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Distribution of hygiene kit after training session on Participatory Hygiene and Sanitation Transformation (PHAST) and Children Hygiene and Sanitation Training (CHAST)

Community World Service Asia is implementing an integrated emergency WASH and Shelter project for families affected by the 2015 earthquake in District Shangla, Pakistan. The target Union Councils of the intervention included Shah Pur, Damorhi, Kuz Kana, Bar Puran and Banglai.

The key components of this short-term disaster response project include Rehabilitation of Water Supply Schemes, Repair and reconstruction of Latrines and Distribution of Self help repair Shelter kits. The project also provides trainings on Participatory Hygiene and Sanitation Transformation (PHAST) and Children Hygiene and Sanitation Training (CHAST) techniques of health and hygiene along with provision of hygiene kits and waste bins to the communities.

The distribution of self-help repair shelter kits to the affected families has been completed. A total of 1400 shelter repair kits have been distributed among the targeted earthquake affected households. The shelter kits distribution was done in three of the selected union councils including Damori, Kuzkana and Shahpur.

A standard process for the distribution based on the selection criteria of participants was followed under the project. Tokens were distributed amongst the concerned communities and information regarding the distribution ceremony was shared with all participants. It was mandatory for the community member to bring their original identity card along with the token to receive the assigned kit.

On the day of distribution, an orientation sessions on safer construction techniques was conducted to enable the communities to utilize the shelter repair kit as per the guidelines. Follow-up visits are scheduled to be conducted in the coming months to guide the communities on how and where to construct their shelter and how to utilize the kit to avail its maximum benefits. Along with follow-up visits, follow-up sessions on safer construction techniques are also planned in the year ahead.

Remote and rural areas affected by recurrent natural disasters often suffer the most when it comes to their recovery, rehabilitation and development. The 7.5 magnitude earthquake epicentered in the Hindu Kush range in winter of 2015 severely shook Pakistan’s mountainous northern belt, killing nearly three hundred people. In its aftermath, more than 14,000 houses were severely damaged or completely destroyed; community infrastructure was unusable and livelihoods were diminished.  Almost a year later, the poor socio-economic life of the inhabitants remained largely unchanged.

High altitude villages perched on the steep mountain slopes of district Shangla in northern Pakistan were severely damaged by the earthquake. One of the hardest hit areas was Village Tanshit; mainly comprised of steep, rocky terrain dotted with 221 traditional, rural homestead compounds. Multiple families reside in each compound. After the earthquake, the community’s most basic infrastructure and facilities, which had been built with great effort and years of savings, were lost. The village’s sole water supply scheme became one of the earthquake’s most significant casualties.

For the next nine months after the earthquake, the local women had to make a forty five minute climb on foot to a mountain stream and return with as much water as they could carry everyday. Families living in mountain village compounds have strong traditional, social and cultural codes for the protection of women, even for those undertaking daily domestic responsibilities.  This usually means that the women stay very close to their homes.  However, to access water, the women of Tanshit had to travel a long distance carrying water on their heads through wild and rocky mountain treks.  As the water carried by a single person was insufficient for the entire family’s needs, sometimes the children were tasked with carrying water from the streams on their way back from school. This was dangerous and had to be done in daylight. In warmer months, these communities became very vulnerable to waterborne diseases as hygiene could not be maintained while carrying and storing this stream water.

“Safe drinking water and adequate sanitation are crucial for poverty reduction, crucial for sustainable development and crucial for achieving any and every one of the Millennium Development Goals,” Ban Ki-moon, UN Secretary General

The human right to water and to sanitation constitutes the right of every individual, without discrimination, to sufficient, safe, acceptable, accessible and affordable water and sanitation for personal use. To ensure this right, in 2016 Community World Service Asia, in partnership with Norwegian Church Aid and ECHO, assessed the village Tanshit’s water system and was selected as one of the twenty communities under its’ integrated WASH, Shelter and Cash-for-Work programme.  Technical assistance, construction materials and paid labor opportunities were provided to help villagers to restore their water system, reconstruct latrines and bathing facilities, and repair their homes.  A village WASH Committees was formed to articulate the basic communal needs according to the project’s objectives and scope.

The project team arranged hygiene sessions with the village women’s group and sensitized them on hygienic practices through Child Hygiene and Sanitation Training (CHAST) and Participatory Hygiene and Sanitation Transformation (PHAST) approaches. A pre-KAP (Knowledge, Attitudes, Practices) survey was also conducted to gauge the pre-existing or baseline hygienic practices of the families and to help demonstrate subsequent gains.

To ensure ownership, each village’s drinking water supply scheme was selected on the recommendation of village committees. After a technical feasibility assessment conducted by members of Community World Service Asia’s engineering team, Tanshit’s water supply scheme was rehabilitated, with additional resources, successfully. The water source was reconstructed, protected and pipelines were installed throughout the village.  The community contributed additional labor and materials as well to this reconstruction.

