INTRODUCTION At the time this report is written - October 2003 - the people of our world are exposed to more than 100 dif- ferent violent conflicts. Most have been running for years. Taken together, they have undermined the liveli- hood of millions - even billions - of people. They may be unable to secure the food and water they need, subject to violence, forced to sell their assets or made to move from their homes. They have precipitated sev- eral humanitarian crises - some graphic, and well reported; others minor, but no less serious for those who are affected by them. They have undermined years of development progress and contributed to increased poverty. Those affected generally face far higher - than normal - risks of illness and death. Violent conflict is not the only cause of humani- tarian crises: whenever the capacity of societies - and Governments - to cope with shocks is over- whelmed, we can expect to see increased insecu- rity and suffering. Indeed, some communities are regularly exposed to both natural and man-made shocks in an apparently immutable pattern - and their people experience permanent crisis. WHO supports the work of national authorities, international agencies and NGOs in Member States as they prevent, prepare for and respond to humanitarian crisis. Given that health workers are often on the front line in the humanitarian response, WHO also provides guidance for health personnel that help them prepare for responses to the needs of the most vulnerable populations within the context of long-term develop- ment efforts. WHO - Health Action in Crises annualreport2002 1 In supporting countries to effectively respond to humanitarian crises WHO works to: • Produce the most reliable information possible on a regular basis about what is happening to people’s health during emergencies - drawing on the full range of available sources; • Provide support to responsible national officials, and those with a mandate to implement humanitarian responses in country, to establish priorities for immedi- ate response that are based on this information; • Promote the optimal intervention to address these priorities - and encourage others whether within or out- side the health sector, to implement them with a spe- cial focus on preparing for, preventing and responding to disease outbreaks; • Provide the necessary facilities to encourage networking between and to improve coordination among different bodies working to improve health of groups at risk; • Track progress, identifying trends, revealing gaps both in the understanding of issues and in the provision of a response, and communicating this information through- out WHO and beyond; • Draw lessons from previous crises, to respond more effectively to crises in the future.
Transcript
INTRODUCTION At the time this report is written - October 2003 - thepeople of our world are exposed to more than 100 dif-ferent violent conflicts. Most have been running foryears. Taken together, they have undermined the liveli-hood of millions - even billions - of people. They maybe unable to secure the food and water they need,subject to violence, forced to sell their assets or madeto move from their homes. They have precipitated sev-eral humanitarian crises - some graphic, and wellreported; others minor, but no less serious for thosewho are affected by them. They have underminedyears of development progress and contributed toincreased poverty. Those affected generally face farhigher - than normal - risks of illness and death.
Violent conflict is not the only cause of humani-tarian crises: whenever the capacity of societies -and Governments - to cope with shocks is over-whelmed, we can expect to see increased insecu-rity and suffering. Indeed, some communities areregularly exposed to both natural and man-madeshocks in an apparently immutable pattern - andtheir people experience permanent crisis.
WHO supports the work of national authorities,international agencies and NGOs in Member States asthey prevent, prepare for and respond to humanitariancrisis. Given that health workers are often on the frontline in the humanitarian response, WHO also providesguidance for health personnel that help them preparefor responses to the needs of the most vulnerablepopulations within the context of long-term develop-ment efforts.
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In supporting countries to effectively respond tohumanitarian crises WHO works to:• Produce the most reliable information possible on a
regular basis about what is happening to people’shealth during emergencies - drawing on the full rangeof available sources;
• Provide support to responsible national officials, andthose with a mandate to implement humanitarianresponses in country, to establish priorities for immedi-ate response that are based on this information;
• Promote the optimal intervention to address these priorities - and encourage others whether within or out-side the health sector, to implement them with a spe-cial focus on preparing for, preventing and respondingto disease outbreaks;
• Provide the necessary facilities to encourage networkingbetween and to improve coordination among differentbodies working to improve health of groups at risk;
• Track progress, identifying trends, revealing gaps both inthe understanding of issues and in the provision of aresponse, and communicating this information through-out WHO and beyond;
• Draw lessons from previous crises, to respond moreeffectively to crises in the future.
Throughout WHO, the departments and unitsresponsible for Emergency and Humanitarian Action(EHA) in the Regional Offices and Geneva lead anorganization-wide support for communities to pre-pare for, and respond to, the health dimensions ofcrises.
For the Biennium 2002-03 WHO established sixExpected Results for this area of work. By highlightingselected EHA activities and describing how they con-tributed to the Expected Results during 2002, thisAnnual Report illustrates how WHO assists its MemberStates to prepare for and respond to emergencies.
Public health demands appropriate action andpermanent learning, and the year 2002 has been richof lessons for WHO. On the basis of these lessonslearnt, WHO has decided to move in a concertedeffort to establish a reliable, effective and credibleservice that helps all concerned prepare for andrespond to the health dimensions of acute and long-term crises.
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Expected Result: Policy and advocacy
positions that promotehealth as the leading
concern in emergencies
Health is the goal and yardstick of humanitarianaction. WHO uses different channels to promote thismessage, including conferences, key WHO events,such as the World Health Assembly, the Meeting ofInterested Parties, the annual launch of the Consolida-ted Appeal, and publications. To highlight the healthstakes in the crisis in Southern Africa, EHA produced ashort video, The Deadly Equation. This video shows thecomplexity of root causes and consequences of thefood and health crisis in Southern Africa. The spread ofHIV/AIDS, drought, water and sanitation problems andlacking capacity of health services altogether call for amultifaceted response. The video was distributed wide-ly to donors and throughout Africa.
On an inter-agency level, WHO advocates for healthin crises in the Inter-Agency Standing Committee (IASC)and its reference bodies dealing with human rights, gen-der, the consequences of sanctions, training, informa-tion and communication technology, transition, financingand the protection of civilians in armed conflicts.
