REPUBLIC OF TUNISIA Ministry of Health Health response to the humanitarian crisis in the Tunisian-Libyan border Feb Sept 2011

Transcription

1 REPUBLIC OF TUNISIA Ministry of Health Health response to the humanitarian crisis in the Tunisian-Libyan border Feb Sept 2011 Training Module 4 Humanitarian Crisis and Mass Gathering May, Amman,Jordan

2 TUNISIAN GEOGRAPHY AND HEALTH SYSTEM Location: Northern Africa, bordering the Mediterranean Sea, between Algeria and Libya Area: 163,610 sq km Population : 10,7 millions Health system: Tunisia's health system incorporates both public and private providers. The public system is structured along three tiers: tertiary university hospitals in large cities regional hospitals in the main towns primary health care at district level. Since the late 1980s, the private sector has grown rapidly in large cities, Still, the majority of care is provided in the public sector and this is particularly true for southern Tunisia bordering Libya. 2

3 Crisis and unrest in Libya February 2011: More than 70 nationalities ( migrants /2 weeks) were fleeing Libya towards Tunisia following the intensification of conflicts in this neighboring country. Period after the Tunisian revolution (5 weeks). Structures not yet stabilized state, popular protests are continuing.

4 As a result, Tunisia, which was neither accustomed nor prepared to handle this kind of event, suddenly faced the obligation and the duty to assist these migrants and refugees.

5 Demography and geography of the population influx into Tunisia There are different and distinct groups of people entering Tunisia from Libya: third country nationals (TCN), Tunisians and Libyans. TCN: included people from across the socio-economic spectrum, including those working in Libya's oil industry, construction or other sectors, or some who were in Libya hoping to continue on-migrating to Europe. their movement principally follows two axes from Libya into Tunisia: Medenine axis (Ras Jdir border): movement with an estimated 340,000 Libyans (UNHCR 2011) and almost 200,000 TCNs (IOM 2011) / Choucha refugee camps Tataouine axis(dehiba): By the end of June, UNHCR estimates that some 90,000 Libyans have entered Tunisia via Dehiba and that up to 20,000 have not returned back/ with tunisian families or renting houses

6 Ras-Jedir Dhiba 6

7 Cumulative arrivals from Libya by nationality

8 Weekly population estimate from Libya to Tunisia

9 Tunisian authorities response Tunisian authorities responded immediately, deploying the army to assist the Tunisian civil protection who manages the border crossing, to handle the situation. Tunisian doctors and nurses also volunteered to assist with the immediate medical needs of the migrants.

10 Office National de la Protection civile P.A.S Zone Camp de refugiés Choucha MEDENINE P.A.S Zone P.A.S Zone 2 Camp de refugiés EUA Point de passage Ras jdir Camp de Transit P.A.S Zone PMA Camp de refugiés IFCR 1

11 Tunisian authorities response Shortly afterwards UN organisations, international and national NGOs arrived to complement these efforts. Camps have been setup at Choucha, close to Ras Jdir (7 km), to host the incoming TCNs and have been in place since. Here, the immediate needs in terms of shelter, food and medical care are seen to by the Tunisian authorities and international organisations in collaboration.

12 The main camps Transit Camp Border Ras Jdir 23 February 2011 Choucha Camp 24 February 2011 Camp Emirati - Ras Jdir 13 March 2011 Camp IFRC (camp El Hayet) 6 April 2011 Camp UNHCR - Remada 10 April 2011 Camp Emirati - Dhiba 13 April 2011 Camp Qatari - Tataouine 23 May 2011 Other known state structures having hosted refugees : youth club Ben Guerdane youth club Dhiba, primary school Douiret, Remada, In Tataouine, only 5 to 7 % of libyen refugees were accommodated in camps

13 The health response The immediate health care needs at the beginning of the crisis were at the Ras Jdir border crossing. The Tunisian civil protection agency have a medical post at the border and together with the military provided the initial first response. After that a number of medical posts alongside, first by Tunisian health personnel followed by national and international NGOs and organisations

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15 The health response The nearest regional hospital - that of Benguerdane - moved some of its personnel to the border to manage care more efficiently. By contrast, the Libyan migrants in need of health services have mostly made their own way to the first point of contact with the health system, including cases of Libyan ambulances delivering patients straight to Tunisian emergency departments. From the initial contact onwards, Libyans have largely followed existing procedures and referral paths designed for the local Tunisian population.

