Gujarat Earthquake
Summary of WHO activities
26th January to 30th April 2001
WHO
GUJARAT
RELIEF MISSION
FIRST QUARTERLY REPORT
OF WHO ACTIVITIES FOLLOWING THE EARTHQUAKE
26th January to 30th April 2001
1
Gujarat Earthquake
Summary of WHO activities
26th January to 30th April 2001
CONTENTS
Executive summary......
Background......
Magnitude of earthquake......
Loss of life and injuries......
Damage to health infrastructure......
Social and economic impact......
United Nations response...... …..
WHO response to the earthquake......
Rapid health assessment in affected areas in cooperation with UNDAC......
Highlights......
Provision of emergency trauma kits, emergency health kits and other essential medical supplies......
Highlights......
Re-establishment and rehabilitation of health services with special attention to primary health care (PHC)......
Highlights......
Technical advice and capacity building to the Government, UN agencies, bilateral agencies and NGOs......
Highlights......
Health sector coordination......
Highlights......
Disease surveillance, early warning system and rapid response to epidemics......
Highlights......
Technical support for water and sanitation......
Highlights......
Challenges faced during first quarter......
ANNEX 1 - Attendanceat Health SectorCoordination meetingsFebruary to end April 2001......
Executive summary
This report describes the role played by the World Health Organization (WHO) in response to the tragic earthquake which struck Kutch (Kachchh) District, Gujarat State 26 January 2001. The earthquake resulted in 20 000 deaths and almost 167 000 people were injured. The earthquake also destroyed the infrastructure (roads, power, communications, water supply and sewerage), houses, schools, health centres and peoples’ livelihoods. The damage was estimated to total US$ 4.6 billion.
The Government of Gujarat, the national and international community responded quickly to the disaster with emergency relief services. The emergency phase lasted until mid March by which time no more people were dying from the injuries sustained during the earthquake, people had returned to Bhuj and a semblance of normal life returned to the city. Since then many relief agencies have left the area and work has commenced on rehabilitation and longer-term support to establishing sustainable livelihoods and reconstruction of buildings and health facilities. This report covers the period from the earthquake (26th January to 30th April 2001) and therefore includes both the emergency and rehabilitation phase following the disaster.
The United Nations Disaster Management Team (UNDMT) prepared a comprehensive report on the UN response to the Gujarat earthquake and developed an overall UN action plan comprised of the individual action plans of each UN agency. WHO was designated as the focal agency for the health sector response. The seven areas for WHO activities defined by the UNDMT were:
- Rapid assessment of health needs of populations in affected areas in cooperation with UNDAC;
- Provide trauma kits, emergency health kits and other essential medical supplies;
- Support the re-establishment and rehabilitation of health services in affected areas with special attention to primary health care;
- Provide technical advice to the Government, UN agencies, bilateral agencies and NGOs on priority public health issues in the aftermath of an earthquake;
- Collaborate in health sector coordination;
- Support the Government in establishing disease surveillance in the affected areas, including an early warning system and capacity for rapid response to epidemics;
- Provide technical support for emergency repairs of water distribution system, water treatment and temporary distribution, sanitation and solid waste disposal, food safety, vector and zoonosis control.
The first two of these areas of work were completed under the emergency response phase with WHO technical support continuing into the rehabilitation phase. WHO provided assistance to the UNDAC Team in a general assessment of earthquake damage and coordination and visited the five worst affected towns and 100 villages. Health assessment reports formed part of the daily UN situation reports (sit-rep). Emergency trauma kits and emergency health kits were received from WHO headquarters in the first week of February and were distributed to primary health centres (PHCs) in Rapar subdistrict (taluka). All except one of these kits were utilised.
WHO has provided input to the development of a government list of health facilities to support the re-establishment and rehabilitation of health services in affected areas with special attention to primary health care. Various international and local NGOs have agreed to provide the physical infrastructure (in the form of prefabricated buildings) and the Government will build more permanent structures as required. WHO will advise on the quality of care provided at these facilities and respond to the training needs of staff identified by the government. WHO has been active in identifying staff shortages within health facilities and informing government officials of these problems.
WHO has given technical advice to the Government of Gujarat and other UN agencies on the health response to the emergency situation, disease surveillance, water and sanitation and this will continue during the rehabilitation phase. Finally, during the emergency response phase, WHO worked closely with international and local NGOs to support their activities and assisted with coordination within the health sector.
