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Overview

The Unicef Turkey-earthquake Situation Report #16, covers the activities in the Recovery Plan for Turkish Children (RPTC), with a feature focus on the control of water-borne and poor hygiene related diseases through the implementation of an articulated water and environmental sanitation project.

The tenth anniversary of the Convention on the Rights of the Child (CRC) gives relief workers around the world further reason to focus on children’s rights as the cornerstone of all implementing activities. It is every child’s right to live in an environment that nurtures and fosters a healthy upbringing. The goal of all relief aid workers is to provide the basic services essential to foster a “Child Friendly Environment” in a disaster area. The fulfilment of these rights is key to UNICEF’s objectives in disaster response.

The provision of safe drinking water and environmentally safe sanitation facilities amongst others, provide the basic building blocks for the growth and health of earthquake-affected children. Following a disaster as catastrophic as the two earthquakes that shook north-western Turkey in 1999, the challenges faced to meet these goals have been both numerous and complex.

Earthquake relief programmes have met multiple difficulties in reaching the population, due to the sheer size of the affected area and number of victims, the tenuous shelter situation and climatic conditions which included the worst winter Turkey has experienced in the past 12 years.

As of 13 March 2000 - seven months after the first earthquake and four months after the second – more than eight percent (8.4%) of the population residing in the five affected provinces live in tent camps or prefabricated cities as a direct result of the disaster. Currently, approximately 85,000 people reside in tents, and 134,000 live in prefabricated housing units, (see Map on page 6). It is estimated that over 77,000 children aged 0-18 years are still homeless due to the two earthquakes.

Unicef’s earthquake related interventions in the Water and Sanitation sector fall within two realms: advocacy and implementation. The direct implementation of services is currently reaching 30,000 survivors in terms of sanitary services, and more than 150,000 through the provision of monitored and safe drinking water. Furthermore, advocacy and awareness-raising activities targeting both the local counterparts and the homeless population, greatly enhance the outcome of Unicef’s assistance.

Even though emergency response is dictated by the urgency of needs, efforts have been made to maintain the CRC as the main focus of the RPTC. The water and sanitation project is one of the sectors that reflect this approach. Water and environmental services have not been limited to shelter conglomerates, but also to schools and Primary Health Care Centres (PHCCs) - key institutions which endeavour to foster a child friendly environment.

 Environmental Sanitation 

WHY IT IS IMPORTANT

The lack of environmental sanitation following a natural disaster such as an earthquake, can quickly escalate to a public health crisis. The change in environment and lifestyle, and the associated trauma, sets the stage for an unsanitary environment and the dissolution of basic hygiene practices. For these reasons, the control of the spread of infectious diseases by reducing human contact with wastes, and supply of safe drinking water, constitute a priority concern of initial disaster relief interventions.

Children are the most vulnerable to environmental disease due to their physiological immaturity and behaviour patterns. The lack of clean water and adequate sanitation services, unhygienic practices, and poor living conditions are among some of the prevailing environmental problems faced by children following the earthquakes in Turkey, as well as and in impoverished communities around the world.

The lack of water and environmental sanitation services following the earthquakes in Turkey has proved a major challenge for women. As the primary caretakers of families, the provision of sanitation infrastructure, especially in a crisis situation, can have a dramatic effect on the quality of life of women, and their families. Irregular access to water renders cooking, washing and child care (such as bathing), a huge obstacle in the day-to-day activities of women. When children fall ill due to poor sanitation related diseases, it is the mothers who are most often charged with facilitating their recuperation.

Perspectives

IN A TENT CAMP

[Text box]

Nese and her family come from Trabzon, a city located on the coast of the Black Sea in Turkey. Today she will cook a typical Trabzon dish of “fasulyeli pilav” - rice mixed with beans. She asks her ten year old daughter, Gokce, to fill the big teapot with clean water from the water jug for cooking. As one of the cities situated in the industrial heart of Turkey, Duzce was officially made a province by a Government decree on 9 December 1999. Duzce is not only famous for its natural springs and dark green forests, but also for its people of diverse cultures. Armenians, Caucasians, people from the Balkans and Black Sea regions - in particular from Trabzon – have been living in Duzce for many years. 

Lunapark is now home to 385 people, all of whom are originally from Trabzon. They are neighbours, relatives or friends… Some of them live in tents because the fear of another earthquake prevails in their hearts. Others prefer to live in a tent city because their houses were heavily damaged. Many of them were able to salvage a few portable items, and some household goods such as radios, TVs, pots and pans, and attempt to resurrect a sense of normalcy in their unfamiliar surroundings.

