SABAH STATE HEALTH DEPARTMENT

RISK PROFILE
OF
TAWAU DISTRICT

HEALTH SURVEILLANCE UNIT

TAWAU AREA HEALTH OFFICE
2023
Table of Contents
LIST OF CONTRIBUTORS........................................................................................ 2
CHAPTER 1: INTRODUCTION..................................................................................3
1.1 POPULATION DEMOGRAPHY..............................................................................3
1.2 POLITICAL STRUCTURE.....................................................................................3
1.3 ECONOMY AND DEVELOPMENT.........................................................................4
1.4 ETHNICITY AND RELIGION.................................................................................5
1.5 HEALTH SYSTEM AND LOCAL HEALTH SYSTEM DISTRIBUTION............................5
1.6 EXISTING HEALTH STATUS...............................................................................6
CHAPTER 2: NATURAL DISASTERS.......................................................................9
2.1 OVERVIEW OF NATURAL DISASTERS IN TAWAU..................................................9
2.2 RISK ASSESSMENT ON NATURAL DISASTERS...................................................12
2.3 PREPAREDNESS FOR NATURAL DISASTERS.....................................................13
2.4 MITIGATION OF NATURAL DISASTERS..............................................................14
2.5 RESPONSE AND RECOVERY TO NATURAL DISASTERS......................................14
CHAPTER 3: TECHNOLOGICAL DISASTERS.......................................................16
3.1 OVERVIEW OF TECHNOLOGICAL DISASTERS IN TAWAU.....................................16
3.2 RISK ASSESSMENT ON TECHNOLOGICAL DISASTERS........................................17
3.3 PREPAREDNESS FOR TECHNOLOGICAL HAZARDS.............................................18
3.4 RESPONSE TO TECHNOLOGICAL HAZARDS......................................................18
CHAPTER 4: OUTBREAKS.....................................................................................20
4.1 OVERVIEW OF OUTBREAKS IN TAWAU.............................................................20
4.2 OVERVIEW OF OUTBREAK SURVEILLANCE IN TAWAU........................................21
4.3 RISK ASSESSMENT ON OUTBREAKS IN TAWAU................................................23
4.4 PREPAREDNESS FOR OUTBREAKS...................................................................25
4.5 RESPONSE TO OUTBREAKS............................................................................26
CHAPTER 5: CRISIS & EMERGENCIES.................................................................28
5.1 OVERVIEW OF CRISIS AND EMERGENCIES IN TAWAU.......................................28
5.2 RISK ASSESSMENT OF CRISIS IN TAWAU.........................................................28
5.3 RISK ASSESSMENT OF EMERGENCIES IN TAWAU.............................................29
5.4 PREPAREDNESS FOR CRISIS AND EMERGENCIES.............................................31
5.5 RESPONSE TO CRISIS AND EMERGENCIES.......................................................31
CHAPTER 6: PREPAREDNESS AND RESPONSE................................................32
6.1 NATIONAL PREPAREDNESS AND RESPONSE....................................................32
6.2 PREPAREDNESS AND RESPONSE AT DISTRICT LEVEL.......................................33
REFERENCES..........................................................................................................35
LIST OF CONTRIBUTORS

Dr. Helmy bin Sajali @ Majali

Medical Officer
Communicable Disease Control & Surveillance Unit
Tawau Area Health Office

Dr. Jalil bin Tiru

Medical Officer
Occupational and Environmental Health Unit
Tawau Area Health Office

Mr. Yusri Umasa

Senior Assistant Environmental Health Officer
Communicable Disease Control & Surveillance Unit
Tawau Area Health Office

Mr. Masrah bin Tata

Environmental Health Officer
Inspectorate Unit
Tawau Area Health Office

Dr. Shameer Khan bin Sulaiman

Gazetting Public Health Physician
District Health Officer
Tawau Area Health Office

Updated: 11 December 2023

CHAPTER 1: INTRODUCTION
1.1 Population Demography
The Tawau District is an administrative district in the Malaysian state of Sabah, part
of the Tawau Division, which also includes the districts of Kalabakan and Tawau.
The district's capital is Tawau City, the third-largest city in Sabah, after Kota Kinabalu
and Sandakan. It is located on the Semporna Peninsula on the southeast coast of
the state in the administrative centre of the Tawau Division, which the Sulu Sea
borders to the east, the Celebes Sea to the south at Cowie Bay and shares a border
with North Kalimantan, Indonesia.

Tawau has a land area of 2,240 square km with a population density of 196
people per square km. The number of residents in Tawau in 2020 is estimated at
438.1 thousand, with an annual population growth rate of 1.3% (1). The male
population of Tawau in 2020 was 51.3%, and the female population was 48.7%.
There are 80.2 thousand residential places with 86.5 thousand households, and the
average household size is 5.2 people. The population of Tawau in 2020 consists of
60.8% citizens, and the rest is non-citizens. Population composition Citizens by
ethnicity are Bumiputera (77.2%), Chinese (16.4%), and Others (6.4%) (1).

1.2 Political Structure

There are two members of parliament (MPs) representing the two parliamentary
constituencies in the district: Tawau (P.190) and Kalabakan (P.191). The area is
represented by six Sabah State Legislative Assembly members from the districts of
Balung, Apas, Sri Tanjung, Merotai, Tanjung Batu, and Sebatik (2).

The town is administered by the Tawau Municipal Council (Majlis

Perbandaran Tawau). The area under the jurisdiction of the Tawau District is the
2,510-hectare (25.1 km2) town area, 3,075-hectare (30.75 km2) surrounding
populated area, 568,515 hectares (5,685.15 km2) of rural land and 38,406 hectares
(384.06 km2) of adjacent sea area.