In Europe, WHO/EHA advisers at regional andcountry levels, in Albania, Russia, Serbia Montenegro,the Former Yugoslav Republic of Macedonia (FYRM),and the UN administered province of Kosovo activelypromoted health in humanitarian action by producingand disseminating Health Action. This newsletterinforms health practitioners, policy makers, other UNagencies and NGOs about health needs and humani-tarian programs. The success of the advocacy efforts ofthe WHO Office for Europe (EURO) in advocacy isreflected in the adoption of policies by numerousGovernments, such as the policy paper on communitybased mental health that was taken up in FYRM andAlbania.
EHA/EURO also chaired several health coordina-tion meetings involving Ministries of Health, UN agen-cies, and NGOs of the region. These meetings havebeen crucial in coordinating the work of humanitarianassistance projects in the health sector.
The WHO Office for the Eastern Mediter-ranean (EMRO) produces regular updates on the humanitarian and health situation of countries in cri-sis that are distributed to policy makers, NGO partners,the media and other interested parties. In 2002, partic-ular attention was given to Afghanistan: the WHOCountry Office issued press releases and regular healthupdates on priority health issues, including women’shealth, access to essential drugs and communicablediseases.
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In Sudan, WHO assisted the federal Ministry ofHealth (MoH) in developing a strategic plan for post-conflict health recovery and to organise a coordina-tion and reconstruction workshop. This processhelped to identify opportunities for health sector poli-cy reforms that have emerged in the new politicalcontext.
In the Americas, since the mid 1990s, the Pan-American Health Organization is promoting the con-cept of disaster-resistant health infrastructures andsystems. 2002 saw more successes of these efforts.In Honduras, the Secretary of Health invested in mit-igation measures against floods; in El Salvador, theMinistry of Health created an office to oversee con-struction of new hospitals and refitting of damagedhospitals. Colombia is preparing legal norms for theimplementation of disaster mitigation in hospitals;Chile established procedures for vulnerability studiesand Ecuador defined terms of reference for vulnera-bility analyses.
A hospital design seminar that took place inBarbados in September was a significant step for-ward, as it helped experts to exchange informationand knowledge on disaster mitigation against hurri-canes and high winds. Following this event, the BritishVirgin Islands, St. Lucia and St. Kitts indicated theirintention to incorporate mitigation measures into thedesign and construction of new health facilities.
Advocacy for public health action in emergencies inthe African Regional Office (AFRO) gained sub-stantially from the creation of a regional EHA web sitewhich now provides decision makers, donors, health
workers and other partners with valuable tools, guide-lines and public health intelligence for countries in cri-sis. EHA AFRO disseminated regular health updates todonors, NGOs, and Ministries of Health.
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Health under difficult circumstances
Major progress in the area of policy setting wasachieved in EMRO, where during the Regional Committeein September 2002, the Ministers of Health of all membercountries adopted a resolution on health under difficult cir-cumstances, thus showing their strong commitment toinclude emergency preparedness and humanitarian actioninto health planning.
Supporting the peace process in Sudan
WHO prepared a study of the Health Sector in Sudan,a strategic framework for recovery in support of the peaceprocess. The document analyses the main features of thehealth system within a changing political environement,identifies the new challenges confronting health playersand, on this base, presents a framework for the healthsector in post-conflict transition.
Advocacy starts with Education
WHO continues to strongly advocate for and educatehealth workers and the population at large on myths andrealities in the event of natural disasters
MYTH: Foreign medical volunteers with any kind ofmedical background are needed.
REALITY: The local population almost always coversimmediate lifesaving needs. Only medical personnel withskills that are not available in the affected country may beneeded.
MYTH: Any kind of international assistance is needed,and it's needed now!
REALITY: Hasty response that is not based on animpartial evaluation only contributes to the chaos. It is bet-ter to wait until genuine needs have been assessed.
MYTH: Epidemics and plagues are inevitable afterevery disaster.
REALITY: Epidemics do not spontaneously occurafter a disaster and dead bodies will not lead to cata-strophic outbreaks of exotic diseases. The key to prevent-ing disease is to improve sanitary conditions and educatethe public.
MYTH: Disasters bring out the worst in human behav-iour.
REALITY: Although isolated cases of antisocial behav-iour exist, the majority of people respond spontaneouslyand generously.
MYTH: The affected population is too shocked andhelpless to take responsibility for their own survival.
REALITY: On the contrary, many find new strengthduring an emergency, as evidenced by the thousands ofvolunteers who spontaneously united to sift through therubble in search of victims after the 1985 Mexico Cityearthquake.
MYTH: Disasters are random killers.REALITY: Disasters strike hardest at the most vulner-
able group, the poor --especially women, children and theelderly.
MYTH: Locating disaster victims in temporary settle-ments is the best alternative.
REALITY: It should be the last alternative. Many agen-cies use funds normally spent for tents to purchase build-ing materials, tools, and other construction-related sup-port in the affected country.
MYTH: Things are back to normal within a few weeks. REALITY: The effects of a disaster last a long time.
Disaster-affected countries deplete much of their financialand material resources in the immediate post-impactphase. Successful relief programs gear their operations tothe fact that international interest wanes as needs andshortages become more pressing.
Source: http://www.paho.org/english/ped/myths.htm
The Regional Office for South East Asia(SEARO) advocated for health in crises through theConsolidated Appeal Process (CAP). In the CAP forthe Democratic People’s Republic of Korea (DPRK),for example, different UN agencies working in the
health sector jointly analyzed the situation, identifiedissues and set priorities. The appeal was distributedto donor Governments, a broad range of healthactors, and to the media. Another example for thiskind of advocacy was the CAP for Sri Lanka whichstrongly advocated for the population’s health needs.SEARO also widely disseminated the Proposal forRecovery of the Health System of North and East SriLanka which outlines the humanitarian and rehabilita-tion needs for the war affected population in theNorth East of the country.
Meanwhile, the EHA team in India completed anemergency health profile for the country. The profileraised awareness of the national and regional author-ities and donor Governments on India's vulnerabilityand risk factors, and was also a major advocacy toolto stress the importance of preparedness andprompt humanitarian health action.
