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Earthquake in Peru

Situation Report
24 August 2007

1. Summary of the general health situation and priorities

Preliminary damage assessment(*)

	Cañete	Chincha	Pisco	Ica	Other locations	Total
Deaths	6	85	336	71	16	514
Injured	172	240	100	487	91	1.090
Missing			49(**)
Homes destroyed	3.429	13.365	16.050	300	4.465	37.599

(*) According to Estimates from INDECI, 24 August 2007.
(**) Source: Public Ministry, Pisco.

• The health network:
  • Pisco: two hospitals destroyed, 22 affected health centers.
  • Ica: four affected hospitals, 19 health centers functioning.
  • Chincha: one hospital is 100% functional, another hospital 60% functional. The health network has 29 facilities, only 3 were affected.
• Eighteen (18) educational centers were destroyed, 118 affected and there are 29 highways affected.
• In Pisco, the most affected locality, tanker trucks continue to supply drinking water to most of the population. The sewage system has collapsed and sewage is draining directly into the sea. 180 chemical latrines have been installed in public places and in shelters, where chemical latrines will be supplemented with dry pit latrines.
• The emergency situation in Pisco continues; the impact of the earthquake along with existing poverty in many parts of the city has caused a large social emergency that will require a great deal of attention to health issues in the coming days, weeks and beyond.
• The majority of the affected population (approximately 40,000 families) is still in improvised shelters without basic necessities, or outside of their homes with their furniture and household items.
• The health network in the affected areas of Chincha and Ica is gradually recovering, and patients are no longer being sent to Lima for care. In Pisco, the health network situation is still critical.
• PAHO/WHO continues supporting a Health Situation Room in the Ministry of Health headquarters in Lima.
• PAHO/WHO has coordinated with UNICEF in the field of water and sanitation.
• The LSS/SUMA system, a tool to manage humanitarian relief and ultimately lead to transparency, continues to inventory and organize the assistance received. Under the coordination of the Civil Defense, additional LSS/SUMA posts have been set up in the Emergency Operations Center in Lima, the port of San Martin in Pisco and in the port of Callao.
• A technical team of engineers and architects is evaluating the structure of the health services network in the area affected by the earthquake; this includes hospitals and health centers. It will identify the degree of damage to the buildings and their surroundings and will recommend rehabilitation or replacement.

Most Urgent Health Sector Priorities

• Water supply and quality control
• Improve basic sanitation and health conditions in all shelters(formal and improvised), and in formally established shelters, improve the provision of basic services, safe drinking water, solid waste management and psychosocial support.
• Continue to carry out assessments of the health services network, particularly in Pisco, and make recommendations for recovery.
• Continue with epidemiological surveillance disease prevention activities.
• Optimize the efficient organization and accelerate the distribution of humanitarian aid by using the LSS/SUMA system.

Complete Report (in Spanish)

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Health Situation Report
22 August 2007

1. Summary of the general health situation and priorities

Preliminary damage assessment(*)

	Cañete	Chincha	Pisco	Ica	Other locations	Total
Deaths	6	75	335	71	16	503
Injured	172	240	100	487	43	1.042
Missing
Homes destroyed	928	16.010	16.000	300	1.012	34.250

(*) According to Estimates from INDECI, 21 Aug 2007.

• In Pisco, the primary affected location, only 3% of the city has water supply at the household level and the rest of the population receives water supply transported through water tankers.
• The majority of the affected population (more than 30,000 families) have vacated their homes. Many people have been transferred to the shelters, while other lodge in improvised shelters that lack basic sanitation, and still others sleep outside their homes with their furniture and household effects for fear of theft.
• The priority health priority concerns the shelters. On the subject, the Ministry of Health is working jointly with several national or international institutions (INDECI, Ministry of Housing, cooperation agencies, etc.. ).
• In the remaining affected locations in Ica, the health network is recovering to normalcy. And, patients are no longer referred to Lima or other places.
• Greater emphasis must be given to health promotion, with clear messages.
• The general coordination for managing the emergency has significantly improved. In Pisco, INDECI is coordinating response actions between national and local actors. They have also formed as well as lead an intersectoral EOC in order to better rationalize decisions and use of the existing resources. The Ministry of Health has established a health EOC which is functioning both in Pisco and Ica, which are supported by situation rooms situation for information follow up.
• PAHO/WHO is supporting the development of a health situation room on the emergency at the Ministry of Health headquarters in Lima.
• LSS/SUMA has extended its processing points. The INDECI headquarters in Lima has installed a unit to continue to inventory and organize the humanitarian assistance received.

