CONTEXT. Emergency Sit-Rep Country (and area of intervention): Philippines Date: November 20, 2013 Sit-rep No. 6 Covering period: November 19-20, 2013

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1 SUMMARY: Emergency medical needs are slowing as health efforts begin to refocus on primary health care, reproductive health care, protection, and psychosocial support. Relief agencies have not reached all of the affected areas; efforts are hindered by logistical challenges and lack of access. The UN states that resources are dwindling and less than 1/3 rd of requested support has been provided. CONTEXT Photo: International Medical Corps Pranav Shetty cares for an elderly patient in a village off the coast of Guiuan. The death toll from Super Typhoon Yolanda has climbed to 3,982 as of 6am yesterday, according to the National Disaster Risk Reduction and Management Council (NDRRMC). The NDRRMC said Yolanda left at least 18,557 persons injured while 1,602 others remain missing. There are 393,116 people in 1,595 evacuation centers, and another 4,007,633 displaced people outside of evacuation centers. Overcrowding is still an issue in centers, especially in the Astrodome evacuation center and the San Jose Elementary School in Tacloban City, which are hosting over 10,000 people. With hundreds of thousands unable to return to their homes and without the support of their communities, displacement has become a serious issue for women, children, elderly, and disabled, exposing them to extreme weather and threats from a deteriorated security environment. Access and logistics are improving, most airports and roads have opened up, but operations in Tacloban Airport are still limited. There is a lack of adequate storage facilities in many of the affected areas, including Roxas City, Guiuan, and Ormac. There are still power outages experienced in some provinces and municipalities in the affected areas, including Capiz Province, Tacloban, and much of Leyte. The municipality of Barbaza, Antique, and some cities in Capiz and Iloilo still do not have water supplies, but the water supply in Leyte is reported to be sufficient as of November 15. Additionally in Leyte, all municipalities in the province are now accessible. 146 roads have been repaired and cleared of debris in MIMAROPA, Bicol, and Eastern, Central, and Western Visayas. Phone networks have been restored in 85 percent of the three worst affected regions in Central, Eastern, and Western Visayas. 1

2 Given that access and logistics conditions have improved, relief efforts from all actors have scaled up substantially. All residents in Tacloban now have access to clean drinking water and hygiene kits are being distributed, preventing the outbreak of water-borne disease. The government continues to encourage humanitarian actors to extend focus from the urban areas to the rural and remote barangays, especially in Western Visayas region. The UN reports that only 1/3 rd of their funding appeal has been fulfilled and current resources are dwindling. This could seriously impact that sustainability of projects and recovery of the affected communities. HUMANITARIAN As logistics and access to the affected areas have improved in the second week after Typhoon Haiyan, the government of the Philippines, relief groups, and other national governments have been able to assess most of the needs of the affected areas while providing direct assistance and care. Local Assessments Cebu: Electricity is limited and communications are unstable. Over 14,000 people have been impacted, and all necessities are needed. Department of Public Works and Highways has dispatched personnel for clearing in Cebu City. They are conducting on-going clearing cleaning, and repair of damaged infrastructure. The DOH has established an advanced action center in Cebu and is providing vaccinations, medical consultations, and psychosocial services to the affected areas. Samar/Leyte: Access to all 40 municipalities is now open. UNHCR has distributed NFIs to 7,000 people in Tacloban and Tanauan. Nearly 2 million individual rations of rice and high-energy biscuits were distributed. People continue to move away from the worst affected regions, increasing the number of IDPs. Tanauan: The city recently ordered an additional 1,000 cadaver bags for corpses. There are food shortages because of the lack of fuel and trucks, even though there is rice stocked in government warehouses. The mayor estimates that 1,200 people died in Tanauan, and 800 more are missing. Tacloban: Tacloban airport operations are still limited, creating a bottleneck for supplies. Businesses are currently reopening. Almost every building in the city has been damaged or destroyed by the Typhoon, and electricity is limited to generator support. There is still no running water. Government officials have stated that relief agencies need to move outside of Tacloban to provide relief for more rural and isolated populations. Guiuan: Many homes were destroyed by strong winds. Most families with damaged homes are beginning to repair the dwellings while those with completely destroyed homes are staying in schools and evacuation centers. Priority needs include kitchen kits, sleeping mats, mosquito nets, blankets, and tarpaulins. 2