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Milestones
A milestone in the history of inter-agency humanitarianadvocacy was the creation of the Regional Inter-AgencyCoordinating Support Office (RIACSO) in Johannesburg,tasked with strengthening the common humanitarianresponse to the crisis that is affecting Southern Africa.RIACSO was jointly established by WHO, WFD, UNICEF,UNHCR, FAO and UNDP. Apart from ensuring coherenceand coordination among UN programs and specializedagencies, RIACSO effectively produced a much greaterpublic awareness on the Southern Africa crisis. WHO’sspecific contribution to RIACSO is to emphasize the healthdimension of the crisis, to ensure that local health systemsare preserved, and that humanitarian and developmentworks remain integrated across the region.
Expected Result: Reliable, independent
and timely public healthinformation produced and
promoted for decision-making and resource
allocation at national andinternational levels
Through EHA, WHO delivers public health infor-mation and tools for situation analysis and healthintelligence. The EHA web site is updated daily withcountry and emergency specific information gath-ered through Regional and Country Offices and part-ners. Technical guidelines and tools for public healthanalysis and decision-making are posted to assistpublic health professionals, policy makers anddonors. In 2002, postings of documents on the website more than doubled as compared to 2001. EHAalso expanded the scope, size and distribution of itsquarterly newsletter, Health in Emergencies, highlight-ing issues under debate in the humanitarian commu-nity and including input from NGOs, UN agencies,and academic institutions. Issues in 2002 focusedon mental health, countries in transition, logistics andemergency health intelligence. As a result of thesechanges, the editing team received positive feed-back and a substantial increase in subscriptionrequests.
Through EHA, every year, WHO collaborates withthe UN Standing Committee on Nutrition in an analy-sis of mortality and nutrition data from selected coun-tries in crisis. WHO is also a member of theStandardised Monitoring and Assessment of Reliefand Transition (SMART), an inter-agency initiative toimprove monitoring and evaluation of humanitarianassistance. As part of the Inter Agency StandingCommittee (IASC) Working Group on the CAP, EHAworked to improve guidelines for needs assess-ments in health and participated in the ODI needsassessment.
The provision of reliable and swift informationcounts among the core priorities of EHA/EURO.During 2002, EURO introduced in Albania, Kosovoand Serbia Montenegro ALERT, a system to improvethe detection of disease outbreaks, shorten the delayin reporting and to increase the capacity of the refer-ence laboratories to confirm cases and identifycausative agents. In the near future, ALERT will beintroduced in FYROM, and then efforts will be under-taken to involve more countries.
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Introducing ALERT
Training sessions on methodology and software wereorganized for epidemiologists and for primary care physi-cians working on surveillance. Laboratories were equippedwith supplies for confirmation of microbiological agentscausing outbreaks.
During 2002, EMRO put particular emphasis onimproving the exchange of health information oncomplex emergencies. This was facilitated bydesigning an EHA regional intranet and a web site topublicize WHO knowledge and expertise. In additionto that, EMRO also carried out public informationactivities and disseminated timely and relevant healthinformation to regional print and audiovisual media.
The EHA team in EMRO conducted rapid assess-ments in Iran, Syria and Jordan to evaluate theregion’s preparedness for the Iraq crisis. InAfghanistan, WHO undertook a nutritional assess-ment, as well as assessments on pertussis andcholera outbreaks. EMRO also developed vulnerabil-ity and disease profiles for Member States in crisisthat were disseminated to health care providers anddecision makers.
In the Americas, the Regional Disaster InformationCenter (CRID) for Latin America and the Caribbeandeveloped a disaster information network in CentralAmerica, providing direct technical support andmaterial resources to seven health sector universitylibraries in Honduras, Nicaragua, and El Salvador.The direct benefits of these efforts include improvedInternet connection, intensive training of more than50 librarians and information specialists in the man-
agement and creation of electronic information serv-ices and technical support to the creation of websites, databases and techniques to promote theiruse.
In SEARO, WHO assisted the Indonesian Ministry ofHealth to establish an information system for emer-gency preparedness and early warning. To install thesystem, WHO and OCHA undertook a joint, independ-ent nation-wide assessment. Based on the analysis ofthe findings, they delivered an overview on the coun-try’s emergency preparedness. Recommendations tothe Government, donors and UN agencies includedthe need to strengthen collaboration and improveemergency management.
The EHA team in the Western Pacific RegionalOffice (WPRO) achieved considerable progress inenhancing the capacity for collecting and analyzingpublic health data on major emergencies in theregion as well as health assessment coordination incase of major emergencies. This was made possiblethrough increasing staff in the Regional Office and onthe Indochina peninsular thanks to funding from DfiD.One main feature of WPRO's work in this area in2002 was the establishment of a database includingover 1200 health emergency events that occurred inthe region from 1981 to 2000.
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Expected Result: Effective support provided
to the health sector of Member States to
institutionalise local capaci-ty to reduce vulnerability ofpeople and health facilitiesas well as prepare for and
act in emergencies
Disaster reduction counts among the core func-tions of Ministries of Health. It requires investing inpeople and institutions that, especially in developingcountries or in crisis situations, must be sustaineddespite competing priorities. For WHO this implies:a) supporting the development of human resources:training is an essential component of capacity build-ing; b) supporting institutional development, e.g.strengthening the disaster office/program in the MoHand/or supporting its decentralization; c) structuringthe Organization's country technical cooperation tointegrate responsiveness against crises as a corefunction of WHO Country Office 1.
Training provides opportunities to support bothMember States and international partners. In 2002,EHA conducted seven training events which includ-ed participants from a wide target audience. EHAtrained over 180 humanitarian workers from WHO,UN agencies, universities and donor Governementsin best public health practices in emergencies.Health as a Bridge for Peace workshops includedstaff from Country Offices and technical departmentsthroughout WHO. The workshops focused on how tosupport health workers in delivering health programsin conflict and post-conflict situations.
Program evaluation is essential in order to consis-tently improve performance in Member States.During 2002, EHA together with its partners fromdonor Governments, conducted program evaluationson program performance in the North Caucasus andthe Thai/Myanmar border. These evaluations illustratethe commitment of donors, WHO/HQ and theRegional Offices to improve the effectiveness ofhumanitarian response. The evaluation on NorthCaucasus is available on the EHA web site:http://www.who.int/disasters/repo/8676.pdf.
