Republic of the Philippines Department of Health HEALTH EMERGENCY MANAGEMENT STAFF GroundFloorBldg. 12, San Lazaro Compound, Sta.

Cruz Manila Telefax Nos : 743-0568/ 740-5030 Telephone Nos : 743-0538/711-1001/711-1002 Trunk Line : 651-7800 local 2200-2207 Email:doh_hemsopcen@yahoo.com

HEARS PLUS REPORT

FOR : ENRIQUE T. ONA, MD, FPCS, FACS Secretary of Health ENRIQUE A. TAYAG, MD, FPSMID, PHSAE, CESO III Assistant Secretary of Health Support to Service Delivery Technical Cluster II CARMENCITA A. BANATIN, MD, MHA Director III VAN ALLEN N. BUSTOS, RN Emergency Officer-on-Duty I LUZVIMINDA C. CLAVERIA, RN Emergency Officer-on-Duty II RAYMOND M. TSAI Emergency Officer-on-Duty III SUBJECT DATE : : HEALTH EMERGENCY ALERT REPORTING SYSTEM (HEARS) October 29, 2013

THROUGH

FROM

There was one (1) new event and one (1) special event monitored from 8:00 AM of October 28, 2013 to 8:00 AM of October 29, 2013. Likewise, two (2) on-going events are being monitored by HEMS Operation Center. I. NEW EVENT (1) No. 1. Incident Tropical Depression at East of Virac, Catanduanes. October 29, 2013 Brief Description The Tropical Depression outside the Philippine Area of Responsibility (PAR) is expected to enter this morning and will be named "VINTA". Actions Taken HEMS OPCEN Sent weather alert thru SMART infoboard.

Location of Center Strengths: Movement: Forecast:

1,150 km East of Virac, Catanduanes Maximum sustained winds of 45 kph near the center Forecast to move West Northwest at 24 kph

Wednesday morning: Thursday morning: Friday morning:

600 km East Northeast of Virac, Catanduanes 300 km East of Baler, Aurora 180 km West of Baguio City Estimated rainfall amount is from 5 - 7.5 mm per hour (moderate - occasionally heavy) within the 300 km diameter of the Tropical Depression. Tropical Depression "VINTA" will not yet affect any part of the country.

II. ON-GOING EVENTS (2) A. EFFECTS OF MAGNITUDE 7.2 EARTHQUAKE CENTERED IN SAGBAYAN, BOHOL ON OCTOBER 15, 2013 I. SITUATIONER On October 15, 2013, a 7.2 magnitude earthquake struck at 8:12 am, and was centered 2 kilometers southeast of Sagbayan, Bohol. The quake's depth of focus was 33 kilometers, and was of tectonic in origin. The quake was felt across the Visayas and Mindanao. PHIVOLCS said the following intensities were felt: Tagbilaran City, Bohol, and Cebu City Hinigaran, Negros Occidental, and Dumaguete City Iloilo City; La Carlota, Negros Occidental; Guimaras Island; Abuyog, Leyte; Ozamis City; Sibulan, Negros Oriental; Camiguin Island; and Gingoog, Misamis Cagayan de Oro IntensityIV Masbate City; Roxas City; San Jose, Culasi , Antique; Bulusan, Sorsogon; Hinunangan, Leyte; Patnungon, Antique; Dipolog City; Bacolod City; Naval, Biliran; Bayawan City; Baybay, Southern Leyte; TabonTabon, Leyte; San Pablo, Leyte; Bato, Leyte; Guihulngan, North Oriental; Butuan City ; and Tacloban Intensity II Davao City; Canlaon City; Cotabato City; La Costellana, Negros Occidental; Zamboanga City; Borongan City, Samar; Bukidnon; Tarragon a, Davao; Surigao City ; Laoan, Antique; Cotabato City; Banisilan, North Cotabato; Potongan, Zamboanga del Norte; Polanco, Zamboanga del Norte; Labason, Zambaonga del Norte; Manukan, Zamboanga del Norte; Balderama, Antique; and Barbaza, Antique; Nabas, Aklan ; Carrascal, Surigao del Sur; Tacurong City; and Libertad, Antique Intensity I Lezo, Aklan Due to the impact brought about by the event, a total of 61,891 houses, 41 bridges and 18 roads were damaged. Seaport, airports, churches, government/public buildings, schools, hospitals and private establishments were also damaged in the Province of Bohol, Cebu, Iloilo, Guimaras, Negros Occidental and Leyte in Regions VI, VII, and VIII. State of Calamity was declared in the province of Bohol and Cebu. A press conference was held at the NDDRMC Conference Room on the same day at 12:00 PM to discuss the effects of the earthquake in Sagbayan, Bohol and the actions that need to be taken. At about 3:00 p.m. President Benigno S. Aquino III presided the meeting held at the NDRRMC Conference Room. II. CURRENT SITUATION As of October 28, 2013 5:00 p.m., there were a total of 2,984 aftershocks recorded, wherein 83 were felt. A total of 671,779 families/ 3,217,094 persons were affected in 1,527 Barangays in 60 municipalities and 6 cities in the 6 provinces of Region VI and VII. Out of the total affected, 71,169 families/ 359,251 persons were displaced and served inside 367 evacuation centers were established to accommodate 20,677 families/ 105,186 persons. Intensity VII Intensity VI Intensity V

There were 218 deaths and 779 injured victims reported from the provinces of Siquijor, Cebu and Bohol (Bohol having the highest number of deaths 204 and injured - 674). Medical and Technical Teams were deployed in different municipalities of Bohol to provide Health, WASH, Nutrition and Psychosocial services to the affected population. Medicines and medical supplies were provided to cover the needs in the community.
Source: NDRRMC Sitrep No.28 as of October 28, 2013, 6:00 pm

III. MAP OF AREAS AFFECTED WITH THE CORRESPONDING TEAMS DEPLOYED, EXISTING FUNCTIONAL HOSPITALS AND ALLOCATION OF DRUGS AND MEDICINES FROM DOH

Note:

A total of 35 teams (medical and technical) were deployed in the different municipalities of Cebu and Bohol. A total of 124 health facilities (Cebu-14, Bohol-110) are functional and is providing continuous health services to the affected population. A total of 3 hospitals, 7 RHUs, 20 municipalities received the assorted drugs and medicines from the Department of Health (List available upon request)

IV. MAGNITUDE OF EVENT A. INTERNALLY DISPLACED POPULATION CENSUS IN Region VII AS OF OCTOBER 28, 2013 6pm
Region Province Guimaras VI Iloilo Negros Occidental Cebu VII Bohol Siquijor Total Mun. / City 1 1 3 10 48 2 Affected Population Brgys 1 1 9 362 1,109 45 1,527 Families 1 1 21 404,107 262,387 5,262 671,779 Persons 2 5 92 1,939,707 1,250,974 26,314 3,217,094 No. of Evacuati on Centers 0 0 0 17 350 0 367 Inside Evacuation Center Families 0 0 0 372 20,305 0 20,677 Persons 0 0 0 2,259 102,927 0 105,186

Source: NDRRMC Sitrep No. 28 as of October 28, 2013, 6:00 pm Note: Based on latest NDRRMC SitRep, there is a 27.7% increase in the number of evacuation centers (265 to 367), and a decreased in number of families/individuals inside ECs (5% families / individuals). Decrease in the number of families and persons affected as per validation of the DSWD. As per CHD VII-Reporting Unit PHO-BOHOL HSU Report No. 3 dated October 26, 2013, there is no change in the number of evacuation centers and total families inside evacuation center (47 evacuation center/ 3,305 families) .

B. DOH CONFIRMED CASUALTIES AS OF OCTOBER 28, 2013 REGION PROVINCE Cebu VII Bohol Siquijor Negros Oriental Total
Source: CHD VII Sitrep No. 40 as of October 28, 2013 as of 6PM Note: Out of 218 confirmed deaths from CHD VII, 218 were identified. NDRRMC Sitrep No. 28 reported 218 reported deaths and 768 injured as of October 28, 2013, 6:00 pm Top causes of deaths: Injuries due to falling collapsed structure, Injuries due to landslide, Injuries due to fallen trees/post. Most of the deaths (93.5%) and injuries (86.5%) reported were from Bohol. Municipalities in Bohol with the highest number of casualties (death and injuries combined) were Loon (191), Tubigon (107), Inabanga (85), San Isidro (72) and Maribojoc (56).