Indonesia has a Tawau consulate and has twin town arrangements with
Zhangping, China, and Pare-Pare, Indonesia. Today, Tawau is one of the ten
districts involved in The Eastern Sabah Security Zone (ESSZONE), which has been
enforced since 2013 by the Malaysian government following persistent attacks by
pirates and militants from the southern Philippines that occurred in the eastern part
of Sabah, especially after the 2013 Lahad Datu standoff.

1.3 Economy and Development

Agriculture is the significant economic activity of Tawau, particularly the oil palm and
cocoa plantations. Exports have traditionally been tobacco, cocoa, and palm oil.
Tawau is one of the top cocoa producers in Malaysia and the world, together
with Ivory Coast, Ghana, and Indonesia (1). The town is the cocoa capital for both
Sabah and Malaysia. Cocoa production is mainly concentrated in the interior, north
of the city, while palm oil production is concentrated along the roads to Merotai and
Brantian. The Majulah Cocoa factory in Tawau, for instance, is said to be the biggest
in Malaysia.

Currently, Tawau Port is one of Sabah's main export gateways for timber.
Forest-related industries are still active in Tawau, especially in the Tanjung Batu
areas. There are also some logging activities south of Tawau within the interior of
Serudong and Kalabakan. Fisheries, particularly aquaculture plays an integral part in
Tawau’s economy. The Prawn farms at Batu Payung are said to be the biggest in
Sabah. Most of the products are exported overseas. The tourism industry,
particularly eco-tourism, is increasingly popular in Tawau. Although the attractions
may not be in Tawau itself, Tawau is used as a transit for the popular destinations of
Pulau Sipadan and Mabul in Semporna.

Most of the town's roads are state roads constructed and maintained by the
state's Public Works Department. Most major internal roads are dual-carriageways.
The only highway route from Tawau connects Tawau – Semporna – Kunak – Lahad
Datu – Sandakan (part of the Pan Borneo Highway). Tawau Airport is the second
largest airport in Sabah state, after Kota Kinabalu, with flights linking the town mostly
to domestic destinations. Destinations for the airport include Johor Bahru, Kota
Kinabalu, Kuala Lumpur and Sandakan. Flights by MASWings connect the airport
internationally to Juwata International Airport in Tarakan, Indonesia, and RB Link to
Bandar Seri Begawan, Brunei. The airport opened in 2001 and, as of 2018, handled
1.64 million passengers annually.

1.4 Ethnicity and Religion

Malaysian citizens in the area were reported divided into Bumiputras (Racially
divided among Bajau, Banjarese, Brunei Malays, Buginese people, Cocos Malays,
Iban people, Kadazan-Dusun, Javanese people, Suluk and Murut including Lun
Bawang/Lun Dayeh and (Tidong) sub-ethnic group, and other smaller ethnic groups)
(134,456), Chinese (40,061), Indian (833) and others (primarily non-citizens) (6,153).

Non-Malaysian citizens are mainly from Indonesia. Like other places in

Sabah, the Malaysian Chinese are mostly Hakkas who arrived during the British
colonial era. Their original settlements were around Apas Road, which was initially
an agricultural area. The Bajau, Suluk, and Malays are mostly Muslims. Kadazan-
Dusuns, Lundayeh, and Muruts mainly practice Christianity, though some are
Muslim. Malaysian Chinese are especially Buddhists, though some are Taoists or
Christians. There is a small number of Hindus, Sikhs, Animists, and secularists in the
town.

Most non-citizens are Muslims, though some are Christian Indonesians who
are mainly ethnic Florenese and Timorese who arrived in the 1950s. A few
Pakistanis live in the town, primarily working as shop or restaurant owners. Most
non-citizens work and live in the plantations. Some of the migrant workers have been
naturalised as Malaysian citizens. However, there are still many who still need
proper documentation as illegal immigrants in the town with their unlawful
settlements.

1.5 Health System and Local Health System Distribution

Tawau has one public hospital, nine public health clinics (including maternal and
child health clinics), five village clinics, and two community clinics as of 2020. Tawau
Hospital, on Tanjung Batu Road, is the city’s main hospital and a vital healthcare
facility that serves as the referral centre for patients from Semporna, Lahad Datu,
and Kunak. Indonesian patients near the border area also frequently visit the
hospital.

The hospital has undergone a series of modernisations since 1990, the latest
one being the new hospital building project, which will accommodate an additional
154 beds, bringing the total number of beds at Tawau Hospital to 555 from the
current 401, in addition to other facilities provided including six operating rooms, four
endoscopy suites, 30 hemodialysis units, as well as the first hospital helipad in
Sabah. As of December 31, 2022, there are 55 private clinics registered in Tawau
(3). There are two private hospitals in Tawau, namely KMI Tawau Medical Centre
and Tawau Specialist Medical Centre, collectively equipped with 198 beds, catering
a wide range of medical disciplines and providing alternative to the people in the
region, especially to the non-locals.

1.6 Existing Health Status

According to the latest mapping of Sustainable Developmental Goals (SDG) in 2020,
the region's health status as stated in Goal 3 of SDG (Good Health and Well-Being)
is depicted in Table 1.1. Other selected health statistics in the Tawau District are
shown in Table 1.2.

