DPRK Ryongchon Train Disaster: Situation Report #3 (WHO) - April 27, 2004

1. During a visit to Sinuiju and Ryongchon today, we saw the hospitals where the injured are treated. 370 injured remains
in four hospitals in Sinuiju, about two-third being children. Four deaths have occurred in the hospitals during the last
two days. Ministry of Public Health has a coordinator in Sinuiju, Dr. Jang To Gyong, Director of Emergency Unit,
Department of Treatment and Prevention.
2. The majority are injuries in the face and head, with cut from glass, bruises and burns. Around 90 patients have eye
injuries, the majority with penetration of the eye by glass on one side and a few on both sides. Multiple injuries with
fractures, open and closed head injuries and internal injuries were also commonly seen. After seeing 150-200 of the
injured, it is estimated that 15% remains in critical condition. About 25% have smaller injuries and could be discharged
within the coming week.

3. It seems that medical treatment is being provided for the patients at a reasonable level, taking the difficult
circumstances in consideration. Medicines and medical supplies, including intravenous fluids, antibiotics, analgesics,
provided by the Ministry of Public Health and international agencies, also from WHO, were available in all the hospitals.
There remains shortage of certain commodities and medicines such as different eye preparations, topical creams and sterile
vaseline compresses for burns and broad specter antibiotics. Ministry of Public Health requested a county kit for City
Hospital No.1 because the large quantities of the medical commodities and the surgical instruments in this kit.

4. The large number of eye injuries represents a technical challenge. Additional eye preparations have now been ordered by
WHO. A slit-lamp and some other equipment are also needed for follow-up of these patients. WHO will renew its offer of
technical assistance in the field of eye injuries.

5. The large number of children among the victims of this disaster suggests the need for follow-up with counseling and
community outreach programs.

6. In Ryongchon, temporary shelters with tents have now been established. Many people are still on the move within the
town with their belongings. Work has also started with repair of houses.

7. The county hospital, about 1.5-2 km from the explosion site, had all its windows broken, and has not been functioning
since the explosion. Some temporary plastic sheets are now covering windows on the first floor, and the hospital will open
for out-patients today. One polyclinic was totally destroyed by the explosion and the Hygiene and Anti-epidemic station
and medical ware house was partially damaged. It is important to restore normal health services in Ryongchon as soon as
possible.

8. Some patients have shown up with respiratory symptoms, although so far none sever. It is important systematically to
register this as part of the strengthening of disease surveillance after the disaster, in particular because of the
possible toxic impact of ammonium nitrate from the explosion. This was discussed with Vicedirector of hospital and
Director of health services in Ryongchon county.