Cyclones in Orissa India

Executive summary

On 17-18 October 1999, 5 districts of the State of Orissa in India were hit by a cyclone, and on 29 October another, exceptionally strong cyclone ("supercyclone") devastated a large portion of the State. This second cyclone caused severe damage in 14 of the 30 districts of Orissa (5 being hit for the second time (See map 1). It is estimated that up to 15 million people (more than 2 million households) are seriously affected by the cyclone one way or another. The official number of deaths is reported to be nearly 10,000 and many more are feared to have died.

Millions of people are left homeless. The affected villages consist mostly of simple huts, which were severely damaged or totally destroyed. Usually people keep at home stocks of food and seeds. These have been destroyed along with people’s essential household items. Water, power supply and telecommunications were completely disrupted in all affected areas. 90-100 % loss of crop is reported in the affected districts. Due to large-scale inundation, there is a widespread contamination of drinking water sources. Sanitation conditions are seriously inadequate particularly in the urban slum areas but also in the rural areas.

A large proportion of the population will depend on food-aid for the months to come, and the food security of many households is severely endangered on a long-term basis. Assets such as boats and tree plantations, which will take many years to restore, have been lost. Signs of migration out of the affected districts have already been reported. The household food security and people’s nutritional status need be closely monitored to ensure that further deterioration of nutritional status does not make the population, especially children, even more vulnerable to infectious diseases. The consensus within the international and bilateral community is that food assistance for a month would be required for approximately 2.25 million people.

Outbreak and eventual epidemics of communicable diseases with a potential public health threat has been, and continues to be, a major concern. Prior to the emergency, the health information system is reported to have had serious shortcomings. Already an outbreak of cholera has been confirmed and an outbreak of measles has been reported. Outbreaks of vector borne diseases such as malaria (which is endemic) and Japanese encephalitis are possible. However, reports are ad hoc and there is no adequate system currently working for the surveillance of communicable diseases.

In spite of intense efforts by the authorities, UNICEF, local and international NGOs to restore and ensure the safety of the various water sources, including tanked water, rejuvenation of wells, drilling of new wells, supply of hand pumps, tests conducted on these are showing an alarming rate of dangerous contamination. Even some of the boreholes assumed to be safe have been reported to be dangerously contaminated.

The damage to shelter is extensive. In the worst affected districts over 70% of the shelter is reported to be completed destroyed and in other districts about 40-50% of the shelter is completed destroyed. Winter is coming and the nights getting cooler. Overcrowding in available buildings is expected to increase the transmission of communicable diseases such as acute respiratory infections (ARI), especially among children, and skin disease. Without proper case management ARI can lead to large numbers of deaths especially among malnourished children. An outbreak of measles is already reported from a village of around 10,000 people who claim there has not been any vaccination programme there for the last two years. If not addressed urgently a major outbreak and potential epidemic could occur given the vaccination coverage for measles was around 60% prior to the disaster. Two rounds of vitamin A have been give to all children aged 1 to 3 ½ years old this year: the last one 24^th October was with polio vaccination during the National Immunisation Day (NID). The second NID will probably not take place on schedule.

Health infrastructure has been seriously damaged and support to the health authorities to restore key institutions, systems and programmes is urgent. A large quantity of vaccines are known to have been lost due to the breakdown in the cold chain caused by a lack of electricity. Samples from the state store have been sent for testing. If they prove to be damaged the whole state stock will need to be destroyed and millions of dollars worth of vaccine will need to be replaced.

Although supplies including stocks of medical supplies are reported to be adequate at state level, reports from the field indicate that there are serious problems of secondary distribution to lower levels of the health services.

WHO has been part of the UNDMT response mechanism right from the beginning. EHA, WHO, SEARO joined the UNDAF assessment team to Orissa and conducted the initial rapid health sector assessment and provided inputs into the UN appeal. WHO has chaired the daily co-ordination meetings where the local health, water and sanitation people, UN agencies, local and international NGOs and donors meet and share information and plan urgent actions (see annex 1 for list of participants). A management sheet (sample in annex 2) was maintained daily and used for monitoring. A rough mapping system was established to monitor gaps and overlaps and GIS mapping has been initiated to further improve this mapping.

