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CAR Monkey-pox epidemic outbreak Emergency Plan of Action (EPoA), Preliminary Final Report (MDRCF020)

República Centroafricana
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On 17 February 2016, the International Federation of Red Cross and Red Crescent Societies (IFRC) released CHF 55,848 from the Disaster Relief Emergency Fund (DREF) to support the Central African Republic Red Cross (CARC) reduce the immediate risk of a Monkey-pox outbreak to 164,000 people (indirectly) and 64,000 people (directly), living in the Bakouma, Gambo, Ouango and Rafaï subprefectures of the Mbomou Province, through support in social mobilization and community communication activities, for a period of two months.

On April 21, an operations update was published, requesting a 2 week timeframe extension (New end date: 30 April 2016) to able the deployment of a Finance Analyst to support the closure of DREF operation; as well as data collection on the number of people reached.

Description of the Disaster

On 4 December 2015, two children aged 9 and 5 were found suffering from an unidentified disease with rashes all over their bodies in Lengo village, located at some 15 kilometres from Bakouma in the Mbomou province, eastern Central African Republic (CAR), and taken to the Bakouma Health Centre.

On 10 December 2015, in response to the outbreak in Bangassou, WHO facilitated an initial assessment carried out by the Ministry of Health (MoH) in the affected province and a joint mission was undertaken by the health district and Médecins Sans Frontières (MSF) Belgium. On 17 December 2015, the children were transferred to the Bangassou Regional Hospital, run by an international non-governmental organization (NGO) and MSF, where their condition got worse. Samples were taken and sent to the Pasteur Institute of Bangui for laboratory testing.

Upon announcement of the outbreak by WHO on 13 January 2016, the CARC and IFRC continued to take part in the crisis meeting co-led by the MoH and WHO on the strategic response plan for this outbreak.

In addition, the Bangassou Red Cross local Committee was part of the provincial response crisis taskforce put in place by the provincial authorities. The MoH requested the CARC, with the support of the International Federation of Red Cross and Red Crescent Societies (IFRC), to carry out social mobilisation, communication and epidemiological surveillance activities.

This DREF was replenished by the Canadian Red Cross Society / Government and Netherlands Red Cross / Silent Emergencies Fund. The major donors and partners of the DREF include the Red Cross Societies and governments of Australia, Austria, Belgium, Canada, Denmark, Ireland, Italy, Japan, Luxembourg, Monaco, the Netherlands, Norway, Spain, Sweden and the USA, as well as DG ECHO, the UK Department for International Development (DFID) the Medtronic and Zurich Foundations and other corporate and private donors. The IFRC, on behalf of the Central African Red Cross would like to extend its thanks to all partners for their generous contributions to this DREF operation.

This report is being issued as a preliminary final report, in advance of the Final report which will be issued once financials are reconciled.

Overview of Host National Society

As a government auxiliary, the CARC has always been fully involved in responding to all epidemic outbreaks in the country. Indeed, the CARC is organised into two main structures: The operational structure which includes programmes in Disaster Management, Community Health/HIV/Malaria/TB and Social Affairs, Water & Sanitation, Communication and Dissemination and the Support Services, which comprises Administration, Finance, and Organizational Development.

The CARC is made up of 69 sub-branches (Comités sous-préfectoraux), eight local committees in Bangui, and 117 community-based committees, though not all are active. It counts on approximately 12,000 volunteers countrywide. In the Mbomou province, the CARC is represented by five local Red Cross committees, comprising approximately 800 volunteers. Volunteers in this part of the country have knowledge of Monkey-pox because an epidemic occurred in the same area in 2001 and in the neighbouring province of Haute Kotto in 2014, although not all the volunteers were involved in the response in these two cases.