3 Ormoc: Officials estimated 97% of homes have suffered damage to roofs. Panay Island: Based on reports from the rapid assessment conducted by SC, the eastern coast of the island was hardest hit, stretching from the eastern part of Capiz province, including Roxas City, to the northern part of Iloilo province. Electricity remains down in across all affected areas. However, roads are clear, facilitating transport between main cities and villages. The coastline was affected by both the strong winds and the storm surge, causing significant damage to the towns and villages along the shore. Due to the destruction caused to housing, and the loss of livelihoods through damaged boats, the smaller barangays are most in need. In addition, damage to boats have left inhabitants on the smaller islands stranded, with no access to the mainland for water or food. Apart from in Roxas city, the water supply to much of the island remains interrupted as a result of the power loss, leaving most of the population with limited access to drinking water. Iloilo Province: Most of the health facilities in Balasan, Sara, Bagacai, Estancia and San Dionisio in Iloilo province have been completely destroyed. Capiz/Roxas City: There are 3 key priority needs within Capiz food, water and shelter. Water remains a concern within the area as the lack of electricity prevents the pumping stations from functioning. The storm has caused significant damage to many of the clinics and health centers, which are now in need of rehabilitation. As a result, much of the population remains in need of medical services, both for treatment of injuries caused by the storm, as well as basic primary care. HEALTH OCHA reports that of the 2,495 health facilities in the affected area, 115 (mostly hospitals) have been assessed and 41% (47 facilities) are not functioning. The Department of Health chief has announced plans for rebuilding or rehabilitating destroyed or damaged health facilities. His statement included an appeal to private sector and NGOs to offer resources and personnel to address gaps in infrastructure, equipment, and staffing. DSWD estimated that 233,697 pregnant women and 155,798 lactating women are affected and are in need of reproductive health services. Of the 89,785 people in evacuation centers, it is estimated that 7,973 are pregnant and 4,716 are lactating. There continues to be a need for basic and essential health care services, including routing surgical capacity. Reproductive health kits are needed throughout the most affected areas. Reports from the Department of health indicate that the top morbidities encountered by their teams who have been providing services at hospitals in Ormoc, Tacloban, Villamor, and more include punctured and lacerated wounds, 2) URTI 3) Acute and asthmatic bronchitis, hypertension, and diarrhea. However, it is becoming more apparent that primary medical needs are shifting away from 3

4 trauma and towards the provision of primary health care, including maternal and child health, and management of chronic disease. Immunization campaigns are underway by the DoH in order to reduce the risk of outbreaks, including measles, polio and vitamin A supplementation. In some of the worst hit areas, this is a particular threat, as current coverage rates for children are approximately 20%. This is a particular concern, especially as disease tracking is hindered as a result of poor communication networks. The current unmet need for psychosocial support services is also an every growing concern. WHO highlights principal health issues as follows: wounds and injuries as result of the storm; lack of food water, sanitation and hygiene facilities and related food and water-borne illnesses; problems associated with pregnancy and childbirth; respiratory infections; measles and potential polio; malnutrition, especially in infants and young children; mental health and psychosocial conditions; leptospirosis; vector-borne diseases; and, sexually transmitted diseases. WASH International Medical Corps assessments have found there are still many communities without access to safe water. These communities need chlorination of water sources and provision of water kits. Debris in the roadways continues to hamper distribution efforts, and water trucking is limited due to a shortage of fuel and trucks. Additionally, continual rain is slowing logistics efforts. The Department of Health has begun to focus on public health as threats of epidemics increase in communities without access to safe water and/or poor or inadequate sanitation or vector control. Current WASH actors are focusing on the provision of safe water, but sanitation gaps also must be addressed. FOOD/NUTRITION With an estimated 2.5 million people in need of food assistance and hundreds of thousands of hectares of crops destroyed or damaged, there is an increasing focus on responding to immediate food needs as well as medium- and long-term planting/harvesting needs. Farmers need rice seeds immediately, as they are time-bound to the cropping calendar. Additionally, the markets in Tacloban City have been severely impacted by the food shortage and most households rely on food assistance. In addition, 1/3 of children are estimated to suffer from malnutrition in the hardest hit areas. Malnutrition continues to be a major concern, and delivery of supplies is still slow. Most markets are generally functioning, but there is a lack of saltwater fish as most fishermen s supplies (boats, nets, etc.) were destroyed by the Typhoon. There are some freshwater fish available. 4