Three WHO work areas, which started during the emergency response phase, are continuing into the rehabilitation phase. In the area of health coordination, WHO has developed good coordination systems between the Government of Gujarat, other UN agencies, bilaterals, national and international NGOs. Eleven meetings of the Health Sector Coordination Group were held during the reporting period with 60 organizations represented. Subsector groups have been established and are functioning with varying degrees of success for: Hospitals; Restoration and rehabilitation of the health infrastructure; Prosthetic and orthotic rehabilitation; Psychosocial support/trauma counselling; Health promotion; and Nutrition. In addition, Health Coordination meetings have been established in four talukas (Anjar, Bachau, Bhuj and Rapar). These have served as a means of discussing epidemiological trends, identifying and finding solutions to local problems, identifying training needs for Medical Officers and sharing information between organizations. WHO is regarded as the focal point, or repository for the collection and dissemination of information between agencies and within the different levels of the health system.
Work in the area of disease surveillance and epidemic preparedness has been commendable. New weekly standardised surveillance forms and case definitions and standard management guidelines have been developed and distributed. A District Disease Surveillance Unit (DSU) with seven staff has been established and functions as an early warning signal unit. A weekly reporting network of 164 reporting units was developed in Kutch, using a standardised surveillance format and the private sector has been included in this regular reporting network since week seven post-earthquake. The DSU has provided regular, consistent feedback to taluka, district and state authorities and Health Sector Coordination meetings. Medical Officers (government and private) have been sensitized for epidemic preparedness and trained in reporting, investigation procedures and rapid response.
Good liaison has been set up between the DSU and government officials, the National Institute of Communicable Diseases (NICD), the State Public Health Laboratory and two medical colleges. Finally, health education, hygiene promotion and water quality interventions have been evaluated for their effectiveness.
The highest incidence of disease was acute respiratory infection (20% of all cases for all age groups). One case of cholera was reported from a traveller to the area, the prompt diagnosis and treatment of the disease ensured there was no further transmission. Cases of Hepatitis A have been reported in scattered populations throughout the district and an outbreak of Hepatitis E was detected in Rapar subdistrict and immediate control measures were undertaken, such as, the repair of a broken water pipeline, sustainable super chlorination and health education and hygiene promotion. Thus further morbidity was prevented.
In the area of water and sanitation, WHOs lead in monitoring of quality of water supply has been established. Good coordination has been established with general administration, water and sanitation authorities at district and taluka level, but there are still gaps at village level. A WHO Water and Sanitation Officer and WHO consultant have been appointed and they have trained over 250 Medical Officers, drivers of water tankers and field technicians to conduct regular checking of free residual chlorine in drinking water. 1250 chloroscopes have been provided for use in monitoring water quality. Water samples have showed variable reports of residual chlorine, largely attributed to the private tankers providing water.
Following the outbreaks of hepatitis A and E (evidenced by jaundice) checks of the water supply were undertaken to identify the cause. Water contamination was found due to poor conditions in hotels, restaurants and underground storage tanks, and chlorination was not being practised on a regular basis at private boreholes and tankers. Human waste and solid waste disposal and sanitation remain the area of greatest concern and there is much work to be done in maintaining improvements in the quality of the water supply. A water quality surveillance programme has begun to address this issue.
In the next three months and beyond, WHO will intensify and strengthen its activities in health coordination, disease surveillance and epidemic preparedness, and water and sanitation. During May a planning retreat will take place to finalise the specific activities to be undertaken and indicators will be developed to assess programme success.
Background
Magnitude of earthquake
On 26 January 2001 at 08:46, an earthquake struck Kutch (also known as Kachchh) District, Gujarat State, in the Republic of India. The epicentre was 20 kilometres north-northeast of Bhuj City in the village of Lodai along a fault extending from Bhuj City to Ahmedabad. The magnitude of the earthquake was recorded at between 6.9 and 7.9 on the Richter scale. Aftershocks in subsequent days measured up to 4.8 on the Richter scale. The earthquake was the largest recorded earthquake in India following the Calcutta earthquake of 1737 in which 300,000 people died. The hazard affected area extended from Gujarat State to neighbouring states of Rajasthan and Maharashtra (see map). The major damage was concentrated in Kutch District of Gujarat State.
Map 1 – Gujarat State
Within Kutch District the most affected subdistricts (talukas) are Anjar, Bachau, Bhuj, Gandidham and Rapar. The destruction has been colossal and most remaining buildings are severely cracked.
