Georgia health cluster: bulletin No. 4, 9 December 2008

Georgia Health Cluster Bulletin No. 4 9 December 2008 HIGHLIGHTS • No communicable disease outbreaks reported • Monthly Health Cluster coordination meetings in the field were held in Imereti and Samegrelo Regions on 25-26 November • 27 805 IDPs have returned to the area adjacent to South Ossetia • 2 300 IDPs were relocated to 5 new settlements • HIV/AIDS Day was commemorated at the UN on 1 December GENERAL SITUATION UPDATE • Relocation of IDPs to new IDP settlements constructed by the Government is ongoing. According to the Ministry of Refugees and Accommodation (MRA)1, 22 852 IDPs are still residing in Collective Centers throughout Georgia. Region IDPs in Collective Centers (As of 5 December, 2008) Tbilisi2 17 827 Shida Kartli 1 565 Other Regions 3 460 Georgia Total 22 852 1 http://www.relief.migration.ge/intranet/index.php 2 According to UNHCR, Tbilisi has 295 Collective Centers, 8 December Cluster Leads Meeting, UN House. NEW IDP SETTLEMENTS • UNHCR estimates that 3 000 – 5 000 IDPs are unable to return to the area adjacent to South Ossetia and will have to spend the winter in displacement. • According to UNHCR3, MRA estimated that 27 805 IDPs have returned to the area adjacent to South Ossetia from Tbilisi, Shida Kartli and other regions of Georgia. IDP Settlement Location in Shida Kartli region Total Resettled IDPs Koda 1 226 Gardabani 287 Teliani 124 Khurvaleti 371 Akhalsopeli 292 Georgia Total: 2 300 • Based on ongoing monitoring mechanisms, UNHCR reports the following with regard to IDP settlements: o Koda village settlement has no hospital, dispensary, drug store or ambulance station. For urgent medical needs IDPs have to call the Marneuli ambulance service which is located 9 km away. Doctors from the local policlinic assessed the medical problems of IDPs in the Koda settlement. IDPs lack medicines particularly for chronic diseases. o Gardabani IDP settlement has better access to health care facilities. There is a hospital within 200 m, an ambulance station approximately 2 km away and pharmacies are in the vicinity. • To ensure the monitoring of access to health care facilities, WHO visited new IDP settlements in Tserovani, Natakhtari and Mtskheta district. Construction of the houses is planned to be finished around December 15. WHO identified two major issues: o Poor hygiene: Some settlements have outside wooden latrines which are to be shared by several households. This will become particularly problematic in the winter season, and may aggravate hygienic conditions in the settlement. o Underdeveloped infrastructure: New IDP settlements provide virtually no social infrastructure. There are no pharmacies, health facilities or grocery stores nearby. According to construction workers, schools are planned to be built on the settlement premises. IDP Settlement in Natakhtari • Health Cluster partners will continue monitoring IDP access to health care provision in the settlements. 3 http://www.relief.migration.ge/intranet/index.php 2 HEALTH CLUSTER (HC) COORDINATION • WHO organized the second round of Health Cluster field coordination meetings in the western part of Georgia. Two meetings were held in Kutaisi, Imereti region and in Zugdidi, Samegrelo region, respectively, on 25 and 26 of November. Imereti Regional Health Department, in collaboration with UMCOR and OXFAM, mobilized 30 representatives of 28 local and international NGOs, as well as government authorities, to attend HC coordination meetings. • Most IDPs registered in the Imereti region originate from the Kodori valley and Abkhazia. 1 700 IDPs reside in Zugdidi. No reports of outbreaks of infectious diseases have been reported in either region. The main causes of morbidity and mortality among IDPs and the local population are chronic diseases, cancer and cardiovascular diseases and surgical ailments. • The health partners participating in the WHO facilitated coordination meeting engaged in a productive dialogue, and prepared advocacy messages to be discussed with the Ministry of Labor, Health and Social Affairs (MoLHSA), donors, UN and other health partners. The following main gaps in IDP health care provision were identified by regional partners: o Shortage of medication and high prices of available drugs; o Rendering equal humanitarian assistance to old (1998) and new (2008) IDPs; o Developing the network of social workers and home care providers; o Revising selection criteria for inclusion of beneficiaries under targeted social insurance health coverage; o Balancing the pensions of disabled and non-disabled persons. • It was agreed that the next Health Cluster field coordination meetings will take place in the beginning of 2009. • Chaired by WHO, five weekly Health Cluster coordination meetings were held in Tbilisi, at the UN House in November and early December. WHO also continued to hold bi-weekly Mental Health and Psychosocial Support (MHPSS) and Nutrition subcluster meetings. While In Senaki, the WHO team visited a hotel, now functioning as an IDP shelter, which suffered substantial damage during the atrocities in August • The Health Cluster identified early child development, child protection, and gender mainstreaming as crosscutting issues. It was agreed that all partners will put emphasis on these issues in their respective project implementation. MONITORING VISITS • WHO team visited IDP polyclinics in Kutaisi, Zugdidi and Senaki. Local medical staff identified the following challenges: o Shortage of medication, including modern psychotropic drugs; o Outdated equipment; o Inadequate workspace; o Delayed reimbursement of health care related costs by insurance companies; o Lack of mental health and psychosocial support (MHPSS) activities and the need for child-focused psychologists; o Professional development opportunities for medical staff; o Strong social stigma of mental health patients resulting in delayed treatment; o Insufficient funding. 