Addressing health challenges in the aftermath of Typhoon Pablo
Typhoon Pablo is one of the most destructive typhoons that hit the Philippines in 2012. The widespread damage to affected areas is considered the most devastating for a region that has never been affected by such extreme disaster in many years. The typhoon also hit a vulnerable population that lives in remote areas affected by armed conflict and civil unrest.
To date, there are at least 1067 deaths, 2666 injured, and 834 still missing. Of the 342 unidentified remains, majority are in Compostela Valley province while most of the 834 missing are from New Bataan, Compostela Valley and General Santos City.
As of 25 December 2012, the total population affected by the typhoon reached 711 682 families (6 243 998 persons) in 318 municipalities (40 cities/34 provinces) in Regions 4B, 6, 7, 8, 9, 10, 11, 12, Caraga and Autonomous Region in Muslim Mindanao. The number of evacuation centres increased from 63 to 87, mostly in Compostela Vally, Agusan del Sur, and Surigao del Sur, but housing lesser number of families at 3011 or 13 940 persons. The National Disaster Risk Reduction and Management Council Situation Report No. 38 on 25 December 2012 reveals that affected families living outside evacuation centres number 223 486 or 959 267 persons.
Some 1.1 million individuals, including at least 163 000 children under age five are suffering from inadequate health service delivery due to the 83 completely damaged and 253 partially damaged health facilities in the Region XI provinces of Davao del Norte, Davao Oriental and Compostela Valley, as well as directly affected medical personnel.
Reporting of epidemic-prone diseases
The Surveillance in Post Extreme Emergencies and Disasters (SPEED), a mobile-based early warning system, was activated by the Department of Health (DOH) and the entire health sector to detect common health conditions in an emergency. The SPEED system was developed by the DOH and with the technical guidance of the World Health Organization (WHO).
Based on SPEED data, top consultations in the communities affected by the typhoon are acute respiratory infections, fever, skin disease, acute watery diarrhoea and open wounds and bruises. There have also been a number of consultations for suspected measles, suspected leptospirosis, acute asthmatic attack, known diabetes mellitus, and high blood pressure. To date, the SPEED system reports have come in from Compostela, Monkayo, Montevista, and New Bataan in Compostela Valley; Baganga, Boston, and Cateel in Davao Oriental; and Lingig in Surigao del Sur.
SPEED reports alerted the Regional Epidemiology Surveillance Unit (RESU) of DOH Center for Health and Development (CHD) XI and the National Epidemiology Centre (NEC) who immediately deployed teams to conduct further epidemiologic investigation. Programme managers and implementers were also dispatched to conduct measles immunization, vitamin A supplementation, health promotion and to provide support to local health staff.
The SPEED system, however, faces many challenges such as disrupted power sources and communication in many of the areas affecting effective SPEED reporting coverage. The limited manpower on-the-ground and the high turnover of medical practitioners who work in the health units affect the consistency of reporting and the quality of information collected.
Immediate Health Challenges Post-Disaster
As in any major disaster, Typhoon Pablo resulted in a significant loss of lives. It also caused serious ill-health directly to people and communities affected by the typhoon. Further damage could affect public health through the disruption of health systems, facilities and services, leaving many without access to health care. The typhoon also affected basic infrastructure such as water supplies and safe shelter which are essential for health.
To date, there are 336 damaged health facilities in Davao del Norte, Davao Oriental and Compostela Valley provinces, according to the DOH. Only 63% of the damaged health facilities remain functional. In Agusan del Sur and Surigao del Sur provinces, 11 health facilities are damaged.
The Provincial Health Office of Davao Oriental reported that 54 Barangay Health Stations in Baganga (17), Boston (8), Caraga (14) and Cateel (15) were damaged and rendered non-functional, with 95% of medical equipment unserviceable. This makes access to reproductive health services very difficult.
Many typhoon-affected pregnant and lactating women lack access to reproductive health services, and youth and adolescents in affected municipalities need improved awareness for early and teen pregnancy and sexually transmitted infections.
Weeks after the typhoon, many displaced communities are still sheltered in evacuation centres while others have started to rebuild their homes. Communicable diseases are a major cause of mortality and morbidity in disaster situations, particularly, where there is:
- population displacement;
- collapsing health services;
- lack of disease control programmes;
- poor access to health care;
- malnutrition;
- interrupted supplies and logistics; and
- poor coordination among agencies.
The risk of communicable diseases is further aggravated by the size and characteristics of the affected population specifically: the amount and availability of safe water; functioning latrines; nutritional status of the displaced population; level of immunity to vaccine-preventable diseases such as measles; and level of access to health care services.
The current situation can potentially increase the transmission of water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis A; vector-borne diseases, such as dengue and other diseases associated with displacement of people, overcrowding and improper waste management.
Communities affected by a disaster often lack basic water and sanitation facilities. They are likely to be traumatized and vulnerable to disease. Disruption of familiar practices or the relocation to new environments can result in deterioration in existing hygiene behaviours. This, in turn, will contribute to an increased risk of disease transmission and epidemics.
Continuing Challenges for Health Response in Post-Pablo Emergency Situation
A strong health information system is crucial to an effective health emergency response in order to detect trends in diseases and provision of health services. The information system is facing problems in accessing accurate data coming from the most affected communities due to lack of access and limited functionality of the communication systems. Telecommunications and accessibility issues continue to hamper disease surveillance.
In addition to an effective information system, a well-functioning health system is essential to save lives and respond to the magnitude of people who need care. As health cluster lead agencies, WHO and DOH are leading the heath sector response efforts. However, damaged, non-functional health facilities, and health workers who are also victims of the disaster continue to hamper health service delivery. Coordination of humanitarian response is a continuing challenge.
Strong coordination with and among international and local partners is vital. WHO and DOH have been working with other health agencies and NGOs in coordinating the health sector response to the affected communities, even through holiday season in order to provide services without any interruption.
For more information, please contact:
Dr Woojin Lew
WHO Representative to the Philippines
Telephone: +632 528 9767
E-mail: leww@wpro.who.int