Pakistan: Update of MSF's response to the floods

Sindh Province

“We are still very worried about potential epidemic outbreaks. All of the elements conducive for this to happen are present – poor sanitation and water supplies and people living in cramped conditions in open camp settings. As the floods recede, malaria, shigella (causing bloody Diarrhea) and acute watery Diarrhea could very well spread among people who are already in a fragile state with limited access to food. Health authorities here have confirmed that there is usually an increase in the number of people who seek medical assistance following Eid, and we are expecting that the health system will be overburdened in the coming days.

“There are about 200 camps in the Sukkur’s urban area, and it is challenging to do active case finding here in order to locate pockets of acutely malnourished children. We expect to find that the malnutrition situation is likely to be similar in the rural areas where we intend to start working next, where people have remained without assistance and largely neglected. As we increase our capacity and move into areas like Larkana, which our teams visited during the weekend, we will get a fuller perspective on how acute the malnutrition emergency really is.”

– Sylvain Groulx
MSF Project Coordinator
Sukkur, northern Sindh.

Hospital Support

Sukkur: A 30-bed capacity Intensive Therapeutic Feeding Center (ITFC) has been established at the Railway Hospital to treat patients suffering from severe acute malnutrition with medical complications. Staff members at the facility are preparing to treat cases of Acute Watery Diarrhea (AWD) and there are plans to support a 30-bed capacity Diarrhea Treatment Center (DTC) in the coming days working alongside the Pakistani Ministry of Health.

Jamshoro: Teams have set up a DTC ready to treat AWD, as well as Oral Rehydration Points (ORPs) to offer treatment for dehydrated patients.

Mobile Clinics

Sukkur: An MSF team continues to conduct mobile clinic consultations and assessments in various camps for the displaced in and around the town of Sukkur. The MSF team in Sukkur has also set up 20 ORPs where health promoters and nurses can rehydrate patients suffering from Diarrhea, assess their condition, and refer them to the DTC if required. These teams are providing hygiene education services to community members and also distributing soap among the displaced people in camps. The team continues to screen children for malnutrition and provide ready-to-use therapeutic food (RUTF) on an outpatient basis to moderately malnourished children who present minimal or no medical complications. In Sukkur, a total of 232 severely malnourished children have been treated and 42 referred to the ITFC, while 552 consultations were conducted during mobile clinic activities.

Jamshoro: MSF teams working in the New Labour camp, Sehwan, Amri, and Manzoorabad have conducted a total of 1,754 consultations so far. This includes nutritional assessments through Mid-Upper Arm Circumference (MUAC) screenings of all children under the age of five and distributions of high-energy biscuits to pregnant and lactating women.

A total of 2,589 consultations have been conducted through MSF’s mobile clinics in Jamshoro and Sukkur (including consultations at the Sukkur ITFC).

Water Distributions

Sukkur: 40,000 liters of clean drinking water is being provided daily through water trucks, tanks, and bladders. An MSF-run water treatment unit in the town has the capacity to produce 80,000 liters of safe water each day.

Jamshoro: Every day 10,000 people have access to 240,000 liters of chlorinated water provided by the MSF team, while the capacity will increase in the coming days in order to support more people arriving. ORPs are also being set up at the Liaquat University of Medical and Health Science.

Relief Kits

MSF teams have distributed 1,532 relief item kits and 668 tents in Jamshoro and Sukkur since the beginning of the emergency.

Jamshoro: A total 464 families in the New Labour IDP camp received relief item kits.

Sukkur: 668 tents have been distributed to affected families who were without shelter and 1,068 families have received relief kits.

Next Steps

Larkana (south of Sukkur): MSF will open a 22-bed capacity DTC and 14-bed ITFC in the coming days to cater for people previously without assistance.

Sukkur: MSF is aiming to increase the amount of water distributed to at least 80,000 liters per day through the water treatment unit. Relief item distributions will also be ramped up to cover temporary settlements in schools, a vital activity because people sheltering there will soon have to move on before schools re-open later this month.

Jamshoro: While health promotion activities are set to continue the teams will distribute at least 2,000 tents and 2,000 relief item kits. As operations expand, the amount of water distributed will increase to more than 250,000 liters per day. Assessments of general hygiene, water and sanitation conditions in the north of Jamshoro will continue and the project team is considering opening a DTC, should the need arise.  MSF teams will continue cleaning and disinfecting services in buildings where flood-displaced people seek shelter, while the installation of hand-washing points and soap distributions will continue.

Punjab

"In Kot Addu, although the number of consultations at our DTC has decreased significantly, we still maintain Oral Rehydration Salt Points in order to prevent an outbreak of Diarrhea. The findings of our assessments in and surrounding Kot Addu have sparked concern about the malnutrition situation. We have started MUAC screenings for children under five years-old and we are ready to open a ward to treat malnutrition if there is a need.