A subgroup on Epidemiological Surveillance composed of local authorities, a local NGO umbrella agency, MSF and WHO has worked out a system which will be used by the NGOs. The system will be set up very rapidly within the governmental sector and the SSH has agreed. WHO and MSF have proposed support and DFID has been approach for funding (Annex 3). OXFAM has developed and co-ordinated agencies’ input into a village level rapid assessment tool. Many questions are health related and a mechanism has been set up to compile and analyse these. Orissa Disaster Mitigation Mission (ODMM) a local NGO umbrella organization will be in charge of this task.

WHO has provided other technical assistance to the health authorities throughout the initial disaster period. Guidelines on the management of ARI, diarrhoeal diseases (including cholera guidelines) and acute malnutrition have been provided. One of the major issues has been the disposal of dead human bodies and animal carcasses. WHO stressed that, although very psychologically disturbing, there was no evidence in the literature that outbreaks of epidemics caused by dead bodies are likely.

WHO along with UNICEF also recommended an urgent measles vaccination campaign as soon as the cold chain is restored. The restoration should be done as a matter of urgency. International NGOs have been asked to help.

A nutritionist from WHO, HQ joined the team to assist with the WHO operation and to begin to address the issues of nutrition, which have been neglected, as the priority has been to get any food available to the affected population.

The state health authorities had prepared for the cholera outbreak by prepositioning the relevant stocks. They rapidly responded to the cholera outbreak by informing all health professionals down to the lowest administrative levels about the outbreak, about outbreak control and case management guidelines.

The Supply and Management system (SUMA) for managing disaster supplies was proposed and would have been useful. However it was not felt by various players that it was needed. A subgroup on logistics has been formed in order to look further into how to improve the secondary distribution.

WHO also proposed an urgent rapid assessment of the immediate structural and equipment damages.

• The confirmed outbreak of cholera calls for immediate strengthening of the diarrhoeal control programme including urgent strengthening of the health information flow, water quality monitoring, continuous overall monitoring and replenishing of relevant stocks, improvement in secondary distribution and an urgent public educational campaign.

• Water purification tablets and essential drugs (in spite of large amount of supplies being distributed, there are still reports of shortages). Water quality monitoring and purification programmes need urgent strengthening.

• Due to overcrowding, low coverage and a reported outbreak an urgent measles vaccination campaign should take place.

• Distribution of the (available but not yet distributed) State case management guidelines should be done immediately along with standard public information and educational material.

• Immediate replacement of vaccination stocks along with the restoration of the cold chain.

• Household food security, quality of the food basket and nutritional monitoring are essential.

• The availability of essential medical supplies need to be monitored and provision of supplies related to specific programmes such as reproductive health need to be secured.

• Installation of an emergency surveillance system and the strengthening of diagnostic facilities and rapid response capacity.

Four areas related to health have been identified as priority areas where WHO should be supporting the local authorities:

• Co-ordination, along with UNICEF of the health assistance between local authorities, local NGOs and international NGOs (there are already around 20 international agencies involved in health and many new arriving).

• In co-ordination with the health authorities, other UN agencies, local and international NGOs, establish an emergency surveillance system. This includes the collection, compilation, analysis and mapping of health information and ensuring the use of these for managing the emergency response. Provide resources to the local health authorities to ensure the surveillance system is restored and the diagnostic and curative health sector has the equipment and supplies needed.

• Ensure that the humanitarian health assistance is implemented in line with international standards including WHO standards. Emergency library kit is on its way along with a stock of guidelines which are being requested by agencies from WHO.

• Systematic assessment of health sector damage and recommendation for emergency repair and supply of priority equipment and supplies.

On 17-18 October 1999, 5 districts of the State of Orissa in India were hit by a cyclone, and on 29 October another, exceptionally strong cyclone ("supercyclone") devastated a large portion of the State. This second cyclone caused severe damage in 14 of the 30 districts of Orissa (5 being hit for the second time). Each district is divided into some 20 blocks and in a block there can be hundreds of villages. It is estimated that up to 15 million people (more than 2 million households) are seriously affected by the cyclone one way or another. The official number of deaths is reported to be nearly 8000 and many more are feared to have died.