DEATHS 13 204 1 0 218

INJURED 101 674 3 1 779

C. SURVEILLANCE IN POST EXTREME EMERGENCIES AND DISASTERS REPORT AS OF OCTOBER 28, 2013 A total of 538 consultations under SPEED were reported from six reporting facilities in Bohol on October 28, 2013. Top five consultations reported were acute respiratory infection (345/64%), fever (51/9%), hypertension (44/8%), open wounds and bruises (32/6%), acute watery diarrhea (30/6%). Other consultations reported were skin diseases (24/4%) acute asthmatic attack and animal bites (1/0.2%), conjunctivitis and fever with other symptoms (5/ 0.9%), As of October 28, a total of 30 cases or 6% of the total consultation were acute watery diarrhea was reported. Seven (7) or 23% of these consultations were among children below five years old. Maribojoc RHU registered the highest number of consultations (19/30) 63%, Danao RHU (5/30) 16%, Clarin Rural Health Unit (4/30) 13%, and Catigbian and Tubigon RHU both with 3.3% (1/30). No new consultation of suspected measles reported during this day. A total of seven suspect measles were reported from Oct 15 to 26, 2013. These were from Loon RHU (4) and Danao RHU (1) and Antequera RHU (2). Epidemiolgic investigation was conducted and specimens collected were sent to RITM for laboratory confirmation. Three other specimens are still at Loon RHU. Mass immunization for children ages 1-15 years old was done in the areas of Maribojoc, Tubigon, Clarin, Loon, Calape, Sagbayan and Inabanga. Twenty-four (24) suspected leptospirosis cases previously monitored from October 15 to 26 were found to be negative as per validation by the CHD. Also, deaths reported due to fracture and hypertension from Danao RHU were found to be dead onsite after the earthquake incident as per validation by the Provincial Health Office. One case of Acute Malnutrition previously reported in Buenavista is already being managed as Nutrition Cluster reached

the area. Surveillance and close monitoring of the health conditions continue. D. STATUS OF DAMAGED HEALTH FACILITIES IN BOHOL AND CEBU PROVINCE AS OF OCTOBER 26, 2013
AFFECTED HEALTH FACILITIES # OF HF OPERATION STATUS FUNCTIONAL NOT FUNCTIONAL EXTENT OF DAMAGE PARTIALLY DAMAGED COMPLETELY DAMAGED ESTIMATED TOTAL COST OF DAMAGE

Cebu
DOH Hospital LGU Hospital Private Hospital DOH Office

15 4 10 -1 135 2 15 36 3 79 150

14 4 9 -1 110 2 14 23 3 68 124

1 0 1 -0 25 0 1 13 0 11 26

14 4 9 -1 116 2 14 28 3 69 130

1 0 1 -0 19 0 1 8 0 10 20

596,950,000.00 82,200,000.00 509,750,000.00 5,000,000.00 398,600,000.00 8,000,000.00 171,100,000.00 115,500,000.00 4,000,000.00 100,000,000.00 995,550,000.00

Bohol
DOH Hospital LGU Hospital RHU Birthing Facility BHS

GRAND TOTAL

Source: CHD HEARS Plus Report as of Oct 26, 2013 11:30 AM

Note: List of damaged health facilities is available upon request. To be determined (TBD)

V. LOGISTICAL SUPPORT RELATED TO EARTHQUAKE IN CEBU AND BOHOL AS OF OCTOBER 28, 2013, SOURCE ITEMS Assorted drugs and medicines, CAMPOLAS Plus kit, Hygiene kit, Folding Cot/Bed, family tent, waterine, Aquatabs, medical supplies, SPEED Materials and drinking water container. Assorted drugs and medicines, CAMPOLAS Plus kit, Hygiene kit, Folding Cot/Bed, family tent, waterine, medical supplies, and drinking water container Sub- Allotment Sub- Allotment (NCHFD) CHD CHD MM CHD X CHD VIII CHD VII CHD IV- A CHD III CHD VI Assorted supplies Assorted supplies Assorted supplies Assorted supplies Assorted Assorted Assorted medicines, medical and WASH medicines, medical and surgical medicines, medical and surgical medicines, medical and surgical medicines, medical supplies medicines, and medical supplies medicines, 100 Hygiene kits, 288 Bohol 556,102.00 200,000.00 102,682.50 405,671.30 258,362.73 33,000.00 312,881.24 RECIPIENT Bohol, Celestino Gallares Hospital AMOUNT 4,463,566.30

DOH-CO

Cebu Vicente Sotto Medical Center CHD VII Sub Total

1,146,951.20 1,000,000.00 2,000,000.00 8,610,517.50

bottles waterine solution, 2,000 vials MMR CASH Sub Total Hospitals EAMC QMMC POC TMC RMC JRRMMC Batangas Medical Center Other Agencies POA PMA UNFPA WHO Plaster of paris, wadding sheet, elastic bandage Assorted medicines and medical supplies 200 pails of Reproductive Health Kit 5 Medical Station Tent Sub Total Gov Celestino Gallares Hospital Bohol 250 amps of ATS, 250 amps of TT, Anesthesia, gloves, mask, assorted medicines Assorted medicines and medical supplies Assorted medicines, medical supplies, external fixators, Surgical supplies Assorted medicines and medical supplies Assorted medicines and medical supplies Assorted medicines, plaster of Paris, wadding sheet, medical supplies, ATS, TT Assorted medicines, medical supplies

2,000,000.00 3,868,699.77

100,941.78 23,165.50 Gov Celestino Gallares Hospital 457,392.84 360,470.97 23,000.00 64,774.68 Bohol Sub Total 46,289.00 1,076,034.77

15,480.00 100,000.00 170,040.00 876,540.00 1,162,060.00

GRAND TOTAL

14,717,312.04

VI. HEALTH HUMAN RESOURCE MOBILIZED AS OF OCTOBER 28, 2013 TYPE OF TEAM MEDICAL TECHNICAL COMPOSITE TOTAL NO. OF TEAMS DEPLOYED 17 9 9 35 NO. OF PERSONNEL DEPLOYED 113 43 81 237 NO. OF AREAS VISITED/ASSESSED 20 out of 48 municipalities affected TOTAL CASES SEEN 1,875 2,367 4,242

Source: CHD VII HEARS Report as of October 28, 2013;

VII. MONITORING ACTIVITIES AND ACTIONS TAKEN OFFICE ACTIONS TAKEN Health Cluster Department DOH-CO: October 15-25 of Health Secretary Enrique Ona with Asec. Roland Cortez, Dir. Jaime Lagahid, Dr. Arnel Rivera and WHO Rep Julie Hall visited Governors Mansion at Tagbilaran City to visit the Incident Command Center established and meet Governor Edgar Chatto. Turn over ceremonies of the hygiene kits donated by USAID was also attended. Secretary and party visited Sagbayan, Bohol to assess the current situation and identify needs in the area (10/25/2013) Deployed six (6) HEMS personnel to Bohol which provided technical assistance on MHPSS, Nutrition in Emergencies and information management in the Operations Center. The team also Visted Celestino Gallares Memorial Hospital to check the situation of hospital response in the main DOH referral facility. Asec. Paulyn Jean Rosell-Ubial visited and attended meetings in the Incident Command Center at Governors Mansion in Bohol and proceeded to the municipalities of Catig bian, Sampaya and Carmen to assess extent of damage and to identify health needs of the affected areas. Coordinated with NDRRMC, Philippine Airlines and Cebu Pacific for the mobilization of logistics to Bohol.

Dr. Carmencita Banatin and other HEMS staff went to Gov. Celestino Gallares Memorial Hospital and Governors Mansion in Tagbilaran City to provide technical assistance for Incident command System, WASH, information management, team mobilization, cluster organization, assessment of damaged health infrastructures and Operation Center activities. Other activities taken are as follows: o Meeting at the Governor's Mansion to provide orientation and technical assistance to CHD 7, PHO, and other focal staff on SPEED and other reports on part of information management. o Meeting with Dr. Portia Reyes, Dr. Edgar Pizarras and supply officer of Gov. Celestino Gallares Hospital, and Hems Operation Center for the facilitation, tracking and distribution of logistics augmented to Bohol. Dr. Arnel Rivera attended the daily press conference at NDRRMC regarding the effects of the earthquake. Likewise, he oriented the team from Philippine Orthopedic Center and Jose Reyes Memorial Medical Center regarding the mission to be conducted in the Province of Bohol. Sec. Enrique Ona with Usec. Garin, Usec. Herbosa and Dr. Lagahid visited the Gov. Celestino Gallares Memorial Hospital and conducted a meeting with Local Government officials and health responders. Raised Code Blue Alert Coordinated with Dr. Alfonso Nuez of East Avenue Medical Center and Dr. Albert Capuno, Quirino Memorial Medical Center and neighboring CHDs for the organization of teams to be deployed in Bohol. Verified and confirmed details of the monitored incident with CHD VI, VII & VIII and coordinated with the Hospital HEMS Coordinator in Don Emilio del Valle Memorial Hospital, Talisay District Hospital, Gov. Celestino Gallares Memorial Hospital, St. Anthony Mother and Child Hospital and Vicente Sotto Memorial Medical Center Dr. Carmencita Banatin attended press conference at NDRRMC regarding the effects of the earthquake.