– Jean Hereu
MSF Emergency Coordinator
Khyber Pakhtunkhwa and Punjab

Hospital Support

MSF supports one hospital in the Muzaffargarh district with the following activities:

Kot Addu: MSF operates a 70-bed capacity DTC, water and sanitation services and medical teams treat, on average, more than 150 patients per day with about 40 patients hospitalized per day. Medical teams have treated a total of 2,039 patients since 21 August 2010. Patients are provided with relief item kits when they are discharged.

In the second week of September, MSF opened an outpatient department in Sheikh Mukhtar, treating on average about 50 patients per day.

In addition to setting up ORPs in Ehsan Pur and next to Deira Din Panah, MSF distributed 200 relief item kits to affected families and the team plans to further assess the needs for more ORPs.

Next Steps

The team plans to distribute relief item kits and tents to 5,000 families who have not received any assistance and to ensure access to safe water for people in the most affected villages in and around Kot Addu.

Medical teams will start nutritional assessment in and around Kot Addu to better understand the current malnutrition situation and to launch an immediate intervention, if needed.

Balochistan

MSF is conducting emergency activities for the affected population in and around Dera Murad Jamali.

Hospital Support & Mobile Clinics

MSF supports one hospital and runs mobile clinics and activities in several areas:

Teams working in Dera Allah Aye, Qabular, Jafarabad, Nasirabad, Patfeeder Canal, the Dera Murad Jamali town area, and Mir Hassan are treating people suffering from malnutrition and severe malnutrition. The teams also operate a DTC and mother and child healthcare services.

MSF has thus far treated 1,219 patients through its DTC, averaging 58 patients per day. The majority of patients are children under five, many of whom suffer from severe dehydration. MSF has set up 4 ORS corners and has recruited 30 health educators.

MSF has set up a 16-bed capacity IPD to manage severe and acute patients. So far the team has treated 31 patients including severe acute malnutrition patients who required stabilization.

MSF is providing obstetric emergency care for IDPs and the general population of Dera Murad Jamali. Since the start of the floods MSF has done 97 baby deliveries with complications, of which 16 required surgical interventions (Caesarean sections).

MSF has enrolled 1,000 children who are severely malnourished, in therapeutic feeding treatment.

MSF has halted medical mobile clinic activities as other organizations have started to take on this task as well. MSF teams are now focusing on running a nutrition program. This has included a recent rapid nutritional assessment (through MUAC screening) in five camps, the results of which indicated high levels of malnutrition (Severe Acute Malnutrition at 10 percent and Global Acute Malnutrition at 34.3 percent). The malnutrition situation is expected to worsen since IDPs are now starting to move back to where their homes once were, where they are likely to face dire conditions as the services that were provided in the camps may no longer be readily available to them.

On the whole MSF teams have provided more than 8,000 consultations through MSF mobile clinics focusing on nutrition, DTC, MCH and IPD/ITFC.

Relief Kits

MSF conducted relief item kits and tent distributions in the following places:

Dera Murad Jamali Town, Quetta Road, Bakhtribad, Patfeeder Canal, Qabula, Manjoshori, Tambu, Sohbatpur road, and Mir Hassan.

So far, MSF has distributed 6,022 relief item kits and 342 tents to flood-affected displaced people.

Water Distributions

MSF provides access to safe water in Nasirabad:

MSF has started to distribute 74,000 liters of safe water per day and a total of 450,000 liters of water is chlorinated daily.

MSF water and sanitation teams are cleaning some 700,000 liters of water through flocculation and they are planning to expand capacity to reach 2 million liters.

MSF is setting up 150 hand-washing points and has so far completed 30 points.

MSF has built 330 latrines in 3 camps and plans to build at least 650 latrines in total. These latrines will be maintained by MSF to ensure proper use and sanitation.

MSF water and sanitation teams have constructed 70 showers and are planning another 300 showers in other IDP camps in order to improve hygiene conditions and reduce skin diseases. This will benefit approximately 10,000 people living in camps.

Health Care

MSF plans to provide access to high quality health care:

MSF will continue running the DTC, while planning to increase ORS points for displaced people.

MCH teams will continue managing complicated deliveries and postal care.

MSF will continue managing severe acute medical conditions in the IPD, while there are also plans to continue with therapeutic nutrition programs.

Next Steps

Teams working in Dera Murad Jamali and surrounding areas will increase access to health care services while the water distribution will increase in scale. There are also plans to increase the number of tents distributed while more latrines are being constructed.