3 • As a follow up to the joint assessment report issued on 8 November by the Public Defender’s Office (PDO) and the Global Initiative on Psychiatry (GIP), WHO visited the Senaki disabled children’s house and met with staff to discuss the possibilities of addressing challenges and problems raised in the report. To improve the crosscutting issue of child protection, WHO and UNICEF plan to initiate a roundtable discussion with the respective government representatives and local NGOs in order to agree on necessary interventions. • In Senaki meetings were held with the Director of the Public Health Center and with psychiatrists of the Psycho-Neurological Dispensary. The discussions focused on ways to overcome existing gaps with the limited recourses available. Beneficiaries of Senaki disabled children’s house need improved health care provision and better living conditions HEALTH SITUATION UPDATE • According to the National Center for Disease Control (NCDC), as of 9 December no outbreaks of communicable diseases among IDPs in the affected areas have been reported4; • Within the framework of the Measles and Rubella (MR) supplementation immunization campaign, 47,2% of the target population has been vaccinated. MoLHSA has decided to extend the campaign until mid-December. FLASH APPEAL FUNDING UPDATE • As of 8 December 2008, the Health Cluster remains the most underfunded of all clusters, with 14% of the US$ 4.2 million appealed for under the Flash Appeal (FA) for Georgia. The revised FA figure is based on OCHA’s financial tracking system5. • As a result, many Health Cluster partners have to put on hold activities such as infant feeding, mobile unit outreach efforts, mental health and psychosocial support and primary health care (PHC) support. In the light of the approaching winter, timely funding is essential in order to sustain crucial health interventions and to prepare for winterization. • Cluster leads continue advocacy for funding at donor meetings and Cluster Lead meetings organized by the UN. HEALTH CLUSTER UPDATES • WHO is in the process of finalizing a project to strengthen the provision of PHC services through: o Integration of 250 IDP health professionals from Kurta Hospital into Georgia’s public health system; o Provision of basic medical and other essential equipment to support PHC home visits through two mobile teams; and o Capacity building/training sessions designed for selected medical staff. Beneficiaries of the project are 21 PHC providers serving the conflict-affected population countrywide. The mobile teams will be dispatched to IDP settlements, villages where returnees reside and the remaining Collective Centers to carry out registration, conduct consultation sessions, provide medical assistance, and - if 4 http://www.ncdc.ge/ 5 http://ocha.unog.ch/fts/reports/daily/ocha_R3_A828___0812170705.pdf 4 needed – dispense medication. They will also conduct initial registration of and consultation with pregnant women. The schedule of the mobile teams will be coordinated with the HC partners in order to avoid duplication of activities. Bidding for medical equipment and preparation of purchase orders is progressing. • In response to the WHO request for HC partners to support the newly renovated mothers and children hospital “Iavnana” in Gori, Caritas has agreed to donate portable ultrasound equipment. The new hospital building is still virtually empty, while sick children are being treated in an adjacent old building with poor hygienic conditions. • In collaboration with WHO, OCHA supported the design of electronic maps reflecting Health Cluster partner activities in Shida Kartli region, Gori district and the area north of Gori. The maps are available at http://www.reliefweb.int/rw/fullMaps_Sa.nsf/luFullMap/23A79C630B3E3C0385257 4F9006E72EC/$File/ocha_HLT_geo081106.pdf?OpenElement and will be updated on a regular basis. • To commemorate the World AIDS Day, the UN hosted a meeting attended by high- level officials and followed by a press conference on 1 December. WHO organized and hosted a presentation on HIV/AIDS and co-infection prepared by the Infectious Diseases, HIV/AIDS and Clinical Immunology Research Center. Epidemiologist delivers presentation regarding Hepatitis C distribution among HIV/AIDS patients in Georgia Partners of the Health Cluster include: ACTS, ADRA, CARITAS, CIF, CLARITAS XXI, Counterpart, GRCS, Hellenicare, IMSS, IRD, IWA, MdM, Merlin, MSCI, MSF, OXFAM, SCF, UMCOR, UNICEF, UNFPA, UNWHO, EC, EC/ECHO, USAID, WB, WF, WVI (see Annex 2 for acronyms) Ministry of Labour, Health and Social Affairs (MoLHSA) Nutrition subcluster: (For more information on infant and young children feeding in emergencies please see: http://www.who.int/hac/crises and http://www.unicef.org/nutrition) • The Embassy of the Republic of Estonia offered to donate Breast Milk Substitutes (BMS) for 180 children 0-6 years old, for 2 months. As a