Orissa has a total population of nearly 35 million people. In normal times, of these, 60% live below the poverty level. Almost 90% of the population live in rural areas. More than 50% of the children below the age of 4 are suffering from malnutrition. Nearly 90% have access to safe water, but only 4% have sanitation. Health statistics are reported to be incomplete. However, under 5 mortality and maternal mortality is reported to be high and measles vaccination coverage around 60%. Cholera and Malaria are endemic.

The most severely affected districts are Balasore, Bhadrak, Cuttack, Ganjam, Jagatsinghapur, Jajpur and Kendrapara (total population: around 11 million people) The districts of Khurda, Puri, Nayagarh, Gajapati, Keonjhar, Mayurbhang and Dhenkanal are partly affected, between 30% and 50% (total population: 7 million). It is understood that up to 15 million people could be seriously affected by this disaster. Most of this population are living below the poverty level.

A devastating combination of two cyclones has produced three different types of impact

(See Annex 1):

• physical destruction directly caused to the cyclone

• flooding

• saline inundation

Millions of people are left homeless. The affected villages consist mostly of simple huts, which have been severely damaged or totally destroyed. Usually people keep at home stocks of food and seeds. These have been destroyed along with people’s essential household items. Whole communities are reported to be in a state of shock. Human deaths, casualties, animal loss, the destruction of plantations, paddy fields, sugarcane, vegetable crop, etc., and the destruction of infrastructure are devastating. Water, power supply and telecommunications were completely disrupted in all affected areas. Although these are being restored, many human settlements are still left without electricity and consequently water systems can not be restored. Water-logging inundation is significant. 90-100 % loss of crop is reported in the affected districts, as the cyclones hit at the most vulnerable time for the paddy crop. The autumn crop is the one the poorest of the poor depend on the most because it is rainfed (as opposed to richer people who have access to irrigation). The next harvest period would fall in April-May 2000. It should be underlined that the loss of both stored food, seeds and crop is overwhelming, as the harvest was about to take place within 3 weeks. A serious shortage of essential food items in the affected districts continues to be problematic mostly due to logistic problems related to secondary distribution.

Due to large-scale inundation, there is widespread contamination of drinking water sources. Safe drinking water is a serious problem, as electricity is still not restored in many places, many hand pumps are damaged and numerous wells, tanks, ponds and canals are polluted. In 10 cities, water supplies have completely broken down. Over 84,000 tubewells in rural areas have been submerged and rendered non functional. 84 village piped water systems are damaged. Thousands of open traditional dug wells are contaminated and these are difficult to disinfect. Sanitation conditions are seriously inadequate particularly in the urban slum areas but also in the rural areas. The municipality sewerage system has also been extensively damaged. In addition, although water is receding, waterlogging is still a problem.

There are unconfirmed reports on secondary damage of industrial sites, which may lead to serious pollution and negative effects on human health. An ammonium factory in Paradip has confirmed that it is releasing ammonium "in a controlled manner" to avoid an explosion as they do not have enough electricity to keep temperatures at appropriate levels.

Analysis of the situation and its health implications

A large proportion of the population will depend on food-aid for the months to come, and the food security of many households is severely endangered on a long-term basis. Assets such as boats and tree plantations, which will take many years to restore, have been lost. Signs of migration out of the affected districts are already reported. The household food security and people’s nutritional status needs be closely monitored to ensure that further deterioration of nutritional status does not make the population, especially children, even more vulnerable to infectious diseases. The consensus within the international and bilateral community is that the food assistance for a month would be required for approximately 2.25 million people.

Outbreak and eventual epidemics of communicable diseases with a potential public health threat has been, and continues to be, a major concern. Prior to the emergency the health information system is reported to have had serious shortcomings. Already an outbreak of cholera has been confirmed and an outbreak of measles has been reported. Outbreaks of vector borne diseases such as malaria (which is endemic) and Japanese encephalitis are possible. However, reporting is ad hoc and there is no adequate system currently working for the surveillance of communicable diseases.