Table 1.1: Indicators of Sustainable Developmental Goal (SDG) for Goal 3 &
Goal 6, Tawau

Year
Goals Indicators
2018 2019 2020
Number of live births 5,409 5,336 4,973
Number of deaths 1,560 1,542 1,408
Main Causes of deaths Pneumonia Pneumonia
n.a
(medically certified) (83) (57)
Goal 3: Old age 65 Old age 65
Main causes of deaths
Good Health years and years and n.a
(non-medically certified)
and over (251) over (253)
Well-Being Number of road accidents 1,586 1,622 1,252
Number of injuries due to
67 58 24
road accidents
Number of deaths due to
36 33 23
road accidents
 Year
Goal 6:
Percentage households
Goals
Clean Water Indicators
received piped water in 95.7 98.6 n.a
and
the house
Sanitation
Source: Department of Statistics Malaysia (1)

Table 1.2: Selected statistics of health, Tawau administrative district

Year
2017 2018 2019
Principal causes of deaths
Total of medically certified deaths 526 579 572
Pneumonia 57 83 57
Ischaemic heart diseases 43 47 49
Cerebrovascular diseases 33 49 28
Malignant neoplasm of breast 7 20 24
Malignant neoplasm of colon, rectum and anus 7 19 22
Malignant neoplasm of trachea, bronchus and lung 17 16 21
Chronic lower respiratory diseases 13 17 12
Diseases of the liver 14 7 8
Total of non-medically certified deaths 953 981 970
Old age 65 years and over 220 251 253
Cerebrovascular diseases 29 20 18
Hypertension 21 24 22
Asthma 5 8 6
Accident - Air, land, water 9 6 3
Diabetes mellitus 10 11 19
Ischaemic heart diseases - 12 10
Mortality rate
Perinatal 26.2 7.5 12.2
Male 27.4 8.3 13.0
Female 24.8 6.6 11.3
Neonatala 18.7 3.7 6.2
Male 20.6 4.4 7.7
Female 16.6 3.1 4.6
Infanta 28.7 7.1 8.0
Male 32.3 7.6 9.2
Female 24.7 6.6 6.8
Toddler aged 1-4b 1.0 0.0 0.3
Male 1.1 0.1 0.2
Female 0.8 - 0.5
Under-5 years 33.5 7.3 9.9
 Year
Male 37.6 8.0 10.4
Female 28.9 6.6 9.3
Maternal mortality ratioc - - 20.1
Source: Department of Statistics Malaysia (1)

Notes:
a
The rates are per 1,000 live births
b
The rates are per 1,000 population aged 1-4 years
c
The ratios are per 100,000 live births
CHAPTER 2: NATURAL DISASTERS
Malaysia is geographically outside the Pacific Rim of Fire and is relatively free from
any severe ravages and destruction caused by natural disasters. However, the
country is still vulnerable to natural hazards including floods, forest fires, tsunamis,
cyclonic storms, landslides, seismic activity, and haze (local and transboundary).
Additionally, in recent years their exposure to a range of climate-related disasters
has been magnified in part, due to climate change. Weather extremes are occurring
more frequently and with higher intensities. Hazards become disasters if there are
vulnerable people affected. For example, the same hurricane can pass over three
countries in the Caribbean and have different effects on each. The intensity of its
impact depends on vulnerability.

Table 2.1 Relative Frequency of Disaster Hazards in Malaysia

Table 2.1 depicts the frequency of disaster hazards in Malaysia as stated in

the Malaysian Disaster Management Reference Handbook (4). The highest
frequency stated is Flood, followed by forest fire and landslide. Earthquake, tsunami,
drought, storm, and haze occurs at a lower frequency.

2.1 Overview of Natural Disasters in Tawau

Like elsewhere in Malaysia, floods are the major natural disaster threat facing
Tawau. The Malaysian Civil Defense Force (APM) in Tawau is focusing on disaster
preparedness operations for eight villages here which are often hit by flash floods
following a continuous downpour. The eight villages are Kampung Batu 2 Tali Air,
Jalan Apas; Kampung Wakuba (Apas Parit); Kampung Rawa-Rawa, Batu 4;
Kampung Pasir Putih; Kampung Serudung, Batu 22; Jalan Bukit Quoin, Batu 15;
Kampung Kijang, Merotai and Kampung Iban, Merotai. Tawau has recorded around
3 – 4 episodes of floods yearly as reported by Jabatan Pengairan dan Saliran in their
annual reports (5,6).
 Fortunately, unlike most of the neighboring countries, Malaysia is not among
the countries that are included in the Ring of Fire, as it is barely situated just outside
of the belt. Regardless, it does not spare Malaysia from the tremors that it felt from
the earthquakes. Arguably, even though Malaysia is not in the Ring of Fire, Malaysia
did have past earthquake events. For example, the earthquake that hit Ranau,
Sabah on 5 June 2015 with 6.2 magnitudes. 2018 Sulawesi earthquake and tsunami
with its epicenter located in the mountainous Donggala Regency, Central Sulawesi.
The magnitude 7.5 quake was located 70 km (43 mi) away from the provincial capital
Palu and was felt as far away as Samarinda on East Kalimantan and also in Tawau
(7).

The coastal area around Tawau faces the highest levels of threat for tsunamis
generated by a large earthquake (8.4 Mw) from the North Sulawesi Trench (8). The
continental shelf is rather narrow, between 10-20 km only. The narrow shelf will have
a limited dissipating impact on incoming tsunami waves. Tawau area is also more
exposed to the open sea compared to Semporna which is partially sheltered by
numerous small islands. The narrow Cowie Bay between Tawau City and Sebatik
Island will have the effect by concentrating the tsunami wave power and may result
in waves much higher than the predicted 3 m tsunami waves near the coast. The
tsunami wave is expected to have an adverse impact on coastal settlements, mostly
water villages in the Tawau area (Figure 15). The narrow continental shelf in this
area and its proximity to the tsunami source make the southeast part of Sabah a
region with the highest level of threat (8).
Figure 2.1: Possible tsunami pathways towards southeast Sabah. Tawau is directly exposed to
tsunami waves from North Sulawesi. Level of threat is shown in red (high) for Tawau and Semporna,
and orange (moderate) for Kunak and Lahad Datu. From Termizi AK, Tongkul F, Roslee R.
Earthquake and tsunami propagation scenario in Tawau, Sabah - Evaluation of the north Sulawesi
fault parameter. ASM Sci J. 2018 Jan 1;11:49–65.

