WHO RELIEF MISSION TO GUJARAT (INDIA) EARTHQUAKE
Update February 26th – March 11th 2001
1.
General Highlights

Frequent aftershocks are still felt in Kutch District. The most severe aftershock
measured 5,1 on the Richter Scale.

With the end of the acute emergency phase, the number of national and
international organizations working in the earthquake areas is declining. Only
agencies involved in restoration and rehabilitation continue to be present.

With the normalization of the relief activities, responsibility of the General
Coordination has been reversed to the District Magistrate and Collector, Kutch
District from the special relief coordinator, Government of Gujarat.

Field level “Health sector coordination mechanism” has also been established at
Bachau and Anjar besides Bhuj under the leadership of the health sector nodal
officer of the Government of Gujarat, facilitated by WHO officials. The
coordination forum has facilitated sharing of facilities amongst agencies for the
general benefits of the population.

The 140 Health Sub Centers and 37 Primary Health Centers are functioning. Tents
and equipment have been provided by national and international NGOs.

Five Community Health Centers are functioning.

The IFRC Hospital in Bhuj is functioning as referral hospital where the
Government of Gujarat is providing most of the manpower. The District Hospital,
Government of Gujarat which collapsed in the earthquake, has been relocated in
pre-fabricated structure and is mainly providing outpatient service.

WHO's lead in monitoring of quality of “Water supply” has been established.

Human waste & solid waste disposal and sanitation still remain the area of
concern.

Shelter issue has become one of the most important issues for the survivors
though the Government of Gujarat has announced the various housing schemes
2.
WHO activities in the earthquake affected areas of Gujarat
A.
Health Sector Coordination

Field level Health Sector Coordination meetings are held weekly in Bhuj, Bachau
and Anjar, by Health Sector Nodal Officer Government of Gujarat, facilitated by
WHO

UNICEF is lead agency for “Mental Health sub-group”

The Indian NGO PNR Bhavnagar is lead agency for “Prosthesis and
Rehabilitation sub-group”

IFRC is lead agency for “Hospital sub-group”

OXFAM is lead agency for “Health Promotion sub-group”

Abhiyan (a local NGO) is lead agency for the sub-group in “Restoration and
Rehabilitation of Health Infrastructure”

Number of attendants in last week health coordination meetings were: Bhuj 36 ,
Anjar 16 and Bachau 30.

Health Coordination forums are important in solving local problems as lack of
water, electricity, equipment etc.

SCF distributes a weekly updated list of health facilities, restoration status and
responsible agencies

A nutritional survey is carried out by WFP in cooperation with other agencies, the
report will be finalized on 26th March

Number of amputees post earthquake is unknown, Government of Gujarat is
advertising in newspapers for registration of Handicap Certificate. 46 patients
have so far received prosthesis in Ghandidham.

Postoperative cases need to be identified in the community for rehabilitation and
follow up at Sub Health Centers or by Mobile Clinics
B.

Disease Surveillance
Disease surveillance system is well established by standardized daily surveillance
system collected in the five most affected (urban and rural) areas of the district.
All PHCs, CHCs, State Dispensaries, Mobile Clinics, Field Teams, Hospitals and
private sector are reporting to District Surveillance Unit. This will contribute to
field epidemiological data for: case detection, outbreak detection, trend
monitoring, priority setting, resource targeting, development of information,
system for analyses and presentation of surveillance data.

No diseases of epidemic potential have been identified during reporting period.

Most common diseases are conjunctivitis 10 %, acute respiratory infections 6%,
fever of unknown origin 5%, infected wounds 5% and uncomplicated diarrhoea
4%.

More diseases of chronicle character and pre earthquake diagnoses are seen at
referral level

Nodal Officers and five WHO/UNV Surveillance Officers are supervising and
monitoring the data collection. Standardized case definition guidelines have been
developed.

Mobile Field Teams have decreased from 450 post earthquake to 90 this week.
These teams are deployed by the state to provide public health and clinical care, as
well as serving as reporting units of epidemiological data from villages.

Cold chain is restored in most of the affected PHCs and CHCs and routine
immunization services are established. A special campaign of TT for pregnant
women will start from 19th March.
C.
Water, Sanitation and Environmental Health

A national WHO consultant on water supply, sanitation and water quality has been
recruited to work together with the Kutch District Water Quality Laboratory,
Collector for Kutch and agencies within the area of water and sanitation.

WHO is one of the designated lead agencies in the water and sanitation subgroups
dealing with (1) water quality and (2) sanitation. OXFAM is the overall
coordinator of the external organizations working with water and sanitation

Most damaged structures for water supply has been repaired by the Gujarat Water
Supply and Sewerage Board (GWSSB) with assistance from external agencies.
Water supply needs are generally met.

WHO is supporting the GWSSB in restoring laboratory capabilities and in
establishing a comprehensive program of water quality surveillance in Kutch
District.

Sanitation in urban areas as Bhuj is a problem the sewerage system has been
damaged and the problem is compounded by poor municipal trash collection.

Sanitation in rural areas has always been a major problem in India. Sanitation
improvement is not readily accepted by people in rural areas and the communities
might not have been involved in the planning and implementation of sanitation
programs by different agencies

Various proposals for improvement of the improvement of sanitation are under
consideration
RECOMMENDATIONS
1. Ensure adequate sanitation facilities in urban areas through prompt reestablishment
of existing sewerage systems or provision of temporary latrines as bridging solution.
2. Facilitate initiatives that support health promotion and education, especially in rural
areas.
3. Encourage systematic collection and disposal of solid waste particularly in urban
areas.
4. Prepare and disseminate public information on personal hygiene through available
mass media and mobile speakers in villages.
5. Continue verification of water chlorinating at end user level through provision of
Chloroscopes to surveillance medical officers and sanitary staff on mobile health
teams and private medical doctors
6. Support the restoration of the Kutch District Health Laboratory.
7. Intensity epidemic preparedness with dissemination of case management guidelines
for communicable diseases with epidemic potential, as well as outbreak investigation
protocol.
8. Reestablish a continuos routine EPI program.
9. Reestablish routine communicable disease control programs especially for malaria
and TB.
10. Provide a health coordinator to support the District Health Office for the next six
months.
11. Conduct refresher training on standardized case management of common illnesses
for PHC staff.
12. Follow up field survey and program of mental health needs among disaster survivors
proposed by IFRC.
13. Continue development of state capacity for material resources management with
attention to commodity warehousing and medical logistics.
14. Compile lessons learned from Orissa cyclone and Kutch earthquake in support of
state surveillance capacity building.
15. Assign a disaster epidemiologist to strengthen communication links with local and
state health authorities in support of future contingency planning.
16. Emphasize affordable earthquake-resistant building standards during reconstruction
of health facilities.
17. Encourage inter-sector disaster preparedness within state government.