HURRICANE PATRICIA COUNTRY: MEXICO FLASH NOTE 25 OCT :00

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1 HURRICANE PATRICIA COUNTRY: MEXICO FLASH NOTE 25 OCT :00 HIGHLIGHTS Hurricane Patricia made landfall as a Category 5 storm at 18:09 local time on 23 October 2015 near the city of Cuixmala, Jalisco, between the Bay of Chamela and Melaque, about 95 kilometers (60 miles) west of the major port Manzanillo, in the western state of Jalisco with sustained winds of 270km/h and gusts of 315km/h. By 10:15 local time of 24 October, the hurricane was downgraded to a tropical depression near northwest of Zacatecas. So far, no major injuries or deaths have been reported. More than 50,000 people were evacuated from coastal areas ahead of the storm. Improving weather conditions have allowed much of the population to return to their homes. The three levels of the Mexican Government (federal, state, and municipal) are conducting assessments and monitoring the situation on the ground in affected areas. Health services are rapidly resuming their functions to pre- hurricane levels. PAHO has activated its Institutional Response to Emergencies and Disasters at the Country Office and the Emergency Operations Center in Washington, D.C. in coordination with WHO HQ in Geneva. PAHO/WHO Representative in Mexico and the Disaster Focal Point have been in constant communication with health authorities in Mexico, and are assessing possible future risks due to the emergency. The Mexican Government has expressed appreciation for support and offers of help from PAHO/WHO and the international community; but has indicated that local and federal capabilities will be sufficient to meet the needs and restore the situation. The Mexican President lifted the preventative alert issued for Colima, Jalisco, and Nayarit indicating the beginning of the recuperation phase. COUNTRY PROFILE 1. Mexico is located in the North American continent, bordering the Caribbean Sea and the Gulf of Mexico, between Belize and the United States and bordering the North Pacific Ocean, between Guatemala and the United States. The country is characterized by high, rugged mountains and low coastal plains, with a climate that varies from tropical to desert. Mexico counts with 9,330 km of coastal line. Its highest elevation point (Volcan Pico de Orizaba) is at 5,700 m and its lowest (Laguna Salada) at 10m.

2 2. Due to its geographic location and geological structure, the extensive Mexican territory is exposed to a range of natural hazards (hydrometeorological, geological and anthropogenic), from tsunamis along the Pacific coast, volcanoes and destructive earthquakes in the center and south, and hurricanes on the Pacific, Gulf of Mexico, and Caribbean coasts, as well as drought, floods and landslides. The most frequent disasters are of hydrometeorological origin, including severe hurricanes bringing strong rainfalls and intense storms throughout the territory with consequent floods. 3. Mexico is an upper middle-income country with a GDP per capita of $15,600. However, the country is marked by significant socio-economic inequalities, with 42% of the population living below the poverty line, meaning that their income cannot cover their basic health, education, food, housing, clothing, and public transportation needs. This number reaches 52.3% when using the food-definition of poverty (insufficient income to obtain a basic food basket). 4. Drinking water coverage is high with a total of 94.4% of the population having access to improved water source in 2011 (95.9% in urban areas and 89.3% in rural) and sewer system coverage in 2009 reached 86.8% (93.9% in urban areas and 63.2% in rural). SITUATION OVERVIEW The Event 1. Hurricane Patricia was a tropical cyclone that formed in the eastern Pacific and rapidly intensified into a Category 5 Hurricane, as its sustained winds reached an unprecedented speed of 200mph (320kph) and its central pressure fell to 879 millibars (25.96 inches of mercury). Patricia became the strongest-ever hurricane to hit the eastern north Pacific region. 2. The eye of Hurricane Patricia made landfall as a Category 5 storm at 18:09 local time on 23 October 2015 near the city of Cuixmala, Jalisco, between the Bay of Chamela and Melaque, about 95 kilometers (60 miles) west of the major port Manzanillo, in the western state of Jalisco with sustained winds of 270km/h and gusts of 315km/h. 3. Patricia's intensity decreased very quickly as it hit the rugged terrain of Mexico's interior. The system was downgraded to Category 4 by 10:00pm on 23 October and further deteriorated Category 2 by 1:00am to a tropical depression northwest of Zacatecas by 10:15am on 24 October. The trajectory of the cyclone spared Mexico's major cities from the worst damage, including the popular coastal resort cities of Manzanillo and Puerto Vallarta and the inland metropolis of Guadalajara, Mexico's second-largest city. The most affected areas are mostly small villages located between Puerto Vallarta and Manzanillo, comprised of impoverished communities. 4. Rainfall was heavy enough to cause flooding and mudslides, including a slide in the state of Michoacán that took a section of roadway out with it. Only minor injuries such as cuts from fallen branches and roofing material and no casualties have been reported so far. In comparison, only one other Category 5 hurricane had ever previously made landfall on Mexico's Pacific coast in late October That hurricane followed a path similar to that of Hurricane Patricia and struck near Puerto Vallarta, causing some 1,800 deaths.