5 Protection An estimated 3.2 million women and 4.6 children affected by the storm are in need of psychosocial support and protection against violence, trafficking, and exploitation. UNFPA has procured 40 sets of display posters with key messages on gender-based violence. However, the number of government social workers who are responding to the emergency is limited. There is a lack of information concerning the number of children at the regional, municipal, and barangay levels. Referral pathways for protection services are also lacking, and local child protection councils are nonfunctional. INTERNATIONAL MEDICAL CORPS RESPONSE International Medical Corps is continuing to provide medical services to outlying communities is some of the worst affected areas. International Medical Corps has been working in partnership with Medical Teams International and AmeriCares, who have provided substantial amounts of medical supplies. Using the mobile medical unit model, International Medical Corps is putting together smaller teams of medical staff who are able to access hard to reach populations, many of which have yet to receive any assistance. While providing direct services, International Medical Corps is conducting WASH, medical and MHPSS assessments to guide program design and allocation of services. These results, in conjunction with secondary information gathered by partners in the field, will ensure that International Medical Corps continues to appropriately address the arising needs of the affected population. The teams have noted that the majority of cases now being treated are no longer trauma or injury arising from the typhoon, but more primary health concerns, including management of chronic illnesses and infections, including respiratory tract infections, in line with emerging reports. In addition, the International Medical Corps team noted that mental health, nutrition interventions, WASH, protection and disaster risk reduction are priority areas to be addressed. International Medical Corps, in partnership with Medical Teams International, travelled to Iloilo in order to provide services within this affected province. In addition assessing damaged health facilities, International Medical Corps met and registered with the Department of Health, who expressed their support for International Medical Corps assistance. International Medical Corps has also arrived in Roxas City, attending the OCHA Cluster Coordination meeting and Health Cluster meeting. The team identified a high level of unmet needs among towns and villages in more inland areas of the province, as the majority of actors are focusing efforts on coastal towns. International Medical Corps is deploying a team of 10 to Roxas City on Thursday November 20 to 5

6 begin to address these needs. By developing a base in Roxas City, International Medical Corps aims to provide much needed services to the surrounding areas through mobile medical units. International Medical Corps has been working closely with Medical Teams International in Guiuan to ensure that medical services are being provided to the injured and ill in the surrounding areas. Following International Medical Corps visit to Homonhon earlier this week, where they were the first actors to provide much needed medical services, the a medical team of 3 will be returning to ensure that all issues were addressed, and to follow up on cases requiring referrals and further treatment. International Medical Corps is deploying an initial medical team to Tacloban on Thursday to begin providing medical services to the outlying communities surrounding the city. Despite the saturation of NGOs that has occurred in Tacloban City, surrounding rural communities have received very little assistance. Included in the team is a mental health and psychosocial support advisor in order to assess the needs, and better integrate necessary services into the ongoing programs. Following the direct request from the Department of Health, International Medical Corps is providing primary care services at 6 evacuation centers in Cebu, for up to 1000 people. The cases treated have included acute respiratory infection, gastro-intestinal problems, and minor wounds. In order to address the psychosocial needs of those residing in the evacuation center, International Medical Corps will be providing psychological first aid training to the center staff. International Medical Corps is planning to send a medical team, including 3 local volunteer nurses, to provide services to those in need on the Island of Coron, Busuaga and Culion in Palawan. Further information regarding the needs, access and available resources are being gathered to ensure a wellexecuted mission. In conjunction with the delivery of medical services, International Medical Corps will identify and address WASH needs as relevant for each location. Based on the results from International Medical Corps WASH assessment, these expected activities will include providing WASH support to temporary health structures, distributing hygiene and water kits and improve the availability of water through repairs to distribution systems and treatment of water sources. International Medical Corps is working to address the MHPSS needs of the affected populations aiming to integrating mental health services with primary care. This will include providing psychological first aid training to local staff, helping to strengthen local capacity. 6

7 Annex 1: International Medical Corps Interventions Maya Bahoshy ERU Officer Rabih Torbay VP, International Operations Chessa Latifi Senior Resource Development Officer 7