Today, Tanshit’s drinking water supply scheme supplies clean, safe and ample water to 221 households as per Sphere standards. The risk of waterborne diseases has been decreased. The social protection of women has been ensured and their cultural sensitivities are preserved. Around 1,200 individuals are undertaking more hygienic practices that will significantly contribute to maintaining healthier families. The project team also mobilized the local community towards the maintenance and upkeep of their water system through a local community savings plan.  They have also begun a small, intra-village savings and lending activity to commonly support their lowest income groups. This will enable every community member to maintain their compound’s connections to the scheme.

A sister holding her baby brother while waiting to see the doctor at the BHU in Kuzkhana

In response to the 7.5 magnitude earthquake that struck the Hindukish mountain range on October 26th this year, affecting thousands of people in northern Afghanistan and Pakistan, Community World Service Asia set up a mobile health unit in district Shangla.  The Mobile unit started its activities on October 30th and continued operation as a static Basic Health Unit in Kuzkana, Shangla, after two weeks and still operational.

In its thirty two days of activities till December 10th, the Health Unit days catered to 4090 earthquake affected community members in its Outpatient Department (OPD),of which 2271 patients were women and infants, and 1820 men and children.  A total of 1033 laboratory tests were conducted to diagnose illnesses among affected communities in the mobile Laboratory and BHU.

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The earthquake 26 October, 7.5 magnitude earthquake affected sixteen provinces in Afghanistan and two provinces along with the FATA region in Pakistan. It left a total of 395 people dead, 2,269 injured and 116,639 houses damaged in both the countries. Infrastructural damage was most extensive near the epicentre of the quake in both the countries. Access to the affected provinces is most difficult due to the volatile security situation in Afghanistan and the rugged terrain in both the quake hit countries.

The decreasing temperatures in the affected zones of both the countries is another hurdle in accessibility to the areas. With no appropriate shelter, the earthquake hit communities are forced to face the harsh winter in compromising conditions, struggling to meet their basic survival requirements.

Pakistan: As per the latest information released by the National Disaster Management Authority (NDMA), so far 280 people have died, 1,745 have been injured and a total of 98,094 houses have been damaged across the country. Out of the total houses damaged, 92 percent were located in Khyber Pakhtunkhwa Province. Damages to infrastructure such as roads, bridges and communication networks, in the affected areas are also significant.

Protection against the near freezing temperatures is the priority need of the affected communities. In this regard, winterization support is a highly recommended form of assistance by the district government. This is followed by health services which also a critical need of the quake hit communities who are exposed to the dropping temperatures without adequate winter supplies.

Afghanistan: A total of 115 people have died, 524 people have been injured and 18,545 houses have been damaged in Afghanistan. A recorded 6,929 houses out of the total damaged have been completely destroyed. A reported 130,093 people have been affected across the country as per the latest report, however the damage assessment is still ongoing which may result in a further increase in number of damages.

More than 50,000 people have been affected in Badakhshan province where property damage was most widespread. Access remains the major challenge in providing assistance to the earthquake affected people in Afghanistan. The primary needs of the affected communities in the country have been identified as basic household supplies, blankets, tents, hygiene kits and shelter for those families whose houses have been completely destroyed.

Quality and Accountability Related Issues

Afghanistan: Community World Service Asia has conducted a Rapid Accountability Need Assessment (RANA) with local and international organizations working on the earthquake response in Afghanistan.  Listed below are the accountability related issues that have surfaced in the assessment;

  • Organizations have less capacity to handle complaints as they do not have proper Complaint Response Mechanisms (CRM) in place or trained staff to deal with the concerns of the communities
  • Due to current developing security situation, some international organizations are unable to reach far flung and remote affected communities

Pakistan: Community World Service Asia organized an Accountability Learning and Working Group (ALWG) meeting on Nov 19, 2015 to discuss the challenges and issues faced by humanitarian actors in responding to the recent Earthquake in Pakistan.  Ten national and International organizations including UN agencies participated in the event. Listed below are the identified accountability related issues;

  • Access to the severely affected areas is still a major issue
  • 50 percent of the affected community is still waiting for compensation
  • The Government is disbursing compensation amounts through cheques however most of the earthquake affected communities do not have bank accounts to cash their cheques
  • No proper emergency evacuation system has yet been placed for children in earthquake affected areas. The schools in these areas are still not functional either.
  • Some of the organizations have provided shelters to the communities but the quality of the shelters does not take in account resilience to changing and extreme weather.
  • Some community members have started reconstructing their homes but they are not following the earthquake resilient structure guidelines.
  • Lack of coordinated assessment is still a major challenge.

Response by Community World Service Asia: Community World Service Asia’s Emergency Health Response team has provided health services through Mobile Health Units in District Shangla for 12 days where the team treated 1,853 patients, of which 975 were male patients and 878 were female. A total of 136 lab tests have also been carried out at the MHU. Since November 16th, the team has started operating as a static Basic Health Unit at UC Kuzkana in the Shangla district, where the team has assisted more than 600 patients, and carried more than a hundred lab tests so far. Community World Service Asia has also distributed one month food packages to 371 families and distributed 812 winterization kits to affected families till date. In the coming days more distributions of winterization kits will also take place.