Figure 2.2: Low-lying and densely populated coastal area in Tawau Town area. Numerous water
villages (e.g. Kg. Pasir Putih, Kg. Pukat, Kg. Titingan, Kg. Hidayat) located along the coast. Tsunami
waves amplified as it enters Cowie Bay. From Termizi AK, Tongkul F, Roslee R. Earthquake and
tsunami propagation scenario in Tawau, Sabah - Evaluation of the north Sulawesi fault parameter.
ASM Sci J. 2018 Jan 1;11:49–65.
2.2 Risk Assessment on Natural Disasters
Natural hazards and threats in Tawau were initially identified and ranked based on
the likelihood and impact. Threat and Hazard Identification and Risk Assessment
(THIRA) tool were used. The results obtained are depicted in Table 2.2. The risk was
plotted in the risk matrix as shown in figure 2.1. Risk assessment was based on
historical incidents of natural disasters in Tawau and based on records from previous
media archives or literature. The hazards and threats identified were described
further on the impacts on human mortality, human morbidity, economic burden,
healthcare system, and social disruption.

Table 2.2: Risk Assessment of Natural Disasters in Tawau

Flood, followed by flash floods had the highest score considering their likelihood and
impact. As described above, floods affected Tawau almost every year costing
economical loss and social disruption. Haze was ranked fourth after Tsunami, like
flood and flash flood, also a yearly affair. Although the likelihood is categorized as
likely, it results in high morbidity, with an increase in hospital admissions,
exacerbation of respiratory diseases, and social disruption. Schools are forced to
close due to haze and productivity reduces, hence causing social disruption.

Figure 2.3: Risk Matrix for Natural Disasters in Tawau

Tsunamis and earthquakes, although unlikely, cause severe impacts on mortality,

morbidity, economic burden, and social disruption. The coastal area around Tawau
faces the highest levels of threat for tsunamis as described above. According to
figure 2.1 flood and flash floods are plotted in high-risk regions while natural
disasters such as tsunamis, and earthquakes, pose a moderate risk to Tawau. Haze
has the lowest risk according to the risk assessment conducted.

2.3 Preparedness for Natural Disasters

CPRC has a range of preparedness programs streamlined to adequately respond to
natural disasters. One main function is to conduct risk assessments in all districts in
Malaysia to create a District Specific Risk Profile. Based on this profile, every district
in Malaysia prepares for the anticipated natural disaster. Training and exercises are
designed according to the natural disaster risk identified.

Besides CPRC, other agencies also conduct risk assessments based on their
area of the domain for preparedness which is shared with NADMA. Some agencies
such as the Flood and Irrigation Department, Meteorology Department, etc. inform
the public about the risk as an early warning system through their official website.
2.4 Mitigation of Natural Disasters
Natural disasters are managed by the Occupational and Environmental Sector at the
Ministry of Health Malaysia. This sector is responsible for preparing and mitigating
natural disasters. The technical committee is chaired by the Disease Control Director
and attended by members from the Occupational and Environmental Health Sector
and Disaster, Outbreak Crisis, and Emergency Management Sector. The meetings
are held twice a year.

Mitigative actions at the national level include a high-level steering committee

meeting chaired by the Deputy Prime Minister of Malaysia while the technical
committee meeting is chaired by the Director General of NADMA. These meetings
are well represented by all agencies involved in disaster management including
health. Amongst the agenda discussed are disaster risk reduction, budget, and
updates from relevant agencies. State and district level conducts similar meetings
regularly.

2.5 Response and Recovery to Natural Disasters

Response to natural disasters is based on the prepared operational guidelines and
SOP as below:

Table 2.3: Guidelines for Natural Disaster Response.

Natural MOH Guideline NADMA Guideline
Disaster
Flood Garis Panduan Pengurusan Peraturan Tetap Operasi
Banjir, Edisi Pertama 2008, Edisi Pengendalian Bencana
Kedua 2019. Banjir, Jilid 1.
Haze Pelan Tindakan Pengurusan Peraturan Tetap Operasi
Jerebu, 2006, Updated 2019. Pengendalian Pembakaran
Hutan, Pembakaran
Terbuka dan Jerebu, Jilid 3.
Tsunami Peraturan Tetap Operasi
Pengendalian Bencana
Tsunami, Jilid 4.
Pelan Pengurusan Bencana
Storm NA.
Peringkat Kementerian
Landslide NA.
Kesihatan Malaysia, 2015.
Earthquake Peraturan Tetap Operasi
Pengendalian Bencana
Banjir, Jilid 5.
Drought Panduan Pengurusan Risiko Peraturan Tetap Operasi
 Natural MOH Guideline
Disaster
dan Nasihat Kesihatan Berkaitan
Gelombang Haba, 2019.
Forest Fire Pelan Pengurusan Bencana
Peringkat Kementerian
Kesihatan Malaysia, 2015.
NADMA Guideline
Pengendalian Bencana
Kemarau, Jilid 6.
Peraturan Tetap Operasi
Pengendalian Pembakaran
Hutan, Pembakaran
Terbuka dan Jerebu, Jilid 3.
CHAPTER 3: TECHNOLOGICAL DISASTERS
Technological disasters are events caused by a malfunction of a technological
structure and/or some human error in controlling or handling the technology which
has a great impact on communities and can often be more detrimental (9). The
effects of a disaster on families and individuals may be long-lasting. Symptoms of
which may appear gradually, and impacts may not be seen immediately. All types of
disasters are challenging, but technological disasters tend to be even more difficult
for the following reasons:

• The threat cannot be anticipated. It is sudden, unexpected, and

unpredictable.
• People are responsible. Victims of technological disasters tend to feel anger
toward people who were responsible for accidents that may have been
prevented.
• Community breakdowns and conflict may result. Technological disasters can
create disputes within communities.
• Longer recovery as community members tends to concentrate on litigation
and blame and less on cleanup and recovery.
• Media covering a technological disaster can be constantly adding to already
heightened stress levels.