Most urgent priorities for the health sector

• The different sectors and authorities agree that one of the of highest priority subjects are the shelters and efforts to guarantee the delivery of basic services: safe water; food; mental health, among others.
• Is necessary to form multidisciplinary teams for public communication and health promotion, in order to educate people regarding healthy habits, hygiene, food management, etc.
• Maintain the supply and provision of safe water, and management of excreta.
• Organize and provide psychosocial asístanse.
• Continue to evaluate the health services network and recovery of the services.
• Need to strengthen epidmiological surveillence to avoid transmission of diseases.
• Optimizing effective humanitarian assistance by using LSS/SUMA.

2. General Epidimiological Situation

• To date there is only information from the province of Ica once a day. During the five days following the earthquake in the province, there has been a downward trend of injuries. The initially high number of psychosocial problems has also shown a downward trend. While respiratory infections, conjunctivitis, diarrheal diseases, and skin infections had increased on the 18 and 19 Aug, they began decreasing on 20 Aug. Initially there were some cases of reported food borne illnesses and dog and spider bites, however, as of the fourth day there have not been any more reported cases of these health problems.
• The provinces of Pisco, Chincha and Cañete have exhibited a similar situation with respiratory infections as the principal health problem.
• However, it still is not possible to conclude if the increase of illnesses is caused by the disaster and population displacement, or if it only reflects the greater availability of medical services.
• The Ministry of Health continues to organize information flow from the affected areas up to the central command in order to maintain a daily monitoring of the affected provinces.

3. General health situation in Pisco

• Basic services are being reestablished. Telephone communication is being restored, electrical power has been restored in some sectors of the city, although it continues to be rationed.
• For two days the most affected buildings are being demolished (including part of the façade of Hospital Dos de Mayo). The demolition has created an increased amount of dust in the air, which affects the respiratory tracts and eyes.
• There are sufficient health workers available to meet the demand for health care. Presently there are additional external workers in the area (both national and international) that need to be organized by the EOC.
• Current figures on health care show an increase, thanks to better information and greater availability of service. According to the information processed in the EOC, respiratory infections have increased but not cases of diarrhea.
• Given the pressure from the media and from the community regarding possible epidemics, the Ministry of Health began to fumigate the affected homes. However, the EOC epidemiology team could not confirm firve reported cases of chicken pox in shelters.
• In the area, the solidarity of the business sector is perceived with the provision of food, telecommunication services, the distribution of clothes, cleaning supplies, etc.

Health services

• Of the 140 beds and 7 pediatric beds existing in Pisco (50 beds in ESSALUD Hospital and the rest of the Ministry of Health) only 4 (of this last entity) are functioning.
• In addition to the Ministry of Health, there are several public and private institutions that are collaborating in the delivery of services, among others:
  • ESSALUD (in the field hospital installed in the Main Square)
  • Municipality of Lima (in a mobile clinic installed in the plaza de armas)
  • Municipality of Callao (in a mobile clinic)
  • Institutions of international cooperation (in different health facilities of the Ministry of Health and AECI in two field hospitals located next to two destroyed health centers: San Clemente and Humay)
• Of the 22 health facilities of the network of Pisco:
  • 18 are functioning (10 of them without electric power and are supplied with water through cisterns), eight of them with the support of external staff, both of the country and from abroad (Cubans, French, Taiwanese, Spanish, Colombians).
  • 2 have not reestablished their services for lack of staff.
  • 2 have been closed from before the disaster.
• In light of the lack of electricity, 10 electric generators are necessary.
• The National Institute of Health has evaluated the laboratories of the Chincha-Pisco network and found the 3 principal laboratories, located in the hospitals of Chincha, Pisco, and Ica in operation.
• The San Juan de Dios Hospital has redistributed its personnel and has general and emergency health care services covered.

Mental Health

A diagnosis or damage assessment of Mental Health needs was carried out and a plan of intervention was agreed upon along with the agencies that work in the subject.