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“The program has provided substantial benefits to thevictims of the war in Ingushetia through the strengtheningof the capacity of humanitarian health actors: the Ministryof Health and NGOs in spite of some shortcomings at cor-porate level. The impact on the health situation inChechnya, although it could not be ascertained on site,definitely needs more attention from WHO and its part-ners.”
Review of WHO Humanitarian Programs in North Caucasus(Russian Federation)
24 October - 12 November 2002
EHA/EURO established technical and logisticpresence in the countries surrounding Afghanistan,including Uzbekistan, Tajikistan, and Turkmenistan. InUzbekistan and Tajikistan, Turkmenistan and Georgia,WHO established and equipped training centres andtrained more than 450 primary health care workers,as part of its long term development program fundedfrom the regular budget. In addition to that, staff ofWHO Country Offices and the Ministries of Health inMember States were sent abroad to receive trainingon emergency preparedness and response, coordi-nation and health care reform. Training opportunitieswill be expanded in the coming years.
In the UN administered province of Kosovo, theauthorities adopted WHO’s proposed Strategy Planfor Mental Health. WHO also carried out an evalua-tion of its operations in Kosovo during 1999-2000.The report is available at http://www.who.int/disas-ters/repo/9938.pdf
In the Russian Federation, a country that is highlyvulnerable to natural and man made disasters, WHOis closely cooperating in the area of disaster medicinewith the Collaborating Centre Zaschita. WHO estab-lished collaboration of Zaschita with countries of theNewly Independent States, including Kyrgysztan andTajikistan.
In the Eastern Mediterranean Region, EHA’soperational capacity was expanded by establishingnew focal points in Sudan and in Somalia. Additionalstaff was recruited to strengthen the capacity ofalready existing EHA focal points.
WHO provided New Emergency Health Kits andTrauma Kits 2 and other humanitarian relief toAfghanistan, Pakistan, the Islamic Republic of Iran,the Syrian Arab Republic, Djibouti, Sudan, andSomalia.
In 2002, major attention was given to Afghanistan.EMRO deployed technical expertise to the Ministry ofHealth and contributed to the rehabilitation of variousacademic institutions, health facilities, and laboratorynetworks. Also, Afghan health officials workedtogether with health staff from Pakistan to collect andanalyze information on diseases. In addition, Afghanhealth professionals received training in Pakistan,Syria and Egypt.
WHO was instrumental in developingAfghanistan's health sector, paying special attentionto the issues considered crucial to the developmentof a reconstruction strategy, offering to stakeholdersgrounds for informed decisions. Moreover, WHOdeveloped a Basic Package of Health Services toguide the country in rebuilding essential health inter-ventions that can guarantee universal coveragethrough continued external funding.
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2 An Emergency Health Kit is one ton of essential drugs, sup-plies and instruments, sufficient to support the basic healthneeds of 10’000 people for three months; a trauma kit includessurgical material, medication and anaesthesia for 100 surgicaloperations.
Training for Preparedness
In 2002, 30 professionals were trained in concepts ofemergency preparedness and response in national andinternational courses. WHO ran a number of training oftrainers courses for officials of the Ministry of Health, localhealth authorities, NGOs and WHO staff in Sudan, Somaliaand Afghanistan. The training courses addressed publichealth management in emergencies. In order to increasethe resiliance of health systems in countries bordering withcountries in crisis, EMRO also supported the transfer ofknowledge and skills between Afghanistan, Pakistan andIran during the Afghanistan crisis. Mechanisms for crossborder support and coordination of health activities wereput in place, e.g. medical supplies for Afghanistan werewarehoused in Pakistan.
Operations and Kits sent in 2002
Total number of operations: 54Total number of kits sent: 1’561 kits,
weight: 732tons,volume: 3360 m3
• operations via EHA / number of kits: 12 / 222 kits• operations for WHO paid by the Italian Ministry of
Foreign Affairs / number of kits: 4 / 62 kits• operations for MOFA / number of kits: 9 / 83 kits• operations related to Afghanistan crisis
number of kits: 33 / 1174 kits
Significant progress was achieved in Somalia.Despite the peace process the country remains frag-mented, and the South is still a conflict zone.Currently, there are more than 350,000 InternallyDisplaced People (IDPs) and about 400,000refugees abroad. In an effort to start the rehabilitationprocess of the health sector, WHO brought togetherthe respective national authorities from variousregions to discuss critical health issues and needs.WHO established an early warning system to controland respond to disease outbreaks. Furthermore,WHO actively supported immunization campaigns,strengthened essential health services, such as TBcontrol, and counteracted the brain drain of skilledhealth personnel by offering local training opportuni-ties and fellowships.
Sudan is experiencing a fast transition and WHOis assisting the country to respond to the new needsand challenges. In 2002, WHO contributed to the
health component of the CAP, elaborated a frame-work for transition and post-war reconstruction, anddeveloped the Country Cooperation Strategy (CCS)for 2003-2007. The CCS presents a strategic agen-da for WHO’s work in Sudan and takes into accountthe new realities prevailing in the country after theMachakos protocol of July 2002 and subsequentagreements signed by the two conflicting parties inpreparation for a peace settlement.
Also in 2002, EHA/HQ and EMRO began contin-gency planning for a potential crisis in Iraq, in collatingand compiling essential background information fromhealth assessments and studies/reviews, identifyingpossible responses according to various scenarios.This preparatory work proved to be very useful as thecrisis unfolded.
In the Americas, approximately 250 health pro-fessionals from Ecuador, Bolivia, Argentina, Peru,Venezuela, Colombia, and Chile received training inhospital disaster planning, public health in majordisasters, health damage and needs assessment,and management of hazardous substances. TwoLIDERES courses were held in 2002, in Argentinaand in Mexico, providing health managers from thepublic and private sectors with knowledge and skillsto manage disaster programs in the Americas.
