Nepal Flu Pandemic: Causes and Solutions

Short notes on the flu, influenza and Pandemic

Influenza also called as flu, is a respiratory illness that is caused by a virus. Flu is highly contagious and is usually spread by the coughs and sneezes of a person who is infected. According to the World Health Organization (WHO), 5% to 15% of the world’s population is infected by flu each year.

The symptoms of flu are:

• High temperature, Joints and limbs pain, headache, fatigue, gastro intestinal symptoms that linger for about a week.

The Precautions that should be taken during flu attack are

• Stay at home
• Avoid contact with other people
• Keep yourself warm and rest
• Consume plenty of liquids
• Avoid alcohol
• Through vaccination that protects you for about two weeks

There are three types of flu viruses ie infuenza A, influenza B and influenza C. Types A and B viruses are the cause of seasonal epidemics and it infect about 20% population of the world each year. The type C influenza virus may cause respiratory illness of mild nature but is not responsible for epidemics. Proteins on the surface of influenza A viruses can be divided into subtypes – the hemagglutinin (H) and the neuraminidase (N). 16 different hemagglutinin subtypes and 9 different neuraminidase subtypes are known to exist. A H1N1 and H3N2 are the current subtypes of influenza A viruses found in people. There are no B virus subtypes, but there are different influenza B virus strains.

Pandemic

A pandemic is a global disease outbreak. It needs global resources to contain the effect of disease. Influenza pandemic means a global outbreak of disease caused by a new type of virus. The past evidences and study suggest that flu pandemic virus spread in all parts of the globe within six to nine months. Due to the changed scenario of the world ie globalization and speed of air travel, influenza pandemic could spread much more quickly. A pandemic usually occur in waves but all parts of the world may not be affected at the same time. The records of pandemic in the world are:

• Spanish influenza killed 40-50 million people in 1918.
• Asian influenza killed 2 million people in 1957.
• Hong Kong influenza killed 1 million people in 1968.

Water, Sanitation and Hygiene Promotion Cluster

The aim of any WASH program is to promote personal and environmental hygiene in order to protect health.. An effective WASH program comprises of

• Information exchange between the agency and the disaster-affected population
• Identification of key hygiene problems
• Formulation of Culturally appropriate solutions
• Ensure the optimal use of all water supply and sanitation facilities
• Practice safe hygiene and positive impact in public health .

Hygiene promotion is essential for a successful WASH intervention. The focus on

Hygiene promotion is general and specific. In general terms, hygiene promotion

Is integral to all of the sections and is reflected in the indicators for water

supply, excreta disposal, vector control, solid waste management and drainage.

In 2005,in order to enhance predictability, accountability and partnership, Humanitarian Reform Agenda introduced the cluster approach with a clear mandate for improving coordination in emergencies. The Global Water Sanitation and Hygiene Cluster is a partnership grouping 32 partners and aiming at improving the coordination and the humanitarian response in the WASH Sector.

The main pillars of WASH cluster are:

• Effective coordination and capacity
• Timely operational support to national WASH coordination platforms response as needed
• Improved emergency preparedness
• Accountability and learning to facilitates effective WASH cluster actions
• Operational advocacy for WASH (Cluster, 2013)

WASH Cluster in Nepal

The WASH cluster is led by the Ministry of Urban Development and co-led by UNICEF in Nepal. The WASH cluster is operational in Nepal since 2008 to respond to the displace people of Koshi Flooding.

WASH looks after the water sanitation and hygiene of vulnerable communities. Its activities include long term resilience of the community through sustained waste access, water supply, initial need requirement assessment at the time of emergency situations to gather information on minimum water quantities required, minimum number of toilet and public places required, monitoring of water and excreta related disease transmission, household water treatments, and solid waste management.

The main focus of the cluster is on the following:

• Hygiene Promotion
• Excreta disposal
• Vector control
• Solid waste management
• Proper drainage systems

The WASH cluster in Nepal has made a preparedness status in case of an earthquake scenario in Kathmandu. According to the report, the water demand of Kathmandu valley is approx. 320 million per day where as the current supply is 160 million per day. UNICEF conducted seismic vulnerability mapping of the drinking water supply system in 2003 along with the capacity mapping in 2008. The cluster has prepared a contingency plan with the participation of Government of Nepal, UN and other I/NGOs. UNICEF has made 22,000 standard hygiene kits available along with prepositioned stock of WASH supplies that include water tanks, toilet slabs, buckets, and water treatment equipment.

Prime Minister Calamity (Relief) Fund 2063 of Nepal

A Prime Minister Disaster relief fund release policy 2063 was formulated to set up a Prime minister relief fund and to define the policy for the use of relief fund so that effective assistance can be provided to the disaster victims. The Fund is operated by the committee of 8 members, secretary from the Prime minister office being the secretary. All the amount of the fund is deposited in Nepal Rastra Bank or any other bank. The amount of the fund shall be operated with the signature of at least two persons. The committee can share its rights of using fund with CNDRC or DDRC as per requirement.

