSM; District Support Manager
EMRO; Eastern Mediterranean Regional Office
ERU: Emergency Response Unit
FP: Family Planning
IEHK: Inter-agency Emergency Health Kit
HRDS: Human Resource Development Society
HTH: High test Hypochlorite
INGOs: International Nongovernmental Organizations
LHV: Lady Health Visitor
LHW: Lady Health Worker
LSS: Logistic Support System
MCHC: Maternal Child and Health Centre
MEHK: Mini Emergency Health Kit
MMT: Mobile Medical Team
NIH: National Institute of Health
MNCH: Maternal, Neonatal and Child Health
NWFP: North West Frontier Province
MSU: Mobile Service Unit
OFDA: Office of Foreign Disaster Assistance
ORS: Oral Rehydration Salt
ORT: Oral Rehydration Treatment
PHRP: Pakistan Humanitarian Response Plan
PIPOS: Pakistan Institute of Orthotics and Prosthetics Sciences,
PPE: Personal Protective Equipment
PPHI: People's Primary Healthcare Initiative
PRC: Provincial Relief Commissionerate
PRCS: Pakistan Red Crescent Society
PWDs: Persons With Disabilities
RH: Reproductive Health
RHC: Rural Health Centre
THQ: Tehsil Headquarter
WMO: Women Medical Officer