designated agency for BMS distribution, the United Methodist Committee on Relief (UMCOR) will carry out the distribution, in collaboration with Claritas XXI. United Nations Children’s Fund (UNICEF) – the lead agency within the Nutrition subcluster - is providing logistical support. • The Estonian government will also donate 5 184 complementary food containers. Each of the 172 beneficiaries in Gori, in the ages 6 months to 2 years old, will 5 receive over the period of one month 6 packages containing 5 different kinds of purees, juices, puddings, etc. • UNICEF has received funds from the Irish government to purchase complementary food. It plans to purchase and distribute porridges for children through the nutrition subcluster partners. Partners of the Nutrition subsector include: CLARITAS XXI, SCF, UMCOR, UNICEF, UNWFP, UNWHO Ministry of Labor, Health and Social Affairs (MoLHSA), Ministry of Refugees and Accommodation (MRA) Mental Health and Psychosocial Support (MHPSS) subcluster: • WHO identified an acute need for trained psychologists to provide psychosocial rehabilitation assistance to IDPs in Zugdidi and Senaki. • An MHPSS working group has developed and circulated a draft Mental Health Assessment Tool for teachers, community members and service providers. The working group includes WHO, World Vision (WV), Children of Georgia (CoG), Georgia Association of Mental Health (GAMH), Georgia Center for Psychosocial and Medical Rehabilitation of Torture Victims (GCRT) and Global Initiative on Psychiatry (GIP). • MHPSS subsector partners collectively identified the following challenges in Collective Centers with regard to MHPSS issues: o Information gaps. Lack of essential information details about relocation and winterization exacerbate mental health problems among IDPs and delay the psychosocial rehabilitation process. The uncertainty about the future might be a contributing factor to newly emerging severe Post Traumatic Stress Disorder (PTSD) symptoms, especially among male IDPs. The subsecor partners underscored the importance and urgent need of the relevant government agencies providing consistent information to IDPs on a regular basis. o Need for binding social activities. Activities involving IDP families and IDPs need to be implemented in order to reinforce and strengthen social links, provide meaningful occupation and prepare the basis for further MHPSS work. Moreover, unemployment is a contributing factor to increased alcohol and tobacco abuse and violence. o Poor living conditions. Living conditions are dire in most Collective Centers throughout Georgia due to poor hygiene, limited space and underdeveloped infrastructure. o Lack of gender-based and child-focused activities. Partners anticipate high marginalization, increased substance abuse and growing numbers of domestic violence cases following the IDP move to new settlements. o Insufficient nutrition for IDP children. Parents are concerned about the lack of vitamins in their children’s food ration. Partners of the MHPSS subsector include: COG, CRS, GAMH, GAPCP, GASW, GIP, GCRT, GPS, GRCS, Hellenicare, IOCC, IOM, INCD, IPS, IRD, MdM, Merlin, MSF, NDOBA, PIN, SCF, WVI, UNICEF, UNHCR, UNWHO Ministry of Labour, Health and Social Affairs (MoLHSA), Committee of Health Care and Social Issues (CHCSI), Parliament of Georgia, Ministry of Education and Science (MoES) 6 7 ANNEX – Health Cluster partners Acronyms Organization CAPS Georgian Alliance for Patient Safety CARITAS CARITAS, Georgia CIF Curatio International Foundation CLARITAS XXI, Georgia CLARITAS (Mother-Child Nutrition and Wellness Association) CHCSI Committee of Health Care and Social Issues, Parliament of Georgia CoG Children of Georgia EC Delegation of the European Commission to Georgia EC/ECHO European Commission’s Humanitarian Aid Office ERE Embassy of the Republic of Estonia EUMM European Union Monitoring Mission FE French Embassy GAMH Georgia Association of Mental Health GAPCP Georgia Association for Psychotherapy and Clinical Psychologists GASW Georgia Association of Social Workers GCRT Georgian Center for psychosocial and Medical Rehabilitation of Torture Victims GHSPIC Georgia Health and Social Projects Implementation Center GIP Global Initiative on Psychiatry GPS Georgian Society of Psychotrauma GRCS Georgia Red Cross Society Hellenicare Hellenicare ICRC International Committee of the Red Cross NB! Not a member of Health Cluster IOCC International Orthodox Christian Charities IOM International Organization for Migration IPS Institute of Policy Studies IRC International Rescue Committee IRD International Relief and Development MERLIN Medical Emergency Relief International MoLHSA Ministry of Labour, Health and Social Affairs MRA Ministry of Refugees and Accommodation MSF Medicine Sans Frontiers NCDCPH National Center for Disease Control and Public Health OXFAM OXFAM PIN People in Need PIP Patriarchate and D. Uznadze Institute of Psychology PDO Public Defender’s Office SCF Save the Children Fund TdH Terre des Hommes TPND Tbilisi Psycho-Neurological Dispensary UMCOR United Methodist Committee on Relief UNAIDS United Nations Joint Programme on AIDS UNFPA United Nations Population Fund UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children's Fund UNWHO United Nations World Health Organization USAID United States Agency for International Development WC War Child Holland WB World Bank WF Welfare Foundation WVI World Vision International 8