December 14, 2005
In Bagh and Mansehra, Doctors Without Borders/Médecins Sans Frontières (MSF) supports district hospitals disrupted by the earthquake. The organization's field hospitals there focus primarily on surgery, emergencies, and intensive care with a view toward enabling other departments of the district hospitals (pediatrics, maternity, etc.) to start functioning again.
MSF teams are ensuring primary health care in areas where Pakistani health facilities were severely damaged, and are following up on the situation in tented settlements where survivors have gathered. MSF teams carry out an average of one thousand consultations every day in 12 permanent sites. The teams are discovering that poor living conditions—rather than the earthquake itself—are causing increasing numbers of pathologies.
To avoid possible outbreaks of disease, MSF is vaccinating children against measles and polio, and the wounded against tetanus. The organization continues to provide mental health support to traumatized victims.
MSF is also improving hygiene conditions in settlements housing internally displaced people (IDP), and is addressing water supply issues in several additional locations.
Distribution of relief goods (non-food items):
MSF has now completed distribution of 10,876 family tents, 14,445 construction kits—including iron sheets, plastic sheeting and construction tools (see sidebar)—and 139,437 blankets to earthquake survivors in remote areas of Pakistani Kashmir and in the country's North West Frontier Province. Relief items such as cooking kits (13,141) and hygiene kits (31,882) have also been distributed. Distributions will continue over the coming weeks, in order to ensure that families have adequate shelter for the winter.
Staff and material:
More than 120 international staff, including doctors, nurses, surgeons, psychologists, social workers, logisticians, and water and sanitation experts, together with over 350 local staff, are working in MSF's earthquake relief operations in Pakistan. The organization has already brought more than 1,115 tons of relief goods into Pakistan, including medical items (emergency medical kits, drugs, surgical material, dressings, plaster, dialysis machines, high-protein food, oral rehydration solution, etc.), logistical material (especially water and sanitation material such as tanks, pumps, and water treatment units) and shelter (tents, blankets, and sleeping mats). Additional relief items, such as hygiene, cooking, and construction kits, are being purchased locally.
DETAILS OF THE OPERATIONS IN PAKISTAN
Bagh district (452,531 inhabitants):
In Bagh town, MSF has set up a tented medical facility outside the compound of the collapsed district hospital. MSF's structure, made up of 25 tents, includes an operation theater, laboratory, delivery room, intensive care unit, emergency room and an approximately 40-bed in-patient department.. MSF's primary activity in the hospital is surgery. MSF has agreed with Pakistan's ministry of health to set up as soon as possible a more permanent 50-bed hospital.
Health Centers are working well, receiving patients presenting general pathologies and treating many people with scabies and skin infections.
Permanent outpatient facilities are operating in Bagh town, Bir Pani, Mallot and Chikhar. In each of these locations, 50 to 100 consultations are carried out each day. Mobile medical teams regularly travel to the village of Paniali, close to Bagh town, to follow up the situation in IDP settlements there.
Pakistan's health ministry, together with UNICEF, has completed a measles vaccination campaign covering the entire Bagh district.
Beginning in the next few days, mobile clinics will move from Chikar and Mallot and a health centre in Bheidi–with a doctor, nurse, gynecologist, and a small surgery unit–will begin serving 23,000 people facing isolation by winter snows. Muzaffarabad district (894,364 inhabitants):
The organization has set up permanent outpatient facilities for consultations, vaccinations and referrals in the villages of Saidpur, Hattian, Lamnian, and Chakmukam (near Lipa). Teams travel to the surrounding settlements by foot or by car. In each location, 50 to 150 consultations, including measles and tetanus vaccinations, are carried out every day.
Mobile clinics are now operating in Charakpura, Therian, Jhandgran and Timi Bhana A permanent clinic is running in one of the IDP sites of Muzaffarabad town and a mobile team follows up the situation in other settlements of the city. A pediatric ward has also been opened in Hattian, and a permanent clinic is functioning in one of the IDP settlements of the locality. A mobile medical team also performs outreach activities by car in the environs of Muzaffarabad. Rapid transport in Muzaffarabad district is facilitated by the use of two MSF helicopters.
The MSF team in Mansehra continues to provide care for patients injured by the earthquake. Many were operated upon in poor conditions with little or no post-operative care, leading to infections and additional surgery. Of these patients, 80 are currently hospitalized in the MSF field hospital set up over one month ago for trauma patients. MSF is also identifying patients residing in camps around Mansehra, Balakot, Atar Sheesha and Gari Habibullah, in order to transfer those requiring further care. Teams are also distributing relief items to the displaced population.
Medical villages have been created in Mansehra town to discharge patients no longer in need of hospitalization but who still require regular follow up.