3.1 Overview of Technological Disasters in Tawau

There have been many technological disasters that have occurred in Malaysia. The
disaster that triggered policy and management change was the Highland Towers
collapse in 1993. Technological disasters encompass a whole spectrum of incidents,
from mass casualty, industrial accidents, structural collapse, transport accidents,
pollution, and many others. Malaysia, being a developing country, considers
technological disasters as a part of the response plan since Malaysia has
encountered many technological disasters in the past. The following table outlines
the technological disasters that have occurred in Tawau.
 Table 3.1: Technological Disasters in Tawau.

YEAR INCIDENT OUTCOME

1995 Malaysia Airlines Flight 2133 crash on 15
34 death with 10 ground
September 1995 at Tawau Airport. injuries. 19 survivors
2016 RMAF Nuri Chopper crash on 4 October No casuality. 14 injuries,
2016 at SMK Balung, Tawau minor structural damage to
school building
2022 Massive fire at Kg. Kurnia Jaya Tawau 700 houses destroyed,
1300 residents displaced
2023 Chlorine gas leak in Pegagau Aquaculture, 6 victims (1 critical), all
Kg. Wakuba Tawau survived

3.2 Risk Assessment on Technological Disasters

Technological hazards and threats in Tawau were initially identified and ranked
based on the likelihood and impact. The Threat and Hazard Identification and Risk
Assessment (THIRA) tool were used. The results obtained are depicted in Table 3.1.
The risk was plotted in the risk matrix as shown in Figure 3.1. Risk assessment was
based on historical incidents of technological disasters in Tawau. The hazards and
threats identified were described further on the impacts on human mortality, human
morbidity, economic burden, healthcare system, and social disruption.

Table 3.1: Risk Assessment of Technological Disasters in Tawau

Air traffic accidents posed the lowest risk with the lowest likelihood and impact.
Petroleum depot explosion, though the likelihood is low the impact on mortality and
morbidity is high.

Figure 3.1: Risk Matrix for Technological Disasters in Tawau

3.3 Preparedness to Technological Hazards

CPRC has a range of preparedness programs streamlined to adequately respond to
all technological disasters. One main function is to conduct risk assessments at all
districts in Malaysia to create a District Specific Risk Profile. Based on this profile,
every district in Malaysia prepares for the anticipated technological disaster.
Mitigative actions include discussing disaster risk reduction in the district disaster
committee meetings. Training and exercises are also centered upon the
technological disaster risk identified.

3.4 Response to Technological Hazards

Response to technological disasters is based on the prepared operational guidelines
and SOP as below:
Table 3.3 Guidelines for Technological Disasters
Natural Disaster MOH Guideline NADMA Guideline
Chemical Leak Chemical, Biological, radiological, Guidelines On The Control Of
Nuclear and explosives (CBRNe) Chemicals Hazardous To
preparedness response and Health, 2001.
recovery plan, 2019. Peraturan Tetap Operasi
Pengendalian Bencana
Natural Disaster MOH Guideline NADMA Guideline
Industri, Jilid 2.
Road Traffic Emergency Medical Team NA
Accidents Command and Control.
Air Pollution Pelan Tindakan Pengurusan A Guide to Air Pollutant Index
Jerebu, 2006, Updated 2019. in Malaysia, 1997.
Peraturan Tetap Operasi
Pengendalian Pembakaran
Hutan, Pembakaran Terbuka
dan Jerebu, Jilid 3.
Fire and Explosion National Disaster Management NA
Sea Accidents Plan, 2015 Prosedur Tetap Mencari Dan
Menyelamat Maritim, 2015.
Mass Casualty NA
Incidents
Air Traffic
Accidents
Water Pollution NA National Water Quality
Standards For Malaysia.
Radiological Chemical, Biological, Radiological, Prosedur Pengoperasian
Accidents Nuclear and explosives (CBRNe) Pusat Pengurusan
preparedness response and Tindakbalas Nuklear
recovery plan, 2019 Kebangsaan.
CHAPTER 4: OUTBREAKS
The Asia Pacific region including Malaysia has experienced numerous public health
emergencies with regards to emerging and re-emerging diseases. In the past
emerging diseases such as the Nipah virus in 1999, SARS in 2003, Avian Influenza,
and Influenza A(H1N1) in 2009 has caused significant challenges to the public health
system in the country. A larger magnitude of the national emerging disease crisis
was seen in 2020 when the novel virus COVID-19 was declared a pandemic. Till the
end of June 2022, Malaysia recorded over 4,5 million cases of COVID-19 with
35,758 deaths. Malaysia saw 3 major waves of COVID-19 infection in the country
with the most impact on the health care systems during the Delta wave where the
severity of the cases impacted the delivery of health care to the population.

Threats posed by these emerging diseases compel health systems to be

constantly prepared and vigilant against the occurrence of these disease threats.
Experiences learned during the Nipah, SARS, and Influenza A (H1N1) and the
COVID-19 pandemic has further strengthened national capacities to respond to such
situations to protect the health of populations in Malaysia and abroad.