Map 2 – Kutch District
Loss of life and injuries
The death toll was estimated to be about 20 000, but it is difficult to be precise as many bodies were not recovered. The number of injured and treated was estimated to be 166 834 in February 2001, of these over 17 000 sustained orthopaedic, head and other serious injuries and were admitted to hospital. The exact number of people suffering from permanent disabilities is not yet known. The Government of Gujarat (GOG) has announced cash compensation (100 000 rupees) for the next of kin of the deceased. Compensation will also be given to those who sustained injuries on a graded scale related to the severity of the injury, the maximum being Rs 5000. [1]
Damage to health infrastructure
Prior to the earthquake, health care in Gujarat was organized by the following levels:
Subcentres 5000 population
Primary health care (PHC) centres up to 30 000 population
Community health centres (CHC) over 30 000 population
District hospitalsfor referral cases
The earthquake has completely destroyed two District hospitals, 20 CHCs, 50 PHC centres and 300 sub-centres. [2] Many other health facilities have sustained partial damage and may have been structurally weakened. A preliminary assessment of the damage was estimated to be Rs 1705 million. [3]
There has also been substantial damage to the water supply with 319 tube wells damaged (274 in Kutch) affecting 18 towns and 1340 villages. [4] About 50% of the pipeline network in Banaskantha, Jamnager, Kutch and Rajkot was damaged. This damage has severely affected access to clean water and health care.
1,774 child development centres (CDCs) managed by anganwadi workers were destroyed and UNICEF has prepared a strategy for the reconstruction of CDCs. Anganwadi workers play an important role in child care and development at community level in India. In some areas they are also active in child health promotion and nutrition.[5]
Social and economic impact
It was estimated that the earthquake affected 37.8 million people. Housing, schools, roads, communications systems and power lines were all severely destroyed and this has resulted in a loss of livelihood as well as life (see Table 1) and has severe financial implications (Table 2).
Table 1 - Affected Districts – Gujarat State
(Source: accessed 17 February 2001, Indian Government Krishi Control Room Report updated to 16 February 2001)
District / Population / Affected Villages / Affected Population / Deaths / Injured / Houses destroyed / Houses Damaged / Cattle DeadKutch / 1,262,507 / 949 / 1,262,507 / 17,030 / 136048 / 207,148 / 147,861 / 19,470
Ahmedabad / 4,687,491 / 392 / 3,894,000 / 750 / 4,040 / 1,768 / 69,530 / 20
Rajkot / 2,514,122 / 686 / 1,594,000 / 422 / 11,951 / 43,702 / 119,762 / 171
Jamnagar / 1,563,558 / 685 / 1,563,000 / 119 / 4,930 / 26,642 / 107,161 / 549
Surendranagar / 1,208,872 / 661 / 1,154,000 / 112 / 2,909 / 29,556 / 180,358 / 121
Surat / 3,397,900 / 94 / 397,989 / 46 / 190 / 32 / 1,222 / 1
Patan / 935,203 / 349 / 664,000 / 34 / 1,695 / 15,765 / 38,891 / 15
Banaskantha / 2,013,519 / 452 / 719,000 / 32 / 2,770 / 1,841 / 8076 / 162
Navsarai / 1,085,692 / 110 / 87,783 / 17 / 52 / 98 / 477 / 1
Porbandar / 376,113 / 157 / 376,113 / 9 / 90 / 2,767 / 17,738 / 8
Bharuch / 1,148,052 / 248 / 460,000 / 9 / 44 / 994 / 7,153 / 76
Junagadh / 2,018,446 / 554 / 597,787 / 8 / 89 / 423 / 11,630 / 3
Gandhinagar / 1,026728 / 210 / 35,000 / 8 / 241 / 3 / 5,536 / 2
Bhavnagar / 2,060315 / 535 / 445,226 / 4 / 45 / 1,216 / 22,781 / 4
Vadodara / 3,039,127 / 85 / 186,092 / 1 / 270 / 18 / 158 / 1
Anand / 1,647,759 / 124 / 4,687 / 1 / 20 / 33 / 804 / 6
Mehsana / 1,648,251 / 611 / 1,648,251 / 0 / 56 / 18 / 1,560 / 1
Sabarkantha / 1,761,086 / 68 / 128,000 / 0 / 56 / 1 / 84 / 1
Kheda / 1,793,138 / 350 / 35,121 / 0 / 28 / 74 / 1,184 / 4
Amreli / 1,484,300 / 273 / 599,000 / 0 / 5 / 510 / 8,963 / 2
Valsad / 1,087,680 / 108 / 5,985 / 0 / 0 / 1 / 72 / 0
TOTAL / 37,759,859 / 7,701 / 15,857,541 / 18,602 / 165,529 / 332,610 / 751,001 / 20,618
Table 2 - Financial Costs
(1 Crore = 10 million)
(Source: Indian Government Krishi Control Room Report updated to 16 February 2001)
Personal Property / Rs 387 crore / USD 83,911,535Household Property / Rs 11,195 crore / USD 2,427,363,399
Public Utilities / Rs 600 crore / USD 130,095,403
Public Infrastructure & Utilities / 1,080 crore / USD 234,171,725
Industrial establishment / 5,000 crore / USD 1,084,128,360
Commercial establishment / 3,000 crore / USD 650,477,016
TOTAL / 21,262 crore / USD 4,610,147,441
The overall situation has been considered a multiple disaster, since the earthquake was the third natural disaster to occur in Gujarat over a four-year period. A cyclone hit Gujarat in 1998 and the drought which began in 1999 is expected to continue through 2001. This has had a cumulative affect on the vulnerable population. Prior to the earthquake most of the districts in Gujarat were highly food insecure with a high percentage of the population living below the poverty line.