CHD VII: October 15-27 Conducted MMR mass immunization with a total of 4,191 individuals served as of October 25, 2013 in seven (7) municipalities in Bohol namely: Maribojoc (1,203), Loon (1282), Sagbayan (47), Clarin (689), Calape (128), Tubigon (770), and Inabangan (72). Transported logistics from CHD Operation Center to Tagbilaran Operation Center/ Cebu City Medical Center/ Gov. Celestino Gallares Memorial Hospital RESU 7 Team was deployed in Loon and turned over assorted drugs and supplies to Loon District Hospital, turned over MMR vaccines and other supplies for mass immunization, assisted CHD 7 Medical team for immunization Meeting with DILG Sec. Mar Roxas and Gov. Edgar Chatto at Governors Ma nsion Regular meeting done every 8am at Health Emergency Provincial Operation Center presided by the head of the Health Cluster, Dr. Reymoses Cabagnot and attended the following meetings conducted: o Emergency Meeting done at the OCD Cebu (Oct 15) o Meeting at GCGMH with Sec. Enrique Ona (Oct 16) o Organizational Meeting at Governors Mansion with Dr. Banatin (Oct 17) o Meeting with City Mayor of Cebu, Hon. Michael Rama (Oct 17) to discuss the status of Cebu City Facilitated the deployment of different teams from other regions and agencies to areas of assignment. Conducted SPEED orientation to teams mobilized. Dr. Bernadas coordinated with Dr. Cabagnot for response plans based in Rapid Damage Assessment and Needs Analysis. Provided WASH, Medical, Psychosocial and Nutrition services to the following affected areas: Tubigon, Loon and Calape. Number of individuals served to follow. Assisted National Epidemiology Center (NEC) in the conduct of Rapid Health Assessment in Cebu and Bohol. Medical Teams were sent to Cong. Natalio P. Castillo Sr. Memorial Hospital to assess patients diagnosed with fractures for transfer to Gov. Celestino Gallares Memorial Hospital. Conducted assessment and ocular survey in the area of Loon, Maribojoc, Catigbian, Balilihan, Corella, San Isidro, Danao, Inabanga, Sagbayan, Clarin, Tubigon, Calape. The team assessed the areas of Medical, WASH, Nutrition, MHPSS and MDM on 16-18 October 2013; Surveillance and monitoring done by RESU 7 in San Isidro, Clarin, Tubigon, Calape, Loon RHU2, Sikatuna, Sevilla, Carmen, Sagbayan and Catigbian Conducted cluster meeting at the Incident Command Post in Governors Mansion presided by the Health Cluster Head, PHO Dr. Reymoses Cabagnot CHD 7 Infra Staff together with PHTls conducted damage assessment to health facilities

Dr. Jaime Bernadas formed Rapid Health Assessment Team that proceeded immediately to Bohol for initial assessment and assistance to PHO for establishment of provincial Opcen Raised Code Red Alert Status and activated Operations Center on Oct 15

CHD X: October 24-27, 2013 o Conducted medical consultation to 486 individuals at the RHU makeshift health center in Municipality of Sagbayan. o Ongoing Tetanus Toxoid, Measles immunization & Vit. A supplementation o Provide daily health education at the evacuation centers. o Coordinated with all involved in health response and conducted coordination meeting. o Provided RHU makeshift health center: (TT injections, Home delivery cord care Re-adjusted flow of consultation) o Health Secretary Ona and Regional Director Jaime S. Bernadas had a short briefing of health situation of the Municipality of Sagbayan o Brief the Municipal Health officer regarding the cluster approach. o Conducted Orientation on SPEED reporting among Health Personnel. o Orientation on the use of standard form for health and introduce the Health Card System and the Health Access Card Form per Family.( Pilot ) o Scheduled the first Health Cluster meeting among service provider. o Helped in Health Information management System. o Initiated the Set up of Health Information board outside the RHU makeshift. o Continuous monitoring of the disease in the evacuation. o Augmented human personnel (3 doctors, 4 nurses, 2 drivers, 1 logistics and 1 HEPO.) CHD MM: October 27-28, 2013 Deployed 16 man composite team (2 MDs, 9 RNs, and 5 WASH trained staff) in municipality of Dagohoy. Conducted medical mission at Dagohoy and seen 400 individuals. GOV. CELESTINO GALLARES MEMORIAL HOSPITAL: October 15 - 26 A total of 265 patients were seen. Out of 265, 109 were admitted and 156 were treated as OPD. Nine (9) deaths were reported. Eight out nine deaths occurred on Oct. 15 (date of incident) and were mostly dead on arrival. Leading causes of mortality were severe head injury secondary to blunt head trauma and acute abdomen blunt thoraco abdominal injury. Leading causes of mortality were fracture of the limb bones, abdominal & chest trauma, fracture of femur, head injury, open wounds, fracture of neck, thorax % pelvis, spinal cord injury, occipital fracture, epidural hematoma, and multiple contusion. As of Oct. 27, there were 44 remaining admitted patients and total of 7 referrals in different hospital. A total of seventy (70) operations were performed which are all orthopedic and trauma cases. (list available upon request) CHD IV-A: October 25 Deployed 9-man composite team (3 doctors, 2 DOHrep, 1 nurse, 1 Engineer, 1 sanitary inspector, 1 support staff) and was assigned in Municipality of Antequerra. CHD CARAGA: October 20-26 Deployed 6-man team medical/MHPSS team, assigned in Calape, Clarin and Carmen, Bohol CHD VIII & EVRMC: October 19-23 Provided WASH, Medical and Psychosocial services to the municipality of Albuquerque, Bohol. Two (2) medical doctors were deployed in Cong. Natalio P. Castillo Sr. Memorial Hospital (Loon Basketball Court) providing medical services to thirteen (13) remaining patients in the said basketball court. The team visited Southern Central Elementary School and Church of Lady Light Parish in the municipality of Loon, Bohol. There were a total of 108 consultations in which majority were Acute Respiratory Infection (ARI). Conducted Psychosocial service to seventy-five (75) evacuees at Southern Central Elementary School Transferred two (2) patients with multiple injuries to Governor Celestino Gallares Hospital from Cong. Natalio.

Deployed 3rd Batch of Medical team composed of 3 Doctors 2 Nurses and 3 Admin aids to Ubay, Bohol.

CHD V and VI: October 20-21 A total of 315 patients were seen by the team. Top causes of consultation were Upper Respiratory Tract Infection (URTI), wounds (all forms), epigastric pain, skin disease, and signs of anxiety. Likewise, psychosocial processing (PSP) were also conducted to 13 individuals. 76 bottles of waterine were also given in 24 barangays and 2 evacuation center CHD VI CHD VI (Western Visayas) deployed medical team composed of 2 Medical Doctors and 3 Nurses the municipality of Sagbayan covering Sagbayan RHU, Central Elementary School, Municipal Plaza and St. Augustine Parish. CHD V provided WASH, Medical, Psychosocial Support and Nutrition services to the municipality of Maribojoc, Bohol. Number of individuals served to follow. (Oct 18) EAMC, QMMC, VSMMC: October 19-20 VSMMC Deployed in Gov. Celestino Gallares Memorial Hospital since Oct. 16, 2013, a total of ten (10) major operations handled such as blunt trauma, appendectomy, amputation and debridement. Served as roving medical team and visited the district hospitals and RHUs in the municipality of Carmen, Sagbayan and Sanria Poliones to assess patients that needs to be transferred. QMMC served as roving medical team and visited St. Anthony Mother and Child Hospital, Tubigun District Hospital and Clarin Community Hospital. to assess patients that needs to be transferred. EAMC deployed in Gov. Celestino Gallares Memorial Hospital since Oct. 16, 2013, routine covers hospital rounds in the morning and handles scheduled operations in the afternoon. A total of twenty one (21) major operations were performed such as debridement, fixation, amputation, laparotomy, castng and molding. There are approximately 150 admissions; major operations handled were external fixation, ORIF, hip spica cast, and skeletal traction. Four (4) Surgical Spinal cord Injury cases were transferred to Vicente Soto Medical Center via airlift. National Epidemiology Center (NEC) Three (3) NEC conducted Rapid Health Assessment after the earthquake, as a result seven (7) evacuation centers has inadequate number of toilet facilities was noted (Tubigan Central School, Poblacion Central School in Loon, Loon municipal Plaza Evac Center, Sagbayan Municipal Hall Evac Center, St. Augustine Parish Evac Center in Sagbayan, Danao Municipal Plaza Evac Center and Clarin School of Fisheries). Likewise, the need for portable water was also noted in Tubigan Community Hospital, Tubigan Elementary School, Sagbayan Municipal Hall Evac Center, St. Augustine Parish Evac Center in Sagbayan and Catigbian Baang Evacuation Center. Plan development to address the above issue was done. Two (2) suspected measles were reported from Cantomucad, Loon and Loon Rural Health Unit 2. Blood samples were already taken and were send to RITM for validation results to be followed up. A Mass immunization in Loon is ongoing. Coordinated with CHD RESU and HEMS for assistance and for appropriate actions taken.