In spite of intense efforts by the authorities, UNICEF, local and international NGOs to restore and ensure safety of the various water sources, including tanked water, rejuvenation of wells, drilling of new wells, supply of hand pumps, tests conducted on these are showing an alarming rate of dangerous contamination. Even some of the boreholes assumed to be safe have been reported to be dangerously contaminated.

The damage to shelter is extensive. In the worst affected districts over 70% of the shelter is reported to be completed destroyed and in other districts about 40-50% of the shelter is completed destroyed. Winter is coming and the nights getting cooler. Overcrowding in available buildings is expected to increase the transmission of communicable diseases such as acute respiratory infections (ARI), especially among children, and skin disease. Without proper case management ARI can lead to large numbers of deaths especially among malnourished children. An outbreak of measles has already been reported from a village of around 10,000 people who claim there has not been any vaccination programme there for the last two years. If not addressed urgently a major outbreak and potential epidemic could occur given the vaccination coverage for measles was around 60 % prior to the disaster. Two rounds of vitamin A have been given to all children aged 1 to 3½ years old this year: the last one 24^th October was with polio vaccination during the National Immunisation Day (NID). The second NID will probably not take place on schedule.

Mental health is already a major concern no-one is dealing with, but the health co-ordination group is aware of the importance of psycho-social programmes and some preliminary plans are being prepared.

Health infrastructure has been seriously damaged and support to the health authorities to restore key institutions, systems and programmes is urgent. A large quantity of vaccines are known to have been lost due to the breakdown in the cold chain caused by a lack of electricity. Samples from the state store have been sent for testing. If they prove to be damaged the whole state stock will need to be destroyed and millions of dollars worth of vaccine will need to be replaced.

Although supplies including stocks of medical supplies are reported to be adequate at state level, reports from the field indicate that there are serious problems of secondary distribution to lower levels of the health service.

 The disaster response

The State authorities, with assistance from the central government, neighbouring States and the army, continue to make great efforts to cope with the situation, but are still overwhelmed by the exceptionally large scale of this disaster. Air dropping of food in inaccessible areas is continuing, along with distribution by road. Many local/national NGOs are involved in the process of assistance.

Based on the Chief Minister’s appeal to the UN system, the UN in India has provided 120 metric tonnes of supplies to the State for emergency relief. Supplies mobilized for the state include medicines, ORS packets, bleaching powder, chlorine tablets, plastic jerrycans, light blankets, polythene sheets, candles and matchsticks, chewda, clothing and food material. Measles vaccines are in stock in Calcutta and can be transported to Orissa as soon as the cold chain is restored. A stock of autodestructive syringes is ready in New Delhi.

In response to the devastation caused to Orissa, the United Nations, in close partnership with local authorities with the international and local NGOs, donor countries and agencies, has combined efforts to facilitate and support emergency relief and reconstruction operations in the state. They have established a planning, facilitation, co-ordination and review mechanism for ensuring effective emergency relief operations. The co-ordination efforts are at present facilitated by the UNICEF Orissa office, which is now functioning as the UN House – the convergence point for international and local NGOs, donors and partners involved in the relief and reconstruction process, in close collaboration with the State Government. The co-ordination group meets daily to plan, review and keep track of the relief efforts, new developments and related actions in the field.

While supporting the immediate relief efforts, the UN system is assessing the requirements for long-term intervention for reconstruction and rehabilitation in the affected areas – especially in the sectors of health and nutrition, shelter, connectivity by road and telecommunication, plantations, safe water and sanitation, primary education and protection of children and women, and a disaster warning system.

The UN Team in Bhubaneshwar has discussed with the State authorities the possibility of strengthening the relief operations in the affected districts. One of the recommendations is to establish structured co-ordination in these districts. It is believed that the State Administration is the best mechanism, and the UN System is willing to be a co-operating partner in this exercise. The United Nations immediate assistance could be to establish district co-ordination cells with necessary communication tools, and if necessary, appoint trained national personnel to co-ordinate the activities. UNICEF and WHO jointly monitor the health situation with local health authorities on a daily basis. The two agencies are further co-ordinating the sharing of health data and diagnostic services between the local health authorities and NGOs.

