Health in South-East Asia
Nepal Earthquake 2015: One month later

Two earthquakes struck Nepal on 25 April and 12 May killing over 8000 people and injuring 18 000. Measuring 7.8 and 7.3 on the Richter scale, the earthquakes affected 35 of the country’s 75 districts, 14 of them severely. Twenty six hospitals and over 1100 health facilities were damaged in the earthquakes and 90% of health facilities outside the main towns rendered non-functional.

Responding to the urgent health needs of earthquake-hit Nepal, WHO has been supporting the Government of Nepal for providing medical relief to the nearly 5.6 million affected people,  2.8 million of whom have been displaced, with many still living in shelters fearing the continuing aftershocks and landslides.

Within hours of the earthquake on 25 April, WHO and the Ministry of Health and Population (MOPH), met at the Health Emergency Operations Centre, set up jointly to work in such crisis. WHO immediately sanctioned emergency funds, disbursed emergency medicines and sent in a surge team of experts to strengthen WHO’s support to MOHP.

WHO conducted a rapid needs assessment with MOHP in the worst affected districts, within a week of the disaster, to guide the health response.  Co-chairing the Health Cluster with MOHP, WHO has been coordinating medical relief efforts of 148 partners to reach medical services to the severely affected areas in the most affected districts. WHO is also coordinating deployment of the over 100 Foreign Medical Teams (FMTs) that came into Nepal to support emergency response. 

A month since the devastating earthquake, WHO is now focusing on district response and planning. WHO has stationed District Support Officers in all the 14 highly affected districts, to coordinate response, strengthen disease surveillance, management of services, while prioritizing assessment and outreach efforts to reach remote areas. WHO has strengthened its presence in Sindhupalchok, Gorkha, Nuwakot and Rasuwa – the worst affected among the 14 severely hit districts. The departure of FMTs is being planned with partners and MOHP to avoid gaps in services.

WHO has helped enhance disease surveillance by establishing an early warning response and alert system and surveillance sites in the key districts to collect information on any suspected cases of communicable diseases.

WHO continues to bring in medical supplies including emergency health kits, diarrheal disease kits, maternity kits, surgical kits and medical tents to meet the shortage of essential medicines and revive, even temporarily, primary health care services.

The ongoing priorities are to manage the injured, provide rehabilitation support to those discharged from the hospitals and psychosocial support to the affected population, while ensuring the regular services for maternal and child care, communicable diseases such as TB etc. The challenge is to address all the issues before the approaching rainy season, less than a month away.
From the Regional Director 
WHO stands in solidarity with the people and the Government of Nepal in this crisis.  I am moved by the terrible human impact of the devastating earthquake and truly impressed by the resilience of the people of Nepal to respond so bravely to the earthquake.

The Nepal earthquake has many lessons in emergency preparedness. We have seen how the key hospitals in Kathmandu continued to function despite the devastating earthquakes that rendered over 90% health facilities outside the main towns non-functional. The retrofitting at these hospitals, years of training of staff to handle mass casualties , and implementation of plans to function during disasters, paid off.

WHO has been working closely with a Ministry of Health and population to prepare the country for such a disaster more than a decade. Our pre-positioned essential medicines and medical supplies were made immediately made available. Emergency funds were sanctioned almost immediately - within six hours of the earthquake - to meet the immediate financial needs and fill critical gaps in the aftermath of the disaster.  WHO surge team comprising of its best experts in emergency response coordination, epidemiologists, water and sanitation, risk communication, mental health, maternal and child health etc, from various office across the world, were called in to strengthen WHO support to Nepal. WHO kept partners appraised of the immediate and future needs of the earthquake-hit Nepal to galvanize support.

One month since the 25 April earthquake, we know that the disaster is far from over. With the monsoons fast approaching, there are more challenges ahead - to urgently restore primary health care services, even temporarily, provide water proof medical tents, essential medicines and keep a strict vigil to rapidly respond to any disease outbreak.

As the media attention fades away, this is the time for WHO and partners to stand with Nepal and help the country build back a more resilient health system. We are committed to support Nepal's health system to deliver life-saving and essential services to its people and build back resilient health facilities that will be safe in emergencies.

Dr Poonam Khetrapal Singh
Regional Director
Emergency preparedness pays off as Kathmandu hospitals respond to earthquakes

Dr Pradeep Vaidya, director of TUTH’s Trauma Centre and coordinator for the WHO-supported Hospital Preparedness for Emergency Programme in Nepal, says the response to the ‪earthquake by health care providers was resilient because of pre-planning and training initiatives.

“The most helpful part during the earthquake response was the hospital emergency preparedness plan. People knew what to do, where to meet and how things will flow when the earthquake happened,” he said. “The roster management system worked well.”

Because of the training, when large number of injured patients began to arrive, the emergency responders could quickly prioritize the injuries and save lives.