Bureau of Quarantine (BOQ) Travelled to West side coastal area of Bohol to transport health teams, supplies, other human resources and patients for hospital referral No. of Individuals Given Health Services as of October 27, 2013 HEALTH SERVICES 1. First Aid 2. Consultation and Treatment 3. Patients Transport 4. Measles immunization 5. Vitamin A 6. Tetanus Vaccination 7. Family Reproductive Planning No. of Population Served (Individuals) 458 4,780 726 418 4,337 81 78 No. of Areas Covered (EC, Community, Hospital) 2 ECs & 12 communities 13 ECs & 17 communities 4 ECs & 10 communities 1 ECs & 3 communities 3 ECs & 8 communities 2 ECs & 8 communities 1 EC & 6 communities

Health

Natal Care Others 8. Health Education 9. Referrals 10. Provision of CAMPOLAS 11. MMR 12. Chemoprophylaxis 13. Activation of SPEED
Source: CHD VII HSU No.2 as of October 25, 2013

104 0 5,914 139 4,191 102

1 EC & 8 communities 1 EC & 12 communities 3 ECs & 8 communities 2 ECs & 7 communities 7 municipalities 1 community 14 RHUs, 4 ECs, & 4 Hospitals

LGU and Partner Agencies

Assist in the recording of relief teams, deployment and status of deployment. Daily monitoring of logistics including origin an allocated delivery sites. Daily monitoring and validation of casualties, injuries, and illnesses as well as hospital status reports. Actual visits to province-owned hospitals in affected areas, other LGU facilities and evacuation centers by PHO and engineering teams. Two sets of RH Kits 6A and 6b (clinical service delivery assistance) were distributed to Carmen and Maribojoc to assist the medical team, including gloves, emergency lights and Oxytocin. One set of RH kit#4 (oral contraceptives) was supplied to the Provincial Health Office to meet the needs of family planning users. Philippine Red Cross (PRC) provided a 50-bed tent to GCGMH to house patients forced to stay in the open. Health Sector partners, Philippine Medical Association (PMA), Philippine Red Cross, BFP EMS, PCG Medical, AFP Medical Corps, PNP Health service, PNA , and Dep Ed also provided technical assistance in Health and Psychosocial services to the affected areas in Bohol. Mercy Malaysia served 192 patients and reported through SPEED. Teams from other agencies providing medical services to the affected areas: PNA with SalamatDoc(Medical) team, BMS w/ PCP BCHCA(Medica) team, Mercy Malaysia, Philippine Coast Guard, Operation Blessing, Save the Children, Nazarine Disaster Response and Bangladesh Fire Services. These teams covered the areas of Cortes, Loon, Tubigon, Sagbayan, Antequera and Calape.

WASH Cluster Department DOH-CO: October 17-18 of Health Assisted in deploying mobile water treatment units to affected municipalities where water supply is a major identified need (4 units - 1 each in Sablayan, Calape, Loon and Maribojoc) and provided briefing to 8-man team from Manila Water Inc. prior to deployment in Municipality of Calape. Conducted 1st WASH cluster meeting and orientation attended by focal persons from PHO, CHD, and WASH cluster partners to ensure coordination of responses / interventions. CHD III: October 26-28, 2013 At South Central School, construction of 6 water sealed toilets was completed and now being used, however the water supply connection from the main line has yet to be provided (no available pipes). Coordinated the actual setting up of the Evacuation command post w/ Brgy Captain Emerson Relampagos. (10/28/2013) At Loon Church Plaza, team coordinated with municipal engineer the actual staking/layout (Digging) for 4 units toilet construction. CHD7 will be delivering the materials soon. The facility, as recommended will also have 4 units of handwashing facility. (10/28/2013) Conducted assessment and survey in University of Bohol Loon Institute: o 3 out of the 8 school toilets are being used at the site; toilets winside the classrooms are closed and not allowed for use. Maintenance and cleaning of the available facilities remain to be a problem because of the distance (50 meters) from the water supply source. Other toilets from partially damaged houses were also used by the evacuees. (10/28/2013) Assessed two (2) evacuation sites namely; South Central School and Loon Plaza. o Water supply is being provided by the local water district. o Inadequate number of toilets as to the ratio on the total number of evacuees. o No reported increase in water related diseases according to the MHO. Supervised the actual construction of the 6 units water sealed toilets in South Central School. (expected to be finished in 2 days) Identified actual site for toilet construction at the Loon Plaza. CHD VII: October 16-26

10

Conducted information dissemination on WASH during Emergency in Panaytayon Elementary School (evacuation center). 70% completion of toilet construction in South Central School, Loon Started construction of toilet at Cong. Natalio Castillo Memorial Hospital, Loon 30% complete construction of toilet at Municipal Oval, Calape 60% complete construction of toilet Municipal Hall EC in Sagbayan. PHO provided Hyposol to Sagbayab. Conducted assessment in Loon and will construct 2 semi-permanent toilets at Loon Evacuation Central School and Cong. Natalio Castillo Memorial Hospital.

CHD X: October 24-26, 2013 Sagbayan, Bohol o Conducted orientation on WASH to the Sanitation Inspector and BHW. o Conducted survey on the water source and inspected the water reservoir o Initiated the Creation of WASH team. o Hand Washing orientation among BHW and performed a returned demonstration at the Evacuation Center. o Conducted rapid assessment on the ECs. o Provided IEC materials ( tarpaulin on Hand washing) o Posted hand washing IEC materials in 24 barangays No. of Families given WASH Services as of October 26, 2013 WASH Services No. of Population Served No. of Areas Covered (EC, (Family or Individual) Community) 1. Provision of potable water 16, 762 individuals 23 ECs (bottled water, water rationing, etc.) 2. Distribution of water 16, 734 individuals 18 ECs container 3. Water testing 500 individuals 1 community 4. Water treatment 14,026 individuals 21 ECs 5. Installation/Construction of 4,400 individuals 4 ECs toilets 130 families and 14,026 6. Provision of hygiene kits 16 ECs individuals
Source: CHD VII HSU No.3 as of October 26, 2013

LGU and Partner Agencies

Nutrition Cluster Department DOH-CO: October 23 of Health Ms. Florinda Panlilio facilitated a Nutrition Cluster meeting held at Governor s Mansion in Bohol attended by Nutrition focal persons in Bohol. Points of discussion and actions taken as follows: o Updates of the situation and actions that has been done: NGOs that provided relief goods to the affected population. Some of the relief goods were distributed to the island barangays but there were areas not reached yet. Vitamin A supplementation is started in the prioritized areas (list being consolidated) o Mapping of MNPCs and Nutrition Program Focal Staffs: trained BNSs and Day Care Workers are available per Barangay. DNPCs to prepare a complete list of

UNICEF constructed pit latrines in two evacuation centers in Maribojoc. PRC mobilized five water purification units with capacity between 28-40 cubic meters per day. USAID provided 6,000 units of hygiene kits through USAIDs Visayas Health Project, and two US military water purification units to Tagbilaran. The water purification units will be operated by the Armed Forces of the Philippines. Manila Water Inc. provided one water treatment unit that produces 4,000 liters of water per hour in Maribojoc. LDS provided 200 hygiene kits to Pasil,Cebu PRC and Latter Day Charities (LDS) provided one and four generator sets respectively to restore water services in Calape, Loon and Tubigon. Rapid Health Assessment done by the Civil defense administrator , Executive Officer of NDRRMC, Philippine Humanitarian Country Team (HCT) and cluster co-lead agencies. OXFAM provided 52 bottles of hyposol Local government unit is providing water tinkering to the interior barangays. World Vision provided food item, 6L of water and hygiene kit among Sagbayan Barangay (1,571). Conducted hygiene prmomotion (hamdwashing prior to hygiene distribution). One water filtration system sent to Municipality of Dagohoy by PDRRMC.

11

o o

the Nutrition workers in their catchment areas. Continuation of the activities: Planning for MUAC and IYCF Assessments with Vit. A Supplementation (teams to be deployed will do the above activities). Review/ orientation on MUAC measurement done by Dr. Martin Parreno and IYCF-E by Ms. Florinda Panlilio. Planning for team deployment represented by the national, regional Nutrition Cluster members (pre-deployment scheduling, grouping, and arrangements done). Other agreements: Initial teams deployed will coach and organize additional teams considering that every municipality and barangay has trained on IYCF-E. Activities for Oct. 24-29, 2013: teams to be deployed will conduct MUAC measurement, IYCF Assessment, Vit. A distribution in Maribojoc, Loon, Antiquera, Calape, Sagbayan, Clarin, Buenavista, and Inabanga.

