January 11, 2006
After several weeks of dry weather, the start of severe winter weather brought sleet and icy rain to Muzaffarabad, Bagh, and Mansehra districts and up to five feet of snow at higher altitudes. Many roads were blocked by landslides and snow. In some places, road access will be difficult or impossible in the coming weeks and months. Therefore Doctors Without Borders/Médecins Sans Frontières (MSF) will continue to use helicopters in certain areas (especially Muzaffarabad and Bagh districts) to transport staff and relief items, and to refer severe patients to hospitals at lower altitudes.
Due to the stormy weather large numbers of tents are leaking or collapsed under the weight of the falling snow, exposing the population even more to the cold, rain, mud, and snow. Inadequate shelter in the more remote regions can result in more displacement as people seek better conditions in the camps in the valleys, increasing pressure on already insufficient facilities.
Though MSF teams have not yet seen any severe health complications related to the precarious living conditions, there is fear that this can rapidly change in the weeks to come.
MSF's medical activities continued as normal in Muzaffarabad and Mansehra, but have been slowed down in Bagh district due to health centers not being accessible anymore (to staff and patients). Main pathologies observed remain similar to previous weeks: diarrhea, respiratory infections or skin infections. Medical teams are now visiting the tented camps to provide medical support when needed.
In Mansehra, surgical activities continue but fewer cases are related to the earthquake. MSF also provides physiotherapy in medical villages and other places across the district.
In Bagh and in Muzaffarabad district, plastic sheeting distributions were organized to support people with inadequate shelters in the tented camps. In Mansehra and Muzaffarabad, MSF is continuing large scale distributions including tents, blankets, shelter kits, and kerosene heaters.
In Bagh, Mansehra, and Muzaffarabad, mental health activities are still going on and it is foreseen that needs may increase with living conditions getting worse.
Water-and-sanitation activities are also ongoing and will be crucial as living conditions may induce illnesses. MSF teams will monitor closely the impact of the weather on health issues.
The number of patients with trauma directly related to the earthquake is now very small. But with the onset of winter health concerns in the IDP camps and at higher altitudes continue to grow. MSF has not yet seen a major increase in the number patients or deaths directly related to the climatic conditions. Still the potential for a health crisis remains high because of the cold weather and the poor sanitation and crowded conditions in the IDP camps. In some areas at the moment, referrals of critically ill patients are only possible by helicopter.
In Muzaffarabad district, the number of medical consultations has remained stable at about 2,700 per week, with most patients suffering from diarrhea, respiratory infections, or skin infections. In Hattian, MSF has started to build a temporary hospital in cooperation with the Ministry of Health; it is expected to be operational by mid-January. In Lamnian, 900 children were vaccinated after a suspected measles case shortly before the start of snowfall. In Leepa, one severe patient was referred by helicopter, but three more were snowed in before transport could be organized.
In Bagh town, the tent hospital (replacing the destroyed district hospital) continues to function well. Some of the tents had to be reinforced, but sustained no damage as a result of the snowfall. The first containers for the future hospital have arrived in Islamabad and will soon be shipped to Bagh.
The health center located near the MSF compound is still functioning. The number of consultations have increased after a huge drop during the first day of rain and snow. The remote health centers of Malot, Bir Pani, and Chikar could not be reached by the MSF teams for a few days due to blocked roads, but the road conditions are improving.
In Bhedi–a isolated area high in the mountains where MSF opened a health center that serves more than 23,000 people–the health center suffered some severe setbacks as part of the temporary structure collapsed under the weight of the five feet of snowfall that came down over a 36-hour period. A rotation of the team took place with the aim to repair the damage to the base. Consultations continued with 39 patients on Thursday, January 5.
In general, the snowfall could prevent the population from gaining access to many of the MSF-run and -supported facilities, and the teams are paying close attention to this issue.
In the Mansehra field hospital, 500 surgical interventions have been carried out since its opening on November 24. Now most interventions are for the cleaning of infected wounds. MSF medical personnel have also been visiting the makeshift camps on the Mansehra- Balakot route, in order to identify the wounded people who require transfer to the hospital. So far, 100 people have been identified for transfer.