The fund comprises the amount received from:

• The aid given by members of government service
• The amount given by NGO, INGos , industrialist, NRN , citizens
• Aid providing country , foreign NGO
• Other sources

The fund can only be used for following purpose:

• Rescue of the disaster victim and protection of property.
• Temporary camp establishment
• To provide Emergency food, medicine , aid, clothes and education
• Medical treatment of those injured due to disaster
• Aid for dead body management.
• Disaster preparedness and awareness
• Debris removal and management
• Aid for Shelter construction and rehabilitation

The fund operation committee comprises following members :

• Vice-Chairperson National planning commission
• Secretary : MOHA
• Secretary : Ministry of local development
• Secretary : Ministry of Population and Health
• Secretary : Ministry of water Resources
• Secretary : Ministry of Agriculture development
• Secretary : Ministry of physical planning and construction
• Secretary: Coordinator, Office of Prime minister and council of ministers.

The accounts and Audits is maintained in accordance of the prevalent law.

National Relief Standard 2064 of Nepal

The National relief standard 2064 was formulated as a guideline for providing financial assistance to the disaster victims. It was amended in 2064 and 2069. This relief standard comprises of

• Rescue preparedness management
• Emergency Relief and Rescue
• Information management, Supervision and Evaluation

Rescue preparedness management

• Central disaster relief committee arranges for standby search and rescue materials for immediate response. Risk assessment and hazard mapping for minimizing risk and warehousing of relief material in centre, regional and district level.
• Identify the type of disaster the district is vulnerable to . Maintenance of standby skilled manpower at least 25 .
• For search and Rescue , in all 75 districts , rescue equipments are warehoused and 25 persons are kept standby.
• Provision of central disaster relief fund of 7 lakh and District disaster relief fund 3 lakh.
• Socials worker, Ngos should coordinate with LDRC for public awareness about disaster management.
• The displace people should be organized in a camp that is established in a open space other than school and healthpost.
• DDRC should coordinate national and international Search and Rescue team.

Emergency rescue and aid distribution

• DDRC should provide 40000 for the family of person who die in a disaster.
• If a house and food crops are destroyed due to disaster, for emergency sustainment of life Rs 5000 per family is given.
• If camp has to be organized, DDRC should coordinate MOHA.
• If food and financial aid is to be provided, the details should be sending to MOHA.
• The aid should be provided through either LDRC or DDRC. The presence of elected Member of Parliament/ leaders of all political parties encouraged.
• If the situation of local displacement is prominent upto 20,000 aid can be provided after the decision of DDRC. For the contingency situation CNDRC can provide additional 15000/ Family.
• The treatment of disaster victim in governmental hospital is free. RS 1000 to be provided for further care.
• For the rehabilitation and Reconstruction Ministry of forest should provide subsided wood.
• If any member of disaster victim family wants to go for foreign employment, DDRC should recommend to Department od labor and transport.
• The victims of Earthquake , Flood, Landslide, Thunderstrom, Strom, Cold web , Snow Fall , Air, road accident and boat capsize due to disaster are only liable for aid.
• CDO can spend Upto Rs 5000, through the decision of DDRC.
• The actions mentioned above can only be implemented by DDRC within the 30 days of disaster.

Information management, Supervision and evaluation

• A website of National focal point should be made for information dissemination.
• NEOC and CDO office should update the statistics of central and district level of disaster and publish it annually.
• RDRC should evaluate and supervise the work of DDRC at least one time a year and send report to CNDRC.
• CNDRC should deploy supervision and evaluation team to monitor the activities of RDRC and DDRC .
• Nepal Government provided medal and prize for those who do commendable work during disaster.

Dead Body management Guidelines 2068

During disaster response the dead body management is equally important as search and rescue actions. Dead body management guidelines was endorsed to guide the concerned stakeholders for effective collection, transport, storage, identification and funeral of the dead body so that dead body can be managed and the community need not bear further loss due to the effect of mismanaged dead body. The dead body management guidelines was approved by council of ministers in 2068 and thus implemented. The aim of this guidelines is to make a standard operating procedure to lawfully manage dead body effectively by

• Assigning responsibility to an agency for dead body management in central and district level.
• Defining the role and responsibilities of concerned stakeholders
• Provide platform for preparedness
• Capacity building
• Training and awareness for proper search, transport, storage, identification and management of dead body.
• Information sharing

The organizational system for dead body Management

• The central responsibility of management of dead body is of MOHA and NEOC.
• In district level the responsibility of dead body management is of DDRC and CDO office.
• There is provision of dead body management committee in every districts that comprise of 8 member that includes members of the Nepal Police, Armed Police Force, Hospitals, Army, Red Cross and DDR The secretary of the committee is the CDO of each district.

The effective dead body management means

1. Search and collection of dead body : The dead body should be searched immediately and should be stored , identified and perform funeral rituals in appropriate manner. The following points should be considered while searching a dead body:

• Security clearance of dead body
• The security of relief workers like use of boot, gloves and personal safety equipments.
• Each dead body should be given different number. If the body is shattered each parts should be given a different number.
• Before wrapping up a dead body four pictures from different angle ie face , whole body , body below chest , body above knee should be taken .
• Identification form should be filled.