CHD VII: Cluster meeting in Bohol to be conducted last October 23 Vitamin A donation from UNICEF transported to Bohol Vitamin A distributed in the MHOs of Balilihan, Catigbian and Loon Closely coordinating with the National Nutrition Council thru Ms. Susan Orpilla Deployed Nutrition workers last Oct. 18, 2013 in Bohol to conduct Rapid Assessment including ICYF Assessment. Vitamin A capsules were given to the MHOs of Balilihan, Catigbian and Loon The Composite Team participated by the Nutritionist and Dietician (ND) and Nutrition Program Coordinator (NPC) of CHD VII conducted assessment in the evacuation center in the municipality of Loon on Oct. 18, 2013. Team also distributed micronutrient powders. Designated focal staff for Nutrition Cluster in the PHO of Bohol CHD X: Conducted crash course on Nutrition: MUAC Concerns on breast feeding station in the evacuation centers Coordinated with DSWD on provision of lunch to health personnel on duty. Provision of health Card to all health care service provider. Initiated / conducted the cluster approach orientation to all RHU health Personnel attended by PHN, midwives, BHW, Sanitation Inspector, RN HEALS, DOH Rep. Nutrition Cluster Report as of October 28, 2013 Fourteen (14) teams composed of Nutrition Cluster members from National (2), Regional (2), Provincial (6) District Nutrition Program Coordinators), Municipal (10), Visayas Health (1) supported by HEMS Staff (1) and ACF Staff (1) were deployed to do MUAC Assessment, IYCF-E assessment and counseling and Vitamin A supplementation in Buenavista, Sagbayan, Calape, Loon, Maribojoc, Antequera, Beatrice, Rafols, Alegria, and Carmen. Results were the following: o Majority (1,326) of the mothers are breastfeeding (2 to 3 per evacuation centers are formula-dependent) o 437 out of 441 children ages 6 to 59 month old have green MUAC measurement (Normal); 4 out of 441 with yellow MUAC (Moderate Acute Malnutrition); none with red MUAC (Severe Acute Malnutrition) o The RHU started early with Vitamin A Supplementation and has on-going distribution as part of the Garantisadong Pambata Campaign. o Selected MHOs are dedicating available DOH and NGO Tents to serve as Breastfeeding area. o There were milk violations during the early response period while the population has greater awareness on the milk code o Evacuees are food secure with availability of cooking facilities and utensils per household; with firewoods; with grocery store at the center of the evacuation site; with food reliefs consisting of fresh fish. Few head of the families have started fishing for foods. o Selected Public Health Teams have focal members for nutrition to ensure that nutrition concerns in the areas can be immediately addressed o Vitamin A supplies are available in the satellite health centers. No. of Individuals given Nutrition Services as of October 28, 2013

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NUTRITION SERVICES 1. Nutrition Assessment 2. Micronutrient Supplementation (Vitamin A Supplementation) 3. Infant and Young Child Feeding (Pregnant and Lactating Mothers Assessed and Counseled) LGU and Partner Agencies

No. of Population Served (Individuals) 441 7,493 plus GP distribution

No. of Areas Covered (EC, community) 16 communities 24communities

1,353

24 communities

Source: Nutrition Cluster Report as of October 28, 2013

Medical Emergency Relief International (MERLIN) conducted Rapid Health Assessment to 5 municipalities (Sagbayan, Clarin, Tubigon, Calape and Antequera). The following drugs, vaccines and medicine supplies are needed for the 5 municipalities: antibiotics, ORS, anti-pyretics, pain reliever, and antacid. Sagbayan and Tubigon need tetanus toxoid, measles vaccine, DPT/pentavax, and polio vaccine all breached in cold chain. Mental Health Psychosocial Cluster Department DOH-CO: October 22 of Health Deployed two (2) HEMS personnel to Bohol, provided the following technical assistance: o Provided background orientation to the MHPSS Focal Person, Mr. Alexis Lofranco, on MHPSS reporting. o Help in the preparation of the 2nd MHPSS cluster meeting scheduled today. o Joined in the discussion of CHD Caraga MHPSS team talking about the gaps and challenges theyve encountered during the provision of MHPSS services in Clarin, Bohol CHD IV-B: October 26 Continuous medical services and health assessment done by the different medical teams assigned in the areas: o Deployed 5-man team MHPSS team in Bohol composed of (2) doctors, (1) medtech and (2) nurses. Conducted PSP for 28 patients of Maribojoc Central Elementary School. MHPSS CLUSTER ACTIVITIES: National Center for Mental Health (NCMH): October 17-20 Initial counseling was done to the identified high risk individual (for follow up and referral to psychiatrist) Provided Psychosocial processing/stress debriefing to 6 families with 36 individuals (mostly doctors), three officers and staff of the Provincial Treasury office and 8 staff at the Command Post, Governors Mansion Conducted the 1st MHPSS Cluster meeting attended by NCMH Team, Bago City Team, CHD 8 Team, Save the Children, Phil. Red Cross, 1 Psychiatrist, four (4) Bohol-based psychologist and BJMP Region VII Team at Governors Mansion Command Center to discuss the organization of the cluster, deployment plans, IASC Guidelines and utilization of reporting tools. Combined MHPSS teams of the National Center for Mental Health, Bago City (Negros Occidental) headed by the City HEMS Coordinator, BJMP region 7 and Bohol- based Psychiatrist Dr. June Anne Daplas, were the teams who conducted the psychosocial activities to the Municipality of Sagbayan. CHD III: October 26-28, 2013 At South Central School, team conducted Psychosocial Support to 18 adults; Play theraphy and hygiene promotion to 52 children. Emergency and Disaster alertness were also taught and demonstrated to the children. Conducted Play therapy and hygine promotion to 58 Children in Loon Church Plaza Provided MHPSS services in Loon RHU I and Brgy. Catagbacan Norte, Loon, Bohol. A total of 16 RHU personnel were given psychosocial services and 102 children were undergone Play therapy. Likewise, the team also provided medical services to 45 pediatric patients and 15 adults that showed anxiety and they were undergone counseling. CHD VII: Provided psychosocial services at municipality of Loon with a total of 33 individuals and 8 health workers given Psychosocial Processing.

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No. of individuals given Mental Health Services as of October 25, 2013 MHPSS SERVICES 1. Psychological First Aid 2. Community and family support 3. Counseling 4. Psychosocial Processing 5. Stress Management Program 6. Referral of Cases 7. Others No. of Population Served (Individuals) 254 13 13 508 321 5 21 No. of Areas Covered (EC, community) 2 ECs, 1 PHO 1 EC 1 EC (Sagbayan) 2 ECs, 2 hosp, 1 community 3 ECs, 1 hosp, 1 PHO 1 EC, 1 community, 1 hosp 1 EC

Source: CHD VII HSU No.2 as of October 25, 2013

LGU and Partner Agencies

DWD 7, HNC Department, Hope Worldwide and RAFI provided MHPSS in the areas of Loon, Sagbayan, Tagbilaran City and Buenavista.

Source: CHD VII Report, HSU No.3 as of October 26, 2013, CHD X HSU No. 3 as of October 26, 2013

B. ARMED CONFLICT IN ZAMBOANGA CITY, SEPTEMBER 9, 2013

I. SITUATIONER Armed Conflict in Zamboanga City broke out on September 9, 2013 between the Moro National Liberation Front (MNLF) and the Armed Forces of the Philippines (AFP). Zamboanga City was placed under Level 4 Crisis Management with the DILG Secretary managing the crisis situation. Curfew from 8:00PM to 5:00AM imposed in crisis-stricken areas. Series of gunfights and fire incidents, as a defensive attack by MNLF, occurred that displaced a total of 23,794 families/ 118,819 persons from fourteen (14) barangays in Zamboanga City and one (1) Barangay in Zamboanga Sibugay. Evacuation centers were established for the affected individuals. The conflict left two hundred and thirty-nine (239) people dead and two hundred sixty-six (266) injured. A total of four (4) health facilities (3 Barangay Health Stations and 1 DOH Hospital) were affected due to armed conflict. All 3 BHS were non-functional since they were burned down. The three (3) DOH hospitals were functional except for Zamboanga City Medical Center (ZCMC) that during on the height of the crisis was also affected. Hospital services in ZCMC were delivered through the satellite hospital in Western Mindanao State University (WMSU). The CHO put up a satellite clinic to serve the evacuees at Joaquin F. Enriquez Memorial Sports Complex (JFEMSC). On September 28, the 20th day of Zamboanga crisis, Local Government Secretary Mar Roxas announced that the siege is over and declared the end of military operations in Zamboanga City. Following this, the city was declared under State of Calamity by Pres. Benigno Aquino on the basis of human crisis. Clearing operations on the affected areas ensued which was projected to last for two weeks. Last October 6, continuous rains brought about by the Intertropical Convergence Zone (ITCZ) triggered flooding in most evacuation centers in Zamboanga City which caused additional burden to the affected families. Houses situated along river banks and low lying areas in the City were advised to take precautionary measures to seek higher and safer ground. In lieu of the situation, DOH-HEMS, CHD IX and DOH Retained Hospitals are still on code alert status to manage the incident. Surveillance in Post Extreme Emergencies and Disasters (SPEED) was established in 35 evacuation centers. Health, Nutrition, WASH and MHPSS services were continuously provided by the 62 medical teams (392 personnel) and 17 technical teams (137 personnel) in the evacuation centers. Medicines and medical supplies were enough to cover the needs of the evacuees. A total of Php 18,258,108.91 worth of logistical support was provided by the DOH Central Office, CHDs, UNFPA and UNICEF to CHD IX. A total of 124 consultations under SPEED were reported from five reporting facilities on Oct 26, 2013. 47% of these consultations were among children below five years old. Top five consultations were acute respiratory infection, fever, acute watery diarrhea, wounds and bruises, and skin diseases. Other consultations were hypertension, acute asthmatic attack, and fractures

