Executive Summary
On 17-18 October 1999, 5 districts of the State of Orissa in India were hit by a cyclone, and on 29 October another, exceptionally strong cyclone (“supercyclone”) devastated a large portion of the State. This second cyclone caused severe damage in 14 of the 30 districts of Orissa (5 being hit for the second time (See map 1). It is estimated that up to 15 million people (more than 2 million households) are seriously affected by the cyclone one way or another. The official number of deaths is reported to be nearly 10,000 and many more are feared to have died.
Millions of people are left homeless. The affected villages consist mostly of simple huts, which were severely damaged or totally destroyed. Usually people keep at home stocks of food and seeds. These have been destroyed along with people’s essential household items. Water, power supply and telecommunications were completely disrupted in all affected areas. 90-100 % loss of crop is reported in the affected districts. Due to large-scale inundation, there is a widespread contamination of drinking water sources. Sanitation conditions are seriously inadequate particularly in the urban slum areas but also in the rural areas.
A large proportion of the population will depend on food-aid for the months to come, and the food security of many households is severely endangered on a long-term basis. Assets such as boats and tree plantations, which will take many years to restore, have been lost. Signs of migration out of the affected districts have already been reported. The household food security and people’s nutritional status need be closely monitored to ensure that further deterioration of nutritional status does not make the population, especially children, even more vulnerable to infectious diseases. The consensus within the international and bilateral community is that food assistance for a month would be required for approximately 2.25 million people.
Outbreak and eventual epidemics of communicable diseases with a potential public health threat has been, and continues to be, a major concern. Prior to the emergency, the health information system is reported to have had serious shortcomings. Already an outbreak of cholera has been confirmed and an outbreak of measles has been reported. Outbreaks of vector borne diseases such as malaria (which is endemic) and Japanese encephalitis are possible. However, reports are ad hoc and there is no adequate system currently working for the surveillance of communicable diseases.
In spite of intense efforts by the authorities, UNICEF, local and international NGOs to restore and ensure the safety of the various water sources, including tanked water, rejuvenation of wells, drilling of new wells, supply of hand pumps, tests conducted on these are showing an alarming rate of dangerous contamination. Even some of the boreholes assumed to be safe have been reported to be dangerously contaminated.
The damage to shelter is extensive. In the worst affected districts over 70% of the shelter is reported to be completed destroyed and in other districts about 40-50% of the shelter is completed destroyed. Winter is coming and the nights getting cooler. Overcrowding in available buildings is expected to increase the transmission of communicable diseases such as acute respiratory infections (ARI), especially among children, and skin disease. Without proper case management ARI can lead to large numbers of deaths especially among malnourished children. An outbreak of measles is already reported from a village of around 10,000 people who claim there has not been any vaccination programme there for the last two years. If not addressed urgently a major outbreak and potential epidemic could occur given the vaccination coverage for measles was around 60% prior to the disaster. Two rounds of vitamin A have been give to all children aged 1 to 3 ½ years old this year: the last one 24th October was with polio vaccination during the National Immunisation Day (NID). The second NID will probably not take place on schedule.
Health infrastructure has been seriously damaged and support to the health authorities to restore key institutions, systems and programmes is urgent. A large quantity of vaccines are known to have been lost due to the breakdown in the cold chain caused by a lack of electricity. Samples from the state store have been sent for testing. If they prove to be damaged the whole state stock will need to be destroyed and millions of dollars worth of vaccine will need to be replaced.
Although supplies including stocks of medical supplies are reported to be adequate at state level, reports from the field indicate that there are serious problems of secondary distribution to lower levels of the health services.
WHO has been part of the UNDMT response mechanism right from the beginning. EHA, WHO, SEARO joined the UNDAF assessment team to Orissa and conducted the initial rapid health sector assessment and provided inputs into the UN appeal. WHO has chaired the daily co-ordination meetings where the local health, water and sanitation people, UN agencies, local and international NGOs and donors meet and share information and plan urgent actions (see annex 1 for list of participants). A management sheet (sample in annex 2) was maintained daily and used for monitoring. A rough mapping system was established to monitor gaps and overlaps and GIS mapping has been initiated to further improve this mapping.
A subgroup on Epidemiological Surveillance composed of local authorities, a local NGO umbrella agency, MSF and WHO has worked out a system which will be used by the NGOs. The system will be set up very rapidly within the governmental sector and the SSH has agreed. WHO and MSF have proposed support and DFID has been approach for funding (Annex 3). OXFAM has developed and co-ordinated agencies’ input into a village level rapid assessment tool. Many questions are health related and a mechanism has been set up to compile and analyse these. Orissa Disaster Mitigation Mission (ODMM) a local NGO umbrella organization will be in charge of this task.
