Urgent need for shelter as aid slowly reaches sick and injured

Winter in the earthquake zone is fast approaching with night-time temperatures well below zero in many places. The World Health Organization (WHO) has expressed grave concern over the lack of shelter, including tents and blankets for the affected population of around 4 million. According to the International Organization for Migration (IOM), an estimated some 200,000 tents have been distributed to affected communities, while the same number are in the pipeline and due to be delivered by mid-November. But IOM estimates another 150,000 to 200,000 shelter are urgently needed. Without adequate shelter and food an estimated 3 million people are at risk in the coming weeks, they added. "Cold exposure reduces defence against respiratory infections and hypothermia is deadly for infants and the elderly," Sacha Bootsma, WHO communications officer said in the Pakistani capital, Islamabad, on Thursday. Mobile medical teams operating in remote areas around Muzaffarabad, close to the epicentre of the quake, have reported a sharp increase in acute respiratory tract infection (ARI). The Office for the Coordination of Humanitarian Affairs (OCHA) said that as of Wednesday there had been no report of measles or any outbreak of major communicable diseases in the quake zone. OCHA added that immunisation campaigns were gearing up with more mobile vaccination teams now covering remote areas around Muzaffarabad. Out of a total of 564 health facilities in the eight quake-hit districts of North West Frontier Province (NWFP) and Pakistani-administered Kashmir, 291 (52 percent) have been completely destroyed while another 74 have been partially damaged. At the moment, only 199 medical facilities are operational, with just 16 in Kashmir and the rest in NWFP. In addition, 52 field hospitals are also in place. According to Pakistani health authorities, the reconstruction and rehabilitation of the shattered health system in quake-affected areas will require an estimated US $651 million. This figure includes the reconstruction of medical facilities, provision of medical equipment and ambulances, restoring laboratory systems, blood banks, nursing schools and the manufacture of artificial limbs. Of the roughly 75,000 people known to be injured as a result of the quake, around 21,000 have been treated at formal civil or military hospitals while some of rest have been treated at field hospitals and mobile medical teams, the WHO said. "So far about 4,000 major and another around 5,000 minor surgeries have taken place. While some 11,000 [people] have been evacuated by air from the affected areas," Bootsma added. In terms of communicable diseases, measles and cholera are the main health risks at the moment, according to WHO officials. In addition, a lack of clean water is currently creating problems with people turning up with skin diseases such as scabies at all health centres in the affected areas. "[The] WHO is providing health and hygiene messages on the radio, partnering with other agencies on the provision of soap and supporting government facilities and mobile teams with medications to meet the need," Bootsma said. With the rush to assist the survivors, thousands of dead remain interned under the buildings that collapsed on them. The decomposition of corpses is creating an intolerable smell but not spreading disease, the WHO emphasised. “Spraying the bodies with chlorine solution or bleach has been widely implemented and is the best solution."