14

There were fifteen consultations of acute watery diarrhea reported on October 26, 2013. 73% of these consultations were among children below five years old. 93% of these consultations were from Joaquin Enriquez Memorial Sports Complex and 7% from Zamboanaga City Childrens Hospital. Close monitoring of suspect leptospirosis consultation is being done. From October 13 to 26, 2013, a total of 10 suspect leptospirosis cases were reported from Zamboanga City Medical Center. There were four (4) deaths reported from Zamboanga City Medical Center (CFR=40%). Some cases came from barangays affected by recent flooding outside the areas affected by armed conflict. No other alarming health conditions were reported. Monitoring of the health conditions through SPEED continue. From September 13, 2013 to October 26, 2013 a total of 3,480 consultation of acute watery diarrhea were reported from all reporting facilities. 46% of these consultations were among children below five years old. 44% of the total AWD consultations were from Joaquin Enriquez Memorial Sports Complex JEMSC) There was 35% decreased of AWD consultations reported from JEMSC on the 7th Week (Oct 20-26, 2013) compared during the 6th Week (Oct 1319, 2013). Among the other existing reporting facilities, Tetuan Elem. School reported 10%, Taluksangay Brgy Health Station (4%), Lunzuran Brgy. Hall (4%), and Sta Maria Elem. School (3%) of the total AWD consultations.. Zamboanga City Medical Center reported 10% of the total AWD consultations. Consultations of AWD in Taluksangay were relatively high for a reporting period of 14 days since October 8, 2013 to Oct. 26, 2013 after it was opened for humanitarian services. Taluksangay Barangay Health Center reports consultation from Taluksangay National High School the second biggest evacuation center after Joaquin Enriquez Memorial Sports Complex. Health services were provided by the Brgy Health Center Staff with the support of Medical Team from MERLIN. The significant decrease in the number of consultations in almost all reporting facilities starting the 5th week was due to the lesser number of days of consultation done due to heavy rains and flooding and the reduction of population resulted from the transfer of IDPs from one EC to another ECs and relatives. There was one reported death due to severe dehydration from Tetuan Central School during the 3rd week of reporting, which registered with the second highest number of AWD consultation. Due to the water testing findings conducted by DOH, which showed that majority of the household containers were found positive for total coliforms, health promotion on proper handling of water containers, hygiene, and waste disposal were intensified especially at JEMSC. As of October 18, 2013, 29 evacuation centers still exist. Task force SUYUD completed its clearing operations at Brgy. Rio Hondo and Zone IV, 30% cleared in Sta. Barbara, and 80 % cleared in Sta. Catalina. Gun ban is still in effect and barangays under critical areas are still under clearing operation by military. Curfew time was moved to 12 MN to 4AM city wide. Schools are now opened on both public and private schools. Barangays in critical areas (Rio Hondo, Kasanyangan, Mariki, Sta. Barbara and Sta. Catalina) are still without electricity and water supply. II. CLUSTER ACTIVITIES AND ACTIONS TAKEN OFFICE ACTIONS TAKEN Health Cluster Department DOH Central Office of Health Code White still in effect since September 9, 2103 All Cluster member agencies (Health, Nutrition, WASH, and MHPSS) at the national level were activated since the event started. Conducted cluster meeting attended by Asec. Tayag, cluster representatives, NEC, NCDPC and PRC. Sec. Enrique Ona visited Joaquin F. Enriquez Memorial Sports Complex (JFEMSC) and conducted a meeting with medical directors of private and government hospitals in Zamboanga last September 17, 2013 Mobilized and augmented assorted drugs, medicines and medical supplies based on the requested needs of CHD IX. Sub-allotment given to CHD IX and to the office of Asec. Busuego. Continuously coordinating with NDRRMC for the health sector reports and services provided. Coordinated with NDRRMC for the transport of logistics augmented to CHD IX. Provided technical assistance on Surveillance and Post Extreme Emergencies and

15

 CHD IX

Disasters (SPEED), reports management through daily reporting using Health Situation Update and Operations Center Management. Continuous monitoring of the situation and coordination with CHD IX, X, XI, XII, CARAGA, ARMM regarding the incident. Continuous provision of daily reports to the Secretary of Health, clusters and partner agencies Prepared presentations and briefers for the meetings conducted by the cluster Prepared Memorandum (situation update) to Pres. Aquino last Sept.1 Office of the Secretary provided 500 cot beds and 50 tents to CHD Zamboanga Peninsula.

Still in Code Blue Alert and Operation Center open 24/7 since September 15, 2013 Established Incident Command System (ICS) at CHD since the event started. Assisted in the transfer of patients from ZCMC to WMSU Gym (Satellite Hospital) and provided 2 ambulances to WMSU for immediate transport of patients. Established isolation tents in 2 ECs (JFEMSC and Sta. Maria Elementary School) and facilitated the deployment of medical teams including immunization teams in different evacuation centers. Provided drugs, medicines, medical supplies, vaccines and cadaver bags to WMSU Gym and evacuation centers. Conducted meeting with the medical directors and chiefs-of-hospitals with CHO Dr. Rodelin Agbulos and Usec. Milagros Fernandez at CHD (September 12). Daily cluster teams and team leaders meeting with the Regional Director for CHDZP. Conducted Psychosocial cluster meeting with PNP, GRRC, PFA providers, DSWD, POPCOM, PCSO, CNGH, ZCMC, ZABIDA, SKI, BHCI, and ADZU. Conducted crash course on SPEED to RNHEALS which were deployed in the evacuation centers and acted as SPEED reporters. Orientation on Mass Vaccination and Vitamin A supplementation to 98 health representatives was conducted in WMSU Gym. Massive immunization done at 6 evacuation centers. Conducted WASH cluster meeting with RD Torizo, ZCHO, and other NGO partner donors last October 15. Strengthened and sustained services to all evacuation centers. Health information education van available and sustained until site is declared closed. Sustained mobile information campaign at evacuation centers for leptospirosis and dengue and other health promotion activities. Attended meeting with OCD on Post Disaster Needs Assessment (Inter-Agency planning workshop). Continuously providing situation report updates to HEMS-Central Office. CHD X, XI, XII, CARAGA, ARMM Raised Code White Alert Augmented logistics and human resources composed of medical team and public health team at JFEMSC. Team from ARMM stayed at CHD ARMM- Crisis Management Committee. Provided assistance in SPEED to CHD IX CHD CARAGA conducted medical consultation, referral of patients needing further medical assistance and health situational assessment of the evacuees in terms of SPEED, WASH and food relief in thirteen evacuation centers. Zamboanga City Medical Center (ZCMC), Mindanao Central Sanitarium (MCS), Davao Regional Hospital ZCMC set up satellite hospital at WMSU Gym which attended and conducted to minor cases and surgeries referred from ECs. Established mobile clinic/ medical mission with PRC in Sta. Maria Covered Court. MCS attended and conducted consultations referred from the evacuation centers. Provided venue/facilities for Zamboanga Medical Center surgery, OB, orthopedic and Pedia cases. DRH organized and deployed medical team headed by Asec. Romulo Busuego and established five (5) operating rooms inside a makeshift tent at WMSU Gym. Hospital services at ZCMC has resumed to its normal operations as of September 20. All patients temporarily housed in WMSU were transferred back to ZCMC.