2. Transportation of Dead Body: Dead body should be transported to morgue. Before transporting the dead body :

• Identification
• Secure the dead body and transport with due respect
• Dead body should be covered.
• Ambulance should not be used.

3. Storage and preservation of dead body : Hospitals and private hospitals can be used
4. Identification of dead body

• By primary methods like fingerprints , forensic deontology , radiology, DNA
• By secondary methods like observation, photograph , details , clothes etc.

5. Verification of dead body: Post mortem data collection and Ante mortem Data collection
6. Final management of dead body

• Set priority
• Issue dead certificate
• Handover the dead body to the concerned

7. Information and communication management

• Media management
• Crisis communication

8. Aid to Victim

• Establish family communication center
• Provide psycho social aid

9. Capacity Building program: The program to enhance the capacity to manage the dead body effectively should be endorsed.

Inter Agency Standing Committee

Inter agency standing committee (IASC) was established in June 1992 after the resolution of General Assembly 46/182 with the prime aim of inter agency coordination of humanitarian assistance. It is a forum where the key UN and non-UN humanitarian partners are involved. Under the leadership of Emergency Relief coordinator, the IASC

• Develop humanitarian policies
• Division of responsibilities on various aspects of humanitarian assistance
• Identifies and addresses gaps in response
• Advocates for effective application of humanitarian principles.

The key principles of IASC are:

• Respect for mandates: IASC respect the mandates of individual organizations.
• Ownership : All organization have equal ownership
• Overall objective : is to support humanitarian action
• Relevance to field operations
• Subsidiarity : decisions taken at the most appropriate level as agreed by IASC
• Impartiality of Secretariat

Full members of the IASC are

• The Food and Agriculture Organisation (FAO)
• The United nations office for the coordination of Humanitarian Affairs(OCHA)
• The United Nations Development Program(UNDP)
• The United Nations Human settlement Programme(HABITAT)
• The United nations High Commissioner for refugee(UNHCR)
• The United Nations Children Fund(UNICEF)
• The United Nation Population Fund(UNFPA)
• The World Food Programme(WFP) and
• TheWorld Health Organisation(WHO).

Standing invitees of the IASC are

• ICRC
• International council for voluntary agencies(ICVA)
• IFRC
• InterAction
• International Organisation for Migration(IOM),
• Office of the high Commisiioner for human Rights,
• Steering committee for humanitarian Responseand
• World Bank

Describe Cluster Approach focusing on Nepal

A cluster is a group of organization working together to improve the humanitarian response.

Humanitarian coordinator leads the cluster at country level. In 2005, in order to enhance predictability, accountability and partnership, Humanitarian Reform Agenda introduced the cluster approach with a clear mandate for improving coordination in emergencies.

Cluster approach id used for any major and new emergencies. The several criteria that triggers the activation of cluster are :

• Lack of capacity on ground
• Multi sector response
• Wide Range of Actors
• The decision lies primary in field.

After the disaster the initial need and gap assessment is done. To fill the gap the appropriate sectors are activated by the humanitarian coordinator in close consultation with the Humanitarian country Team.

Explain UN Civil Military Coordination in your own words

Un civil and military coordination is an essential dialogue and interaction between civilian and military actors in humanitarian emergencies necessary to promote and promote humanitarian principals, avoid competition , minimize inconsistency and when appropriate pursue common goals. (OCHA). Coordination is generally a shared responsibility. It is facilitated by liaison and joint training. The basic elements of UN civil Military coordination are:

• Information sharing
• Task division
• Planning

United Nations Humanitarian Civil-Military Coordination (UN-CMCoord) is essential for the establishment and protection of the ideal humanitarian operating environment in emergencies. Cooperation and co-existence are two strategies that can be applied in certain emergency contexts. However competition and conflict may still occur. It is essential that in the times of disaster, the military and civilian actors involved in response, must coordinate in critical areas in order to enhance cooperation and co-existence and minimize competition and conflict.The critical areas for cooperation can be security, logistics, transportation, communications, health and information.

Primary Tasks Associated with the UN-Civil Military coordination function are :

• Support the establishment and sustainment of dialogue with military forces.
• Assist in the development and dissemination of guidelines for the humanitarian community’s interaction with military forces and armed actors.
• Establish a mechanism for the coordination of the UN humanitarian interaction with military forces and other armed actors.
• Monitor assistance activities undertaken by the military forces.
• Assist in the negotiation of issues in critical areas of coordination.

UN civil military coordination is a broad framework that integrates the effort of civilian and military and guides political and military actors on how best to support the humanitarian action. Based on internationally agreed guidelines, a context-specific policy is developed that establishes humanitarian civil-military coordination structures, ensuring staff members are well trained to make that coordination work. UN-civil military coordination is essential in complex emergencies order to facilitate humanitarian access, the protection of civilians and the security of humanitarian aid workers. (OCHA)