During the emergencies that occurred in 2002,such as floods and the volcanic eruption in Ecuador,mudslides and floods in Bolivia, Chile and Peru, thehealth sector responded with improved technical cri-teria that resulted in better outcomes in terms ofimmediate relief and prompter reactivation of caredelivery. Honduras was a good specific example ofthe value of the capacity building conducted byPAHO/WHO for the past thirty years. A number ofsmall emergencies struck Honduras in 2002. Whilevirtually none made news headlines outside the
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The Basic Package of Health Services for Afghanistan
• Maternal and newborn health: - Antenatal care -Delivery care - Postpartum care - Family planning -Care of newborn
• Child health immunization: - EPI services (routine andoutreach - Integrated management of childhood illnessesNutrition: - Micronutritient supplementation - Treatement of clinical malnutrition
• Communicable Diseases: - Control of Tuberculosis - Control of Malaria
• Mental Health: - Community management of mentalproblems - Health facility based treatement of outpa-tients and inpatients
• Disability: - Physiotherapy integrated in the PHC serv-ices - Orthopaedic services expand to hospital level
• Supply of essential drugs
The Horn of Africa
A cross-border action plan for the Horn of AfricaInitiative (HOAI) was adopted and a coordination team wasset up. The HOAI addresses the needs of public healthsystems in the border areas of Djibouti, Kenya, Eritrea,Ethiopia, Somalia, Sudan ans Uganda.
In July 2001, an Inter-Regional Meeting had been heldin Nairobi to map out the future directions of the Initiative.Participants included the WHO Representatives from theparticipating HOAI countries, representatives from EHA inthe country office in Ethiopia, AFRO, EMRO, HQ and theItalian Istituto Superiore di Sanità (ISS).
In 2002, WHO started to increase activities in areasthat have already benefited from the Initiative in the past.By focusing on issues related to early warning, communi-ty emergency preparedness and response, food security,conflict mitigation and peace-building, the Initiative isexpected to foster a shift from humanitarian relief worktowards rehabilitation and development.
Focal Points play key role in Emergency Response
PAHO disaster focal points who serve as member ofthe Caribbean Disaster Response Team received trainingand technical guidance to improve their capacity to assistdisaster-affected countries. The performance of PAHO’sdisaster focal point in Jamaica following tropical storm Lilidemonstrated the effectiveness of this strategy. Supportfor rapid assessment teams and arrangements for hiringlocal officials were well organized and liaison with otherinternational agencies was facilitated. The positive resultsof these efforts included rapid mobilisation and delivery ofsupplies to meet needs in the water sector and motivatingother UN agencies to support response efforts.
country, an analysis of events following these emer-gencies demonstrated the impact of training andawareness building activities.
The scene in the African Region was dominat-ed by the crises in Southern Africa, West Africa andin Ethiopia.
In West Africa, fighting in Liberia and the end of theconflict between Sierra Leone and Guinea triggeredmass population movements in the region that con-tinued until August 2002. Then, in September 2002,the conflict in Côte d’Ivoire generated new massmovements of people to neighbouring Liberia,Guinea, Burkina Faso, Mali and Ghana. WHO'scapacity in the sub-region was reinforced. One inter-national and one national professional staff wererecruited at the Regional Support Office inKissidougou, Guinea, to assist in various tasks relat-ed to the management of IDPs and other vulnerablegroups. EHA/AFRO provided technical support toMali and Burkina Faso through rapid health assess-ments and contingency planning.
In Ethiopia, due to the past conflict with Eritrea andrecurrent droughts, the majority of health institutionsin rural areas are still weak. Meanwhile, HIV/AIDS isemerging as a major health problem. In December2002, around 12 million people were affected bydrought and major population displacements tookplace. The top causes of morbidity among refugeesand Internally Displaced Persons are malaria, acuterespiratory infections, intestinal and diarrhoeal diseases. WHO/EHA played a vital role in ensuringdisease control, surveillance and response. TheOrganization was involved in the training of healthworkers, assisted the expanded program on immu-nization and strengthened laboratory services in con-flict and drought affected areas. Thanks to fundingfrom the Netherlands, WHO also shipped 164 emer-gency health kits to Ethiopia for immediate relief.
Strengthening institutional capacity was a high pri-ority in the Region. AFRO trained EHA focal points in43 countries, both at the Ministry of Health and atWHO Country Offices. The training focused on build-ing knowledge and skills for improved preparednessand response for emergencies, as well as enhancedinter-agency coordination.
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Managing crises in Honduras, 2002
• The SUMA system was installed in the Ministry ofHealth Emergency Operation Center.
• 600 persons in 30 communities in Honduras who hadreceived training demonstrated their capacities to reactquickly during the tidal wave that struck Cedeno,Choluteca.
• Communities affected by drought have included theconcept of risk management in their food security andnutrition plans.
• A communication network was installed in 11 commu-nity health centers in southern Honduras, linkingtogether the Ministry of Health and area hospitals andstrengthening communications in this area.
• Two health situation rooms were set up in the depart-ments of Valle e Choluteca for disease surveillance inthe aftermath of disasters.
Southern Africa: responding to the unfolding ofdevelopment
In Southern Africa, WHO called for a response strategythat takes into account the impact of poverty, failing socialsectors as well as the HIV/AIDS pandemic. WHO establishedan inter-country technical team in Harare composed of anemergency health coordinator, an epidemiologist and a nutri-tionist. Immediate health actions of all WHO country officesin the region included assessments, monitoring and analysisof the health situation and needs. WHO technical programswere reprogrammed from their longer term perspectivetowards more immediate and medium term activities. WHOparticipated in the inter-agency meetings on refining the vul-nerability assessment tools, and adapted a rapid healthassessment tool which is now piloted in Zambia.
Altogether, WHO/AFRO allocated about 50% of itsregular budget to assist countries in crisis, and sup-ported Member States by enhancing their capacity toprepare for emergencies. AFRO advanced instrengthening WHO as leader in emergency pre-paredness and response for health. As a first step inthis direction, a framework for vulnerability assess-ments was adopted and a group of consultantstrained to take this forward. In addition to that, partic-ular emphasis was put on hospital emergency plan-ning and the creation of strong community basedhealth programs as a means of reducing vulnerabilityto disasters.
