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SWATEARTHQUAKERELIEFPROJECT

KPK,PAKISTAN

3stPROJECTPROGRESSREPORT31stJan2016

PreparedbyREALMEDICINEFOUNDATION,Pakistan328,MainServiceRoad,St67,SectorE-11/3Islamabad,Pakistan,rmfpakistan@gmail.com

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TABLEOFCONTENTS

1 BACKGROUND 1.1 GovernmentandCivilResponse 31.2 RMFResponse 31.3 CollaborationbetweenRMFandLDS 4 2 PROGRESSSOFAR 2.1 ObjectiveI:ProvisionofImmediateReliefandShelter 52.2 ObjectiveII:ProvisionofFoodRations 62.3 ObjectiveIII:ProvisionofHealthCareServices 9 FirstMorbidityReport 2.3.1 DemographicDistribution 9 2.3.2 PrimaryHealthCarestatistics 10 2.3.3 MaternalChildHealthcareStatistics 112.4 ObjectiveIV:ReconstructionofHomes 12

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I:BACKGROUND

On October 26, 2015, an earthquake of magnitude 7.7 hit the Hindu Kush region ofAfghanistan.SustainedtremorswerefeltallthewaydowntoIslamabad,LahoreandNewDelhiin India. Emergency response by the National Disaster Management Emergency ResponseteamsandPakistaniArmyRapidResponseunitsweretheinitialfaceoftherescueoperations.Mortality andmorbidity figures rose to nearly 300dead andover 2,000 injured in KPK’s keyaffectedareasofDistrictsDir,Chitral,Buner,Swat,ShanglaandMalakand.

Due to the depth of the earthquake the damage impact of this otherwise powerfulearthquakewascontrolled,but themainquakewas followedby87aftershocks,whichalongwiththewinterrainsandsnowfall,triggeredoffseriesoflandslidesinthemountainousregionscausingweakly structured houses build on hill slopes to collapse. So far 59,000 houses havebeendestroyedrenderingnearly600,000peoplehomelessorlivinginmakeshiftshelters.

1.1:GOVERNMENTANDCIVILRESPSONSE

AlthoughnoformalrequestwasmadebytheGovernment for internationalassistance,a factattributable to the security concerns related to these previously Taliban infested areas, localNGOs and CSOs along with the Government and the Pakistan Army provided rescue andimmediate relief services tovictims.Reliefefforts included supplyofwinterized tents,plasticmatting, food packages and bottled water. According to OCHA, a total of 4,876 householdswere served by several local CSOs.Medical care services were provided by augmenting theGovernmenthealthfacilitieswithnearly5tonsofmedicalsupplies.Volunteersregisteredwiththegovernmenthealthfacilitiesassistedineasingtheburdenonthehealthfacilities.

1.2:RMFRESPONSE

Detaileddataofaffectedpopulationsintermsofshelter,foodandhealthneedswaslackinginthe immediate aftermath of the event when people were in most dire need. RMF Pakistancarried out a 3-day needs assessment survey at the end of October and identified andregistered100affectedhouseholds.Usingsurveyforms,bothshort-termandlong-termneedswereassessed.

30and70householdswere identified inMohallaBhakharawan inUnionCouncilKabal,TehsilMatta,andMohallaAkhonbaba,UnionCouncilShagai,TehsilSaiduShariff, respectively.Withan average household size of 7-11 familymembers and an average income of USD 100 permonth,theoccupationsofthesepeoplerangedfromdailylaborers,carpenters,farmhandsandsweepers.Most of their houses were weak structuresmade from amixture of bakedmud,stonesandbrickhouses,oftenbuiltwith theirownhands thatcollapsedat the first tremors.Somepeoplelosttheirlivestockwhichwasbeingkeptindoorstoprotectthemfromthecold.Their hand-to-mouth existence meant that their entire existence collapsed with the rubble.Theirneedswereidentifiedas:

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• Shelter: Families neededwinterized tents andwarmblankets for thewinter until theweatherwouldthawoutandtheycouldreconstructtheircollapsedhomes.

• Food:Mostfamiliesmanagedtosalvagesomeoftheirhomefurniture;cookingutensilsetc. from the rubble, hencewere able to cook for themselves using firewood as hadbeentheirnormalpractice.Theyneededuncookedfoodrationsforthefamily.

