Translated from French

PR/IB 2002-1068.doc1

Translated from French

WORLD HEALTH ORGANIZATION

EMERGENCIES AND HUMANITARIAN ACTION

DEMOCRATIC REPUBLIC OF THE CONGO

GOMA OFFICE, E-DRC

,

END OF MISSION REPORT

Dr Anne Ancia

Emergency coordinator

Goma, E-DRC

15 February – 30 April 2002

World Health OrganizationEnd of mission report

Submitted by: A. Ancia, EHAProgramme classification/EHA

Visit to: Goma

Inclusive travel datesCo-travellers: none

14 February to 14 April 2002

Purpose/objective of travel: To support the WHO EPI-Polio coordinating office in Goma, with coordination of public health in emergencies, following the Nyiragongo volcanic eruption of 17 January 2002.

Brief summary: The eruption of the Nyiragongo volcano, on 17 January 2002, caused considerable damage to the town of Goma, in the east of the Democratic Republic of the Congo. A total of 450 000 people fled, before rapidly returning to find that 14 000 houses, some 13 % of the town, had been submerged in lava or looted. The victims were accommodated by their families or took refuge in makeshift camps. Despite this situation, the immediate public health impact was minimal; an estimated 70 deaths were recorded as a result of the eruption, subsequent looting and the explosion of a petrol station. The incidence of conjunctivitis and of respiratory infections also increased. Immediate and effective reaction from the humanitarian community in Goma to the already existing complex emergency situation averted a catastrophe. Now that the initial phase of the emergency is over, the humanitarian community is attempting to restore living conditions to their pre-eruption state. Sectoral committees are working on this, and WHO is involved in coordinating the health committee. However, Goma is still under threat from abnormal geological and volcanic activity, which is difficult to predict. Surveillance of these phenomena is being boosted, and a contingency plan has been drawn up. WHO is the coordinating agency for emergency preparedness and response in the health sector, in close collaboration with the overall plan. WHO also has a role to play in assessing and forestalling hazards resulting from the volcanic eruption, which was begun by Professor Baxter in March 2002. Lastly, this experience has demonstrated the need for, and ability of, WHO to coordinate emergency preparedness and response in the whole of the eastern RDC, which has been in the grip of a complex emergency for years. All national and international partners, as well as the donors, with whom we have discussed this, fully approve of this idea.

Recommendations/Actions to be taken

1)Follow-up of the coordinating work of the health committee in Goma and active participation in drawing up the contingency plan for response to the threat of a volcanic eruption.

2)Monitoring activities to assess and forestall the risks from the geological and volcanic activities, unique to the Kivu region.

3)Finalization of training on emergency preparedness and response for health workers in the region under threat.

4)Extension of WHO’s public health activities in Goma, with the opening of a permanent emergency preparedness and response post in eastern DRC.

1. Background

Following the volcanic eruption of Mount Nyiragongo, on 17 January 2002, the WHO/EHA Office, in collaboration with the WHO Offices in the Democratic Republic of the Congo (DRC) and Rwanda, conducted a health assessment in Goma and Gisenyi.

One of the principal findings of this assessment was the need for the presence of a WHO-EHA Consultant in eastern DRC able to work jointly with the Epi-Polio Coordination Team already established in Goma. I accepted the post on 27 January 2002 and arrived in Goma on 19 February 2002, after a briefing in Kinshasa.

1. Terms of reference

1. To represent WHO in health-sector coordination functions in support of local health authorities, in collaboration with UN agencies, representatives of NGOs and donors. To act as health sector coordinator.
2. To identify priority health- and nutrition-related issues among the affected population and ensure that these are properly addressed in an integrated primary health care approach that preserves and strengthens the existing health system.
3. To ensure immediate life-saving actions through outbreak response and nutritional interventions.
4. To ensure control of preventable ill health particularly communicable and vaccine-preventable diseases.
5. To ensure that risks to the environment are recognized and properly managed.
6. To ensure good quality access to basic preventive and curative care including essential drugs and vaccinations for all, with special focus on vulnerable groups: the elderly, very young children, pregnant women, the disabled and the chronically ill.
7. To ensure that Humanitarian Health Assistance is in line with international standards and local priorities.
8. To contribute to advocacy efforts for secure humanitarian access, neutrality and protection of health workers, services and health structures as integral parts of health promotion.

1. Humanitarian Situation

The Nyiragongo eruption on 17 January 2002 caused

• A massive exodus of the 450 000 inhabitants of Goma, followed by their rapid return in the days following the eruption.
• The destruction of 12 000 houses and shops in the commercial heart of the city, and to the looting of many others.
• The destruction of three health centres and a 100-bed hospital
• A significant increase in the number of homeless people, the majority of whom sought refuge in makeshift public buildings or with shelter families already overburdened and stressed by earlier events.
• Splitting in two of the city by the lava streams, creating communication and transport problems.
• Collapse of the main public services.