In South East Asia, in 2002 WHO substantiallyincreased the presence of EHA focal points at coun-try level. Focal points were appointed in the Ministriesof Health of India, Indonesia, Sri Lanka, Thailand,Timor Leste, Myanmar and Nepal. A part time FocalPoint was recruited in the Ministry of Health inBangladesh. The establishment of a strong networkof focal points who collaborate directly with the des-ignated EHA officers in WHO offices greatlyenhanced the countries' capacity to prepare for andto respond to emergencies. The ministerial FocalPoints were trained on public health management inemergency situations, as part of the inter-regionalPHEMAP courses that were developed by WPROand SEARO in collaboration with the Asian DisasterPreparedness Center.
Major progress was noted in Indonesia. The coun-try has an enormous potential for natural and manmade disasters. In addition to that, civil upheavalsdue to political, religious and ethnic differences con-tinue to destabilize the country. Several crises areongoing in the Malukus, West Timor, Aceh, Irian Jaya,Central Sulawesi and Kalimantan provinces. They arenot linked to each other but have a severe cumulativeimpact on the country at large. Therefore, emergencypreparedness and response constitutes a substantialpart of WHO’s technical work in Indonesia. In 2002,besides focusing on health relief and contingencyplanning, WHO also assisted the Government instrengthening emergency preparedness though theimplementation of a strategic approach that empha-sized the need for long term preparedness of the pop-ulation and health workers.
Another priority on the SEARO agenda in 2002was the post conflict rehabilitation and reconstructionof the public health programs and infrastructure in SriLanka. As designated lead agency for health coordi-nation, and in partnership with other UN agenciesand NGOs, WHO assisted the Government tostrengthen the health system to meet the short termneeds of the population and to initiate long termrecovery strategies.
Another country highly vulnerable to natural disas-ter, such as earthquakes, floods and landslides, isNepal. In addition, the country faces social and polit-ical conflicts involving IDPs. WHO set in motion a col-laborative health sector emergency plan with theDisaster Health Working Group 3 and theEpidemiology & Disease Control Division of theMinistry of Health. In 2002, more than 600 healthsector staff were trained in mass casualty manage-ment through various modalities such as computersimulations, desk-top exercises, and real life exercis-es, including role plays. Health sector staff alsoreceived training in structural and non-structural vul-nerability assessments of hospitals.
In November 2002, the EHA program in WPROconducted an inter-country workshop on healthemergency and disaster management in collabora-tion with the Ministry of Health of Papua New Guineain Madang. National health officials of Fiji, Papua NewGuinea (PNG), Solomon Islands and Vanuatu, provin-
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Inter-Regional Collaboration in Bangkok
EHA/SEARO and EHA/WPRO held two Inter-RegionalCourses on Public Health and Emergency Management(PHEMAP) with outstanding success. The training courseswere conceived for the two WHO regions and took placein the Asian Disaster Preparedness Center (ADPC) inBangkok. The first was carried out in March 2002 withfinancial support of the Japan International Corporation ofWelfare Services (JICWELS). The second took place inOctober and was organized with financial support ofEHA/WPRO. As a result of these two courses, nationalcourses on Public Health and Emergency Managementare now planned for India, Myanmar, the Philippines andLaos.
The PHEMAP course is the first ever international trainigcourse dealing with public health issues in the context of nat-ural and man-made disasters. Responding to the need for acomprehensive training program for Ministries of Health toenhance their capacities in providing a coherent response toan emergency, the course was conceived specifically for pol-icy makers. PHEMAP courses are adapted to all levels of aMinistry, ranging from national directors to district medicalofficers. The agenda covers a wide spectrum of public healthproblems ministries face during natural and man-made dis-asters. They include policy management, organizational andtechnical issues.
3 The Disaster Health Working Group includes representativesfrom different organizations and sectors (public, private and mil-itary) who work in the health arena.
cial health staff of PNG and other major health part-ners reviewed health emergency management inMelanesia and proposed a plan of action.
EHA/WPRO delivered health relief to communitiesof the Solomon Islands who had to be evacuated tobe protected from civil strife. In collaboration withseveral departments of the Regional Office, medicalsupplies and equipment for emergency health sup-port were quickly procured and delivered.
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Expected Result: Alliances, at national
and international levels,involving local health
systems, UN agencies,NGOs and other partners
to reduce the vulnerability,provide effective health
humanitarian assistanceand promote transparency
and accountability
Donor support is critical for WHO’s work in emer-gencies around the world. It is encouraging to seegrowing awareness in Member States of the need toinvest more resources into the Organization's ownpreparedness and readiness.
In 2002 the policy of regular dialogue to strength-en relationships with donors continued - in Geneva,as well as in other places. For example, an EHAMedical Liaison Officer was posted in Brussels at theWHO Liaison Office with the European Union.
CAP, Flash Appeals and related processes con-tinue to be the most effective instrument for buildingpartnerships in humanitarian action. WHO, throughEHA, supported country level humanitarian actionplanning by facilitating three CAP field workshops,including Burundi, Sierra Leone and the Great LakesRegion. EHA also strengthened international partner-ships as an active member of the Active LearningNetwork for Accountability and Performance inHumanitarian Action (ALNAP) which is an internation-al, inter-agency forum working to improve learning,accountability and quality across the humanitariansector. Furthermore, in collaboration with theHumanitarian Accountability Project, EHA convenedin Geneva a group of experts to discuss and devel-op recommendations on ethics in humanitarianaction.
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UKOthers
Canada
USA
Italy
Norway
Sweden
Kuwait
RoK**
**Republic of Korea
BelgiumEAR*
*European Agency for Reconstruction
ECHO
EuropAid
OCHA
Contributions to WHO activities for Emergency Preparedness and Response
by donor country 2002 (USD)
WHO collaborates with the International Strategyfor Disaster Reduction (ISDR) and other initiatives.WHO actively participates in IASC subsidiary bodiesdealing with humanitarian accountability, HIV/AIDS inemergency settings, engagement with armedgroups, humanitarian interface with military and polit-ical actors, forgotten emergencies, inter-agency pre-paredness, contingency planning, effective use ofemergency response capacities, preparedness andresponse to natural disasters and staff security. WHOcontinues to strive towards improving the CAP andstrengthening the linkages with humanitarian coordi-nators.