• Healthservices:RemotevillagesespeciallyinUCKabaldidnothaveeasyaccesstoanykindofhealthcarefacility.

• Rebuilding of homes:A need that could only be possible to be addressed byMarchwhenthewintersnowthawsoutandconstructionactivitiescanbeimplemented.

1.3:COLLABORATIONBETWEENRMFANDLDS

AMOUwassignedbetweenRMFUSAandLatter-daySaintCharities,Inc.(LDS),anot-for-profitorganizationorganizedunderthelawsofUtah,USAon1stDecember2015forareliefprojectforearthquakeaffectees inDistrict Swat. LDS is the fundingpartnerandRMFPakistan is theimplementingpartner.Theproject is takingplace in twosites,mainlyMohallaBhakharawan,UnionCouncilKabal,TehsilMattaandMohallaAkhonbaba,UnionCouncilShagai,TehsilSaiduShariff,DistrictSwat.Theprojectgoalsandobjectivesare:

ProjectGoal:Torehabilitate2015OctoberearthquakeaffectedvictimsofDistrictSwat,ProvinceofKhyberPakhtunkhwa(KPK),Pakistan.

ProjectObjectives:

1. Toprovideimmediatereliefshelter2. Toprovideimmediaterelieffood3. Toprovideimmediatehealthcare4. Toassistinrebuildingofdestroyedhomes

ProjectLocationandTargetpopulation:Thetargetpopulationis100households(1,106men,womenandchildren).Projectsitesarethefollowingtwoareas:

• UnionCouncilKabal,TehsilMatta,DistrictSwat• UnionCouncilShagai,TehsilSaiduShariff,DistrictSwat

After taking permission from the relevant authorities, the project was launched on 10thDecember2015with the initiationofObjectives Iand IIwhichwere implemented inMohallaAkhonbaba,UCShagai.

Data of our registered families was first shared with the local city council administrationdatabase and the army brigade to avoid duplication of aid with other NGOs/Governmentcharities.46familieswhohadreceivedassistanceofanysortfromothersourcesweretakenoffthelist.TheRMFteamcarriedoutadatavalidationandaqualityassuranceexerciseofthe54registeredfamiliesandreliefgoodsrespectivelypriortothedistributionactivity.

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II:PROGRESSSOFAR

2.1:OBJECTIVEI:PROVISIONOFIMMEDIATERELIEFSHELTER

Atotalof100winterizedtents,plasticmatsand500blankets(5foreachfamily)wereprocuredin Peshawar and transported to Swat. With the assistance of the local Army Brigade,distribution ofwinterized tents, plasticmats and blanketswas conducted on 10th December2015to54families.Theremainingtentsandblanketsweredistributedto46familiesthatwereidentified over the next couple of weeks using a snow balling technique; each family wasassessed individuallyby theRMFgroundstaffbeforeclearance.Thisexercisewascarriedoutoverthefollowingcoupleofweeks.ObjectiveIwasachievedsuccessfullybythemidofJanuary2016.

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2.2:OBJECTIVEII:PROVISONOFFOODRELIEF

ObjectiveIIofprovidinguncookedfoodrationswascarriedoutalongwithObjective1.Theone-daydistributionoftentsandblanketsto54familiesalsoincludedthefoodrationdistribution.TherestwasdistributedtotheabovementioneddeservingfamiliesidentifiedoverthemonthofDecember 2015.Althoughwehave 100 families registeredwith us,wedeveloped a strictcriterionforselectionoffamiliesinneedoffoodrations.Webasedourcriteriaonthefollowingfactors:

• Womenheadedhouseholds• Householdswithchildrenunder12• Householdswithgeriatricadults• Familysizeof5ormore• Householdsthathaveasinglefamilyearner

Basisonthesecriteria,wefinalizedourlistdownto83families.ObjectiveIIwasproposedandbudgetedfor3monthsfromDecember2015toFebruary2016.Sinceour initialestimatewasfor 100 families but our strict criteria has identified less, we have decided that the mostvulnerable of these families on our list should receive food rations beyond this three-monthperiod. Vulnerabilitywill be determined by howmany families fulfill all 5 criteriamentionedabove.Thetotalnumberoffamilies/monthswillbedeterminedbythebudgetbutweestimatethat5familiescanreceivemonthlyfoodrationsforatotalof8monthseach.