Water and Sanitation in Urban Areas

• DIGESA- General Environmental Health Directorate- is coordinating the institutions and international players involved in areas of water and sanitation through daily meetings.
• International cooperation has mobilized to the area 14 potable water treatment plants (of different productive capacity), and DIGESA will define its location. The large shelters that will be installed as well as the principal health facilities that lack this service will be a priority.
• In order to reestablish water and sanitation services in the area of Chincha/Cañete, Ica, and Pisco, the Ministry of Housing has requested the effort of various service providing entities (EPS) of the country. They are supporting the EPS of Pisco (EMASPISCO), that of Lima (SEDAPAL, that has mobilized 56 professionals), Cuzco, and Arequipa. This equipment has the operational support of the Army and is accompanied by the National Authority of Water and Sanitation (SUNASS).
• The water services in Chincha/Cañete and Ica are recovering upon the return of electricity and the replacement of destroyed health networks. The sewers have been damaged and continue to be an unknown with respect to the extension of damages and its repair, which will take a long time to rehabilitate. While the service is rehabilitated, there will continue to be a distribution of water through cisterns providing the population with bottles of chlorine for domestic disinfection.
• The management of human waste continues to be a critical subject. The decision to install 500 DISAL latrines with chemical solution chambers are indispensable in the short term but they involve the challenge of its daily operation and the sanitary disposal of the chemical substance and the feces/urine.
• The ministry of housing is planning to construct 100 latrines, whose location will be defined jointly with health.
• The excreta management continues to be a critical subject. The decision to install 500 DISAL latrines with chemical solution chambers are indispensable in the short term, but the daily operation and sanitary disposal of the chemical substances and the excreta/urine presents a challenge.
• The Ministry of Housing is planning to construct 100 latrines, whose location will be jointly defined with the health sector.

Shelters

• There are 24 registered shelters (some are supplied with tents that have been delivered by national institutions and international cooperation, others are simply "refuges" made of materials recovered from homes and tarps).
• The Ministry of Health is in charge of health care and as such surveillance of water quality and INDECI coordinates food delivery and the distribution of water using tankers.
• Mental health actions are being executed with the participation of Ministry of Health professionals, professionals from international organizations, as well as national artists that are deployed to the zone to help the population face recovery.
• Authorities consider the shelters a priority in care. In light of the situation, INDECI is proposing the installation of large shelters where large groups of the population can be stay. Foreign government ( such as Venezuela), international agencies and the Un will be supporting these actions.

4. General Health situation in Ica

• The aftershocks in the region continue with less intensity. In the city of Ica, social, economic and productive activities are practically normal.
• Medical brigades continue to be mobilized to the rural areas and to the outlying areas of Ica.
• Psychological support to the population and to workers affected by the earthquake has been initiated.
• In the Regional Hospital of Ica clean up efforts have started in affected areas that are safe enough to work, in order to adapt some services. Outpatient consolations are operating from tents and temporary structures.
• Patients are being seen in health facilities, network hospitals, and health brigades that are deployed daily (Cañete, Ica and Chincha).
• Patients are no longer being transferred to Lima; they are being served in the department’s network. Trauma care is at a minimum.
• There are no established shelters in Ica and as such, people are staying in their yards and in many cases have made provisional housing using recovered materials, mats or other means. People are grouped into small conglomerates of neighbors to receive assistance (Ica, Chincha, Cañete).
• There exist a small increase in the number of cases of acute respiratory infections and diarrhea, but the Ministry of Health attributes it to the increase of health services offered by the medical brigades.
• The department of social work of Ica, along with the health sector, has begun the task of assistance to those affected with an evaluation of damages and needs.
• As of 20 August, 35,000 food rations have been delivered to 35,000 families. Prepared food is not being rationed, and in some cases communal meals are encouraged.
• There is a health EOC that has daily meetings for the general coordination of activities, resources, needs, etc. there is a situation room where information is managed and analyzed. Tracer diseases, case reports, etc and information is sent at the central level.

5. Humanitarian Assistance. LSS/SUMA Situation in Pisco

The LSS/SUMA team was installed in two points of the Lima-Pisco aerial bridge, which was established by the Peruvian government to facilitate movement between the capital and the affected zone.