Malnutrition in Gujarat is high for a prosperous state. In the 1998-9 National Family Health Survey (NFHS) II census, 45% of children under 3 years were underweight (compared to 47% for India), and 16% were wasted (compared to 15.5% for India overall). Among children aged 6-35 months, 75% are anaemic (similar to the data from the rest of the country). Many women have a low body mass index (37% of them are considered to be at risk) and 46% of ever-married women have iron deficiency anaemia. [6]
The United Nations Disaster Management Team (UNDMT) has expressed concern that the serious implication of the earthquake on poor rural households has not been sufficiently recognized. [7]
United Nations response
The UNDMT in India prepared a comprehensive report on the United Nations system response to the Gujarat earthquake on 8th February 2001. [8] This report detailed the impact of the disaster and the response to the disaster by the Government of India, international agencies and the UN. Each individual UN agency developed an action plan to be coordinated under the umbrella of the UN systems as a whole. WHO was designated as the focal agency for the health sector response and a cooperating agency for water and sanitation, and food and nutrition –Table 3.
Table 3 – Agencies responsible for sector coordination
Sectors / Focal agency / Cooperating agenciesCoordination / UNDP / DMT members
Health / WHO / UNICEF, UNFPA
Water and sanitation / UNICEF / WHO
Education and child protection / UNICEF / ILO
Food and nutrition / WFP / UNICEF, WHO, FAO
Shelter and survival / UNDP / UNICEF, UNV
Livelihoods / UNDP / ILO, UNFPA, UNV, FAO
Logistics / WFP / UNDP, OCHA, UNICEF
An external team conducted an evaluation of the UN response to the earthquake in April. [9] This evaluation found that the initial response was not fast enough, or large enough to have the required impact. There was a perceived lack of coordination and low UN profile. However, the UN agencies in India had a pre-existing good working relationship which provided a sound basis for work during the crisis. A number of early cooperative efforts have yielded good results and positive feedback has been received. WHO has been commended for providing an immediate response with high visibility and good coordination.
WHO response to the earthquake
WHO responded rapidly to the earthquake by mobilizing three poliomyelitis eradication surveillance medical officers already in Gujarat and placed a staff member expert in emergency and humanitarian action in Ahmedabad on 27 January, the morning after the earthquake. Two tuberculosis (TB) control medical officers and one water and sanitation expert from the WHO India country programme have been providing technical assistance in Gujarat. WHO staff from country and regional offices collaborated with state and local health authorities in the coordination of health activities.
By March, WHO had deployed 18 public health experts to Ahmedabad (Ahmedabad District) and Bhuj (Kutch District). One was a public health expert from the WHO Regional Office for the Americas with broad experience with earthquakes. As of 30th April the WHO team in Bhuj consisted of the following staff:
Table 4 - WHO team in Bhuj (30th April 2001)
Designation / NumberTeam Leader / 1
Health Coordinator / 1
Surveillance Coordinator / 1
Field Coordinator / 1
Surveillance Officers (UN volunteers) / 5
Water and Sanitation consultant / 1
Logistics officer / 1
Information Technology officer / 1
Data entry operator / 1
The WHO country office has, in collaboration with the WHO South East Asia Regional Office (SEARO) and staff in Bhuj, produced a video on the WHO response to the disaster. The video shows how WHO was able to mobilize resources from within the State of Gujarat (through using existing polio surveillance officers), from the WHO country and Regional Offices (South East Asia and the Americas) to strengthen and support field activities.