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The mechanism of food distribution is as follows. RMF has entered into a contract with areliable and honest vendor inMingora City and trained him tomake the RMF Food Rationspackages as per the proscribed amounts. He has also been given the list of our registeredfamilies each with a designated adult with a National Identification Card (NIC) number toreceivethepackage.Thismeansthatonlythedesignatedpersoncanpickupthepackageandnooneelse. Familieshavebeen informedabout the timeanddateof eachmonthonwhichtheyareeligibletopickuptheirmonthlyrations.

Atthebeginningofeachmonth,fromthe1sttothe4th,approximately20familiespickuptheirfoodpackagefromthevendoronadailybasis.PackagesarereleasedafterverificationoftheoriginalNICcard.Fooddistributioniscarriedoutover4daystoavoidtherushofahugecrowdon one day. Further, to ensure transparency and accountability of the vendor, a RMF staffmemberwill be present on ground during these 4 days. The vulnerable families selected toreceivethismonthlypackageforthenextsixmonthswillfollowthesameprotocolonthe1stofeachmonth.

Sincethelaunchoftheproject,atotalof183familieshavereceivedtheRMFfoodrationssofar.

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2.3:OBJECTIVEIII:PROVISIONOFHEALTHCARESERVICES

Objective III was initiated on 21st December 2015 with inauguration by the local electedCouncilor. For selection of a clinic site, RMF’s policy is to choose a site that is outside aminimumofa20Kmradiusof thenearesthealth facility.Weselectedsuchasite inMohallaLalooBandee,UCKabal,TehsilMatta.

Our initial proposal had envisioned a large tent to house the clinic. However, the reality ongroundgaveustheoptiontotakeupapermanentbuiltstructure.WerentedoutaportionofahouselocatedcentrallyintheMohalla.Thisportionhasaseparateentranceandiscomposedoftwo rooms and a shared compound. The compound is divided by a curtain into two gendersegregatedwaitingareas.Oneroomisforthefemalepatientsandtheotherroomisthemaledoctoraswellasthepharmacystand.

The5memberclinicstaffiscomposedofamaledoctor(Dr.NasarKhan),afemaledoctor(Dr.FatimaNasar), amedical technician (Mr.AdnanKhan), cleaning lady (Ms. Shahida)andnightsecurityguard (Mr.KhanLala).AsperRMF’sprotocolofgivingemploymentopportunities tothelocalcommunity,alltheclinicstaffisfromUCKabal.

Asperourqualityassuranceprotocols,medicalsuppliesareprocuredfromourPeshawar-basedvendorwhohasbeensupplyinguswithmedicineforourNowsherahealthclinicforthelasttwoyears.Monthlymedicalsuppliesaretransporteddirectlytotheclinic.

Theclinicoperatinghoursare8.00amto5.00pmMondaytoSaturday.SundayisdayoffandonFridayahalf-dayisobservedinlinewithreligiousdemandfortheFridayafternoonprayerswhichareconsideredsacred.

FirstMorbidityReport

2.3.1:DemographicDistribution:

Overtheperiodof21stDecember2015to31stJanuary2016,atotalof962men,womenandchildren were provided with primary health care (PHC) and maternal and child health care(MCH)services.Theagedistributionisnearlyequalnumberofadults(487)andchildren(475).Thegenderdistributionamongstadultswaspredominantlywomenat79.2%(389)withmenatalow20.8%(101).Amongstthechildren,boyswereat57.6%(274)andgirlsat42.4%(201).

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AGEANDGENDERDISTRIBUTIONOFPATIENTS

2.3.2:PrimaryHealthCare(PHC)Statistics:

A total of 662 men, women and children sought primary healthcare services. The mostcommonlypresentedillnesswasrespiratorytractinfectionsatanastounding50.6%accountingforhalfofallthecasespresentedattheclinic.Naturallythiswasinlinewiththewinterweatherandtheirprecariouslivingconditions.Ofthesethemajoritywerechildren.