As of August 21, the Pisco Aerial Base has received 931 tons, of which 74% is food, drinks and water. These items are being distributed daily by INDECI to district, provincial and region committees of Civil Defense such as shelters, populated centers and settlements in Ica, Chincha and Pisco.

The mobilized team is made up of personnel from FUNDESUMA and the Ecuadorian Red Cross, and has worked with INDECI. The team has relied on the invaluable assistance of Telecoms Sans Frontieres, the UNDAC team and the Argentine White Helmets.

6. General Coordination

• The general coordination of the emergency management has improved significantly. In Pisco, INDECI is articulating actions between the national and local actors, and has formed and led an intersectoral EOC that is allowing for the better rationalization of decisions and better use of existing resources.
• Health actions are being led by the Ministry of Health. In Pisco a health EOC has been set up under the coordination of the director of the San Juan Hospital, which is also allowing for more adequate intersectoral action and for more coordinated assistance. Information is updated daily in the health EOC’s situation room.
• The UNDAC team continues to strengthen the coordination process, supporting the INDECI leadership, articulating the action of actors and providing technical assistance for a better response. They have emphasized the task of the health sector in addressing the treatment and the prevention of the public health problems, as well as in the quality of information that it processed in its situation room.
• The Peruvian Minister of Health traveled the disaster impact zone along with the Chilean Minister of Health, who offered her solidarity in name of the Chilean and Latin American people. The Peruvian minister pointed out the immediate response of the health sector and thanked all the institutions that have collaborated in the response.

7. PAHO/WHO Actions and Responses

• Supporting authorities in defining a mass communication work strategy, in promoting health in shelters, and in collaborating actions with the media and other institutional actors that help to protect the public health of affected people.
• The teams of experts in the affected zones are continue to support damage assessment and health needs, intersectoral coordination, the formation of an EOC in Pisco and the development of a situation room.
• Coordination with the UNDAC team and other international cooperation agencies in the capital of the country and in affected zones.
• Supporting the implementation of SUMA-LSS under the coordination of the National System of Civil Defense.
• Permanent coordination with the UN system and the established EOC.
• Permanent support to the Ministry of Health in strengthening the leadership and general coordination in health.

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Health Situation Report
21 August 2007

1. Summary of the general health situation and priorities

Preliminary damage assessment(*)

	Cañete	Chincha	Pisco	Ica	Other locations	Total
Deaths	6	75	335	71	16	503
Injured	172	240	100	487	43	1.042
Missing
Homes destroyed	928	16.010	16.000	300	1.012	34.250

(*) According to Estimates from INDECI, 21 Aug 2007.

• The most severe damages in the service network are concentrated in Pisco, with 2 hospitals collapsed and more than 25 health centers affected.
• The population needing shelter could increase in the coming days, as homes are evaluated and declared uninhabitable. The number of those left homeless could surpass 30,000 families.
• 650 wounded have been transported to Lima (417 women and 250 men); of these only three have passed away.
• The Ministry of Health is organizing information flow from the affected areas up to a command center and it is expected to establish and maintain a daily monitoring of the other affected provinces within one to two days.

  Most urgent priorities for the health sector

• It does not seem necessary to send additional health workers to the affected areas. But rather to reorganize the health workers present.
• Provide safe drinking water to the affected population.
• Assess the health service network and service recovery.
• Need to strengthen epidmiological surveillence in shelters to avoid transmission of diseases.
• Environmental health and trash and rubble collection.
• Launch a psychosocial support program and mental health support for the affected population and for health workers.
• Public information and communication campaign to the community on environmental health and safe water management.
• Optimizing effective humanitarian assistance by using LSS/SUMA.
• Support basic sanitation and water quality control for refugees.

2. General health situation in Pisco

• The accelerated demolition of unsafe homes and buildings has increased the levels of particle materials in the environment and consequently has increased respiratory infections.
• The evacuations of damaged homes in poor conditions have increased the population in shelters.
• The city has begun to recover electrical power.
• Water distribution continues to be provided from water tankers.
• The local health workers are returning to work in their usual workplaces, accompanied by foreign aid support workers who are being permanently relieved.
• Medications and medical supplies are available.
• The principal need is providing electrical power generators to the different establishments.
• It has been emphasized that NO more additional health workers are needed but rather the reorganization of existing resources.