[End of text box]

 Unicef response 

FRAMEWORK OF ACTIVTIES

Credit: Zeynep Erdim

Young girl washing dishes in Unicef tent city, Duzce

The Recovery Plan for Turkish Children (RPTC), developed in consultation with the Government of Turkey in August 1999 and conceived for a period of six months, is being implemented in all areas affected by the 17 August and 12 November Earthquakes. The international community, through 15 UNICEF National Committees and 9 Governments, has responded generously to the UNICEF Recovery Plan. This commitment has been concretized by contributions of $US 14.6 million.

 Activities are implemented through an integrated multi-sectoral approach which aims to provide a sound environment for children and their mothers in tent camps and prefabricated cities, using the concept of “Child Friendly Environment” as a model. This concept is based on the provision of an integrated set of services to meet the basic needs of children and their mothers in various areas, namely the health, nutrition, education, water, sanitation, and psycho-social sectors.

WES Projects 

Water and Environmental Sanitation

Following the August and November 1999 earthquakes that devastated five high density urban centres in the populated and industrialised region of north-western Turkey, some two hundred thousand people were left homeless and resorted to living in tent camps before gradually moving into prefabricated housing settlements. Extensive damage was suffered not only by buildings, roads and the electricity grid, but also by the water pipe and sewage network throughout the earthquake area. One of the many challenges faced by relief workers was to provide rapid water and sanitation facilities to contain the spread of water-borne and poor hygiene related diseases, and to provide the surviving population with their basic hygiene needs.

Unicef initiated field coordination meetings between implementing partners to maximise the relief resources available, and as part of the Recovery Plan for Turkish Children activated two parallel projects:

• Provision of environmentally safe water and sanitation facilities – the WES cluster
• Provision of safe drinking water – Operation Water Jug

WES Facilities - The Unicef Cluster

In addition to other relief partners, Unicef has provided the required water and sanitation facilities to the population left homeless by the earthquakes. Unicef’s efforts concentrated on raising awareness about the minimum standards required for the provision of services to be installed, coupled with proper waste disposal systems, and has contributed to a considerable percentage of the water and sanitation services provided. Within this approach, a WES cluster of moveable container sized units was conceptualised and designed.

The objective to design a unit that could be easily installed and relocated according to needs, providing quality latrines and showers with hot pressurised water and a waste disposal system culminated in the Unicef WES cluster. Each cluster is composed of two 12-ton galvanised steel water tanks housed in a half sized container shell, two 6-latrine container units, two 5 shower container units and two 12-ton, triple over-flow chamber container sized septic tanks.

Water in the cluster units is pressurised through two 0.5 Atm booster pumps and heated in four 50 lt geysers. The shower and latrine container units are fully illuminated with external photo cell activated lights to facilitate entry at night. The internal chambers are water proofed for durability, and provided with extraction fans to reduce humidity build-up.

The units are built to European safety standards and hold a one year warranty for the replacement of faulty components. The cluster units serve a population of 600, and can be broken down into individual components according to needs.

15 seconds Mpeg audio/video file double click on image to view

Credit: William Gardner

Tent camp, Kaynasli

Installation of Clusters

Local authorities in Duzce agreed that there is no need for additional latrine and shower units other than those that have already been planned. There has been a rapid decrease in the number of tents in the first earthquake area, due to the movement of the homeless population from tents to prefabricated houses with sanitation facilities. As the clusters are being re-allocated to the second earthquake area, UNICEF’s efforts are ensuring that water and sanitation units with below standard waste disposal systems are being replaced with fully functioning environmentally safe facilities.

The distribution of latrine, shower, water tank and septic tank units throughout the five provinces is displayed in the graph above. These units, totalling 50 clusters, are now providing sanitation services to 30,000 people.

Maintenance Protocol for Cluster Hand-over

The Protocol concerning the maintenance and future use of UNICEF clusters has been jointly prepared by UNICEF, the Provincial Governors of the five provinces and the Disaster Coordination Governor (DCG) in Izmit. The Protocol describes the three tier system involving tent camp managers/school principals, provincial governors/municipalities and the DCG, which delineates roles and responsibilities to maintain and carry out the day-to-day cleaning of the units and repair work. The Protocol has been signed by the Disaster Area Coordinator Governor, Unicef Turkey Representative and all Provincial Governors.