Though the devastation caused by the earthquakes is enormous, the strength of the retrofitted health facilities and the quick response of the health workers show that investment in preparedness pays off.
Full story: Emergency preparedness pays off as Kathmandu hospitals respond to earthquakes
SEARHEF emergency funds reach Nepal within 24 hours
After the mega disaster in 2004 when massive tsunami waves struck multiple countries in the WHO South-East Asia Region, WHO and Member States together set up the South-East Asia Regional Health Emergency Fund (SEARHEF) to meet the surge of needs in the first few days following an emergency. The SEARHEF, proven to be a rapidly mobilized resource, was immediately made available to Nepal, approved within six hours and released within 24 hours of the earthquake on 25 April 2015.

“The earthquake struck at noon, and within two hours, I was in the Ministry of Health and Population. The Health Minister requested for the release of SEARHEF. I made a phone call to the Regional Director, and the first tranche of US$ 175 000 SEARHEF funds was approved within six hours of the earthquake. This kind of fast-track mechanism to help Member States by releasing funds within the first 24 hours of a disaster helps countries with their immediate response,” WHO Representative to Nepal, Dr Lin Aung, said.
Full story: SEARHEF emergency funds reach Nepal within 24 hours
Retrofitting hospitals
On 25 April 2015, when the 7.9 magnitude earthquake struck Nepal, Kathmandu’s Tribhuvan University Teaching Hospital withstood the impact. No one was injured in the hospital. The furniture, beds and equipment stayed in position and nothing was damaged. The hospital had undergone retrofitting with WHO support in 2014.

At the Tribhuvan University hospital non-structural retrofitting that was done included fastening equipment and shelves to the wall, as well as securing water and power sources. Retrofitting is hence an important initiative. WHO has been strongly advocating Member States to make health facilities resilient.

Hospitals must prepare to prevent becoming victim to a disaster long before an emergency strikes. This functioning hospital was able to provide care for thousands of mass casualties.
Full story: Retrofitting hospitals
Triage – prioritizing the seriously injured
Preparedness to respond to emergencies proves its worth when disaster strikes. On 25 April when the earthquake struck, Dr Rasila Amatya, Medical Superintendent from Dhading District,in Nepal and her colleagues rushed to hospitals and health posts in the district.

As a flood of patients began pouring in, many with multiple fractures, spinal cord and head injuries, the situation was quite overwhelming. However, Dr Amatya was able to provide leadership to coordinate the triage efforts. 

“I knew that in a post- disaster situation, unless a coordinated triage effort is maintained, the seriously sick can easily be overlooked and be left neglected queuing up behind the less seriously sick. Triage allows patients to be segregated according to the seriousness and urgency of their injuries. As I had been given a Triage management training some months ago, organized by WHO and the Ministry of Health and Population of Nepal, thankfully I could oversee the efforts of the health teams to ensure that the seriously injured received priority attention”. 
Full story: Triage – prioritizing the seriously injured
WHO flags spinal care as critical medical gap, long-term health need of Nepal
When Nepal’s devastating April 25 earthquake hit, Nanda Thami was safe. The forty-two year-old resident of Phopa Chaku, a small village in Dolakha district east of Kathmandu, was in an open space, away from the mud-brick structures dotted throughout his village.

Nanda rushed into the house to rescue his five-year-old son Gopal who was still inside the family house as the earthquake’s aftershocks continued with terrifying frequency. While the boy was saved with only minor injuries, Nanda bore the brunt of the family home structure as it collapsed. 

Nanda now lies in a bed in the foyer of Bir Trauma Centre, Kathmandu’s primary critical care provider, and cannot move from the shoulders down. His head remains in a fixed position.

“Treatment, proper handling and care of those injured are essential to prevent future disabilities,” said Damodar Adhikari, Programme Manager at WHO Nepal Earthquake Response, adding, “If people are not properly cared for, spinal cord injuries could lead to paralysis.”

According to Dr Roderico Ofrin, WHO’s Overall Health Response Manager in Nepal, spinal care has been identified as a critical medical gap, and is being flagged for funding, reflecting WHO’s long-term commitment to the health and welfare of the Nepalese people. 
Full story: WHO flags spinal care as critical medical gap, long-term health need of Nepal
WHO supports Nepal to set up first sub-national hub at Gorkha, to extend health-care reach after the earthquake
In a major step to boost the health-care assistance to earthquake survivors who have been unreachable since last week’s disaster, the World Health Organization in coordination with the Nepalese government and other humanitarian partners has established a new field office in the Gorkha district of Nepal.

From there, WHO and the national authorities will be able to coordinate land and air support to reach medicines, health care professionals and other life-saving resources to some of the most remote regions impacted by the earthquake.
Full story: WHO supports Nepal to set up first sub-national hub at Gorkha, to extend health-care reach after the earthquake
Psychosocial support a critical need after an emergency
12 year old Nikesh Pahari has been living in a tent with his parents and neighbours. However since the earthquake he has refused to speak or eat and is afraid to go near his house. Psychiatric social workers can help to teach children to slowly normalize, and one such worker from the mobile mental health team taught Nikesh ‘balloon blowing’ breathing technique, which eventually calmed the child, and even coaxed a smile out of him and his friend.

At several temporary clinics set up in the outlying districts of Kathmandu, at least 10% of the 500 or so patients seen daily, report mental health issues , as many survivors are experiencing mental health problems. Many still feel that the earth is moving.
Full story: Psychosocial support a critical need after an emergency
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