About the health service network

Hospital San Juan de Dios. The hospital continues to provide services in the new building of the hospital, where a health situation room has been set up and where health workers from other parts of the country who are supporting the delivery of services are staying overnight.

Hospital Antonio Skabronja. The hospital is destroyed. Health care is being provided in a field hospital in the Plaza de Armas, where to date 4,933 patients have been seen and 250 patients have been evacuated to Lima.

The laboratory network is functioning. 22 other outpatient health units have been evaluated in the Chincha-Pisco network.

• Only 5 are operating at 100% capacity.
• 10 are without lights.
• 2 operating at 50%, partial building damage or lacking access to basic service or lacking health workers.
• 2 closed.
• 12 have still not documented the damages.

Water and Sanitation in Pisco

The city continues to lack water. Water distribution continues to be provided by water tankers both to shelters as well as the rest of the community.

The evaluation of the water systems has started in the rural sector and serious damages have been detected in the systems, some have used alternate water sources that are not chlorinated.

23 shelters are being established with a total capacity for 11,899 people. The most immediate need is for latrines.

3. General health situation in Ica

• The rural and surrounding areas of the city are being served by medical brigades both from the region and professionals from Arequipa, Moquegua, Saint Martin, Lima, Apurimac and the NGO Solaris.
• The surrounding health services have remained operational with adequate resources.
• Food rations have been distributed for at least 35,000 families. With contributions from WFP there are enough food resources to continue with the distribution. A community common pot is being used to feed organized communities. Food distribution for children under the age of 2 does different from the regular regional diet does not exist.
• A downward trend has been observed of injuries due to external causes, wounds and traumas; respiratory infections, conjunctivitis, diarrhea diseases, foodborne illnesses and skin infections have increased during this period. However this does not indicate epidemics and outbreaks. It is still not possible to conclude that the increase in morbidity is caused by the disaster and population displacement or if the figures only reflect the increased availability of medical services at the moment.

A donation of 30,000 oral dehydration packets and chlorine tablets for water purification.

Water and Sanitation Ica

• The drinking water supply is gradually being reestablished throughout the city and has arrived to 90% of the urban area, 60% of the outlying areas through water tanks transported in cars.
• The solid waste collection system is functioning at the same level as before the earthquake.
• Damage has been detected to 200 meters of the sewage system in one of the sectors of the city.
• Outdoor defecation has been increased as a consequence damages to homes and as fears remain of remaining trapped given the number of aftershocks.

In several outlying and rural area, the communities have started to adapt their homes using materials that remained in working condition (adobes, wood, mats.)

A structural assessment mission is necessary for the Regional Hospital of Ica to determine if it should be rehabilitated or demolished. It is recommended to increase the hospitalization area and to relocate the outpatient consultation area.

4. PAHO/WHO Response actions

• Expert teams continue to support the affected areas in damage and needs assessments, intersectoral coordination, establishing the EOC in Pisco and the development of a situation room.
• Coordination with the UNDAC team and other international cooperation agencies in the capital and affected areas.
• Support for the establishment of LSS/SUMA, under the coordination of the National Civil Defense System. Continuing to inventory the national and international humanitarian assistance and distribution from the airports in Pisco and Lima (Group 8), with the support of White Helmet personnel and from INDECI.
• Coordination with the United Nations for the joint preparation of a “Flash Appeal.” Based on information consolidated by the team – Ministry of Heath-PAHO on the health situation, an interagency health group of the UN System (PAHO/WHO, UNICEF, UNFPA, UNAIDS) developed this component for the global proposal, for a total of $1,970,000USD to strengthen the service sector, water and sanitation, improve general coordination, and epidemiological surveillance and control outbreaks.

5. Humanitarian Assistance

About the LSS/SUMA situation in Lima. Based at the Jorge Chavez Airport

• A SUMA team formed including the National Logistical Directorate of INDECI, the Peruvian Agency for International Cooperation (APCI), the Lima Branch of the Red Cross and the Peruvian Air Force.
• Registry of the distribution of the supplies prior to the Point of Entry from the Military Airport of Pisco.
• Generating consolidated reports since the 17 Aug for local and international donations sent to Pisco.
• 100% registry of supplies dispatched from the point of entry to the city of Pisco in approximately 40 air operations and 15 land operations, since 16 August, with official support provided by the National Logistical Directorate INDECI.