WHO has provided other technical assistance to the health authorities throughout the initial disaster period. Guidelines on the management of ARI, diarrhoeal diseases (including cholera guidelines) and acute malnutrition have been provided. One of the major issues has been the disposal of dead human bodies and animal carcasses. WHO stressed that, although very psychologically disturbing, there was no evidence in the literature that outbreaks of epidemics caused by dead bodies are likely.
WHO along with UNICEF also recommended an urgent measles vaccination campaign as soon as the cold chain is restored. The restoration should be done as a matter of urgency. International NGOs have been asked to help.
A nutritionist from WHO, HQ joined the team to assist with the WHO operation and to begin to address the issues of nutrition, which have been neglected, as the priority has been to get any food available to the affected population.
The state health authorities had prepared for the cholera outbreak by prepositioning the relevant stocks. They rapidly responded to the cholera outbreak by informing all health professionals down to the lowest administrative levels about the outbreak, about outbreak control and case management guidelines.
The Supply and Management system (SUMA) for managing disaster supplies was proposed and would have been useful. However it was not felt by various players that it was needed. A subgroup on logistics has been formed in order to look further into how to improve the secondary distribution.
WHO also proposed an urgent rapid assessment of the immediate structural and equipment damages.
Recommended immediate actions
The confirmed outbreak of cholera calls for immediate strengthening of the diarrhoeal control programme including urgent strengthening of the health information flow, water quality monitoring, continuous overall monitoring and replenishing of relevant stocks, improvement in secondary distribution and an urgent public educational campaign.
Water purification tablets and essential drugs (in spite of large amount of supplies being distributed, there are still reports of shortages). Water quality monitoring and purification programmes need urgent strengthening.
Due to overcrowding, low coverage and a reported outbreak an urgent measles vaccination campaign should take place.
Distribution of the (available but not yet distributed) State case management guidelines should be done immediately along with standard public information and educational material.
Immediate replacement of vaccination stocks along with the restoration of the cold chain.
Household food security, quality of the food basket and nutritional monitoring are essential.
The availability of essential medical supplies need to be monitored and provision of supplies related to specific programmes such as reproductive health need to be secured.
Installation of an emergency surveillance system and the strengthening of diagnostic facilities and rapid response capacity.
Four areas related to health have been identified as priority areas where WHO should be supporting the local authorities:
Co-ordination, along with UNICEF of the health assistance between local authorities, local NGOs and international NGOs (there are already around 20 international agencies involved in health and many new arriving).
In co-ordination with the health authorities, other UN agencies, local and international NGOs, establish an emergency surveillance system. This includes the collection, compilation, analysis and mapping of health information and ensuring the use of these for managing the emergency response. Provide resources to the local health authorities to ensure the surveillance system is restored and the diagnostic and curative health sector has the equipment and supplies needed.
Ensure that the humanitarian health assistance is implemented in line with international standards including WHO standards. Emergency library kit is on its way along with a stock of guidelines which are being requested by agencies from WHO.
Systematic assessment of health sector damage and recommendation for emergency repair and supply of priority equipment and supplies.
General situation
On 17-18 October 1999, 5 districts of the State of Orissa in India were hit by a cyclone, and on 29 October another, exceptionally strong cyclone (“supercyclone”) devastated a large portion of the State. This second cyclone caused severe damage in 14 of the 30 districts of Orissa (5 being hit for the second time). Each district is divided into some 20 blocks and in a block there can be hundreds of villages. It is estimated that up to 15 million people (more than 2 million households) are seriously affected by the cyclone one way or another. The official number of deaths is reported to be nearly 8000 and many more are feared to have died.
Orissa has a total population of nearly 35 million people. In normal times, of these, 60% live below the poverty level. Almost 90% of the population live in rural areas. More than 50% of the children below the age of 4 are suffering from malnutrition. Nearly 90% have access to safe water, but only 4% have sanitation. Health statistics are reported to be incomplete. However, under 5 mortality and maternal mortality is reported to be high and measles vaccination coverage around 60%. Cholera and Malaria are endemic.
The most severely affected districts are Balasore, Bhadrak, Cuttack, Ganjam, Jagatsinghapur, Jajpur and Kendrapara (total population: around 11 million people) The districts of Khurda, Puri, Nayagarh, Gajapati, Keonjhar, Mayurbhang and Dhenkanal are partly affected, between 30% and 50% (total population: 7 million). It is understood that up to 15 million people could be seriously affected by this disaster. Most of this population are living below the poverty level.