16 MEDICAL TRANSPORTATION OF INJURIES TO REGIONAL HOSPITALS HOSPITAL MASS CASUALTY

17 COORDINATION March 4, 2011: videoconferencing link between the MOH Shocroom center level & Zarzis Shocroom field level Daily monitoring of the situation Daily flash ; weekly; monthly om

18 Coordination with International NGO and organisations

19 National Survey Establishment of an early warning system for communicable diseases and response from 1 March 2011 on the axis Ras Jdir Ben Guerdane and from April in the axis of Dhiba-tataouine Another information system has been implemented in public health structures to document the load on structures of first and second line resulting from the arrival and presence of migrants and refugees in southern Tunisia Contribution of the majority of health partners in the collection and analysis of data. Initially, daily and weekly reports

20 TCN consultations in camps in Ras Jdir and choucha per week (SHOC room data)

21 Number of TCN contacts with the public health system, by level (Ben guerdane)

22 Overview of the quantity of use of public health services by the Libyans and TCN

23 Some pathological cases

24 Epidemiological Survey Epidemiological situation (in the camps): Stable and controlled Epidemiological data Lack for Refugee supported by some partners (at the begenning of the crises)

25 Epidemiological Survey in Camps - 2 cases of typhoid fever is suspected. - 7 suspected cases of measles and one confirmed case: MOH preventively vaccinated 9 children aged from 1 to 15 years. - 4 suspected meningitis. - 4 suspected tetanus in children diarrhea cases. - 3 cases of chickenpox in Tataouine.

26 Main results of health activities and the epidemiological situation 20/09/2012 MSP-DGS

27 Psychological support Psychological support is provided by MSF (individual Consultations and discussion groups) in coordination with psychiatrists military field hospitals Tunisian and Moroccan. Several organizations involved in Psychosocial programs through conducting focus group, including MSF, UNFPA, UNICEF Deaths : Total: 101 Death Tataouine: 28 Médenine: 73

28 REPRODUCTIVE HEALTH Medenine / Choucha camps (march september 2011) : 23 cases of violence based on gender were detected and supported by teams of UNFPA to medical and psycho social plans. Contraception 385 STI 197 Prenatal visit 720 Post natale 62 other 377 condoms distributed 380 Tataouine (April - august 2011) : UNFPA and ATSR Tataouine: 11 cases of violence based on gender were detected and supported Libyan refugees Awareness (235 group sessions/2619 individual sessions) distributed condoms. A Psychological support was provided to 150 Libyan refugees.

29 Vaccination 1421 children were vaccinated in Tataouine and Medenine (Choucha camps) by teams of public health and 46 by NGO (Tunisian vaccination calendar). 252 pregnant women vaccinated against tetanus Environment hygiene and sanitation MOH: DHMPE, support shoc room Zarzis, UNICEF and UNHCR (especially in the camps). The military health at the Choucha camp.

30 Health Education ( WHO support) 6000 Posters and leaflets distributed (Tataouine, Medenine, Gabes): - Breastfeeding; - Scabies; - Acute respiratory infections (ARI); - The scorpion envenomation and viper; - bodily hygiene and diarrhea 800 posters and 6000 flyers (health Partners and refugee-migrants) in Medenine and Tataouine camps treating the same topics Installation of 20 frames for exhibition on tarps in various camps in Ras Jdir- Choucha and Remada and Tataouine Dhiba Radio spots (Arabic language) dealing with the general and hand hygiene (English and French language versions were distributed to partners for distribution in the camps of chousha - Ras Jdir)

31 20/09/2012 MSP-shocroom

32 Recommendations & lessons learned Survey Provide a weekly monitoring system of the number of consultations in health centers and hospitals to monitor in real time and meet needs (personnel, medicines, etc...) Need for an early warning system "ready to use Train up of doctors and other personnel in the management of humanitarian crises

33 Recommendations & lessons learned Survey Establish "standards" to respect safety, hygiene, sanitation, medical and paramedical personnel working in the field according to WHO data, taking into account the country's reality Having a team dedicated to information management including epidemiological, monitoring the activities and needs, and for the preparation and dissemination of social mobilization messages and health education

34 THANKS FOR ATTENTION Dr HENDA CHEBBI SHOCRoom GENERAL DIRECTION OF HEALTH MINISTRY OF HEALTH OF TUNISIA Bab saadoun tunis/ tunisia TEL/FAX/ / henda.chebbi@rns.tn