Operation Water Jug in Duzce and Adapazari

The provision of safe drinking water will continue in Duzce and Adapazari until mid and end of April 2000, with a gradual phasing out in the number of water trucks. This new plan will allow for the continuation of services for two months longer than initially forseen, with no increase in the budget. The phasing out has been designed to allow the municipalities to gradually take over water distribution both through the reconstructed water pipe network and municipal water trucks. At a cost of 3 US cents per person per day, this project providing 150,000 survivors with 20 litres of safe drinking water daily has proved to be cost effective and key to allowing reconstruction works to take place.

As the eartquake in Duzce damaged mostly the smaller pipe lines, with 90% of the main pipe lines in function, UNICEF’s Water and Sanitation team proposed a “community water collection points project” which has been agreed upon by implementing partners. Through the collaboration of the Duzce Provincial Health Directorate and Water Works, sixty-two possible locations for water points have been identified. These water points will provide water from the Duzce Water Treatment Plant to the affected population on a 24 hour basis. The project will be carried out under the supervision of Duzce Municipality and Water Works, with contributions for materials and labour from the Turkish Protestant Churches.

Schools Receive UNICEF Clusters

An official request was made to UNICEF by the Adapazari municipality for the provision of septic tanks to complement unsanitary latrine facilities in schools. This need arose due to the temporary non-functioning municipal sewerage system that is undergoing reconstruction. In order to ensure that school activities are not disrupted, school toilets will be connected to the septic tanks. Many of the septic tanks were previously installed in Bolu and Duzce, where the sewage system is now re-operating and the tanks are no longer needed. A total of 40 tanks will be installed in the same number of schools.

Mobile Water Monitoring System

To assist the Municipalities of Duzce, Bolu and Adapazari in the control and prevention of water borne diseases during the reconstruction phase of the water and sewage pipe network, the Unicef WES team has designed a water quality monitoring system. The project will supply 18 sets of Oxfam Delaqua and Hach portable laboratories with computers for data gathering and analysis. Municipality and provincial Ministry of Health staff will be trained by water monitoring specialists on the use of the laboratories and the implementation of monitoring systems. The project will help contain possible outbreaks during the coming warmer spring and summer months.

Health and Nutrition 

Nutritional Supplement Distribution

The fortified high protein, vitamin, mineral and energy biscuits are in their third month of distribution. The logistic deployment of these key supplies targets primary school children through the school system, and 1 to 6 year olds, pregnant women and lactating mothers through the Primary Health Care Centres (PHCCs).

A total of 412 MT of the supplement are distributed monthly, 323 MT through 222 schools and 89 MT through 67 PHCCs, reaching a total of 146,500 beneficiaries daily. The distribution programme will continue until the end of May, by which time over 2,000 MT will have been distributed over a five month period

Measles Mass Immunisation Campaign

The Ministry of Health has made on-going progress in the measles vaccination campaign. Thus far, 165,165 children between the ages of 1 and 14 have been vaccinated against measles in the five reporting Provinces.

Cold Chain System

The fundamental cornerstone to a successful EPI programme is a functioning cold-chain system for the distribution of thermo-sensitive vaccines. The Heath and Nutrition team has mapped out the complete network in terms of locations and equipment available. Additional data is being gathered including routine vaccination coverage, vaccine and para medical supplies stock, diseases incidence etc.

A rapid cluster survey on Diphteria and Tetanus immunisation coverage has been carried out in the five provinces. Collected data will be available in the coming report. Preliminary assessments indicate that third immunisation coverage may be as high as 90 % in the 1 to 2 year old population in tent cities. This is above the national averages, and may well be due to the increased number of visits mothers make to PHCCs following the earthquakes. Routine visits to the health directorates and PHCCs has ascertained that most of the storage cold rooms are temporarily housed in hospitals with whom they share back-up generators. A need for additional refrigerators and freezers will have to be addressed in the coming future in order to provide the necessary support to the immunisation programmes. Duzce, having recently become a province, will require it’s own cold storage facility soon, which it presently shares with Bolu.

Credit: Ilker Arslan

UNICEF H & N Programme Officer, inspecting vaccine freezers

Monitoring of Emergency Health Kit Distribution

The 526 UNICEF Emergency Health Kits (EHKs) distributed to the 3 provinces of the first Earthquake area have been redistributed to PHCCs in the five earthquake provinces. In some instances, PHCCs have opted to reserve the emergency health kits, as the shelf life of the medication contained in the kits between 3 and 5 years.

