7 days after the disaster on the Venezuelan coast, the situation is stabilizing and information is flowing in more orderly fashion. Communication with the stricken states is almost reestablished, which is making information easier to acquire.

According to the national government, the partial figures on the disaster in the country are projected as follows:

• Persons affected: 331,164
• Persons left homeless: 250,000
• Disappeared persons: 7,200
• Deaths: 30,000
• Housing units affected: 63,935
• Housing units destroyed: 23,234

International aid has been important and significant.

1. Current situation

   HIDROVEN (Hidrológica de Venezuela, a water supply system) advises officially that the water supply systems of the central littoral, the state of Vargas, and the Barlovento or eastern region (state of Miranda), are in a state of total collapse, which has resulted in a loss of water supply to about 600,000 persons in those states.

   A significant number of areas have suffered damage to their water supply and sanitation systems, in consequence of which the subcommittee on coordination has decided to make adjustments under a plan of short-, middle-, and long-term measures. To this end, operations are going forward to develop the central integral system (Vargas state) and the Barlovento (Miranda state) system.

2. PAHO/WHO support

• Support in preparation of community materials in environmental health (water, wastes, and excreta disposal)
• Grant of 20 residual chlorine determination kits with the requisite DPD.
• Support in determination of requirements of the National Technical Committee on Water.
• Support in coordination of operations to rehabilitate the drinking water supply and excreta disposal systems with the HIDROVEN management and the general directorate of Environmental Health in the Ministry of Health.
• Delivery of technical-scientific information for disaster management through the virtual library on disasters to the Ministry of Health and Social Development (MSDS), Corposalud of Aragua state, HIDROVEN, the national Armed Forces, Civil Defense, and universities.
• Support to the NSDS, with the U.S. Embassy, in coordinating the receipt of supplies of water container equipment to solve water shortage problems in operating hospitals (Pariata hospital) and Maiquetía International Airport.
• Support to the Ministry of the Environment and Natural Resources and to HIDROVEN in the framing of operational plans for rehabilitation.

The enterprise operating the systems has requested PAHO support in:

• The purchase of three UPA 200 portable water purification plants with an output capacity of 20 liters per second.
• The purchase of 10 sodium hypochlorite generating plants powered by solar panels.
• Study of the vulnerability of reservoirs in Venezuela to locate hazards and determine their nature, and their possible effects.
• The purchase of three 20-liters/sec. desalting plants.
• Reproduction of technical materials on drinking water, waste water, excreta, solid wastes, and foods.
• Acquisition of 15 portable water-testers.
• Acquisition of 5 free chlorine detectors (20 already delivered) with sufficient DPD.
• Purchase of shovels for interment of excreta and solid wastes.
• Acquisition of plastic-lined cellars for foods.
• Acquisition of one hundred (100) comparators for determination of residual chlorine, with about 100,000 DPD reagents.
• Acquisition of two (2) portable water quality analyzers, which could be HACH No. 26885-06 Cel model/890 (Advanced Portable Laboratory)
• Acquisition of two (2) CALIZER coliform determinator sets.

1. Current situation

   At the very outset communication was established with the designated officer for the drugs area, and he was given all necessary advise to draw up the list of basic drug requirements.

2. PAHO/WHO support

   PAHO/WHO will coordinate international support in the drugs area by decision of the Minister of Health and Social Development.

   PAHO/Venezuela made a preliminary estimate, which was rushed to PAHO headquarters.

   Contact was established with the associations of the laboratories of the pharmaceutical industry; the Instituto Nacional de Higiene (National Hygiene Institute) and the Pharmacy Faculty of the Central University of Venezuela.

   The SUMA system was set up in the Health Ministry’s bulking center to handle all drug matters (SEFAR).

    

3. Requirements

1. Current situation

   Humanitarian aid continues to arrive in sizable quantities for support of those left homeless by the floods on the Venezuelan coast. Both the health sector and the armed forces are engaged in the management of large quantities of supplies.

   Warehouses for reception and distribution are already established in CEFAR under the Ministry of Health and Social Development, Fort Tiuna of the Venezuelan Army, the National Directorate of Civil Defense, the Venezuelan Red Cross, and in the states of Lara and Carabobo.