No. of Individuals Given Health Services as of October 18, 2013

16

HEALTH SERVICES 1First Aid 2Consultation and Treatment 1. Patients Transport 2. Measles Immunization 3. Flu vaccination 4. Pneumonia vaccination 5. Mass prophylaxis of Doxycycline 6. Vitamin A 7. Dewormed 8. FeSO4 9. Tetanus Vaccination 10. Oral Polio Vaccine 11. MMR Natal Care Family 12. Reproductive Planning Health Others 13. 14. 15. 16. Health Education Referrals Activation of SPEED Provision of CAMPOLAS Plus

No. of Population Served (Family or Individual) 17 30,402 individuals 223 8,413 individuals 359 356 10,155 5,289 individuals 6,731 individuals 232 55 8,518 individuals 1,061 individuals 70 individuals 12 individuals 1 delivery done in the hospital tent 20,223 families 163 15,068

No. of Areas Covered (EC, Community) 3 34 ECs 16 Ecs 1 (JFEMSC) 1 (JFEMSC) 29 Ecs 16 Ecs 1 (JFEMSC) 1 (JFEMSC) 7 Ecs 11 Ecs 1 1 1 35 Ecs 16 Ecs 34 Ecs 9 Ecs

Source: CHD IX Health Situation Update No. 34 as of October 18, 2013

CHO headed the ICS and strengthened coordination and networking among Local Radio Groups for surveillance and monitoring. Health needs of IDPs in the ECs (8:00am to 5:00pm) attended and conducted the following activities: measles vaccination in main ECs, prenatal check-ups and tetanus immunization at all ECs, and provided food and fluids to AFP and PNP personnel deployed at the field. PRC provided standby ambulance to WMSU gym and deployed emergency response team and vaccinators in different ECs. Health services (medical consultations, wound dressing, nebulization hydration, dispensing of medicines, and patient referral) provided toIDPs in ECs with partnership with the DOH and CHO. Emergency health station established. UNFPA sent 2 Reproductive Health Kits 2A (clean delivery kits) with medicines, that can provide safe and clean deliveries to 400 pregnant women in their last trimester. Rapid assessment in ECs through FPOP and local partners conducted. UNICEF/WHO distributed 600 Protection kits and 600 hygiene kits including plastic rolls for 727 vulnerable families in Zamboanga City and Basilan. On-going distribution of additional relief items. Vitamin A supplementation, deworming, and measles vaccination on-going for children 0 to 59 in all evacuation camps DOLE provided dental supplies, cadaver bags, assorted drugs and medicines at JFEMSC. Philippine Air Force conducted aeromedical and land evacuation of casualties conducted by the evacuation teams from PAF military treatment facilities (Edwin Andrews Air Base Hospital and Air Force General Hospital). WHO presided the second cluster meeting update at the RDs office last Oct. 18 Water, Sanitation, and Hygiene Cluster Department DOH Central Office of Health Provided WASH logistics to CHD IX distributed in the evacuation centers. National Center for Disease Prevention and Control (NCDPC) deployed a six-man team last October 14 to Joaquin F. Enriquez Memorial Sports Complex (JFEMSC) and Sta. Maria Elementary School to conduct WASH assessment in water bladder sites, waste disposal perimeters, drainage systems, hygiene practice of evacuees, and bathing areas in the ECs specified. NCDPC WASH team conducted water sampling analysis among four (4) evacuation centers (JFEMSC, Sta. Maria Elem. School, Tetuan Central School and Cawa-Cawa shore line. CHD IX Assessed the condition of portalets in the main evacuation site. Conducted water sampling, testing and treatment of water supply. Provided and distributed WASH supplies (jerry cans, hygiene kits, hyposol) to evacuation centers and sanitary sprays to Sanitary Inspectors for disinfection of LGU and Partner Agencies

17

 CHD X

portalets in evacuation centers. Disinfected/Sanitized 54 portalets, 16 comfort rooms at 4 ECS. Continuous monitoring and sanitation of portalets and comfort rooms being done. Conducted vector control measures, disinfection and applied larvicidal agents in JFEMSC, Sta. Maria Elementary School and Pasonanca Elementary School. Coordinated with the CHO of Zamboanga and General Service Office (GSO) for the garbage collection and proper waste disposal (daily from 8:00 AM to 5:00 PM) at JFEMSC (Grandstand). Conducted WASH training at WMSU College of nursing with 181 participants. DOH-CHDZP WASH covers Zone (60 additional latrines, 3 sets bathing cubicles) ZC Engineers office will cover labor and cost for the construction of additional latrines in all zones at JFEMSC. Construction period is within 2 months. Construction of 6 cubic meter water bladder at ZCHS West completed last Oct. 5 Construction of 5 cubic meter water bladder at Baliwasan Central School completed Oct.7 Installation of water pipes, tap stand/ water tap faucets in coordination with ZCWD Conducted random water sampling at JFEMSC Distributed IEC materials for hand washing and good hygiene practice ACF will install 78 units latrines, 1 communal kitchen, six water tanks and 20 bathing cubicles starting Oct 18 Deployed WASH team to Zamboanga City headed by Engr. Ma. Carmela Roa.

No. of Families given WASH Services as of October 18, 2013 WASH Services No. of Population Served No. of Areas Covered (EC, (Family or Individual) Community) 1.Provision of potable water 17,781 families 10 ECs (bottled water, water rationing, etc.) 2.Distribution of water 2000 families 6 ECs container 3. Water testing 651 14 ECs 4. Water treatment 400 families 16 ECs 5.Other water related 12,809 families 6 ECs services (portalet sanitary spraying) 6.Installation/Construction of 15,889 families 12 ECs toilets 7. Provision of hygiene kits 965 hygiene kits 5 ECs 7. IEC Materials 100 families 1 EC
Source: CHD IX Health Situation Update No. 34 as of October 18, 2013

LGU and Partner Agencies

LGU through the Zamboanga City Water District (ZCWD) provided water trucking services to ECs. LGU provided portalets in the main EC. Solid Waste management handled by Office of the City Environment and Natural Resources (OCENR). Garbage collection done every hour (JFEMSC) and twice a day in some ECs. Sweepers are around the ECs to maintain cleanliness. Enough trash bins provided. DSWD installed 20 portalets (8 installed in the JFEMSC) ICRC distributed 9000 hygiene kits PRC set up water bladders installed in 8 evacuation centers and provided WASH materials/supplies and Essential Household Items to different ECs. Trained community health volunteers which facilitated health and hygiene promotion sessions in ECs. Philippine Nurses Association conducted health education, health promotions activities on safe water, sanitation and hygiene to ECs. UNICEF sent water kits and 1000 hygiene kits to CHD IX and WASH Cluster provided hyposol/aquatabs, flush water seal toilets (3), hygiene kits (32,808), mobile water tanker (1), portalets (81), water bladders (10), water kits (12,300), water tap faucets (15), water trucking (8) USAID & private sector installed 34 portalets and provided 15,000 bottles of Zinc drop/syrup, 16,000 ORS sachet, 27,000 bottles purified drinking to ZCHO, pocket wifi load for medical admin team at JFEMSC amounting Php 430,000.00 WHO conducted monitoring visit at different evacuation centers. LGU Zamboanga City provides separate bathing units for male and female in JFEMSC. Provide additional lighting facilities at the back area of the grandstand where

18

portalets are located. Provide proper solid and liquid waste management procedures.

Nutrition Cluster Department CHD IX: of Health No. of Individuals given Nutrition Services as of October 18, 2013 No. of Population NUTRITION SERVICES No. of Areas Covered (EC) Served (Individual) 1. Nutrition Assessment 6,869 21 2.Micronutrient Supplementation 3,809 16 4. Supplementary Feeding 55 1 5. Integrated Management of 347 Moderate Malnutrition 16 Acute Malnutrition 152 Severe Malnutrition 6. Infant Young Feeding 46 1 7. Deworming 6,416 16 8. Zinc Sulfate Drops 18 1 (JFEMSC) 9. Zinc Sulfate Syrup 204 1 (JFEMSC) 10. Mothers given with FeSO4 211 16
Source: CHD IX Health Situation Update No. 34 as of October 18, 2013

Partner Agencies

UNOCHA, UNFPA, IOM, UNDSS and CFSI conducted the following to JFEMSC, Immaculate Concepcion Archdiocese School (ICAS), and Immaculate Concepcion Elementary School (ICES): o Distributed food packs and cooked food daily (breakfast, lunch, dinner). o Provided supplementary feeding for children and pregnant/lactating mothers. o Conducted malnutrition screening. o Selected distribution of milk formula (sanctioned by DOH because most mothers are not producing breast milk due to stress/trauma). o Established breastfeeding area. DSWD conducted mass feeding thru community kitchen and provided supplemental feeding to 824 children while undergoing Supervised Neighborhood Play. UNICEF provided 10 metric tons (MT) of high energy biscuits. Establishment of outpatient treatment of acute malnutrition and promotion and protection of infant and young children feeding and care in progress. UNICEF and Save the Children delivered 200 posters and 150 flipcharts to partners as protection aides and posters supporting breastfeeding in emergencies