Nutritional Surveillance

UNICEF is exploring potential opportunities for cooperating with the Ministry of Health on nutritional surveillance activities in the earthquake area to identify children in special need of interventions. Other concerns include: micronutrient deficiencies (anemia) in pregnant and lactating mothers, and the continuous provision of Vitamin A capsules as a prophylaxis to children against child morbidity and mortality, as well as to pregnant and lactating mothers.

Impact Evaluation Study

UNICEF’s is assessing the feasibility of conducting an impact evaluation study using the Multi Indicator Cluster Survey (MICS). The survey may be used to provide documentation for a number of indicators, including: EPI coverage, diarrheal diseases, acute respiratory infections, among others.

Education 

All schools were open during this reporting period in the five Provinces. Repairs are ongoing in Sakarya and Kocaeli for the school buildings that have been classified as having suffered little damage.

Duzce Province is still facing many constraints to schooling. Prefabricated schools are urgently needed, particularly for the pre-school classes and the secondary school computer classes. Specialized teachers for subjects such as geography, English and science are not available, and those who are sent to the area temporarily do not wish to remain there. Teachers, as well as medical staff, are being given priority for prefabricated housing units, however the shortage of prefabricated housing units remains acute.

Supply of School Materials Project

As a result of the earthquakes, many schools lost materials and supplies. In addition, many students lost their houses and with it all their possessions. This project aims to identify those schools that have been most affected by the earthquake, and supply materials to these classes.

Educational and recreational kits, whiteboards, flooring pallets, and pre-school kits have been distributed to all tent schools in Bolu and Duzce, and to affected schools in the first earthquake area. The list below shows the distribution to date of these supplies according to Province.

Credit: Nalan Yilmaz

Children receiving UNICEF school kits, Gumuspinar Mehmetcik.

The table below indicates distribution of school materials as of 26 February 2000.

Additional whiteboards have been ordered following the first distribution, as they have proved very useful for tented classes and container classes. In addition, five thousand flooring pallets are under construction for use, mainly in Duzce Province.

One hundred and six new prefabricated schools have been planned for the earthquake area by the Ministry of National Education. These schools will provide more than 1,000 classes. Prefabricated schools are currently under construction in most Provinces. As the targeted completion dates for many schools have not been fully met, a new target date has been set for the end of March. Until the prefabricated schools are completed, school materials will remain in the warehouse until they can be delivered directly to schools.

School Nutrition Programme

In response to a concern by the health teams as to the well being of the children in the earthquake area, UNICEF has begun a short-term programme to distribute high energy/protein biscuits in the health centres of the tent cities and in schools within the earthquake area. The Ministry of National Education has identified the most vulnerable schools by surveying the school transportation system, and assessing where the children from the tent cities attend school. The total number of beneficiaries can be found in the table below, together with the cumulative quantity of biscuits distributed.

Support Programmes

Cooking sets for 800 teachers in Bolu and Duzce have been requested in order to provide assistance to teachers as they move to prefabricated housing units. Twenty-five special needs kits for handicapped children have also been requested.

Drawing Competition in Primary Schools

The Governor of Kocaeli has agreed to hold a competition among participating schools for the best design to promote the consumption of UNICEF high energy/protein biscuits. The competition will be announced in a newspaper - following the normal practice for this activity - and the closing date for submissions will be the end of March 2000. The designs generated by students participating in the contest will be used in UNICEF promotional brochures and literature.

Psychosocial Intervention 

Numerous studies and assessments have shown that the psychological impact of disasters on the affected population can be profound. Experiences from comparable earthquakes in other regions of the world have indicated that psychological disorders caused by the extensive exposure to traumatic events, coupled with grievance due to losses will result in long-term psychological, educational and health disturbances in a significant portion of the affected population. Such trauma may hinder the resumption of normal daily life activities.

Both limited psychological interventions, such as debriefing and more intensive methods as psycho-education and Classroom Based Interventions (CBI), if implemented in an appropriate manner, can have a lasting positive impact, enhancing the return to normalcy of children and adults. The comparative advantage of these methods is their ability to provide relatively rapid support to a significantly large percentage of the survivors.

As the debriefing phase of the psychosocial project has come to a close, the second phase is now underway, including the training of both national core trainers and provincial counsellors in Classroom Based Intervention techniques and Psycho-education.