Khyber Pakhtunkhwa

“[The] situation is improving little by little and communities are recovering. Even though many challenges remain, we can say that we are switching from the first days of emergency to a post-emergency phase now. Our epidemiological data suggests a quite optimistic outlook…”

– Tommaso Fabbri
MSF Peshawar Project Coordinator
Peshawar, Khyber Pakhtunkhwa Province.

MSF teams working in Peshawar, Nowshera, Charsadda, Swat, Malakand, Lower Dir, and Hangu districts are winding down activities directly related to the emergency, although they remain vigilant and prepared in case of epidemic outbreaks. Affected communities are slowly starting to rebuild their lives.

Hospital Support

MSF supports 4 hospitals with the following activities:

• Mingora: Emergency and Observation Room and a DTC.
• Timurgara: ER, OT, and two DTCs.
• Dargai: ER, OT, MCH, IPD services and a DTC.
• Hangu: ER and observation Room, Emergency Operating Theater and 20-bed surgical ward, as well as a DTC.

Mobile Clinics

MSF teams still conduct 7 mobile clinic activities in order to reach people in the following locations:

• Charsadda: Utmanzai, Tarnab, Nisatta, Tangi. The number of patients seen by MSF medical teams conducting mobile clinic services in Swat, Deulay, Shamozi, Parrai, and Khazana has decreased steadily over the last month and mobile clinic activities were halted on September 10.
• Malakand: A total of 624 consultations were conducted in Isar Baba and Kalangi, while the flood-related outreach care activities which started on August 6 have been concluded.
• Lower Dir: Outreach care is still provided to Tawda Cheena and the Summerbagh IDP camp.
• Peshawar: Communities in Wadpaga and Mandrakhel continue to be served with outreach care.

Water Distributions

MSF also provides safe water distributions in the following places:

• Nowshera: A total of 250,000 liters is distributed per day in Nowshera town and Pir Sabak.
• Charsadda: About 90,000 liters is distributed per day in the Hizara, Utmanzai, and Motorway camps.
• Swat: MSF has 20 water trucks which provide 160,000 liters of clean water per day to affected people. In addition MSF has provided 2 million liters of safe water through activities set up at the water treatment unit set up in Mingora.
• Lower Dir: About 8,000 has been distributed at water points set up near the Khazana pass to provide water to people leaving the area. MSF also provided drinking water at District Headquarter (DHQ) hospital and is still engaged in well cleaning services in Timurgara.
• Dargai: MSF has distributed 30,000 liters of water per day in Chakdara, Isar Baba, Jala Lawanan, Kalangi, and Isar Kale using water bladders and tankers, while teams have cleaned five wells.

Relief Kits

MSF has distributed a total of 25,163 relief item kits and 9,534 tents to flood-affected people in the following areas:

• Peshawar: Before distributions were concluded in September 8, 8,575 relief item kits and 6,324 tents were given to people living on side of the Charsadda highway, the Khorasan Afghan Refugee Camp, Jala Beala, Mian Guja, Landi Dozai, Zandai Afghan Refugee camps, and Peshawar schools.
• Charsadda: 4,870 relief item kits have been distributed in the following union councils: MC2 Charsadda, Rajja, Umerzai, Turangzai, Sherpao, Tangi, Mizar Dher, and Tarnab.
• Nowshera: 11,147 relief item kits and 3,210 tents were delivered to people living in Chowki Town, Nawa Kali, Haq Nawaz, Javid, Zara Meina, Daftar, Killi, Akthar Munir, Kafyat, Misri Banda, and Manghan.
• Swat: About 50 relief item kits have been distributed.
• Lower Dir: Relief item kits were distributed in Tawda Cheena.
• Dargai: 466 relief item kits have been distributed to families in Totaka, Isar Baba, Kalangi, , Jala Lawanan, Sanamabad and Batkhela left bank

Next Steps

• Charsadda: Opening a DTC in case of an outbreak.
• Nowshera: Setting up community ORS points, increasing the distribution of safe drinking water, building latrines in IDP settlements if needed, covering gaps in terms of the need for relief item kits and tent distribution services. Opening a DTC in case of an outbreak
• Peshawar: Increasing health promotion activities and distributing of safe water and setting up new water points. Opening a DTC in case of an outbreak and closely monitoring epidemiological data of the district.
• Dir: Maintain the 2 DTCs and outreach care while cleaning services continue at the Taudu China Basic Health Unit.
• Swat: Continuation of activities as reported earlier, but flood response related activities will conclude at the end of September.
• Dargai: More wells will be cleaned around the town, but flood-related activities will also come to an end by 30 September.

With the number of patients who need Diarrhea treatment decreasing significantly in recent weeks, MSF teams in Khyber Pakhtunkhwa will gradually reduce the number of DTCs and mobile clinic activities.