In the European Region, WHO collaborated withintergovernmental and UN agencies, in particularthrough the Common Country Assessment (CCA) 4
and the UNDAF 5, with significant benefits for coun-tries in the area of health.
In 2002, the joint Rapid Health Assessments andResponse, conducted in the conflict areas of FRYMand in the flooded areas in Albania, were clear exam-ples of partnership among different agencies workingtogether on health during emergency situations.
Good inter-agency collaboration in the EuropeanRegion was also achieved in the framework of theCAP, where WHO coordinated health sector require-ments for all consolidated appeals covering Europeand Central Asia. Among WHO's successes countsthe CAP Northern Caucasus: donors funded 100%of the proposed health activities. CAPs for othercountries received less attention, but considerableamounts of money were raised.
The CAP also played a major role in the EasternMediterranean Region. Joint analysis of the health sit-uation, identification of needs and implementation ofindividual public health interventions contributed tostrengthening local, regional and global partnerships.WHO sustained its good working relationships with
various local authorities, NGOs, self-help groups andother UN agencies to enhance effective coordinationof humanitarian and health assistance. InAfghanistan, WHO formulated the health componentof two appeals: the Program for Immediate andTransitional Assistance (ITAP), and the TransitionalAssistance Program Assistance (TAPA). The appealsstressed the key role of health in the overall humani-tarian context and served as important advocacy andcoordinating tools.
In the Americas, the System for the Managementof Humanitarian Supplies (SUMA) marked its tenthanniversary in 2002. During the last decade, the proj-ect has trained more than 3000 persons to use thesoftware and the system methodology. SUMA’seffectiveness as a management tool is now widelyrecognized. A new release of the SUMA softwarewas launched officially in October 2002, and is avail-able on SUMA’s web site http://www.disaster-info.net/SUMA/index.html and on CD-ROM. Thenew version represents several years of efforts tocapture and incorporate users’ experiences andneeds, in addition to substantial technical improve-ments for the registration of humanitarian donations indisaster situations.
A Memorandum of Understanding (MOU) wassigned by PAHO and the World Food Program(WFP), allowing WFP to use PAHO’s institutionalcapacities in areas where WFP does not have anyexisting assets. The MOU was applied in 2002 dur-ing simulation exercises to prepare for emergencies.WFP representatives were able to role play the use ofPAHO facilities in the Caribbean to simulate the deliv-ery of humanitarian assistance to countries affectedby emergencies.
Also in 2002, WHO and WFP signed a TechnicalAgreement at global level, for logistics cooperation tofurther enhance collaboration in the area of opera-
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4 CCA: The Common Country Assessment is a country-basedprocess reviewing and analysing the national development situ-ation and identifying key issues as a basis for advocacy and pol-icy dialogue and preparation.5 UNDAF: The United Nations Development AssistanceFramework is the planning framework for the developmentoperations of the UN system at country level. It consists of com-mon objectives and strategies of cooperation, identified with theCountry Common Assessment (CCA, see above), a programresources framework and proposal for follow-up, monitoringand evaluation. The UNDAF lays the foundation for cooperationwithin the UN system, government and other development part-ners through the preparation of a complementary set of pro-grams and projects.
Coordination for improved Logistics
The Global Logistic Support Systems Initiative (LSS),brought forward by WFP, WHO, OCHA, UNICEF andUNHCR is based on the SUMA model in the Americas. Itproposes a three year project to redesign the software toserve as a common logistical support system for inter-agency coordination and to develop local capacitiy inselected pilot countries. So far, no funding has beenreceived for these activities. However, the cohesion andsolidarity of the sponsoring agencies in support of the con-cept is encouraging.
tional planning and implementation. This will allowboth organizations to rationalize the use of logisticsinfrastructure, as well as to maximize the use of avail-able resources and to increase the overall efficiencyof their operations.
In the African Region, WHO contributed to thehealth sector component of the CAP for 2003 whichwas launched in November 2002. The CAP includesAngola, Burundi, Côte d’Ivoire and the West Africasub-region, Democratic Republic of Congo, Eritrea,Ethiopia, Great Lakes Region and Central Africa,Guinea, Liberia, Republic of Congo, Sierra Leone,Somalia, Southern Africa Region and Uganda. Aspart of a wide inter-agency effort, WHO sent threefacilitators to Burundi, Sierra Leone and the GreatLakes Region to conduct CAP workshops. In 2002WHO noticed great interest and significant atten-dance from donors and NGOs. In West Africa, WHOassisted UNICEF to run a training course on SUMAfor logisticians.
In South East Asia, WHO’s new Country Office inDemocratic People’s Republic of Korea (DPRK) pro-vided outstanding leadership in preparing the healthcomponents of the 2002 CAP. Donors funded 34%of the proposed projects. WHO’s proposed inter-ventions included strengthening of community healthservices, the fight against tuberculosis, provision ofessential drugs, and surveillance and control of com-municable diseases.
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Earthquake Mitigation in the Americas
PAHO has a long history of collaboration with Peru’sEarthquake Mitigation Center (CISMID), an excellent multi-sector source of regional training in this field. in 2002, thecourse focused on microzonification for disaster preven-tion in water and sanitation systems. This new focus onthe health sector, traditionally the realm of engineers, willallow the participants to multiply this knowledge through-out Latin America and the Carribean and is expected inincreased requests for PAHO’s technical cooperation fromthose countries who sent participants to the course. It isalso expected that health will continue to be a major com-ponent of future CISMID training activities.
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Expected Result: Greater leadership
of WHO in coordination of international health disaster reduction and
response efforts
Emergencies are characterised by fluid informa-tion, shifting operational priorities, often precariousmanagement structures and high turn over of staff.
In such circumstances, one key requirement forleadership is to formulate a vision that is wide enoughand a strategy that is articulate and flexible, as well aseasy to understand, so to accommodate frequentand fast changes in situations, priorities, mecha-nisms and people. Formulating strategies, buildingpartnerships and coordinating effective action requirespecific competencies that need to be nurtured.