3 The Impact Human Impact 1. No death or serious injuries have been reported so far. Only minor injuries such as cuts from fallen branches and roofing material were reported. 2. There were 1,782 shelters were set up with a total capacity of 258,000 people in Michoacan, Nayarit, Colima, and Jalisco. More than 50,000 people were evacuated from the coastal areas ahead of the storm. However, with improving conditions, people are already returning to their homes. Aproximately 500 persons remain in shelters and are set to return to their homes by Monday 26 October. 3. No case of communicable disease has been reported so far. The epidemiological profile of the impacted areas includes vaccine-preventable diseases (rotavirus, whooping cough, chickenpox, mumps, hepatitis A) and endemic vector-control diseases (dengue and chikungunya). Other prevalent infectious diseases in the area are typhoid and paratyphoid, salmonella, shigella, tuberculosis, ricketsiosis, geohelminths, and other parasites. In 2015 so far, there have been no reported cases of cholera or rabies, and only one case of leptospirosis was reported in Michoacan. There are no cases of falciparum malaria, and four cases of P. vivax were reported in Nayarit. Health Infrastructure 1. A total of 39 out of 55 first and second level medical facilities of the Mexican Social Security Institute (IMSS) were affected by the storm but only two were temporarily out of function in Colima (see table below *). There are no reports of significant damage to the primary and secondary health infrastructure or interruption of services. Reported damages were minor, and hospitals in the area were able to quickly return to normal operations. Health Facilities of the Mexican Social Security Institute exposed to Hurricane Patricia State First Level Second Level Affected Functioning Affected Functioning Total Affected Total Functioning Total out of Function Jalisco Nayarit Colima 7 7 3* Michoacán Total Seven health facilities five in Puerto Vallarta, State of Jalisco and two in Manzanillo, state of Colima had been evacuated prior to the passage of Hurricane Patricia and their patients transferred to other hospitals as preventive measures. These are: San Javier Private Hospital, IMSS Regional Hospital Zone No.42 and Family Medical Inpatient Unit 19 & 170, ISSSTE (Institute for Social Security and Services for State Workers) Clinical Hospital and Regional Hospital of Tomatlán in Puerto Vallarta; and IMSS Zone 1 General Hospital and the ISSSTE Regional Hospital in Manzanillo. These institutions are restoring full operation.

4 3. State Committees for Health Security, and State and Jurisdictional Civil Protection sessions have been activated in Nayarit, Colima, Jalisco and Michoacan, to perform damage assessments at all locations where there are health sector medical units. General Infrastructure 1. Airports in Tepic, Puerto Vallarta, and Colima are all operational and air bridges are active. Most of the roads are now open and debris is being removed. 2. There are no reports of damage to seaports; ship operations will soon resume operations, except for small vessels that are still restricted. 3. Electricity was interrupted as precaution measure in several at-risk areas. The electrical company is restoring electricity to all areas. 4. There has been no report of damage to the water supply distribution system and the coverage of drinking water remains high, including rural areas.. ONGOING RESPONSE National Response 1. To ensure the health security of the population, the Ministry of Health deployed teams from the federal level on Wednesday, October 21 to: Manzanillo, Colima, Puerto Vallarta, and Jalisco, with staff from the Epidemiology General Directorate (DGE), the Health Sector Planning and Development General Directorate (DGPLADES), the Federal Commission for Sanitary Risk (COFEPRIS) and the National Center for Preventative Programs and Disease Control (CENAPRECE) with its Direction of Epidemiological Urgencies and Disasters. 2. Seven health facilities located in the densely-populated areas of Puerto Vallarta and Manzanillo were preventively evacuated: JALISCO. In Puerto Vallarta: San Javier Private Hospital, IMSS Regional Hospital Zone No. 42 and IMSS Family Medical Inpatient Unit, 19 and 170, ISSSTE Clinic Hospital and Tomatlan Regional Hospital. All patients in these facilities were transferred to different public and private hospitals in Nuevo Vallarta, Guadalajara, and Tomatlan to ensure continued medical care. COLIMA: In Manzanillo the IMSS Zone No. 1 General Hospital and ISSTE Regional Hospital were evacuated and patients were transferred to the SESA Manzanillo Hospital. 3. Elective procedures, external consultations and surgeries scheduled on the coastal areas of Jalisco, Nayarit, Colima, and Michoacan have been suspended. Patients have been sent back to their homes under strict medical supervision and personalized follow-up. Hemodialysis support has been ensured in the four delegations. 4. Medical personnel were deployed to assist with potential increase in demand of medical consultations and support response operations. 19,226 doctors, 24,204 nurses, 650 health brigades, and 103 health sector workers are responding to the affected areas by performing the following functions: Coordination, Health Care Infrastructure, Psychology and Dentistry, Temporary Shelters, Epidemiological Surveillance and Laboratory Health Promotion, Vaccine Protection Against Health Risks, Vector Borne Diseases, and Human Resources. In addition, the following medical support has been deployed to the affected area:

5 25 mobile medical units (FMT 1) and 3 emergency medical teams 15 ambulances and 33 support vehicles A naval hospital ship has been positioned in Manzanillo 5. Health Risk Protection Brigades are conducting health assessments in temporary shelters, as well as in the medical units, and water supply systems. In the city of Manzanillo, health assessments are planned for supermarkets and purification plants. PAHO/WHO Institutional Response 1. PAHO activated its Institutional Response to Emergencies and Disasters. Both the PAHO/WHO Country Office and PAHO s Emergency Operations Center in Washington, D.C. have been monitoring the situation and are in constant communication with health authorities in Mexico, as well as assessing possible future risks due to the emergency. 2. International Medical Teams offered support through coordination platforms and the FMT Global Secretariat. The EOC has maintained contact with them and their offers were channeled to the authorities in Mexico in case there had been any specific requests. All FMTs have reported their availability and were on call in their countries until health authorities reported full national capacity to handle the emergency. In addition, the EOC alerted members of the Regional Health Response Team to facilitate rapid deployment, if necessary. 3. PAHO/WHO continues to work closely with health authorities to support any collaboration for public health needs that may arise in the coming days will continue. The Mexican Government has thanked the international community s support and offers of help, but it has been reported that from the beginning the capacity of local governments and the federal governments were sufficient to meet the requirements to restore services back to normal. EXPECTED RISKS 1. Due to the significant rainfalls and resulting stagnant waters, an increase in the number of mosquitoes and therefore of mosquito-borne diseases such as dengue and chickungunya which are endemic in the region can be expected in the coming weeks. With the potential deterioration of environmental conditions in certain areas, increases in food- and vector-borne diseases, as well as skin and respiratory infections and scorpion stings could be anticipated. As the water supply system does not seem to be affected and drinking water coverage remains high, even in rural areas, there is a low-risk profile of waterborne diseases. 2. However, the current epidemiological curve of vector-borne diseases in the affected areas is within normal range. There has been no particular outbreak reported within the weeks prior to the event and no major outbreak is expected within the coming days. Health brigades are already working on vector control measures, and, in the absence of interruption of primary and secondary health services and the strong capacity of the Mexican health network, epidemiological risks remain low and fully manageable by the national health system. 3. There continues to be heightened risk for occurrence of floods, mudslides, and landslides due to accumulation of moisture and water in the impacted areas.

6 RECOMMENDATIONS & FUTURE ACTIONS The level of preparedness and response capacity shown by Mexico should be enough to cope with the emergency. When requested or accepted, PAHO/WHO may provide technical support to Mexico in the following areas: Complete the operational capacity assessment of health infrastructure and health networks. Recovery of health facilities affected by floods. Damage of water and sanitation systems. Heightened epidemiological surveillance of epidemic borne diseases, including vector and foodborne illnesses/diseases Organize a lessons learned exercise. Identify and analyze evidence regarding protective measures taken regarding the implementation of the Safe Hospitals initiative. Provide the principles and toolkit for Smart Hospitals (Safe and Green).