1. Public Health and HIV Section1 Refugee and Displaced Population Operations During a Pandemic Dr. Sibyl Jade Pena, MPH Regional Emergency Preparedness and Response Coordinator for Asia United Nations High Commission for Refugees Senior Leaders Event for Asia Pacific Phnom Penh, Cambodia 12-15 October 2009

2. Public Health and HIV Section2 Pandemic Preparedness HCR is mandated to lead & coordinate international action for protection and resolution of refugee issues Guided by 1951 UN Convention relating status of refugees and its 1967 protocol Consolidated Action Plan* for AHI states that HCR will work with other UN agencies, funds & programmes and their partners in support of refugee pandemic preparedness planning A Special Project was established (2007)in this regard with one senior coordinator in GVA and 6 regional coordinators…(funded by USAID since 2008)

3. Public Health and HIV Section3 Focus on POCs Refugees, other population of concern (POCs)  Dependent on agencies for assistance (food rations from WFP)  Overcrowded living conditions  Background of infectious diseases and malnutrition  Watsan situation  In case of urban refugees, scattered all over the city

4. Public Health and HIV Section4 Nepal7 camps – 80,000 Bangladesh2 camps- 27,000 Indiaapprox. 12,000 (New Delhi) Thailand9 camps- 130,000 Pakistan> 82 camps - > 1 million Malaysia100,000 (Kuala Lumpur) Myanmar*800,000 (Northern Rakhine State) PoC numbers

5. Public Health and HIV Section5 Regional Updates

6. Public Health and HIV Section6

7. 7 Pandemic Preparedness Project Camp specific Contingency Plans / Operational Plans for AHI: 1.Establishment of Outbreak Control Team (OCT) 2.Surveillance and Early Warning – HIS 3.Public information – awareness trainings, mass campaigns, IEC materials 4.Health Facility Planning – stockpiling, isolation & surge capacity, waste disposal, training 5.Protection of staff – health & other critical staff 6.Continuity of essential services – health, food and water & sanitation 7. Coordination with host country government agencies, UN agencies, NGOs 8. Coordination with Red Cross movement in H2P activities

8. Public Health and HIV Section8 Pandemic Preparedness Project 1.Camp preparedness plans- Nepal, Bangladesh Epidemic Preparedness Committees – Nepal, Bangladesh 2.Surveillance – HIS Nepal, Bangladesh, Thailand 3. IEC materials Awareness programs (NB: Malaysia 4. Stockpile- Nepal, Bangladesh, Myanmar 6. Isolation room/ward for township hospital Myanmar, health facility improvement in a couple of camps in Pakistan Watsan project – Bangladesh, Myanmar, Pakistan

9. Public Health and HIV Section9 Pandemic 2009 Reviewed stockpiles, preparedness plans, increased surveillance, food stocks checked with WFP Increased awareness activities, orientation of staff Coordination with district authorities Seasonal Influenza Outbreak in Nepal in 06.09 to 07.09 - gaps in preparedness revealed H1N1 cases in Mae La camp in Thailand Monitoring of situation for urban refugees in Malaysia and India

10. Public Health and HIV Section10 Clear case definition for Influenza-Like Illness (ILI) for HIS to alert health staff on increased cases. District level preparedness including simulation exercises. Linkage of camp preparedness plans with host country’s plans Plan for frequent staff turnover (due to resettlement) Address inadequate isolation facilities (HCF & homes) Address inadequate water and sanitation facilities Lessons Learned

11. Public Health and HIV Section11 Lessons Learned Social distancing – food distribution, water points Coordination and relationship building with government agencies, other agencies to cover other areas such as improving capacity of district governance structures Focus not only on upgrading government structures but also on human resources.

12. Public Health and HIV Section12 Challenges Support from technical agencies (WHO, UNICEF, FAO) in advocating for inclusion of refugee population in host country’s preparedness plans. Inclusion of refugee population in pandemic related activities by technical agencies (UN) and the national governments. Access of refugees to health services and treatment in the event of pandemic. Non-discriminatory implementation of bio-safety measures Provision and development of remote managing tools

13. Public Health and HIV Section13

14. Public Health and HIV Section14 Thank you very much penas@unhcr.org