4.1 Overview of Outbreaks in Tawau

Malaysia is a tropical country, where tropical diseases are prevalent. Tuberculosis
(TB) is a highly endemic and significant public health concern in Malaysia especially
in Tawau and Sabah, with an incidence rate of as high as 93 per 100,000. While the
incidence rate has been slowly rising over the last decade, the TB mortality rate has
declined in the same time frame. A significant vector-borne disease in Tawau is
Dengue Fever. Dengue fever outbreaks continue to occur, despite significant
prevention and mitigation efforts by Tawau Area Health Office. The engagement of
local communities and the private sector is a continuous challenge in controlling and
managing dengue epidemics in Tawau. Looking at the 5-year data from 2017 till
2022 the number of infectious disease outbreaks reported to the Tawau Area Health
Office, the Hand Food Mouth Disease (HFMD) is most prevalent with 87 outbreaks
comprising 58.4% of the total number of outbreaks in that 5-year period. This is
followed by Food poisoning outbreaks 36 (24.2%) outbreaks, Cholera outbreaks 15
(10.1%), Diphtheria 3 (2.0%), Influenza-like Illness, Leptospirosis, and Measles all
contributed to 2 outbreaks (1.3%), and lastly Typhoid and Hepatitis A with 1 outbreak
each (0.7%).

4.2 Overview of Outbreak Surveillance in Tawau

Malaysia has established a list of notifiable priority diseases; both for human health
and animal health. Human health is governed by the Prevention and Control of
Infectious Diseases Act 1988 (Act 342) –in which, as of November 2016 the list
comprised 31 notifiable infectious diseases. Besides, the list is expanded to include
other infectious diseases of public health importance in Malaysia within the
document titled ‘Case Definition on Infectious Diseases in Malaysia’. For animal
health, a list comprised of 125 mandatory notifiable animal diseases is listed within
the Animal Act 1953 (Act 647) in accordance with Animal Health Code diseases
listed by the OIE. The surveillance activities are governed at the local level by the
Communicable Disease Control (CDC) and Surveillance Unit of the Tawau Area
Health Office, using the pre-existing protocols and systems.

The notification of diseases listed within Act 342 is aided by the development
of eNotifikasi; an electronic (online) system that facilitates and expedites the
process. This system allows real-time access by program managers at the national
and sub-national (state and districts) levels. In addition, there are separate systems
developed for selected diseases, and these systems are linked to eNotifikasi.
Preliminary data entry from eNotifikasi for these diseases will be pushed for further
management to the respective systems; namely e-Dengue for dengue, SM2 for
measles, MyTB for tuberculosis, MyKusta for leprosy, and National AIDS Registry
(NAR) for HIV/AIDS.

In addition, the utilization of electronic reporting for syndromic surveillance

was initiated through the establishment of eWabak System in 2011 for prompt
reporting of verified outbreaks / public health emergencies occurring on the ground.
The preliminary report will be submitted by the related District Health Offices and
later endorsed by the State Health Department. The National Crisis Preparedness
and Response Centre (CPRC) closely monitor all the reports received nationwide via
this system. Each notification recorded in eNotifikasi and eWabak systems will
prompt field investigation (conducted by a team from the District Health Offices)
which among others; will trace the result of laboratory investigation done for the
case. The result obtained will be keyed-in accordingly into the system.

The Coronavirus disease 2019 (COVID-19) has posed an unprecedented

global public health threat. The disease was first reported in an outbreak of
pneumonia of unknown etiology in the city of Wuhan, China at the end of December
2019. The pandemic has led authorities to develop various control measures and
public health strategies to control the spread of the disease. The MOH together with
the National Security Council (MKN), Malaysian Communications and Multimedia
Commission (MCMC), and several other agencies had developed eCOVID, an online
reporting system that ensures data collection exclusively related to COVID-19 can be
carried out more effectively, avoiding the labors of handling data manually.

Subsequently, to strengthen the existing COVID-19 surveillance activities,

several improvements to the ILI/SARI surveillance activities were implemented: (1)
The case definition for ILI was updated, and (2) All health clinics were included in the
clinical ILI/SARI surveillance to better represent the states, and (3) and at local
setting, Klinik Kesihatan Tawau had been chosen as one of the sentinel centers for
ILI surveillance.

With regards to animal health, the Animal Disease Information Centre (ADIC)
acts as the national animal disease reporting platform responsible for collecting and
collating all animal disease information and this is supported by the e-Makvet
System; a web-based laboratory database. Whereas for human health, the
surveillance program is aided by the SIMKA and ELBIS laboratory systems, which
are coordinated by the National Public Health Laboratory (NPHL) Sungai Buloh.

In summary, Malaysia has established the required systems for public health
surveillance, which is capable of promptly detecting diseases, syndromes, or events;
both within the human health and animal health sectors. However, there could be a
significant opportunity for improvements towards accomplishing a robust surveillance
system –, particularly through a comprehensive and cohesive data organization
system between human and animal health sectors. Besides, enhancement of the
ADIC with the development of the Malaysian Animal Disease Information Centre
(MADIC) by the year 2020 will further enable users from various levels of the
organization to implement effective veterinary practice and management.

4.3 Risk Assessment on Outbreaks in Tawau

In Tawau, COVID-19 (9.0) and Tuberculosis (8.6), are two of the communicable
diseases which pose the highest risk. The impact of COVID-19 is high in all aspects
except mortality. As of August 2022, at least 56.5% of the Tawau population had
completed the primary series of COVID-19 vaccination, while Malaysia has covered
83.5% of its population with a primary dose of COVID-19 vaccination and another
23.6% had received a booster dose. For a record, the first COVID-19 case in Sabah
was reported in Tawau on March 11, 2020, while Tawau also recorded the first
COVID-19 death in Sabah (10).