In the emergency room, MSF teams together with Pakistani hospital staff carry out an average of 1,200 consultations per week. Every day, an average of 10 patients needing intensive medical care are stabilized in the field hospital and then referred to the main hospital in Abbottabad, as the internal medical wards of the Mansehra district hospital are still not functional.
An MSF physiotherapist, together with a team of Pakistani volunteers, carries out rehabilitative care for hospitalized post-surgical patients. A physiotherapy center has also been opened in Balakot in order to provide follow up to many of the wounded who came from this area.
In association with local organizations, MSF has installed three medical villages inside Mansehra town, with a capacity to accommodate 25 families each. Patients who no longer require hospitalization and who cannot go back home, but still require medical follow up, are transferred to the medical villages. An MSF physiotherapist, psychologist, and physician continue to check on the patients.
MSF is now replacing the tents in the medical villages with semi permanent structures which are more resistant to the weather.
The deteriorating conditions of course do little to improve the mental health of the population, traumatized by the earthquake and the continuing aftershocks (the last being felt on December 29). In Muzaffarabad mental health counseling is continuing. In Lamnian, MSF has initiated an assessment of mental health needs and training of national staff.
In Mansehra district, a team of three psychologists provides care for patients suffering from trauma following the earthquake. Four hundred patients have been followed up since October. Currently two hundred patients in the hospital and medical villages receive psychological care.
Non-Food Items Distribution
With the recent harsh weather conditions, distributions of plastic sheeting were organized in camps in the districts for people with inadequate shelters. Some 5,000 to 7,500 people received sheeting in near Bagh and another 5,000 kits were distributed in the district of Muzaffarabad district where about 80 percent of tents are not winterized.
In Bagh large scale distributions ended on December 31, 2005. In total, 83,220 blankets and 8,321 construction kits–including iron sheets, tools and plastic sheeting–together with cooking and hygiene kits have been distributed. More than 61,000 people in the district have benefited from the distributions.
In Muzaffarabad and Mansehra, large-scale distributions continue. On the Mansehra- Balakot route relief items for 13,974 families (92,994 people) living in makeshift settlements were distributed. The items are adapted to specific needs, but range from blankets to cooking pots, to soap, jerry cans, and to tarpaulins and tents.
In Muzaffarabad district, thus far MSF has distributed 11,400 tents, 58,000 blankets, and 34,400 hygiene kits.
Additionally, heaters are also being distributed in order to help the people cope with the cold temperatures (1 heater and 40 liters of kerosene per family). Some 12,259 displaced families have been targeted for this distribution, so far 6,250 families have received heaters.
Water, Sanitation, and Hygiene Assistance
In Muzaffarabad, MSF is closely monitoring the hygiene conditions in several IDP sites. Water bladders have been set up, 900 latrines installed, and hundreds of hygiene kits distributed in ten tented settlements.
Due to the rain and snow and the rocky soil, some latrines were flooded and collapsed. During the winter months maintenance will demand a large share of attention and resources. Also in the town of Muzaffarabad, MSF supports two areas where 360,000 liters of chlorinated water are distributed daily.
Nineteen hygiene promoters have been trained and operate in eleven camps in Muzaffarabad; 2,838 tent-to-tent visits were undertaken (13,400 individuals reached). Activities include "cleanliness drive" with prizes for children who collect garbage and bucket distributions for pour-and-flush latrines.
In Bagh, teams had to interrupt their work for a few days because of the weather. Until then, several water supply ramps had been installed in Bagh town and water- and-sanitation facilities established in IDP sites of the city and in many villages and camps around Bagh, Mallot, Bir Pani, and Chikar. In many of those places, the teams are supervising the operations to repair the water-supply system. MSF also installed more than 380 latrines for an estimated population of 12,000. In camps, MSF's approach combines hygiene promotion with water-and-sanitation work. Special attention is given to women and children by promoting regular hand washing, specific awareness about infectious diseases and safe disposal of human excrement.
Water-and-sanitation facilities have been provided in the medical villages set up in Mansehra, as well as in Mansehra District Hospital.
The MSF teams are currently concentrating on providing sanitation facilities for the displaced living in 22 makeshift camps on the Mansehra — Balakot road. A total of 150 latrines have been constructed so far. Additionally, the water supply in 11 camps has been rehabilitated.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)