Many local and international NGOs, United Nations agencies, donors and representatives of civil society were already on the spot in Goma on account of the complex emergency in DRC. Their presence made it possible rapidly to organize humanitarian assistance for the population, thus averting the expected catastrophe. The humanitarian agencies met at sub-committee level to deal with the different problems caused by the volcanic eruption. The following committees were set up:

the health committee, coordinated by WHO and Asrames;

the education committee, coordinated by UNICEF;

the water and sanitation committee, coordinated by OXFAM;

the child protection committee, coordinated by Save the Children;

the shelter and reinsertion committee, coordinated by CONCERN;

the food committee, coordinated by WFP;

the non-food items committee, coordinated by UNICEF.

The objectives of the humanitarian actions were:

1. To prevent any further catastrophes, such as the outbreak of an epidemic or a deterioration in security;

2. To restore as quickly as possible the pre-emergency situation.

The main actions carried out to achieve this were:

1. The repair of the road network with the assistance of the German Agro Action NGO;

2. The organization, from the very first week, of chlorination points for the water drawn along Lake Kivu, by the AMI-KIVU NGO, the provision of water supplies by tanker lorries and tanks installed by the IRC and OXFAM NGOs. These actions resolved the problem of water distribution by Regideso, whose network was heavily damaged by the eruption. Most of the network has now been repaired, thanks to the help of ICRC.

3. Organization, by WHO, UNICEF and MSF-B, of a measles vaccination campaign in Goma and Kirotshe health districts;

4. Repair of part of the electricity network, either from Goma and Bukavu in the west or from Gisenyi, in the east, by SNEL (National Electricity Company);

5. Free provision of public services, including health services;

6. Free distribution of food by WFP and its distribution partners, first of all to the entire population of Goma and subsequently solely to victims of the catastrophe;

7. Organization by UNICEF of reception sites for the displaced population, at which food and non-food items (tarpaulins, soap, kitchen utensils and blankets) were distributed; provision of sanitation for the sites, installation of water supply, construction of latrines and showers by MSF and OXFAM.

8. Organization of family reunion by ICRC and Save the Children;

9. Implementation of a contingency plan for the possible evacuation of Goma, in the likelihood of a further volcanic eruption or earthquake.

These emergency measures were mainly undertaken during the first phase of the emergency, which lasted until 1 March 2002. The next, transition phase, involved:

1. The return to charges for part of the cost of public services;

2. Staggered and focused distribution of food, and distribution of non-food items only to displaced persons returning from Gisenyi or Bukavu;

3. Distribution and construction of temporary shelters on individual plots;

4. Cutback in the number of tanker lorries used to distribute water and of lakeside chlorination points;

5. Reopening of schools, despite a number of strikes by teachers on account of non-payment of salaries;

Overview of the situation at present

A total of 10 000 families are still being relocated, 2500 of them are at the Esco site, 15 km west of the town, and 1000 at the Itig site near the airport. The others are with host families. In Rwanda there are still 2500 families in reception sites, although they are gradually returning to Goma. Most of the families will be entitled to the temporary shelters provided by the SRC, Atlas, BRC, CONCERN and LWF NGOs, although no decision has yet been taken on where they will be definitively housed.

The electricity supply network to the eastern part of Goma has not yet been repaired. This part of the town is currently supplied by the Rwandan network, but SNEL says that it has no funds either to pay the Rwandan bill or to repair the damaged network.

Most of the Regideso water supply network has now been repaired, although some minor repairs are still required. The work should be completed by mid-May.

Food will be distributed to the victims until 30 June 2002, and a food-for-work programme has been set up to help revive the town's economy. However, Save the Children, which in March 2002 carried out a social and economic survey in Goma, has drawn attention to an economic recession in the aftermath of the eruption, and has recommended preventive measures such as cash for work, food for work and housing aid.

The persistence of magmatic, tectonic and volcanic activity in Goma has led to the reinforcement of:

1. Monitoring of the Nyiragongo and Nyamulagira volcanoes;

2. Monitoring of developments associated with rifting in the regions; tracking the faults and ascertaining whether the towns of Goma and Bukavu are sinking below the level of Lake Kivu.

3. Monitoring gaseous emissions at the sites known as “mazuku” and in the faults.

4. Studies into the consequences of the presence of methane and carbon dioxide pockets in the depths of Lake Kivu.

The contingency plan drawn up to deal with this threat has not yet been finalized. In Goma, two groups have informed and educated the population and organized civil defence. Now that this work is more or less complete, it has to be shared with Sud Kivu and Rwanda for final acceptance. This task, which was supported by OCHA, was carried out in partnership with the local authorities.