The likelihood of Tuberculosis is very high given that the prevalence of

Tuberculosis in Sabah is the highest in Malaysia. When compared to other districts
within the state, Tawau, alongside Kota Kinabalu and Sandakan are the districts
where Tuberculosis is the most prevalent (11). The impact of Tuberculosis is
moderately high on morbidity, mortality, and the healthcare system. Previous studies
have indicated that the TB epidemic in Sabah is chiefly related to delayed health
seeking and limited access to TB care.

While Dengue/ Dengue Hemorrhagic Fever also scored high in likelihood due
to the high proportion of the Ae. albopictus and Ae. aegypti, the vector transmitting
dengue in the region (12). Despite having a high likelihood, Dengue/ Dengue
Hemorrhagic Fever has a lesser impact on mortality and morbidity due to the current
advancement in clinical management, preventive, and control measures.

Hand, foot, and mouth disease (HFMD) pose a high likelihood score;
however, it has a lesser impact on mortality, morbidity, and morbidity burden. Recent
data have shown a rise in HFMD cases in Tawau, and the rise in the number of
cases has increased the burden on our healthcare system, especially at the primary
care level.
 Although the polio immunization program was in place since 1972 and was
subsequently declared polio-free in 2000, Malaysia declared the return of polio
involving a 3-months old boy with Type 1 Circulating vaccine-derived poliovirus
(cVDPV) sequence detected in Sabah on December 8, 2019. Given that Tawau has
a significant number of undocumented immigrants population, most of them are from
neighboring Indonesia and the Philippines, and most of them have doubtful
immunization status, any vaccine-preventable disease, especially Polio poses a
greater risk. Nevertheless, the risk assessment of polio in Tawau shows a relatively
lower THIRA score (4.8) but it has a high impact on morbidity and the healthcare
system, as a substantial amount of funds have been spent by the Ministry of Health,
particularly during the recent Kempen Imunisasi Polio Sabah (KIPS) following the
outbreak in 2019.

Table 4.1 Risk Assessment on Outbreaks in Tawau

 Figure 4.1 Risk Matrix on Outbreaks

4.4 Preparedness to Outbreaks

The Asia Pacific region continues to face health security threats arising from
emerging diseases and public health emergencies. With the introduction and
implementation of the International Health Regulations (IHR 2005) effectively in Jun
2007, member countries are obligated to assess and then to comply with the
minimum requirement stated under the IHR 2005. As one of the implementation
strategy in the region, WHO Western Pacific Regional Office (WPRO) together with
South East Asia Regional Office (SEARO) has developed the Asia Pacific Strategy
for Emerging Diseases, or APSED to provide a strategic direction and priority actions
for managing health security threats arriving from emerging diseases and other
acute public health events.

CPRC has a range of preparedness programs streamlined to adequately

respond to outbreaks. All outbreaks at the national level are led by the Ministry of
Health Malaysia through CPRC. One main function is to conduct risk assessments in
all districts in Malaysia to create a District Specific Risk Profile. The outbreaks based
on likelihood and impact are stated as plotted on the risk matric in figure 4.1. As for
districts and states, the risk differs. Based on this profile, every district in Malaysia
prepares for the anticipated outbreaks. Mitigative actions include discussing disaster
risk reduction in the district health department committee meetings. Training and
exercises are also centered upon the outbreak risk identified.

4.5 Response to Outbreaks

Like the national level, response to the outbreaks in Tawau is based on the prepared
operational guidelines and SOP as below:

Table 4.2: Guidelines for Outbreaks

Outbreaks Guideline
Tuberculosis Garis Panduan Kawalan Tibi di Kalangan Kanak-Kanak:
Edisi Pertama, 2017.

Guidelines on Prevention and Management of

Tuberculosis for Health Care Workers in Ministry Of
Health Malaysia, 2012.

Clinical Practice Guidelines - Management of Drug

Resistance of Tuberculosis: 1st Edition, 2016.

Dengue Clinical Practice Guidelines - Management of Dengue

Infection in Adults: 3rd Edition, 2015.
 Garis Panduan Program Bebas Denggi Di Kemudahan
Kesihatan, 2005.
HIV Guideline for Anonymous and Voluntary HIV Screening:
2003
Garis Panduan Pengendalian Jenazah Islam dari Aspek
Kesihatan: 1999.

Guidelines For The Management of HIV Infection in

Malaysia: AIDS Series 3.

Clinical Practice Guidelines - Management of HIV

Infection in Children: February 2008.

HFMD Pelan Tindakan Bersepadu bagi Mencegah dan

Mengawal Kejadian Penyakit Tangan, Kuku dan Mulut
(HFMD), 2006.
Viral Hepatitis Guidelines on Management of Health Care Workers
infected with Human Immunodifeciency Virus (HIV),
Hepatitis B Virus (HBV), Hepatitis C Virus (HCV),
December 2007.

Garis Panduan Pelaksanaan Program Imunisasi

Hepatitis B bagi Anggota Kementerian Kesihatan
Malaysia.

Food Poisoning Garis Panduan Pengurusan Wabak Keracunan

Makanan di Malaysia - Jilid 4: Edisi Kedua, 2006.

Leptospirosis Guidelines for the diagnosis, management, prevention

and control of Leptospirosis in Malaysia, 2011.

Malaria Management Guideline of Malaria in Malaysia, 2014.

CHAPTER 5: CRISIS & EMERGENCIES
Crisis is an important element to consider as it poses a significant risk to the
population at large. Malaysia is known to be a harmonious and multiracial country
with diverse beliefs and practices. Emergencies are an important element to
consider as it poses a significant risk to the population at large. Malaysia is known to
be a harmonious and multiracial country with diverse beliefs and practices.