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Evaluation of Health Situation
20 August 2007 (supersedes the 19 August report)
(In Spanish)

Preliminary Evaluation Report on Health Facilities in Chincha and Ica
19 August 2007

Chincha

The province of Chincha has a population of 194, 124. The city of Chincha, capital of the province, has a population of 59,189. There is no potable water or electricity at the time of evaluation. Potable water is being distributed by the city with previous chlorine disinfection. There are no visible problems with the sewage system in the city of Chincha. Solid waste is being collecting irregularly and the biggest problem is the elimination of rubble.

Currently, there are 60,000 people affected, 101 deaths, 800 injuries, and 12,000 homes with moderate or severe damage. The communities of Sunampe and Tambo de Mora report severe damages in homes. There are no shelters and tents and as such, people are living in their yards.

Damages to the health sector

• Hospital San Jose de Chincha (Ministry of Health)
  It has a bed capacity of 96. There was a total collapse of the frontal perimeter and significant damage to the administrative building and morgue (an older area made of adobe). There was also damage to electric generators that were substituted with new equipment. There is no water or electricity in the public system, but the hospital is using its own supplies. Decalibration of lab equipment and x rays. Key areas such as the operating room, urgencies, hospitalization, obstetrics, external consulting, the kitchen and general services are functional. Seriously injured patients were transferred to Lima and Cañete. The hospital is operating 100% with 60% occupation. There are medical personal and sufficient nurses. There are enough medications, supplies, intravenous liquids, and food for patients and personnel. There is adequate accessibility to the hospital. The demand and inflow of poly traumatized patients has decreased significantly, the morbidity is routine for the hospital.
• Hospital Basico Essalud Renato
  Has 90 beds with coverage for 65,000 beneficiaries. The main building that has administrative services, information support, files and external consulting has collapsed, with severe damages to the infrastructure. The water tank and the columns that support them are broken, as well as damage to the system of water distribution and elimination. The hospital evacuated all patients in serious condition. Currently, the hospital in functioning in hospitalization and emergency at 60% in a recently constructed area.
• Centro de Salud Sunampe
  The damage caused by the earthquake was peripheral, there is no water or functioning sewage system. The number of consultations for severe respiratory infections and severe diarrhea infections has started to increase. The people affected by the destruction of homes do not want to live in shelters and are staying in the front of their homes for fear of being robbed, and are being exposed to the weather conditions because tents have not been distributed. This is taking place in Sunampe and its annex, Lomo Largo, and in the latter the destruction of homes was approximately 85%; however, they were served with water containers.
• Centro de Salud de Grocio Prado
  The earthquake only damaged the inside of the installation, due to the type of materials with which they were constructed. In addition to severe respiratory infections, mental health problems have been reported in children older than ten and the elderly. Trash has not been collected, the water supply by pipe is not working; however, a cistern is being used that does not need electricity to function. This district has 18,000 inhabitants, 60% of its homes have been affected, and the water system does not work as well as sewage, there is no regular collection of waste nor has it received food or clothing. Personnel are making field visits to the affected people in the neighborhood El Progreso.

Province of Ica-city of Ica

• General direction of Health
  The health command post operates in the General Direction. They compiled post disaster epidemiological information about morbidity and mortality, and they are preparing a report that will be presented soon. They constructed three mobile epidemiological teams for Ica, Pisco and Chincha with two epidemiologists and one IT person for each. A shelter has been created in the Pisco stadium with 13 tents, which are maintained in good hygienic condition. A mental health team was created to assist health personnel that are presented with psychological traumas.
• Hospital Regional de Ica
  200 beds. The main building has significant damages en walls and windows. The water tank collapsed, flooding the building. The 40 year old building has prior vulnerabilities due to where it was constructed. Currently the affected zone is almost completely evacuated. It appears that the infrastructure of the hospital is affected. The emergency room is functioning in its normal place. The ICU was transferred to another area and three tents have been sent up on the hospital patio and are being used to ambulatory attention. Some areas of hospitalization were transferred to the halls.
• Hospital San Socorro
  96 beds, all functioning. The old building that was used for preventive promotions, storage and general service is collapsed. The hospitalization, emergency, surgery and obstetrics center, pharmacy and lab are functioning100% Water and electricity are available with the hospital’s equipment. There are no obstructions or barriers to access to the health unit.
• Hospital de la Red Regional de Ica Essalud
  The four floors of the main building have been evacuated completely due to damages in the partitions and secondary eaves. Patients were evacuated to Lima and discharged. The evaluation was done by engineers of Essalud who determine that in this moment there is no evidence of structural damages. The emergency services, pharmacy, and diagnostics are functional.