Mental Health Psychosocial Cluster Department CHD IX/MHPSS CLUSTER ACTIVITIES: of Health Set up psychosocial tent that served as the venue for psychosocial activities at JFEMSC evacuation center. Conducted MHPSS cluster meeting with DOH reps, CARAGA MHPSS Team, and DepEd Zamboanga Psychosocial Team. Strategy and target ECs discussed. Conducted MHPSS quick orientation and coaching to DepEd personnel and PHT staff. Direct interventions were done such as defusing of individuals/small groups and psychosocial processing/debriefing of groups from CHD IX, DOHreps, CARAGA Team, PRC and ZCMC. PSP for Children Using Arts (CYLT) and Recreational Activities (song, play, and dance) was also done. Visited Harmony Village which serves as temporary shelter for mental patients (ZCMC). Documented and monitored adverse effects on health (mental and physical) brought about by human and induced conflicts to families with severe traumatic experience and provide professional help to most affected individuals and families. National Center for Mental Health (NCMH): Deployed a 9 man psychosocial team last September 21 and conducted orientation on the MHPSS cluster/Crash Course on PFA/ with lecture on Well -being, Resilience, and Coping and IASC guidelines on MHPSS (with 54 participants). Recommended the use of SRQ (Self Reporting Questionnaire - will help identify high risk individuals) and attendees were taught how to use/administer it to the victims (soft and hard copies were distributed). Deployed another eleven-man team composed of 1 psychiatrist, 1 psychologist, 4 nurses, 4 nursing attendant and 1 medical social worker last Oct.9 and provided PSP to 507 adults and 273 children as of October 13, 2013. CHD CARAGA: Deployed team with seven (7) MHPSS trained personnel (September 21). 37 MHPSS Staff from CHD CARAGA and PHTO 9 visited and conducted MHPSS to 13 ECs. Activities were mostly PFA: Emotional Ventilation/ Defusing, Psychosocial

19

Processing/Debriefing, Stress Management, and Psychiatric Referral. (September 23 A total of 1,791 individuals were given MHPSS service in 14 ECs. This includes Psychological First Aid (1,758), Psychosocial Processing (28) and referrals (5). No. of individuals given Mental Health Services as of October 18, 2013
MHPSS SERVICES No. of Population Served (Individuals) No. of Areas Covered (EC)

to 27)

1. Psychological First-Aid 2.Community and Family Support 3. Counseling 4. Psychosocial Processing 5.Stress Management Program 6. Referral of Cases 7.Trauma Healing Partner Agencies

30,102 144 344 3,491 8,330 3,059 568

22 22 22 22 22 22 22

Source: CHD IX Health Situation Update No. 34 as of October 18, 2013

DSWD established psychosocial processing/trauma management center for elderly and PWDs in the psychosocial tent manned by stress debriefers. Conducted psychosocial processing sessions (CISD) to 366 individuals, afternoon play and art therapy sessions to 1,287 kids at the Special Day Care Center, and Supervised Neighborhood Play (SNP) for 853 child-evacuees in different ECs. Dep-Ed conducted psychosocial interventions to affected DepEd personnel, teachers and school children. PNP Health Service conducted monitoring, medical evaluation and psychosocial processing to wounded personnel and MNLF hostages retrieved by PNP personnel from the area of conflict. PRC assisted DOH in the conduct of psychosocial activities in the evacuation center. Ateneo de Zamboanga University assisted DSWD in providing Psychological First Aid (PFA) and manning the Psychosocial Processing Trauma Management Center in JFEMSC since September 15, 2013.

Source: CHD IX Health Situation Update No. 34 as of October 18, 2013, and other health sector partners

III. SPECIAL EVENT (1)

A.

2013 NATIONWIDE BARANGAY ELECTION

I. BACKGROUND October 28, 2013, is the day of reckoning for the 94,124 candidates running for Barangay captain, while 715,012 are running for positions in the Barangay council for 2013s Barangay Elections. Around 54 million voters voted in the said nationwide barangay election. Meanwhile, Barangay elections in Bohol and Zamboanga was postponed and rescheduled on Nov. 25, 2013 for both provinces. Out of 42, 200 barangays, 6,195 have been identified as areas of concern for violent incidents by the PNP. The top priority areas are in the ARMM and some areas in Regions I, V, VII, VIII and XII. The regions were chosen based on several factors, including the existence of private armed groups, threat groups and history of electionrelated violence. In anticipation of any eventualities that may occur during the 2013 Nationwide Barangay Elections, Code White Alert is raised in all Center for Health Development (CHD) offices and DOH Hospitals effective Oct. 28, 2013 except for those CHDs and DOH Hospitals which are already with ongoing Code Blue or Code Red Alert. They are advised to raise the code alert and deactivate it based on the situation in their area.
Source: COMELEC Website and DILG

II. SITUATION REPORT AS OF OCT. 28, 2013 At least 22 candidates (8 barangay councilors, 3 barangay captains, 3 candidates and 12 civilians) and supporters have been killed in election related violence over the past month ahead of todays village polls across the Philippines. Twenty-four others were wounded in 51 suspected election-related incidents since the start of the election period last Sept. 28, 2013, records of the Philippine National Police (PNP). The incidents monitored are higher compared to the 25 incidents reported during the entire 45 day election period for the 2010 barangay elections. At least 588 people have been arrested for violating the elections gun ban with police confiscating thousands of deadly weapons.
Source: GMA news / PNP

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III. MONITORING ACTIVITIES

MONITORING ACTIVITIES TO DIFFERENT REGIONS RELATIVE BARANGAY ELECTION AS OF OCT. 28, 2013 CHD REMARKS I On Code White status OpCen is open from 8am-5pm The 3 DOH retained hospitals (Ilocos Training and Regional Medical Center-San Fernando City, La Union; Region 1 Medical Center-Dagupan City, Pangasinan; Mariano Marcos Memorial Hospital and Medical Center-Batac City, Ilocos Norte) on 24 hours duty to attend to casualties brought to the hospitals. Coordinated with the RDRRMC in monitoring election related events. The 4 provincial OpCen coordinated with their concerned local DRRMC and local units for needed assistance, investigation and documention of election related events. Vehicular accident in Cabaritan Norte, Nagulian, La Union with one (1) injured reported -10/27/2013 II On Code White status No untoward incident reported OpCen is open 24 hours Continuous active monitoring of the whole region status Coordinated with key health personnel and other stake holders (OCD, PDRRMO, CDRRMO) Prepositioned drugs and medicines, first aid kits to different provinces in the region amounting to P78,494.08 III On Code White status OPCEN open 8am 5pm No untoward incident reported IV-A On Code White No untoward incident reported IV-B On Code White status No untoward incident reported OpCen is open 24 hours V On Code White status OPCEN open 24 hours Ambush incident in Brgy. Divisoria, Cataingan, Masbate involving (1) electoral candidate for Brgy. Captain and 3 supporters. All victims were safe. Shooting incident in Brgy. Parina, Palanas, Masbate involving (1) election officer and 3 policemen. The victims were fire upon by undetermined number of unidentified armed men. Victims were immediately brought to Dimasalang Emergency Hospital and CAtaingan District Hospital. VI On Code White status No untoward incident reported VII On Code Red status OPCEN open 24 hours No untoward incident reported VIII On Code White status No mass casualty related incident Shooting incident reported in Jaro, Leyte (1 male, dead and 1 injured--gunshot wound in pelvic area referred to EVRMC from Carigara District Hospital) X On Code White status OPCEN open 24 hours No untoward incident reported XII On Code White status OPCEN open 24 hours No untoward incident reported CAR On Code White status OPCEN open 8am 5pm No untoward incident reported

TO

NATIONWIDE

SOURCE Mr. Florentino Lopez, EOD OpCen-RHEMS CHD I

Mr. Julius Cesar Estrada, P.A Baccay, and Mario RamiloEODs OpCen-RHEMS CHD II

Dr. Evelyn David, CHD III RHEMS Coordinator Ms. Tangalen, CHD IV-A staff Mr. Nestor Loyola, EOD OpCen-RHEMS CHD IV-B Mr. Bernard Mongo, EOD OpCen-RHEMS CHD V

Dr. Edna Lopez, CHD VI RHEMS Coordinator Ms. Alel Pacres, EOD OpCen-RHEMS CHD VII Dr. Fidelita Dico, CHD VIII RHEMS Coordinator Ms. Josephine Lacua, EOD OpCen-RHEMS CHD X Mr. Leo Chiong, RN, RHEMS Coordinator CHD XII Ms. Elnoria Bugnosen, CHD CAR, RHEMS Coordinator

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CHD MM

On Code White status Ms. Eden Ebajo EOD OPCEN open 24 hours OpCen-RHEMS CHD MM No untoward incident CHD On Code White status Mr. Ron Aray, CHD ARMM OPCEN 24 hours open at the Office of the Regional Asst RHEMS Governor. 2 staff sent to man the OpCen Coordinator Two medical teams are on standby in case any mass casualty incident occurs. No untoward incident Note: Out of the 17 CHDs OPCEN , 8 were on 24 hours, 3 were on 8am 5pm and others are on call IV. ACTIONS TAKEN DOH CO On Code Blue Alert Declared Code White Alert to all CHDs and Hospitals Continuous monitoring of the events related to the 2013 Nationwide Barangay Election to different regions.

Note: HEMS Operation Center is manned by 3 EODs and 1 Driver Mr. Jerry Dela Cruz for 24 hours duty

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