2. Measures taken to date

The following warehouses have been set up so far:

• CEFAR, which will coordinate drug deliveries nationwide.
• the National Directorate of Civil Defense
• The Venezuelan Red Cross
• The army has been contacted to handle the information on international donations of drugs, but it remains to be decided how the system is to be used.
• It is set up in the states of Lara and Carabobo, where local donations are being received.

Because of the magnitude of the humanitarian aid, it is important to reinforce the Health Ministry, the Civil Defense and the Venezuelan Red Cross with trained personnel to operate the system full-time.

An evaluation is being made of the need to obtain equipment to enable the system to function efficiently, and to prepare identification material for the supplies.

The disaster has partly or totally uprooted the affected population from their places of residence and deprived them of their livelihoods and their social support network. A very sizable proportion of the victims has had their families disrupted by the loss of some or all of their members, and there are very large numbers of orphans, widows, widowers and abandoned elderly persons.

This situation prompts the prediction of severe psychosocial and affective repercussions and sequelae characteristic of post-traumatic stress.

PAHO is supporting the Health Ministry authorities in the educational communication aspects of:

• The framing of a rapid plan of training for the personnel working with the persons left homeless and those in shelters to improve the quality of the care they are receiving, especially in the preventive aspects of mental health.

The epidemiological and environmental information must be analyzed to determine the effects on health and the needs at present and in the next 90 days, as a guide to effective and efficient action and resource allocation.

The states hardest hit by the disaster are Vargas and Miranda. The effects on the Federal District (D.F.) must also be considered owing to its geographic contiguity to them and to the fact that it shares their population dynamics. The states of Zulia, Falcón, Yaracuy, Sucre, Anzoátegui and Nueva Esparta have also been affected, but in less degree.

It has been observed that major outbreaks of post-disaster communicable diseases have been rare, which may imply failings in the observation and regular notification of diseases or effectiveness of public health operations. The fact remains, however, that the environmental hazards of disease transmission are heightened, and epidemic outbreaks are possible, which makes it necessary to assign priority to epidemiological and environmental surveillance so that proper sanitary measures may be taken.

• The diseases already present in the population prior to the disaster and their endemic and epidemic levels.
• The environmental changes caused by the disaster.
• Population shifts.
• Damage to public facilities.
• Shortcomings in surveillance and in disease-control programs.
• Changes in the resistance of individuals to diseases.

The danger of an epidemic in the wake of a disaster is a function of the preceding endemic and epidemic levels of diseases in the population. Moreover, there are reports of changes in the patterns of emergence of some diseases, which changes the danger of their transmission after the disaster; cholera has become very widespread in recent years; bacillary dysentery has caused massive epidemics in Central America, and leptospirosis recently caused a great epidemic in Nicaragua.

The recurrently most important diseases are the diarrheas, dysentery from different causes, measles, airway infections, meningococcal meningitis, intestinal parasitoses, scabies and other dermatoses, tuberculosis, and malaria.

Predisaster situation of the leading endemo-epidemic diseases in Venezuela

Malaria: the cumulative reported incidence in the country in 1999 is below that of 1998. In 1999 the country places in the safety zone of the endemic route despite the fact that in the seven epidemiological weeks prior to the disaster the reported incidence was higher than in the same epidemiological weeks of 1998 and underreporting is assumed. The states at risk for this disease are Amazonas, Bolívar, Miranda, Sucre, Apure, Portuguesa, Delta Amacuro, and Zulia.

Dengue: the cumulative reported incidence in the country in 1999 is below that of 1998. In 1999 the country places in the alarm zone of the endemic route. In the six epidemiological weeks prior to the disaster incidence was on the rise. The entire country is affected, and the states at greatest risk for this disease are Zulia, Vargas, Sucre, Portuguesa, Miranda, Falcón, Barinas, and the Federal District. The situation is aggravated by the presence of hemorrhagic dengue. The aedes index is reported on the rise in homes and on the decline in warehouses.