General Comments

The good response of the health center should be recognized in this event: the immediate attention to patients, triage and transfer of patients to Lima and Cañete. Also they supported local resources with resources from other locals, mainly from Lima. Health personnel has been available to complete their work in regional hospitals and networks for 36 continuous hours in spite of being affected themselves. The aftershocks in the area continue, some of which are significant in intensity. Therefore, this evaluation is only valid for the date it was written.

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Situation Report
17 August 2007

As a result of the earthquake (MW 8.0) that struck off the coast of Peru on August 15, and several aftershocks, reports indicate that more than 80,000 people have been affected. There have been 446 confirmed deaths and over 1,000 injured, and at least 16,997 homes destroyed. Four heath facilities are reported destroyed, one hospital in Pisco, near the epicenter and 3 health centers in the province of Castrovirreyna, which is one of the poorest zones in Peru.

Several walls of the emergency and surgical rooms collapsed in the ministry of health hospital in Pisco. The most important regional hospital in Ica and the main hospital in Chincha could only partially operate due to functional collapse* of basic services. Seven specialized hospitals in Lima also presented physical damage, especially in walls, prompting the evacuation of some services.

Ministry of Health officials began home-to-home visits in the city of Pisco in order to identify any injured persons that have not reached health services and to provide recommendations for the prevention of communicable diseases (mainly acute respiratory infections and diarrhea) in the event of a collapse of the water and sewage systems.

It is still difficult to reach several localities in the affected areas due to extensive damage to the main highway that connects the capital of Peru with the affected zone, as well as many other secondary roads. An air bridge between Lima and Pisco is facilitating the humanitarian aid transportation as well as medical evacuation of severe injured patients.

Two PAHO/WHO disaster management experts arrived yesterday to support Peruvian efforts and joined interagency assessment teams. An additional ten experts on humanitarian supplies management, public information, health services, post-disaster assessment among others have been deployed and will arrive in the next 12 to 48 hours.

The National Civil Defense with the cooperation of PAHO/WHO is setting up Logistic Support Systems (SUMA/LSS) in Lima and Pisco to ensure rapid inventory, classification and distribution of urgent humanitarian supplies to the affected population.

* When a hospital is overwhelmed due to a disaster and is not able to operate at a normal basis.

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Situation Report
16 August 2007

An earthquake with a magnitude of 8.0 (magnitude revised by the USGS) struck off the coast of Peru on August 15 at 18:40 local time. The epicenter was located in the sea approximately 60km from the city of Pisco. The quake caused the interruption of both power and telephone services, which are gradually being reestablished, within Peru and in the capital city of Lima . There have been reports of hundreds of collapsed homes in the cities of Pisco, Cañete, and Chincha. Several health facilities in the department of Ica, including hospitals in Pisco and Chincha, have suffered physical damage and are operating on a limited basis. According to the Civil Defense the death toll stands at 437 with more than 1,000 injured from the quake, and thousands affected. These numbers are expected to rise as search and rescue continues in a number of cities. Structural damage and needs are being assessed. The Peruvian government has declared a state of emergency in order to mobilize personnel and supplies to the affected zones.

Actions

• The PAHO/WHO Representation in Peru is meeting with the UN Emergency Team and the Vice Minister of Health to assess priority relief needs.
• Pre-hospital care units have been deployed to the affected zone, including Ica, in order to assist with the rescue effort and to attend to those injured and transport them to health facilities.
• Peru’s Minister of Health has deployed to Chincha and Ica, with a health team composed of 50 doctors, 30 nurses, 20 ambulances, a mobile Operations Center and medical supplies.
• President Alan Garcia decided that all hospitals of the Ministry of Health, Armed Forces and Social Security system provide care at no cost to patients.

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