Lastly, the inter-Congolese dialogue, which is under way on 19 April 2002, also raises political and security issues that call for continued attention, on account of its potential humanitarian and health effects in Goma and in the whole of eastern DRC.

4. The health situation

1. Morbidity and mortality

The volcanic eruption killed approximately 70 people. Some of them died in villages on the side of Nyiragongo, where children and the bedridden were unable to escape in time. In Goma, one family suffocated after having taken refuge in the basement of a house. Some people also died during the looting. However, most deaths were caused by the explosion of a fuel reservoir which survivors were trying to drain.

Seven cases of burns to the feet and thighs were reported; these occurred when people tried to cross the lava flow in the first few days after the eruption, and after the first rainfall, as a result of hot lava heating the water vapour.

two women lost consciousness near the fissure running through the 8th Cepak Church in Goma: this was probably due to carbon dioxide emissions. Three weeks later, when we took gas readings at the spot with Professor Baxter, we could find no traces. However, this does not mean that there were no emissions earlier.

An increase was reported in the number of cases of conjunctivitis in the two days following the eruption. However, the situation became stable the following week. Upper and lower respiratory tract infections also increased significantly in the wake of the eruption, and are now the second reason for consultation in Goma health centres, ahead of diarrhoea. There was little change in the incidence of diarrhoea after the eruption, thanks to the rapid measures adopted by the water and sanitation committee.

However, the cutback in large-scale distribution of water in the western part of the town, as part of the return to normal, led to an increase in reported cases of gastroenteritis. Last week, epidemiological week 14, six out of seven stool samples were found to be infested with Ogawa-type cholera vibrios. The Carmel cholera treatment centre, which covers the area concerned, has been opened and supplied with Ringer lactate, ORS and chlorine. Community health workers and the local radio station have been mobilized to promote preventive measures and to broadcast messages. All the patients reported that they had failed to chlorinate water taken from Lake Kivu. The number of chlorination points maintained by Ami-Kivu was immediately increased. Regideso and ICRC were also requested to complete repairs to the district water supply system as a matter of urgency. No cases of cholera were reported in the other parts of the town, although active surveillance is being maintained, and we hope to be able to prevent any outbreak of cases in the centres for displaced persons.

The WHO Office in Kinshasa also sent a mental health expert, Professor Mavinga, to assess the impact of the volcanic eruption on the mental health of Goma's population.

2. The health system

The lava flow carried off three health centres and a 100-bed hospital (CBK Virunga). All these facilities are now being rebuilt (MDM-B, Merlin, DOCS).

After the eruption, these centres stopped operating for only four days. They resumed work, providing services free of charge and with the support of the following NGOs: Asrames, Merlin, MDM-F and SCF-UK, who provided primary health care assistance; NPA, Malteser and Médecins en catastrophe, who provided hospital support; OXFAM and Goal, who helped with health education; World Vision and SCF-UK, who provided nutritional assistance, and MSF-E, who helped with epidemic prevention.

Epidemiological surveillance activities were carried out daily rather than weekly, and diseases specific to a post-eruption phase were added to those usually included in the surveillance.

From 6 to 11 February, UNICEF, WHO and MSF-B organized a measles vaccination campaign in Goma and Kirotshe health districts. The level of vaccination coverage attained was 64.6 % in Goma and 101 % in Kirotshe.

Free care, which was provided until 1 March 2002, led to a sharp increase in attendance at all Goma's health centres. On average, the number of consultations increased ten-fold in comparison with the pre-eruption period. After the introduction of a patient's contribution of CF 50 on 1 March, the number of consultations was divided by four. On 15 April 2002, the patient's contribution was increased to CF 120, half the fee charged before the eruption. Changes in the number of consultations subsequent to this charge increase were not available before my departure, but they should be followed up. I personally believe that these changes came too rapidly in the wake of the crisis, before the local population had fully recovered from the natural catastrophe; as the SCF-UK study shows, this is a town, which is in the throes of economic recession. It should be noted, however, that the disaster victims housed in the makeshift camps still have access to free primary health care.

A survey on the economic and financial resources of the Goma population in relation to their access to health care was carried out in 488 families in the first week of April 2002. Results were not yet available when I left, but they should be taken into account in any decisions to raise the patient’s contribution to the costs of health care. To be continued…

It should be said that collaboration between all health partners and health authorities was excellent. The Goma province health office was very actively involved in the emergency response, although we regret the lack of involvement on the part of the Goma health area central office, which was conspicuous by its absence from health committee meetings or activities during the crisis period. The collaborative spirit which reigned between the different health partners and between different committees and local authorities was a key factor in the effective response to this emergency. Similarly, the fact that NGOs and UN agencies were already on the scene at Goma in connection with its long-standing problems was also a key factor for the rapid organization of the crisis response following the eruption.