5.1 Overview of Crisis and Emergencies in Tawau

Crises and emergencies that have occurred in Tawau are described in table 5.1.

Table 5.1 Crisis and Emergencies in Tawau

YEAR INCIDENT OUTCOME

1963 Kalabakan Confrontation on December 29, 1 officer and 7 personnel

1963. Confrontation from intruders (TNI) from the 3rd Battalion of
who were dissatisfied with Sabah joining RAMD was killed. 18
the Malaysian Federation on September injuries.
16, 1963.

5.2 Risk Assessment of Crisis in Tawau

Based on the risk assessment exercise, war, although the likelihood was unlikely,
scored the highest risk. This is due to the impact being very high. Public order and
food crisis are likely but the impact on mortality, morbidity, economy, healthcare
system, and community is low and localized to certain areas. Border intrusion also
scored a moderate risk, though the likelihood was unlikely.
 Table 5.2: Risk Assessment on Crisis in Tawau.

Figure 5.1: Risk Matrix for Crises in Tawau

5.3 Risk Assessment of Emergencies in Tawau

Based on the risk assessment exercise, flood and pandemic scored the highest risk
with a high likelihood of flood although the likelihood for a pandemic was unlikely.
Earthquake, tsunami, Petroleum Depot Explosion, border threat, riot, and public
order dan border threat scored moderate risk.
Table 5.3: Risk Assessment Emergencies in Tawau.

Figure 5.2: Risk Matrix for Emergency in Tawau

5.4 Preparedness for Crisis and Emergencies
The Royal Malaysian Police and Armed Forces of Malaysia have their intelligence.
These agencies would advise the prime minister on further actions and advice.

5.5 Response to Crisis and Emergencies

This is led by the National Security Council and the Royal Malaysian Police. The
guidelines used are NSC 18, 20, and 21.
CHAPTER 6: PREPAREDNESS AND RESPONSE
6.1 National Preparedness and Response
Disaster management in Malaysia is currently run by the National Disaster
Management Agency (NADMA). NADMA was officially established on 1 October
2015 under the Prime Minister’s Department replacing the National Security Council
(NSC) as the focal point for disaster management and consolidating the Disaster
Management Division of the National Security Council (NSC), the Post Flood
Recovery Unity of the Prime Minister's Department, and the Special Malaysia
Disaster Assistance and Rescue Agency (SMART).

Malaysia Civil Defence Forces (MCDF) has been appointed as the Secretary
for Disaster Management Committee at the state and district level and is responsible
to enhance community resilience and preparedness towards disaster through the
Cabinet Meeting chaired by Malaysia Prime Minister on September 8 th, 2015. MCDF
set up a Disaster Management Secretariat Branch in order to regulate and
coordinate the secretariat Disaster Management Committee's activity at the state
and district level.

The disaster management organization structure continues under three levels:

federal, state, and district. Management of disaster risk is regulated by Directive No.
20, established in May 1997 by the Prime Minister’s office. Directive No. 20 issues
guidance on policy and mechanisms related to national disaster management and
relief activities. It guides the integration of the various agencies on disaster
management responsibilities and functions, and it regulates the management of
disaster risks. Additionally, Directive No. 20 breaks down the disaster management
cycle into four stages consisting of prevention and mitigation, preparedness,
response, and recovery. In March 2012, the second edition of Directive No. 20 was
released to include a comprehensive response and incorporation of international
best practices.
6.2 Preparedness and Response at District Level

The District Disaster Management and Relief Committee (DDMRC) functions out of

the District Disaster Operation Control Center (DDOCC) handles district and village-
level disasters. The village-level disasters are managed by the DDMRC with inputs
from the village committee as they do not have official disaster management at the
village level.

The District Disaster Management Committee is chaired by the District Officer to

ensure coordinated actions, sufficient assets, human resources, and manage the
media. The District office is the key implementing agency in Level 1 disasters,
controlled and containable incidents on the ground to ensure responses are
coordinated, assets and human resources are sufficient and communication is
established with the media. Additionally, Level 1 disasters are not complex and
would only cause minimal damage to life and property. The District Level Authority
has the capacity to control Level 1 incidents without or with limited outside
assistance.

The members of the District Disaster Management Committee are the following:

a) District Police Chief

b) District Fire and Rescue Officer
c) District Health Officer
d) District Social Welfare Officer
e) District Environment Department Officer
f) Representative of the Malaysian Armed Forces
g) Head of District Maritime Enforcement/Agency Representative Malaysian
Maritime Enforcement
h) Municipal/District Council Secretary
i) District Civil Defense (APM) Officer
j) Representative of the Department of Meteorology Malaysia
k) District Information Officer
l) District Education Officer
m) District Engineer, Public Works Department
 n) District Engineer, Irrigation and Drainage Department
o) District RELA Officer
p) Representative of the State Department of Minerals and Geosciences
q) Telekom Malaysia District Manager
r) Representative of Sabah Electricity Sdn Bhd
s) Deputy Director/Department Manager/State Water Supply Company
t) Deputy Manager of the State/District Civil Aviation Department

Disaster preparedness plans and contingency plans are in place at all administrative
levels, and regular training drills and rehearsals are held to test and develop disaster
response programs. As for early warning system, Tawau District had been equipped
with Tsunami Early Warning siren, installed at Al-Kauthar mosque, Tawau since
2006.

At the health facility level, The Tawau Area Health Office has recently updated its
own Disaster Management Plan at Health Facility Level in January 2022 (Pelan
Pengurusan Bencana, Pejabat Kesihatan Kawasan Tawau, January 2022). It has
been formulated to achieve a satisfactory level of readiness to respond to any
emergency situation at the health facility level.
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