CPRC: STRATEGY, SUPPORT & COORDINATION
IN THE RECENT FLOODS DISASTER
LOKMAN HAKIM S, PhD, FASc
DEPUTY DIRECTOR OF HEALTH (PUBLIC HEALTH)
MINISTRY OF HEALTH (MOH) MALAYSIA
11th MOH-AMM Scientific Meeting Incorporating the 18th NIH Scientific
and Annual National Ethics Seminar
12 August 2015
Numbers and Types of Natural Disasters, 1950-2012
(Source: EM-DAT International Disaster Database, Centre for Research on the Epidemiology of Disasters, University of Louvain)
Malaysia: Flood risk
3
MAJOR FLOODS IN MALAYSIA
Year
Incidence
Property, Material, Crop or other losses
USD
Deaths
1926
Flood known as ‘The storm forest
flood’
Thousands of hectares of forest
destroyed
NA
1970-1971
Floods in Kelantan, Terengganu,
Pahang, Perak, Kelang, Gombak
243,00 victims
61
December
1996
Floods brought by Tropical Storm
Greg in Keningau (Sabah)
300 million
241
2000
Floods caused by heavy rains in
Kelantan & Terengganu
Millions
15
December
2004
Asian Tsunami
Millions
68
December
2006 &
January 2007
Floods in Johor state
489 million
18
2008
Floods in Johor state
21.19 million
28
2010
Floods in Kedah & Perlis
8.48 million (Aid alone)
4
Source:
Adopted & adapted from
Chan, N. W. (2012),
‘Impacts of Disasters and
Disasters Risk
Management in
Malaysia:
The Case of Floods’, in
Sawada, Y. and S. Oum
(eds.), Economic and
Welfare Impacts
of Disasters in East Asia
and Policy Responses.
ERIA Research Project
Report 2011-8,
Jakarta: ERIA. pp.503551.
Functional Model of Public Health’s Roles in
Disaster Management
• Before a disaster
(preparedness phase);
• During a disaster (response
phase);
• After a disaster
(reconstruction phase).
Source: Noji EK, The public health consequences of disasters. Prehospital and Disaster Medicine. 15(4): 147-157. 2000
CRISIS PREPAREDNESS AND RESPONSE CENTRE
(CPRC), MINISTRY OF HEALTH (MOH)
• Established under the 9th Malaysia Plan (2005-2010)
• Operates daily from 8.00 am till 5.00 pm
• Officers will be on call after 5.00 pm
• Operates in Passive Surveillance mode daily for DOCE
• Operates in Active Surveillance Mode for identified DOCE
 Director of Disease Control or
 Deputy Director General of Health (Public Health) or
 Director-General of Health
CPRC: RESPONDING TO FLOOD AS A DISASTER
A) Pre Flood Preparedness:
o Operational room identification & maintenance of equipments at CPRC
o Planning of on call rosters and information gathering on respective
players
o Evaluation of suitability of relief centres
o Preparedness of healthcare facilities in terms of logistics, man power
and medicines
o Dissemination of health advisory to the general public
o Dissemination of information on MOH’s preparedness to NSC
CPRC: RESPONDING TO FLOOD AS A DISASTER (cont.)
B) During Floods Response
o Activation of Operational Room
o Liase with NSC according to Order 20 (NSC)
o Ensuring of alternative logistics for medical facility is available and functioning
in the event the facility is faced with floods
o Ensuring all the preparedness plans are in placed and functioning
o Monitoring of evacuees at relief centres – communicable and noncommunicable diseases, food and water borne diseases
o Coordinate the movements of medical staff to affected areas if the need arises
o Placement of medical teams at relief centres
o Ensuring clean water, clean toilets, hygienic food preparation, health
education at relief centres
o Daily preparation of flood report
CPRC: RESPONDING TO FLOOD AS A DISASTER (cont.)
C) Post Floods Response
o Conduct post flood impact assessment on the affected area /
village
o Health monitoring of the public/victims
o Preventive measures to prevent infectious diseases
o Final report preparation
“THE ROUTINE FLOOD MANAGEMENT”
CPRC FUNCTION AND COORDINATION
NATIONAL CPRC
STATE CPRC
DISTRICT CPRC
DISASTER STRIKED: 2014/2015 YELLOW FLOOD
• 2014 flood was the worst experienced by Malaysia, associated with:
o 25 deaths
o 541,896 victims, 2,076 houses destroyed, 6,698 houses damaged
o Estimated RM 2.85 billion public property damages
o 168 government healthcare facilities affected with estimated RM 380 million damages
• Water level were 5-10 m above floodplain
• Among the worst hit areas were Kuala Krai, Manik Urai and Dabong in
Kelantan
• Greatest impact due to flood water content – mud, debris and sand (Prof. Dr.