A devastating combination of two cyclones has produced three different types of impact
(See Annex 1):
1) physical destruction directly caused to the cyclone
2) flooding
3) saline inundation
Millions of people are left homeless. The affected villages consist mostly of simple huts, which have been severely damaged or totally destroyed. Usually people keep at home stocks of food and seeds. These have been destroyed along with people’s essential household items. Whole communities are reported to be in a state of shock. Human deaths, casualties, animal loss, the destruction of plantations, paddy fields, sugarcane, vegetable crop, etc., and the destruction of infrastructure are devastating. Water, power supply and telecommunications were completely disrupted in all affected areas. Although these are being restored, many human settlements are still left without electricity and consequently water systems can not be restored. Water-logging inundation is significant. 90-100 % loss of crop is reported in the affected districts, as the cyclones hit at the most vulnerable time for the paddy crop. The autumn crop is the one the poorest of the poor depend on the most because it is rainfed (as opposed to richer people who have access to irrigation). The next harvest period would fall in April-May 2000. It should be underlined that the loss of both stored food, seeds and crop is overwhelming, as the harvest was about to take place within 3 weeks. A serious shortage of essential food items in the affected districts continues to be problematic mostly due to logistic problems related to secondary distribution.
Due to large-scale inundation, there is widespread contamination of drinking water sources. Safe drinking water is a serious problem, as electricity is still not restored in many places, many hand pumps are damaged and numerous wells, tanks, ponds and canals are polluted. In 10 cities, water supplies have completely broken down. Over 84,000 tubewells in rural areas have been submerged and rendered non functional. 84 village piped water systems are damaged. Thousands of open traditional dug wells are contaminated and these are difficult to disinfect. Sanitation conditions are seriously inadequate particularly in the urban slum areas but also in the rural areas. The municipality sewerage system has also been extensively damaged. In addition, although water is receding, waterlogging is still a problem.
There are unconfirmed reports on secondary damage of industrial sites, which may lead to serious pollution and negative effects on human health. An ammonium factory in Paradip has confirmed that it is releasing ammonium “in a controlled manner” to avoid an explosion as they do not have enough electricity to keep temperatures at appropriate levels.
Analysis of the situation and its health implications
A large proportion of the population will depend on food-aid for the months to come, and the food security of many households is severely endangered on a long-term basis. Assets such as boats and tree plantations, which will take many years to restore, have been lost. Signs of migration out of the affected districts are already reported. The household food security and people’s nutritional status needs be closely monitored to ensure that further deterioration of nutritional status does not make the population, especially children, even more vulnerable to infectious diseases. The consensus within the international and bilateral community is that the food assistance for a month would be required for approximately 2.25 million people.
Outbreak and eventual epidemics of communicable diseases with a potential public health threat has been, and continues to be, a major concern. Prior to the emergency the health information system is reported to have had serious shortcomings. Already an outbreak of cholera has been confirmed and an outbreak of measles has been reported. Outbreaks of vector borne diseases such as malaria (which is endemic) and Japanese encephalitis are possible. However, reporting is ad hoc and there is no adequate system currently working for the surveillance of communicable diseases.
In spite of intense efforts by the authorities, UNICEF, local and international NGOs to restore and ensure safety of the various water sources, including tanked water, rejuvenation of wells, drilling of new wells, supply of hand pumps, tests conducted on these are showing an alarming rate of dangerous contamination. Even some of the boreholes assumed to be safe have been reported to be dangerously contaminated.
The damage to shelter is extensive. In the worst affected districts over 70% of the shelter is reported to be completed destroyed and in other districts about 40-50% of the shelter is completed destroyed. Winter is coming and the nights getting cooler. Overcrowding in available buildings is expected to increase the transmission of communicable diseases such as acute respiratory infections (ARI), especially among children, and skin disease. Without proper case management ARI can lead to large numbers of deaths especially among malnourished children. An outbreak of measles has already been reported from a village of around 10,000 people who claim there has not been any vaccination programme there for the last two years. If not addressed urgently a major outbreak and potential epidemic could occur given the vaccination coverage for measles was around 60 % prior to the disaster. Two rounds of vitamin A have been given to all children aged 1 to 3½ years old this year: the last one 24th October was with polio vaccination during the National Immunisation Day (NID). The second NID will probably not take place on schedule.
Mental health is already a major concern no-one is dealing with, but the health co-ordination group is aware of the importance of psycho-social programmes and some preliminary plans are being prepared.
Health infrastructure has been seriously damaged and support to the health authorities to restore key institutions, systems and programmes is urgent. A large quantity of vaccines are known to have been lost due to the breakdown in the cold chain caused by a lack of electricity. Samples from the state store have been sent for testing. If they prove to be damaged the whole state stock will need to be destroyed and millions of dollars worth of vaccine will need to be replaced.
Although supplies including stocks of medical supplies are reported to be adequate at state level, reports from the field indicate that there are serious problems of secondary distribution to lower levels of the health service.