To enhance the institutionalisation of the approach, with a view to integrate these methods within a Disaster Prepardness framework to be used countrywide, an agreement was signed between the Ministry of National Education (MoNE) and UNICEF on February 28, 2000.

Classroom Based Intervention

Over a period of six weeks, the CBI method provides a three hour a week, expressive, cognitive and role playing psychological support course to primary school children. School counsellors with the use of numerous props including beach balls, fabric dyes, frisbees, paints and an innovative multi-coloured parachute encourage children to express their feelings, fears and preoccupations, often to the sound of music.

Credit: Zeynep Erdim

CBI training seminar lead by R. Macy of the Boston Trauma Centre

A total of 222 counsellors of the 320 in the EQ area and 33 core trainers were trained between 6-11 March, together with the provincial school guidance and research centre directors. Classroom courses will begin in April on a rotation basis, as following the earthquakes only 320 of the 1,500 schools have resident counsellors.
 

The psycho-education method targets not only school children but also teachers, and parents, in cognitive and educational psychological support activities. Though less intense than the CBI, this method implemented by teachers has the advantage of being able to reach all children in primary schools throughout the earthquake area. The method will run parallel to CBI and is to commence also at the beginning of April, involving up to 8,000 teachers and 240,000 children.

Training for Social Workers

The CBI method has been adapted for use in both creches and youth centres, so as to target the pre-school age children, youths and children that do not attend school. A total of 105 SHCEK (Department of Social Welfare) social workers were trained at the end of February and provided with the CBI kits to commence activities in the existing tent camp structures and the pre-fab facilities under construction
 
 

Child Friendly Environment

COMPLIMENTARY ACTIVITIES

UNICEF has been at the forefront in advocating that all prefabricated cities must have a supportive physical, social infrastructure and services to meet the basic needs, of children. All efforts are being made to ensure that prefabricated cities provide the services that are not provided by the existing infrastructure such as creches, youth activities and after school recreational activities.

Allocation of Space for Creche and Youth Centres

Following the second earthquake, the demand for housing units became priority over the allocation of space for creche and youth activities leading often to the exclusion of the latter. Recent meetings held between UNICEF’s Child Friend Environment team, the Governor of Bolu and of Duzce, and the Earthquake Governor’s office to explain the importance of these activities, have resulted in a pledge to provide additional spaces.

Creches and youth centres in the following prefabricated cities have been secured to receive Unicef insulation, furnishings and staff training.
 

Training of Child Educators

A short training workshop will be given in Izmit to provide theoretical and practical guidance to child educators, social work students and volunteers on appropriate recreational activities for traumatised children. This training will be undertaken in partnership with SHCEK, UNICEF and Enfants du Monde, (a French NGO), during the month of March.
 

CEM

COMMUNICATIONS MONITORING AND EVALUATION

Geographic Information Systems (GIS)

A Geographic Information System is being designed and developed to facilitate and enhance data analysis, programming, evaluation and monitoring of the earthquake programme activities. Extensive baseline data has been gathered and entered into the system’s database, including comparative countrywide indicators and specific EQ area pre and post disaster figures. Hard copy ground maps of city centres and provinces have been digitised into vectoral geographic data layers and are being used as base layers for the superimposition of programme activity data.

Monitoring UNICEF Activities in the Earthquake Area

UNICEF/Ankara and Kocaeli University entered into an agreement on 29 December to monitor the humanitarian situation in tent camps and prefabricated cities in the earthquake area. This accord has helped UNICEF assess the implementation of project activities and review the availability of basic services for children in the education, psycho-social, health, water and sanitation sectors by collecting data in all tent camps and prefabricated cities. On 4 February, two Assistant Professors and Kocaeli University students underwent in-depth technical training in the sectoral area of Water and Sanitation, in order to be fully incapacitated to administer a survey on the same theme. Between 8-14 February, data collection in the sectoral area of Water and Sanitation was undertaken by teams between 8 February and 15 February in all tent cities in the earthquake region, and schools where UNICEF has installed water and sanitation facilities. A consolidated report based on survey findings was submitted to UNICEF on 24 February 2000 and is currently being reviewed.

Level of Funding

As of 13 March, contributions pledged to UNICEF Recovery Plan for Turkish Children total US$ 14,608,067 million. Contributions received amount to 14,244,126. US$ 7,493,786 has been pledged from UNICEF National Committees, and US$ 7,114,281 from Governments. The following table provides a breakdown of the funds pledged: