Construction Course, March 16 – 20, 2009 in Walkringen 1 Site and Shelter Planning in emergencies...

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


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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?


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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


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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


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ASSESSING THE MORTALITY IN DISPLACED POPULATION

BURRIAL SITE SURVEILLANCE

HEALTH POST RECORDS

COMMUNITY BASED REPORTING

POPULATION SURVEYS


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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)


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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


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REFERENCE VALUE/ HEALTH INFORMATION

EPI VACCINATION COVERAGE RATE

ENDEMIC/EPIDEMIC DISEASES

VECTORS

HIV PREVALENCE


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REFERENCE VALUES

WATER : QUALITY, QUANTITIY, ACCESS , STORAGE

EXCRETAL DISPOSALS

SOAP AVAILABILITY: 250 gr/ person / month

FUEL FOR COOKING


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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


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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?


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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


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MALARIA

VECTOR: ANOPHELES

PARASITES: PLASMODIUM SPECIES

Plasmodium Falciparum

Plasmodium Vivax Plasmodium Ovale Plasmodium Malariae


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MALARIA


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REDUCING THE BURDEN OF MALARIA

Rapid and correct diagnosis

Correct treatment

Chemoprophylaxis

Individual protection against vector

Environmental vector control measures


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ACCESS !!!


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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


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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...


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MALARIA VECTOR CONTROL : NEW TOOLS

INSECTICIDE TREATED PLASTIC SHEETING

INSECTICIDES BLANKETS, PILLOWS


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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


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EPIDEMIC DIARRHEAL DISEASES

CHOLERA

TYPHOID FEVER

SHIGELLOSIS

OTHERS ( HEPATITIS, INTESTINAL PARASITES)


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THE IMPORTANCE OF WATER AND DISEASE TRANSMISSION

DIARRHEAL DISEASES

DERMATOLOGICAL DISEASES (PEDICULOSIS, SCABIES)

EYES DISEASES: CONJONCTIVITIS, TRACHOMA)

TYPHUS ( LOUSE TRANSMISSION)


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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


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BEFORE THE OUTBREAK

PREPAREDNESS:

EMERGENCIES STOCKS LABORATORY TRAINING COMMUNITY AWARENESS

CHOLERA TREATMENT CENTER CHLORINE BIOLOGICAL AND HOSPITAL WASTE DISPOSAL


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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


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TREATMENT CENTERS

NUMBER OF BEDS ACCORDING TO ESTIMATED ATTACK RATE

FULL BOARD INCLUDED !

200 BEDS = 150 PERSONAL !


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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


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DISINFECTION

FLEES CONTROL

PEOPLE COMING IN AND OUT

SURFACES


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BIOLOGICAL WASTE

INCINERATE

DIG A PIT

SUN DISINFECTION

CHLORINE DISINFECTION


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EFFECTIVE CONTROL MEASURES

WATER

FOOD HYGIENE

SANITATION (1 LATRINE/ 25)

SOAP DISTRIBUTION

COMMUNITY AWARENESS


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AIR BORNE DISEASES

Acute respiratory infections

Measles

Meningitis


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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


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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..


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MEASLES

COMMON HEALTH HAZARD IN EMERGENCIES

COMPLICATIONS

HIGH LETALITY

VACCINATION


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MEASLES


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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


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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


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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


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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


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SOME OTHER TIPS

DEAD BODIES

HAZARDOUS HEALTH WASTES

ZOONOSIS ( INTERACTION MAN / LIVESTOCK)


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DEAD BODIES

MYTH: DEAD BODIES ARE A CAUSE OF EPIDEMICS


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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


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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


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HAZARDOUS HEALTH WASTES

SHARPS ( NEEDLES, CUTTERS, SURGICAL, IV DRIPS)

BODY FLUIDS OF HIGHLY CONTAGIOUS DISEASES


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INJECTION OVERUSE

A CULTURAL PATTERN

THE VICIOUS CIRCLE PERCEPTION

SOME INCENTIVES

A REAL RISK OF HBV HCV TRANSMISSION


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INCINERATION

THE MOST APPROPRIATE

THE HIGHEST THE TEMPERATURE THE BEST

ENVIRONMENAL ISSUES


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LIVESTOCK

WHAT PROXIMITY TO THE CAMPS / TENTS

INCREASES MALARIA TRASMISSION IN SOUTH EAST ASIA


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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


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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


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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


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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


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THANK YOU FOR YOUR ATTENTION

Construction Course, March 16 – 20, 2009 in Walkringen 1 Site and Shelter Planning in emergencies...

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