Field Hospital set up for Surgery, emergencies and in-patient facilities
The field hospital, composed of nine inflatable tents, serves as the main orthopedic referral centre for the wounded in Mansehra district. The hospital houses four operation theaters, an intensive care unit and an emergency room. There are also 5 hospitalization wards with a capacity of 120 beds.
The MSF surgical team, together with Pakistani hospital staff, carry out an average of 20 interventions per day, 80% of them related to earthquake-associated wounds. Between November 24 and December10, 251 surgical interventions were conducted on earthquake survivors, of which 159 were major orthopedic operations.
The teams are also working in the new intensive care unit and the emergency room. Between December 5 to 10, 300 patients were admitted into intensive care. In the same week, 680 patients were treated in the emergency room, of which 224 required surgical interventions. An MSF physiotherapist, together with a team of Pakistani volunteers, carries out rehabilitative care for post-operative patients. A total of 750 patients are currently receiving physiotherapy treatment in the hospital and the medical villages. An MSF psychologist team carries out support for traumatized earthquake survivors.
Additionally, a temporary out-patient department for the district hospital has been established, as well as a laundry room. MSF has also begun restoring the x-ray room and the internal medical wards of the district hospital. Patients are now being admitted into the gynecological-obstetric wards and the pediatric ward of the district hospital. These wards had not been functional since the earthquake as a result of overcrowding by wounded patients.
Medical Villages to discharge Patients
In association with local organizations, MSF has begun installing medical villages in Mansehra town, each with the capacity to accommodate 25 families. Patients from Mansehra hospital who no longer require hospitalization but who cannot return home are transferred to these medical villages. Four such villages are already functional . MSF provides the tents, water and sanitation equipment, as well as blankets, hygiene kits and cooking sets. Patients who decide to return home are provided with relief kits consisting of tents, blankets, cooking sets and hygiene sets. An MSF physiotherapist, psychologist and doctor conduct follow-up consultations with patients.
Transfer of patients and distribution of relief items in makeshift camps
Approximately 100,000 people who have lost their homes and have traveled down from mountainous areas, are settled in hundreds of camps around Mansehra, Balakot, Atar Sheesha and Gary Habibulah. The camps, with varying living conditions, range in size from 25 to 5,000 people. MSF is distributing relief items based on identified need. Kerosene heaters will be distributed to 12,000 families to help them cope during the winter months. Patients in need of specialized orthopedic care are being transferred to the MSF hospital in Mansehra. In the past ten days 111 patients have been identified for transfer.
Mental health support:
MSF continues to provide mental health care to hundreds of traumatized victims in Muzaffarabad, Mansehra and Bagh districts:
– In Muzaffarabad district, mental health teams, including international and national staff, are working in the IDP sites of Hattian and Muzaffarabad town.
– In Bagh district, a mental health team of two psychologists provides psychosocial support to patients treated in MSF outpatient and inpatient facilities, and to their relatives. Community sessions, with the help of local social workers, are also organized.
– In Mansehra, an international volunteer and two Pakistani psychologists are working with hospital patients in a consultation tent.
Distribution of relief goods:
MSF is currently distributing family tents, plastic sheeting, construction kits, blankets and hygiene and cooking kits to thousands of affected people in Bagh, Muzaffarabad, and Mansehra districts:
– In Muzaffarabad District, 8,639 tents and more than 45,788 blankets have been distributed around the district capital and in the areas of Lamnian, Kai Manja, Hattian and Panjgran. In addition, 5,214 cooking kits and 23,568 hygiene kits have been distributed. In Panjgran, distribution by helicopter is still hampered by irregular flight schedules.
– In Bagh District, 63,657 blankets and 7,502 construction kits–including iron sheets, tools and plastic sheeting–together with cooking and hygiene kits, have been distributed in the Badhal, Bedi and Dharray regions.
– In Mansehra District, MSF teams have carried out an assessment of tented and makeshift camps to identify families still in need of relief items. So far, MSF has distributed 360 tarpaulins, 47 new tents (to replace inadequate ones), 35,475 blankets, 460 cooking sets and 1,178 hygiene kits.
Water and sanitation:
In Muzaffarabad, MSF is following up closely on hygiene conditions in several IDP sites. Water bladders have been set up, 700 latrines installed, and hundreds of hygiene kits distributed in ten tented settlements. MSF is also supporting two water-truck points with chlorination capabilities.
In Hattian, MSF ensures water supply to the hospital and performs water and sanitation activities for the town. MSF has also set up water supply and sanitation facilities for Bagh and Mansehra district hospitals.
Several water supply ramps have been installed in Bagh town and water and sanitation facilities have been established in the town's IDP sites. In Bir Pani, MSF is supervising operations to repair the village's water supply system. Similar activities have begun in Mallot.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)