The World Health Organization is concerned about the lack of shelter and safe water for people affected by the earthquake ten days ago in Pakistan. Despite the best efforts of the Pakistan Government, the United Nations and non-governmental organizations, many people have still not been reached by adequate relief supplies. As time passes and the weather gets colder, the health risks of sleeping with inadequate shelter increase - particularly for people who have been injured. The provision of adequate safe food and water remain vital for the survival and health of all those affected.

Here is the latest health information from the earthquake-affected areas of Pakistan:

o Tens of thousands of people have been killed and more 65 000 injured, according to official government figures. Many have still received no treatment. Teams from the Ministry of Health and from international field hospitals are operating around the clock to find and treat the injured. Many people with normally non-life threatening injuries who have not yet received treatment or have not been accessed by relief teams are now at serious risk of fatal infection or crush syndrome.

o Supplies of winterized tents and blankets are becoming essential as winter approaches.

o Sustainable supplies of clean water are essential for health facilities - for both drinking water and sanitation. Hundreds of thousands of litres are needed for people's survival and to protect against disease outbreaks. Some purification plants are already in Muzaffarbad and more mobile plants are on the way.

o A WHO/UNICEF team has checked into reports of an increase in diarrhoeal cases in Balakot - the reported increase turned out to be based on false information.

o Disease surveillance, particularly in larger towns, will be critical in order to identify and control any disease outbreaks. WHO is helping to establish an Early Warning and Response Surveillance Network (EWARN) with health professionals from the Ministry of Health and from other provinces to track and respond to outbreaks of disease. Diseases surveillance training is being provided to more than 200 national officers and all health partners (including surgical teams, medical teams and field hospitals). They will be asked to provide EWARN with updated information on the number and type of cases treated.

Islamabad

o The Pakistan Institute for Medical Sciences (PIMS) in Islamabad is still receiving up to 300 patients daily and is sending stabilized patients to other public hospitals around the country. The hospital has put up tents in the grounds for families of patients.

o The Pakistan Armed Forces has set up a field hospital at Islamabad airport, and with staff from the Ministry of Health, this facility is undertaking triage of patients and dispatch to adequate treatment facilities in Islamabad and in other cities according to the preliminary diagnosis.

Muzaffarabad

o Muzaffarabad, a district of 600 000 people has been massively damaged. Half of the population has no access to any kind of services.

o The Combined Military Hospital (CMH) in Muzaffarabad, the main health facility, has been extensively damaged and is closed. Most other health facilities in the district are thought to have been destroyed or severely damaged.

o The Abbas Institute of Medical Sciences is the only hospital in Muzaffarabed which managed to withstand the earthquake. It is now carrying out dozens of major and minor surgical interventions in its operating theatres every day.

o In spite of the fact that many Ministry of Health staff are direct or indirect victims of the disaster, many have started to report back for duty.

o Medical and surgical field teams report 2000 patients are being treated daily in Muzaffarabad. The first three days after the earthquake, most patients were treated for trauma injuries. Currently, about 40% of patients are treated for trauma; the remainder being largely acute respiratory infections.

o Surgical services are being delivered in four field hospitals.

o A dialysis unit is being set up in the next two days to to prevent renal complications of crush injuries, (location to be determined).

Bagh

o Bagh is a district with a population of 400 000 people. Of these, about 100 000 people live in Bagh city.

o All civil and military health facilities have been destroyed. There is reportedly not a single building in the city that could be used to establish even a makeshift hospital.

o The district health system has ceased to function. Information from peripheral areas is not available, and it seems that most primary health care facilities are non-functional.

o Health staff are focusing on emergency surgery. Non governmental organizations and the armed forces, with a team from Mayo Hospital in Lahore, are providing the health services.

WHO Assistance: assessments, supplies and coordination

o The Ministry of Health, supported by WHO, is working to respond to the earthquake emergency and coordinate the health response both in Islamabad and in the field. WHO has set up coordination units in Islamabad, Bagh, Muzaffarabad and Mansehra.

o The Ministry of Health , with the support of WHO, is sending 40 teams of surgeons and public health/environmental specialists to affected areas today. Another group of 100 students and 30 epidemiologists from Aga Khan University will be trained, with the help of WHO and will be dispatched to help with ensuring disease surveillance and response. 200 surveillance officers public-health experts have been trained and recruited to go to the affected regions next Monday (the same 200 mentioned in fifth bullet point). Another 200 physicians from Karachi and Punjab are available for immediate mobilization.

o The Ministry of Health, WHO, UNICEF and other partners, are planning a measles vaccination campaign in Muzaffarabad, to be extended to other affected areas. The vaccine will be given to children between 9 months and 15 years old with Vitamin A supplements in areas where people have congregated at medical sites or tent camps. 25 teams are already in the field and 20 more will be there by today. Generators are needed urgently to ensure the cold chain system for vaccines. Four warehouses in Manshera and five in Muzaffarabad will be established with cold chain facilities.

o WHO, with the Ministry of Health, the government of the Islamic Republic of Iran and the Italian Government have delivered nine emergency health kits or sufficient medicines and medical supplies to serve the needs of 270 000 people for one month or 90 000 people for three months. Of these, four emergency health kits have been delivered to Mansehra and three to Muzaffarabad with the remainder in Islamabad. A further ten 10-thousand person emergency health kits are in the pipeline.

o WHO, with the Ministry of Health and the Italian government have delivered seven trauma kits or surgical supplies and medicines sufficient for 700 surgeries. Two of these have been delivered to Mansehra with a further two to be shipped from Islamabad. Three of these kits have been delivered to Muzaffarabad. A further 12 trauma kits are in the pipeline.

o WHO, with the Ministry of Health and the Italian government are also sending five diarrhoea kits which provide enough medicines and supplies to treat up to 500 cases of severe diarrhoea.

o A broad range of health messages, varying from the fact that dead bodies do not transmit disease, the importance of personal hygiene and the use of latrines will be transmitted today to the affected population from a local radio station, Power 99.