Please follow our live photo update from the earthquake affected areas on our Facebook page at: https://www.facebook.com/communityworldserviceasia/ .

Contacts:
Allan A. Calma
Deputy Director
Disaster Management Program
Email: allan.calma@communityworldservice.asia
Cell: +92 301 5801621

Muhammad Fazal
Associate Director
Emergencies/DRR/Climate Change
Email: fazil.sardar@communitryworldservice.asia
Cell: +92 332 5586134

Nejabat Khan Safi
Associate Director
Disaster Management Program
Email: nejabat.safi@communitryworldservice.asia
Mobile: +93 799 326 628

Palwashay Arbab
Head of Communications
Email: palwashay.arbab@communityworldservice.asia
Ph: +92 42 3586 5338

Sources:
http://www.ndma.gov.pk/new/
http://www.pmd.gov.pk/
http://www.Reliefweb.int
OCHA Afghanistan
IOM Afghanistan

An 8 year old Kainat was spotted during our visit to DHQ Alpuri. She was injured when we met her as she was held by her father, who supports a family of nine including his wife, his father, two sons and four daughters. Kainat’s family are residents of the earthquake affected village Maal of UC Kuzkana, District Shangla.

“We were all sitting in the kitchen after having lunch when the earthquake hit with full intensity. We rushed and evacuated our house and gathered in the fields outside. I was looking around at the shaking houses, mountains and trees as the earthquake continued. Then, all of a sudden, our house started to collapse around me, giving me no time to move. A wooden beam fell on my leg while at the same time some pieces of stones hit my grandfather,”

narrated Kainat’s as she recalled her experience during the devastating earthquake.

Kainat’s father added, “Nearly fifty percent of houses were destroyed in our village but the neighbors whose houses survived showed great solidarity and immediately started helping those families affected. They  helped us to rescue my daughter and my father from the rubble and quickly moved them to the hospital. We reached RHC Karora in a state of emergency, where, after being provided with first aid, we were referred to the Swat Hospital, as Kainat’s leg was broken in two places and my father was severely injured. We received a thorough treatment at the Swat Hospital; my daughter was discharged but my father is still admitted there.”

Upon inquiring about the current needs of those affected by the earthquake, he replied that the affected communities are currently seeking shelter under polythene sheets in open fields as the other villagers help in providing them with food and comfort to the best of their abilities. The weather is becoming extremely cold. Tents, blankets and food items are most needed for families like Kainat’s to survive and recover.

The provision of health education and professionally staffed out-patient departments, fully equipped with Disease Early Warning System (DEWS) and Health Information System (HIS), significantly improved access and the quality of health care.
PhasePhase OnePhase Two
DurationJul 01, 2014Jun 30, 2015
LocationUC Korora and Shangla, District Shangla, KPK, Pakistan
Key Activities
  • Provision of services through 2 health centers in Karora, Allpuri and a delivery room in Besham.
  • Provision of general OPD out-patient department care services.
  • Provision of ante and postnatal checkups Referral of complicated cases to the next level of health facilities.
  • Provision of free essential medicines to patients attending our health facilities in Shangla.
  • Screening of malnourished, lactating, or pregnant women for nutritional status.
  • Screening of children who are malnourished.
  • Distribution of safe delivery kits and hygiene kits to pregnant and lactating women
  • De-worming of children
  • Establishing DEWS (Disease Early Warning System) and HIS (Health Information System) reporting.
  • Deliver basic trainings to traditional birth attendants in the catchments of our health facilities.
  • Delivery room of Besham hospital remains operational with staff and material resources.
  • Provision of Health Education through IEC (Information Education and Communication) materials
Participants38,000 Preventive and curative services
7,000: Reproductive health services
10,000: Broader assessment of nutritional health status among women and children
34,000: Health Awareness

Only two delivery cases were handled in this building during the past 15 years. [The health education campaign] really brought positive change into the community. Now, many women visit this health facility. It strongly reflects in the fact that in five months we handled 50 labor room cases.

Dr. Ayesha, a doctor with Community World Service Asia’s health program

Improved mother and child health care has significantly reduced the maternal and infant mortality rates.
PhasePhase OnePhase Two
DurationJul 01, 2013Jun 30, 2014
LocationShangla, Khyber Pakhtunkhwa Province, Pakistan
Key Activities
  • Patient examination (by doctors, medical officers and lady health visitors)
  • Provision of essential drugs
  • Reproductive health services with a special focus on Mother and Child health care including antenatal and postnatal care
  • Distribution of safe delivery kits
  • Health Education sessions focusing on water borne diseases, STIs, HIV/AIDS, locally endemic diseases and distribution of information materials
  • Referral of patients to secondary and tertiary health care facilities
  • Management of alerts, threats and outbreaks, if any, in collaboration
  • DEWS reporting
  • Referral of disabled patients to facilities where assistance is available
Participants

Only two delivery cases were handled in this building during the past 15 years. [The health education campaign] really brought positive change into the community. Now, many women visit this health facility. It strongly reflects in the fact that in five months we handled 50 labor room cases.

Dr. Ayesha, a doctor with Community World Service Asia’s health program