Cholera: The cumulative reported nationwide incidence in 1999 is below that of 1998; in the weeks leading up to the disaster it was present in the states of Sucre, Nueva Esparta, Delta Amacuro and Monagas.

Enteritis and other diarrheal diseases: the eighth-ranking cause of death and an important reason for presenting among children under 5.

Hepatitis A: The notifications on hand are for hepatides in general. The largest numbers of cases have been reported in the states of Zulia, Táchira, Miranda, Mérida, Lara, Falcón, Carabobo, Aragua, Anzoátegui, and the Federal District.

Special mention must be made of two diseases:

Venezuelan equine encephalitis: Remains under surveillance; no cases have been reported either in animals or in humans. Equine vaccination coverages must be reviewed in the states at risk: Zulia, Falcón, Lara, Yaracuy, Trujillo, Carabobo and Miranda.

Leptospirosis: There is a risk, but it has not yet been quantified.

These changes could alter the possibilities for the spread of diseases, the most important of which are the vector-borne (mainly mosquitoes) and the water-borne.

Floods heighten the risk of leptospirosis. Inadequate collection of solid wastes leads to the multiplication of flies as a physical vector for diarrheas and conjunctivitis.

The water supply is reportedly greatly compromised in the states of Vargas and Miranda, and water disinfection is a high priority for the prevention of water-borne outbreaks (diarrheas, including cholera).

The severity of the disaster and the large numbers of people affected by it have their prompted rapid evacuation to makeshift shelters and gradual relocation to quarters with improved sanitation, especially military installations. An unspecified number of people have moved in with relatives and friends. These movements have been to different states in the country.

This aspect has to be taken into account because the migrants are exposed to diseases and vectors that were not present in their places of origin or bring with them diseases not present in the places to which they relocate.

In the situation we face, damage to and defects in the water supply and liquid waste or sewage collection systems heighten the risk of epidemics from water contamination. This situation is critical in the states of Vargas and Miranda. Monitoring of the quality of drinking water and ensuring its potability are a priority.

The disaster could itself destabilize the disease surveillance and control programs in the hardest-hit states, and priority attaches to their reinforcement with human and material resources. Sustained implementation of epidemiological and environmental surveillance and the control measures involved in the refuges and shelters and for the stricken (unsheltered) population, and their intensification among the rest of the population are a priority for public health in the country.

This factor may not be underestimated. Mental health care is needed for the population of refuges and shelters. Moreover, the aforementioned factors and the scientific literature cite the need to see to the nutritional status of children and the possibility of increased incidence of tuberculosis and malaria, among other diseases.

In building a scenario for the effects on the health of the population in the short and middle run, it is also necessary to take account of the outbreaks of diseases in the wake of natural disasters —among them leptospirosis, typhoid, food poisoning, minor infections of the airways, diarrheas, cholera, and malaria— reported in the international literature.

• On Thursday, December 16, 1999, immediately upon the occurrence of the disaster, Dr. Gilberto Rodríguez Ochoa, Minister of Health and Social Development, set up four committees which under his direction took over the areas of communications, logistical support, services and coordination with shelters, and epidemiology and the environment. The last-named committee is headed by Dr. José Mendoza, Director of Epidemiology and Strategic Analysis in the MSDS, and covers epidemiological and environmental surveillance (water, solid wastes, liquid wastes, foods, and vectors) and the control of disease outbreaks and environmental health hazards.

• On Friday, December 17, 1999, Alerta (the weekly epidemiological report) gave the Epidemiology Directorates in the states indications for:

• The activation of epidemiological surveillance in shelters based on a simple form for reporting syndromes for use by nonmedical personnel and the usual disease report form for use by medical personnel.
• The intensification of epidemiological and environmental surveillance in the stricken areas.
• The guidance of sanitary measures in shelters and stricken areas.
• Organization at the regional and district levels of the available guard units, the telephonic location of the members of health teams, and determination of their availability for immediate transfer.
• The daily reporting of cases and outbreaks of and deaths from diseases under surveillance, from the local level to the immediate sanitary structure so that a nationwide daily report may be constructed.