Zulkifli Yusof, UTM)
Chronology
CPRC: RECENT FLOOD RESPONSE
• Flood Management Committee was formed
• Meetings held twice daily
• Activation of National CPRC on 21 November 2014
• Operates daily from 8.00 am till 10.00 pm
• Supported by multiple disciplines involved in floods management at MOH
• A quick checklist was developed for immediate actions to be taken daily
CPRC: RECENT FLOOD RESPONSE (cont.)
• Monitoring of:
 Infectious diseases & non infectious diseases
o
Food poisoning, cholera, leptospirosis, melioidosis, skin infection etc.
o
Dengue, food & water borne diseases, chronic diseases
 Sustainability of healthcare facilities to provide services
 Adequacy of medical supplies to healthcare facilities
 Meteorological updates
 Number of evacuees and relief centres
 Safety of food prepared, drinking water, sanitary facilities and environment
at relief centres
 Daily progress report compilation and dissemination to respective
stakeholders
 Deployment of healthcare workers to affected areas
CPRC RESPOND: CRISIS NO. 1 – BREAKDOWN IN
COMMAND & COMMUNICATION
 NSC dysfunction
 Disruption of Government Integrated Radio Network (GIRN)
 Over congestion or disruption in telecommunication channels
 Resulted in:
•
Uncoordinated and delayed respond
•
difficulty for State CPRC to report the progress to National CPRC
•
difficulty for State CPRC to communicate with respective healthcare facilities under
their jurisdiction
•
difficulty in getting real time information on the flood situation from affected states
•
difficulty in assessing the types of assistance needed
•
difficulty in knowing the whereabouts of affected healthcare workers
•
no clear line of command and inefficient resource management
CPRC RESPOND: CRISIS NO.2 – DISRUPTION IN HEALTH
SERVICES FUNCTIONALITY
• Worst affected – Kuala Krai Hospital, Raja Perempuan Zainab II Hospital ,
Tanah Merah Hospital, Gua Musang Hospital
• Among the problems faced:
a) Disruption in electrical supply
b) Breakdown in communication
c) Land access disruption
d) Dwindling of food supply and clean water supply
e) Diminishing medical supplies (oxygen, blood, medicines) and others
f)
Need for patients transfer
g) Staff were victims and existing staff exhausted
CPRC RESPOND: CRISIS NO. 3 – SEVERE PUBLIC HEALTH
THREATS
• Cramped relief centres and undesignated centres
• Disruption of safe water supplies
• Destruction of waste disposal and sewage systems
• Unprecedented mud flood
 Risk of massive infectious disease outbreak
 Influenza and influenza-like illnesses
 Cholera
 Typhoid
 Amoebiasis
 Leptospirosis
 Melioidiosis
CPRC RESPOND: KEY DECISIONS AND ACTIONS
a). COMMAND AND COMMUNICATION
 Independent from NSC – securing dedicated helicopter, boats, 4WD
 Alternative communication systems
 Deployment of district public health commanders
b) FUNCTIONALITY OF HEALTH SERVICE
 Procurement/donation of portable generators
 Collaboration with USM University Hospital
 Army field hospital
 Deployment of mobile medical and health teams from unaffected
states
 Deployment of staff volunteers
 Evacuation of patients
 Temporary cabin and tents as clinics
CPRC RESPOND: KEY DECISIONS AND ACTIONS
c). ADDRESSING PUBLIC HEALTH THREAT
 Purchased 10 units of Atmospheric Water Generator
(AWG) & 20 units of Airemist Water Dispenser (AWD)
 Coordinated with Singapore Civil Defence for one unit of
AWG & with Puncak Niaga company for one unit of water
filter
 Re-establishing safe rural water supplies – repairing GFS,
construction of tube wells
 Massive chlorination of flooded wells
 Mobile toilets
 PH education and communication – mobilisation of HE
teams
THE LESSONS LEARNED
1)
Self efficient and self sufficient in obtaining logistics to sustain healthcare services
 Hospital power and water supply capacities
2)
Emphasize on sustainable communication channels
3)
Establishment of clear line of command and command centre
 Establishing Central Logistic Common and Supply Centre
4)
Sending of appropriate and coordinated medical relief staffs
 Managing volunteers
 Psychosocial support
5) Identification of flood prone facilities; implementation of appropriate sustainable and mitigation
actions, including investment in new technologies – water supply, tracking system
6) Re-evaluation of flood disaster management protocols to adapt current developments
7) Improvement in communication and collaboration with other stakeholders (NSC, Meteorological
department, etc)
THANK YOU