 WHO disaster response

WHO has been part of the UNDMT response mechanism right from the beginning. EHA, WHO, SEARO joined the UNDAF assessment team to Orissa and conducted the initial rapid health sector assessment and provided inputs into the UN appeal. WHO has chaired the daily co-ordination meetings where the local health, water and sanitation people, UN agencies and local and international NGOs and donors meet and share information and plan urgent action (see annex 1 for list of participants). A management sheet (sample in annex 2) was maintained daily and used for monitoring. A rough mapping system was established to monitor gaps and overlaps and GIS mapping has been initiated to further improve this mapping.

Outbreak of communicable diseases with potential public health threat has been a major concern. Prior to the emergency the health information system is reported to have had shortcomings. Already outbreak of Cholera has been confirmed and outbreak of measles has been reported. However, these reports are ad hoc and there is no system currently working for the appropriate surveillance of communicable diseases. Following emergencies of the scale that hit Orissa the system used to monitor the health of the population in normal times can not been used to detect outbreaks quickly and take appropriate action urgently. The Emergency Surveillance system needs to be reliable and efficient. This was discussed with the State Secretary Health (SSH) and a tool to facilitate an emergency epidemiological surveillance system for early detection and control of outbreaks was provided to the local authorities and NGOs. During the most urgent phase the SSH did not want to impose a new system on their staff but a system to report under the categories of diarrhoea, snakebites and other aliments has been maintained at the state government control room. The SSH encouraged WHO to set up the system among the local and international NGOs providing curative health services as long as the information was shared with the state health authorities. Subsequently, a subgroup on Epidemiological Surveillance composed of local authorities, the local NGO umbrella agency, MSF and WHO has worked out a system which will be used by the NGOs. The SSH has decided to set up an emergency epidemiological surveillance system within the government system as well. Orientation training will be started immediately. WHO and MSF have proposed support and DFID has been approach for funding (see Annex 3).

OXFAM has developed, and co-ordinated agencies input into, a village level rapid assessment tool. Many questions are health related and a mechanism has been set up to compile and analyse these. Orissa Disaster Mitigation Mission (ODMM) a local NGO umbrella organization will be in charge of this task.

The list of epidemiological investigation and response kits was also shared with the SSH to and other measures to strengthen diagnostic services have been offered.

WHO has provided other technical assistance to the health authorities throughout the initial disaster period. Guidelines on management of ARI, diarrhoeal diseases (including cholera guidelines) and acute malnutrition have been provided. One of the major issues has been disposals of dead human bodies and animals. WHO stressed that although very psychologically disturbing there was no evidence in the literature that outbreaks of epidemics caused by dead bodies are likely. A large amount of kerosene was being used to burn bodies and animal carcasses while there was a serious shortage of kerosene for cooking for the survivors (15 litres reported to be used to half burn a buffalo).

WHO along with UNICEF also recommended an urgent measles vaccination campaign as soon as the cold chain is restored. The restoration should be done as a matter of urgency. International NGOs have been asked to help.

A nutritionist from WHO, HQ joined the team to assist with the WHO operation and to begin to address the issues of nutrition, which have been neglected, as the priority has been to get any food available to the affected population.

The state health authorities had prepared for the cholera outbreak by the prepositioning of relevant stocks. They rapidly responded to the cholera outbreak by informing all health professionals down to the lowest administrative levels about the outbreak, about outbreak control and case management guidelines.

The Supply and Management system (SUMA) for managing disaster supplies was proposed and would have been useful. However it was not felt by various players that it was needed. A subgroup on logistics has been formed in order to look further into how to improve the secondary distribution.

WHO also proposed an urgent rapid assessment of the immediate structural and equipment damage but it was felt that this would be forthcoming from the district collectors and a separate assessment was not needed.