Furthermore, the CARC, which has managed DREFs and Emergency Appeal (EA) operations before, is experienced with IFRC modalities and procedures. To date, the CARC is implementing activities of an Emergency Appeal targeting 23 areas of the country hardest hit by the ongoing violence in CAR, which has left over one million people homeless. The areas affected and targeted by this DREF are, however, not part of the 23 areas that were targeted by the EA. As such, the funding from the DREF will strictly target the Monkey pox outbreak and not the EA activities or any other epidemic outbreak outside the one intended by the DREF.

Thanks to the DREF funds received for this operation, the CARC was the only organization that conducted awareness in all the five (5) cities of Health Region No. 1, namely Gambo, Ounago, Bangassou, Rafai and Bakouma). Indeed, at the start of the response to this epidemic, the Ministry of health and WHO trained 10 community mobilizers in the city of Bakouma (starting point of the epidemic) without setting up a sensitization program. Thus, it is only when the CARC started implementing activities of this operation in this city that community mobilisers understood that they should have conducted sensitized the population on the epidemic. The local Red Cross committee ended up enrolling these mobilizers in its team of first aid volunteers involved in social mobilization activities.

Overview of Red Cross Red Crescent Movement in country

The IFRC provided assistance through its CAR Country Representation, The Yaounde Country-Cluster Support Team (Yaounde CCST), and Africa Regional Office. From the onset of the disaster, there has been regular contact with the IFRC CAR Country Representation, and Africa Region Disaster Crisis Prevention, Response and Recovery (DCPRR) unit and regular updates on the situation and activities. On 18 January 2016, an alert was issued using the IFRC Disaster Management Information System (DMIS), and an Operational Strategy Call was carried out with colleagues at regional and Geneva levels. It was agreed that given the nature of the outbreak, specifically the lack of evidence of sustained transmission (limited only from animal to human, restricted to people directly in contact with those initially infected) that a DREF allocation could not be considered but continual monitoring of the situation should be carried out to establish how the epidemic was evolving (i.e. moving to human to human transmission, and/or increase in the cases reported). Given the reporting of a new case (on 5 February 2016), a follow up Operational Strategy Call was convened (on 10 February 2016), and it was agreed that a targeted DREF allocation should be considered for “imminent crisis” linked to the strengthening of CARC’s volunteer capacity, and to carry out social mobilization in the Mbomou Province.

The IFRC CAR Representation, in collaboration with the CARC, continued to attend the crisis meetings co-led by the MoH and the WHO on the strategic response plan for Monkey-pox outbreak. Movement partners in CAR set up Movement coordination meetings on the areas of security, communication and programme management. In this regard, regular meetings were held to improve collaboration and seek, where necessary, synergies that will have a positive impact on activities implemented for the affected population.

Following the issue of a DMIS, discussions were held between IFRC CAR and ICRC counterparts on the intention to launch a DREF operation for the Monkey pox outbreak; then following the initial Operational Strategy Call, and decision given the stabilization of the situation, to stand down the response. Following the reporting of a new case (on 5 February 2016), and subsequent decision to launch a DREF operation, efforts were made to ensure coordination at all levels, including the sharing of information on the implementation of the activities planned.

Overview of non-RCRC actors in country

In total, approximately 105 national and international non-governmental organizations and United Nations agencies were operating in CAR; however they were mostly involved in the response to the on-going civil unrest, and not in the Monkey pox response in Bangassou. Caritas, Catholic Relief Services (CRS), the Multidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA), UNICEF, CARC, IFRC and WHO are the only organizations that were involved in supporting the MoH in this response to the Monkey-pox outbreak. Also, regular crisis meetings were held at the WHO headquarters in Bangui and at provincial level in Bangassou to coordinate the strategic response plan. In addition, following the occurrence of the new case on 5 February, the MoH response plan was set up to strengthen activities in the following five areas:

  • Epidemiological surveillance,
  • Social mobilisation and community communication,
  • Treatment of contaminated cases in quarantine areas,
  • Research of contact cases,
  • Coordination.

Based on past campaigns, the MoH requested the CARC to assist with social mobilization and community communication as part of response to the Monkey pox outbreak.