ThesecondmostcommonlypresentedillnesswasUrinaryTractInfections(UTI)at14.5%.Thiscanbeattributedtothepoorhygienemaintained,againconsistentwiththeir livingstandardsandthebittercoldandlackofheatingandwarmwater.Generalbodyweaknesswaspresentedat third place by 6.3% of patients. This is not an actual category of illness but with ourexperienceofhealthservicesinPakistanoverthepast10years,thisisacommonlypresentedsymptom. Often such cases have no accompanying symptoms. Our conclusion is thatpsychologicalstressismanifestedinmanywaysandlocalcolloquialvocabularylacksthewordsfordepression.Theclosestword that canbeused is ‘sad’. Sodepression,asa resultof theirexperienceoftraumaandlossoftheirnormallivingconditions,isoftenpresentedattheclinicas ‘general body aches and weakness” with the hope that a medicine may cure them. Ourresponsetothis,overtheyears,hasgraduatedfrominitialrejectionofcomplainttousingtheplaceboeffectwherebyweprescribemulti-vitaminsasacure.Thishasbeenquitesuccessfulinthepast.Hencesuchpatientsareissuedvitaminswhichimprovetheirhealth.

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50

100

150

200

250

300

350

400

Adult Children

Male

Female

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2.3.3:MotherandChildHealthCare(MCH)Statistics:

Aroundfigureof300womenandchildrenutilizedMCHservicesfromourclinicoverthepast4-5 weeks. Pregnant women seeking antenatal care were 60 (20%) while lactating mothersseekingpost-natalcarewereat8%(24).Only6womensoughtfamilyplanningservices.

Theremaining210womenpresentedwithOB/Gynpathologies.Themostcommoncomplaintwas abnormal leucorrhea at 34.3% (103 women). Irregularmenstruation and dysmenorrheawere at a close second and third at 13.66% (41) and 10.3% (31), respectively. Women thatcamewith a complaint of either primary or secondary infertilitywere 17 (5.6%)while thosepresentingsymptomsofPelvic InflammatoryDisease(PID)were4%(12).Threewomenhadahistoryofamenorrheaandasamenumberwithahistoryofabnormalvaginalbleeding.

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96

42

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0 50 100 150 200 250 300 350 400

Respiratorytractinfections

uti

generalbodyweakness

diarrhea&abdominalpain

hypertension

Gastritis&vomiting

anemia

others

DistributionofPHCCases

49%

20%

15%

6%8% 1% 1%

DistributionofGyne/ObsPresentations

AbnormalLeukorrhea IrregularPeriods Dysmenorrhea

PID Infertility Amenorrhea

PelvicBleeding

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2.4:OBJECTIVEIV:RECONSTRUCTIONOFHOMES

Objective IVwas to be implementedwhenwinter snow thaws out, expected at the start ofMarch2016.

Currentlyadetailedneedsassessmentforthisobjectiveisunderway.Wehavedevelopedasetofcriterionforselectionofhouseholdssimilartothesetwehaveforthefoodrationssupply.Naturally the first priority is being given to families in our database butwe are not limitingourselvestojustthisarea.Beingongroundfornownearly2orsomonths,wenowknowthatremotehousesathigheraltitudeswerebadlydamagedand their inhabitantswereunable toreach down to even receive relief aid. Close collaboration with the local Army Brigade hasidentified several of such households.We are calculating the feasibility of reconstruction atthesenot-so-easily-accessibleareas.

We are also researching the local market for the most economical and easily availableconstructionmaterialsaswelllocallabor.Luckilywehavehadsomesturdyyoungmenwillingto volunteer in the reconstruction process in the neighborhoods. As per our procurementprotocols,wehaveinvitedquotationsfortheabovebothprocessesofmaterialsandlabor.

TheProjectSupervisorhasbeenhiredforthisphaseandisinchargeoftheneedsassessmentsurvey and collection of quotations and data.Meanwhile we have collaboratedwith a localarchitecture firmthathasgenerouslyagreedto,probono,designplans forus for twomodelhouses thatwehave proposed. Themodelswill differmainly in covered surface area of thehouse,dependingonthefamilysize.