Day 3 in a Gorakhpur Relief Camp: Diarrhoea, Rumours and Standards
On day 3 after flooding in Gorakhpur, 612 people are living in a degree college: four rooms, three toilets, one hand pump in the courtyard, and a kitchen run by two self-help groups. The CMO's team reports 8 cases of watery diarrhoea in 24 hours, two of them children under 5 with sunken eyes and no tears. The hand pump is 12 m from a temporary pit latrine dug on the second day. ORS stock is 40 sachets; chlorine tablets have arrived but nobody has been trained to use them. A rumour is spreading that the Rapti will rise again tonight, and about 80 people have already started to leave on foot. The district's only mobile medical unit is 18 km away at another camp. You are the nodal officer; it is 5 p.m. and the mobile unit can reach you by 8 p.m.
1. Rank your first actions for the next three hours, and state one thing you deliberately will not do.
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Order of action:
- The two children first. Sunken eyes and no tears mean severe dehydration. Start ORS by cup and spoon while an IV is set up, and divert the mobile medical unit to the camp - do not send the children 18 km to the unit. A severely dehydrated child may not survive an untriaged journey.
- Break the faecal-oral route tonight. The pit latrine 12 m from the hand pump is the likely source. Stop its use, dig new latrines more than 30 m from the pump and downhill, and chlorinate the pump water with two trained volunteers using a measured dose.
- Line-list. One register: name, age, onset time, number of stools, treatment, outcome. Without a denominator you cannot see an outbreak.
- Answer the rumour with one voice. Verify the river level with the CWC or the tehsil control room, and have one named officer announce it at a fixed time.
- Do not stop people leaving. They have the right to move. Register them and tell them which route is above the flood level.
Will not do: move 612 people at 5 p.m. on an unverified rumour, and will not hand out ORS indiscriminately.
2. Apply minimum relief-camp standards to this camp. Compute the requirement, identify the biggest gap, and say how you would present it to the DDMA.
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Using Sphere-type minimum standards (verify the district relief manual for the UP norms in force):
- Water: 15 litres per person per day x 612 = 9,180 litres per day for drinking, cooking and hygiene. One hand pump cannot reliably deliver this, so you need storage tanks and tankers.
- Toilets: 1 per 20 people = 31 toilets. You have 3. Gap: 28.
- Shelter space: 3.5 square metres per person x 612 = 2,142 square metres of covered floor. Four rooms plus corridors and verandahs may just reach this if they are counted.
Biggest gap: sanitation, with water quantity second. This is not a comfort issue - with 3 toilets for 612 people, the 8 diarrhoea cases are the predictable result, and the latrine sited 12 m from the pump is the likely route.
How to present it: send the DDMA the arithmetic, not adjectives. A request for more facilities gets no response; a request for 28 toilets, 2 water tankers and a trained chlorination team, with the calculation attached, can be sanctioned the same day.
3. Who coordinates what in this camp, and which single indicator would you watch daily to decide whether this has become an outbreak?
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Who does what:
- DDMA/Collector: overall responsibility, sanctions funds, requests SDRF or NDRF if needed, and notifies the camp. The nodal officer reports to the DDMA, not to the media.
- CMO/district health officer: outbreak investigation, the mobile medical unit, ORS and IV stock, stool sampling, and a daily line-list review. Health is a technical line, not a camp-management line.
- Camp manager: registration, food, water, sanitation, lighting and a complaints register, with separate spaces for women and children.
- Gram panchayat and volunteers: local knowledge, missing-person lists, cooking, and passing information in the local language.
Indicator to watch daily: new diarrhoea cases per 1,000 people per day - the attack rate. At 8 cases in 612 people this is about 13 per 1,000 in 24 hours, which is already an alert. Track also litres of chlorinated water supplied per person per day. If the attack rate rises, or a second cluster appears in a different room, treat it as an outbreak and send stool samples the same day.