Constraints

Health information is still incomplete for various reasons. There is further a lack of availability of reliable demographic, health and nutritional baseline data.

The cold chain is non functional. For the general EPI programme including NIDs large quantities of vaccines are known to have been destroyed due to the breakdown of cold chain.

Secondary distribution is still a major problem even in areas which are accessible by road. For example one NGO reported that while large stocks were observed at a district facility an acute shortage of medical supplies were observed at the lower levels in the districts. In one village ORS was being sold for 10 Indian rupees (around 25 cents). Many inappropriate ORS brands are reported to be on sale in India and consumption of these can cause diarrhoea.

Humanitarian assistance activities are still somewhat hampered by the destruction of the electric power supply and telecommunication system.

There are still areas which are totally inaccessible except by boat and therefore food drops are continuing. Aerial surveys have been the only way to identify these isolated communities.

Disposal of human bodies according to religious custom is slow due to lack of manpower, fuel and protective clothing. This is having an enormous psychological effects on the population and relief workers. Disposal of animal carcasses is also a huge burden on the relief resources.

A confusion concerning the use of various water-purification materials has been reported. Further conflicting public health educational messages are reported to have caused confusion among the general public.

• The confirmed outbreak of cholera calls for immediate strengthening of the diarrhoeal control programme including urgent strengthening of the health information flow, water quality monitoring, continuous overall monitoring and replenishing of relevant stocks, improvement in secondary distribution and an urgent public educational campaign. Streamlining of information and educational messages is essential.

• Water purification tablets and essential drugs (in spite of large amount of supplies being distributed there are still reports of shortages). Water quality monitoring and purification programmes need urgent strengthening.

• Due to overcrowding, low vaccination coverage and a reported outbreak an urgent measles vaccination campaign should take place.

• Distribution of the (available but not yet distributed) State case management guidelines should be done immediately along with standard public information and educational material.

• The immediate replacement of vaccination stocks along with the restoration of the cold chain.

• Household food security, quality of the food basket and nutritional monitoring are essential.

• The availability of essential medical supplies need to be monitored and the provision of supplies related to specific programmes such as reproductive health need to be secured.

• The installation of an emergency surveillance system, strengthening of diagnostic facilities and rapid response capacity.

• Psycho-social programmes need to be established as soon as possible.

 Medium term

• Based on thorough assessment, a detailed plan for restoration of the health services needs to be implemented. Programmes such as Mother and Child Health Care (MCH), Expanded Programme on Immunisation (EPI), control of Tuberculosis (TB) need to be restored. Strengthening of the health system linked to the Role Back Malaria (RBM) programme should be considered.

• The restoration and strengthening of the health information system.

• The most essential health infrastructure which does not need immediate rehabilitation needs to be restored based on the detailed assessment of damages.

• The continuation of food security and nutritional monitoring.

• The improvement of water systems at village level and establishment of community based water maintenance systems. Water quality monitoring.

• Sanitation programmes

Long term

Long-term international assistance would aim at the restoration of basic social services, putting in place effective prevention, preparedness and response mechanisms, and creating a basis for sustainable development. Proposed assistance activities would include:

• Elaboration and implementation of a coastal area development plan.

• Study and advice on future sustainable development of the region.

• Aid in developing economic activities in the affected areas.

• Capacity-building in the affected areas.

• Continued restoration of essential health programmes including nutritional monitoring and the restoration and rehabilitation of services

• Disaster preparedness programmes including cyclone shelters and community based cyclone early warning systems

• Strengthening of the system for demographic and health statistics

• Contingency planning for water and sanitation.

• Environmental rehabilitation.

• Reforestation activities.

• Capacities for a better cyclone prediction and early warning.

 WHO proposed activities:

Four areas related to health have been identified as priority areas in which WHO should be supporting the local authorities:

• Co-ordination, along with UNICEF of the health assistance between local authorities, local NGOs and international NGOs (there are already around 20 international agencies involved in health and many new arriving).

• In co-ordination with the health authorities, other UN agencies, local and international NGOs, the establishment of an emergency surveillance system. This includes collection, compiling, analysis and mapping of health information and ensuring the use of these for managing the emergency response. Providing resources to the local health authorities to ensure the surveillance system is restored and diagnostic and curative health sector has the equipment and supplies needed.

• Ensuring that the humanitarian health assistance is implemented in line with international standards including WHO standards. An emergency library kit is on its way along with stocks of guidelines which are being requested by agencies from WHO.

• Systematic assessment of health sector damage and recommendation for emergency repair and supply of priority equipment and supplies.

 Proposed use of the USD 50 000 provided by RD

Objective:

The objective is to assist the health authorities in Orissa to prevent an outbreak of epidemics, manage the health relief operation and restore most the essential health system.

• Hire a public health professional (locally if possible) to co-ordinate and implement the activities mentioned below (3-6 months) .

• Hire a secretary/administrator (secretarial work, hotel bookings, air-tickets, appointments etc driver (and eventually a translator).

• Set up an office which can accommodate three people with phone/fax, computers and copy facilities.

• Mobilise SEARO, HQ staff and consultants (epidemiologist, health systems specialists, laboratory specialists etc) to support the professional (mentioned above) to implement the above mentioned activities.

• To purchase laboratory equipment and supplies as required by the local authorities.

Conclusion

The devastation caused be the cyclones to health infrastructure, systems and programme is such the WHO should, within the framework of UN assistance, offer special assistance to the health authorities in Orissa. The WHO India office should discuss these proposed activities with the National MOHFW while the WHO focal point within the UN mission in Orissa should discuss the proposed activities within the UN and with the State health authorities. All available resources within WHO should be used to ensure that resources which will become available from the international community are directed towards the health sector in a sustainable way which will leave the state of Orissa with a stronger health system for the future.

Annex 3

Emergency Epidemiological Surveillance System in the cyclone affected areas in Orissa

 Background

 Following the two cyclones which hit Orissa in October 1999 outbreak of communicable diseases with potential public health threat has been a major concern. Prior to the emergency the health information system is reported to have had serious shortcomings. Already outbreak of Cholera has been confirmed and measles have been reported. However, these reports are ad hoc and there is no system currently working for the surveillance of communicable diseases. Following emergencies of the scale that hit Orissa the system used to monitor the health of the population in normal times can not been used to detect outbreaks quickly and take appropriate action urgently. The Emergency Surveillance system needs to be reliable and efficient. A subgroup on Epidemiological Surveillance composed of local authorities, local NGO umbrella agency, MSF and WHO has worked out a system which could be set up very rapidly but resources are scarce.

 Objectives of the Emergency Epidemiological Surveillance

 Short term:

• To describe the trends of major communicable disease, by time, place and person’s characteristics

• To provide early warning of outbreaks for immediate epidemiological control action

• To ensure that the health system in Orissa has the means to collect and transport and diagnose communicable diseases.

 Longer term:

• Strengthen the health surveillance system in Orissa

• Strengthen laboratory services in Orissa

• The subgroup on Epidemiological surveillance obtains agreement from the Health Secretary of State (HSS) to implement the system in the governmental sector (The health secretary already agrees that the system will be used by local and international NGOs

• Hire a full time epidemiologist to manage the project

• Mobilize the 4 trained WHO polio surveillance officers and 20 sites to assist in setting up the system (to be cleared with EPI SEARO)

• Introduction and orientation of the system to all users using existing orientation packages.

• Material support (registry, formats, paper, pens etc (the system will only be computerized at state level but block level information will be available)).

Responsibility for implementation

The local health authorities, MSF, ODMM and WHO jointly

Resources needed

 The local health system has limited capacity to address the issue of emergency surveillance. MSF has an epidemiologist in the field and WHO has limited resources (USD 50 000) to address four priority areas (Health co-ordination, Emergency surveillance system, ensuring international standards in the humanitarian assistance and health system damage assessment). WHO will give priority to the Emergency Surveillance. However, given the size of the area and number of institutions which need to be involved additional resources are needed. A very rough cost estimation is as follows (this needs to be confirmed):

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