• Guidance was provided on recommendations for the special care of populations in shelters.

• On Friday, December 17, 1999, the Minister of Health and Social Development held a technical meeting with the other health authorities to make an analysis of the situation and the immediate measures taken.

• On Saturday, December 18, 1999, a technical meeting was held between the Minister of Health and Social Development and the other health authorities, with the presence of specialists from Mexico and Cuba, and important accounts of experience and recommendations were introduced.

• On Saturday, December 18, 1999, the services in the states were contacted to determine the existing health situation and provide operational guidance.

• On Sunday, December 19, 1999, using information obtained by telephone from the health services of the stricken states, the first report was drawn up on the numbers of refugees, the population in shelters, the stricken population, the injured treated, and the medical inputs required for the emergency.

• On Monday, December 20, 1999, it was found that the great communications difficulties had caused deficiencies in activation of the surveillance system for shelters and stricken areas.

• On Tuesday, December 21, 1999, specific instructions were issued for activation of the surveillance system in places where this had not yet been done and to ensure a daily flow of information on cases and outbreaks of and deaths from diseases under surveillance. It was directed that a member of the regional, district and/or municipal staff be appointed to see to each shelter and ensure epidemiological and environmental hazard surveillance in it. Guidance was provided in the organization of working teams at the regional level for integration and coordination of the surveillance and control of hazards and diseases.

• On Wednesday, December 22, 1999, an outbreak of food poisoning at a shelter in the Federal District and four cases of cholera confirmed by laboratory were reported as important occurrences.

• Coordinating arrangements were made between the MSDS and Military Health to address the situation.

• On Thursday, December 23, 1999, it was decided:

• To establish a unified command center for epidemiological surveillance and rapid response for the metropolitan area to support the health teams in the states of Vargas and Miranda, with the direct participation of the health staff of the Federal District and MSDS specialists.
• To set up a working group to define the material requirements for dealing with the health emergency.
• To set up a multidisciplinary team to deal with the drinking water situation, with priority in the states of Vargas and Miranda.
• To set up a command center for communications, information and education.

• To strengthen epidemiological surveillance in shelters and stricken areas, reinforce operations and field work (define requirements in human resources, personnel mobilization, blank forms, etc.).
• To strengthen the regular epidemiological surveillance system.
• To ensure timely notification.
• To step up measures to ensure a water supply of healthful quality for the population.
• To intensify the surveillance and control of vectors and rodents.
• To ensure support in the form of laboratory diagnoses (define requirements in inputs, reagents, culture media, etc.).
• To produce at the different levels useful information for decision-making (daily reports, weekly reports, information bulletins for medical care teams, etc.).
• To carry out risk and outbreak control measures (define requirements in human and material resources: drugs for control of foci, personnel mobilization, larvicides, pesticides, etc.)
• To define requirements for training in different technical areas at different levels.

• The activation of epidemiological surveillance in shelters based on a simple form for reporting syndromes for use by nonmedical personnel and the usual disease report form for use by medical personnel.
• The intensification of epidemiological and environmental surveillance in the stricken areas.
• The guidance of sanitary measures in shelters and stricken areas.
• Organization at the regional and district levels of the available guard units, the telephonic location of the members of health teams, and determination of their availability for immediate transfer.
• The daily reporting of cases and outbreaks of and deaths from diseases under surveillance, from the local level to the immediate sanitary structure so that a nationwide daily report may be constructed.
• Guidance was provided on recommendations for the special care of populations in shelters.

• Framing of messages for the committee on communications through mass media of the Ministry of Health.
• Support in framing of the plan of action approved by the Ministry of Health and Social Development.
• Support in channeling requests to the United Nations system.
• Suport to the National Civil Defense in the determination of requirements, the channeling of inputs from United Nations agencies and in the handling of supplies (SUMA).
• Support in assembling the technical damage assessment team requested by Civil Defence (in progress).
• Support by providing technical information and presentation thereof in connection with setting up shelters.
• Support for and coordination of measures with OFDA/AID in the proposal of cooperation to water sector institutions.

DATA AS OF 23/12/99