In order to better integrate essential public healthconcerns in the humanitarian agenda, to share itsvision of emergencies and to strengthen partner-ships, WHO provided over 50 resource persons for international training on emergencies in 2002.These included the prestigious ICRC course onHealth Emergencies in Large Populations (HELP), UNcourses such as the training of the United NationsDisaster Assessment and Coordination (UNDAC)Teams, OCHA's Effective Field Coordination Training(EFCT), UN Civil Military Coordination Training, andworkshops for the CAP.
Furthermore, WHO collaborates with the UnitedNations Disaster Management Training Program. Ofparticular interest in 2002 was the development of amodule on man-made disasters and terrorism. EHAdeveloped training modules on ManagementPractice in Emergencies, Health and Human Rights inEmergencies, Learning for Field Coordination andPublic Health and Terrorism.
In the European Region, WHO and its partners setup specific inter-country mechanisms to improve theexchange of expertise, knowledge and equipment,the provision of technical support to project imple-mentation, and coordinated contingency planning.
WHO/EHA Induction Briefings
To reinforce WHO leadership in health and emergen-cies, in 2002, EHA provided specific training to over 60key field staff working in emergencies. The EHA InductionBriefings provide essential knowledge and skills for fieldwork in a crisis. The briefing sessions cover 1) WHO’sresponsibilties in emergencies; 2) Case studies based onthe participant’s experience; 3) Interactive panels andgroup work where participants become more familiar withwhat partners expect from WHO in the field and the tech-nical services that the organization can provide.Participants include WHO country representatives, EHAfocal points at country and regional levels, representativesfrom NGOs and bilateral donor agencies.
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Enhanced inter-country cooperation helped WHOoffices and Ministries of Health in Europe and CentralAsia to develop greater capacity to effectively pre-pare for and respond to disasters and crises.
In the Eastern Mediterranean Region, WHOdemonstrated leadership by assisting theGovernment of Afghanistan during its transition afterthe conflict. EMRO developed a National HealthPolicy, which serves as the basis for the rehabilitationof the health sector in Afghanistan and assists policymakers at the Ministry of Public Health.
PAHO/WHO played a key role in the Americas forMinistries of Health to take the leadership in nationaldisaster programs of their respective countries,notably Colombia, Peru, Ecuador and Bolivia. Inthese countries national disaster programs act asadvisers to highest-level authorities. Often these pro-grams also manage substantial resources. PAHO’sfocus on developing institutional capacity can becredited with these positive results since the pres-ence of a disaster program in the Ministry of Health ispart of PAHO’s programmatic strategy. In theCaribbean, the Allied Forces Humanitarian Exercise(FAHUM) provided important institutional capacitybuilding opportunities, especially for testing and eval-uating health sector and national plans. PAHO played
a key role in integrating the health sector into theseevents, where five islands tested their national disas-ter and health sector plans.
In the African Region WHO demonstrated leader-ship in coordinating the health sector in the SouthernAfrican crisis. WHO invited the Health Ministers of tenSouthern African countries to Harare to address themost urgent health needs. An action plan was devel-oped to ensure an effective health sector response.
In SEARO, at the end of 2002, WHO completedthe implementation of the project Health Coordinationat the Myanmar–Thailand Border. The health statusof migrants was assessed and needs were identified,health initiatives could be better coordinated and dis-tribution of health information was considerablyenhanced.
Evaluating WHO Experience on the Thai-MyanmarBorder
A joint WHO/DfiD review of WHO’s position and compar-ative advantage confirmed that WHO is best placed toimprove the health of migrants. The project which is fundedby DfiD, was launched in January 2001 for a two-year periodwith the objective to improve the health conditions of themigrant population.
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Expected Result: Availability of authoritative
and up-to-date scientificinformation on best healthpractices and policies for
disaster reduction andhumanitarian assistance
Through EHA, WHO selects, produces, consoli-dates and delivers best practices and tools for emer-gency preparedness and response through its website, newsletters, Emergency Health Learning Kits,technical guidelines, manuals and CDs. In 2002, inresponse to a request from the field, the EmergencyHealth Library Kit, a set of over 140 books on publichealth in emergencies, was translated into Russian.
During an emergency public health professionalsneed easily accessible tools and references. TheTools and References CD contains over 60 docu-ments including technical hazard sheets, templates,reports, forms, a bibliography and lists of useful websites. It was distributed to WHO Representatives andother public health professionals world-wide. TheEssentials for Emergencies booklet was also in greatdemand. This booklet was designed as a shorter ver-sion of the Handbook for Emergency FieldOperations and about 1500 were disseminated. Inan inter-agency context, EHA took part in the globalstudy on the participation of affected populations inhumanitarian aid.
From its Regional Office for Europe, WHO gener-ated a vast amount of scientific knowledge in 2002.Themes included communicable diseases, mentalhealth, pharmaceuticals, and health information sys-tems. A study on the Impact of Long-TermEmergency Situation on Mental Health in theChechen Republic was published by the WHO Officein the North Caucasus. The study was funded byWHO and conducted by the Moscow PsychiatricHospital. WHO’s North Caucasus office also pub-lished an Evaluation of WHO Projects on the
Desseminating Public Health Knowledge
Distributed in 200222 Emergency Health Learning Kits1433 Booklets: Essentials for Emergencies3014 CD-Rom: Health Library for Disasters
Revising SPHERE
WHO participated in the revision of the SphereMinimum Standards in Disaster Response handbook. Theminimum standards include indicators and guidance notesin five core sectors - water supply and sanitation, nutritionand food aid, shelter and site planning, and health servic-es. This handbook provides the esssential standards forthe emergency response which are used by providers ofhumanitarian assistance in the area of research.
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Communicable Disease Surveillance and ResponseSystem and on the Overall Coordination of Huma-nitarian Assistance to the Health Sector of theRepublic of Ingushetia.
The WHO office in the UN administered Provinceof Kosovo disseminated numerous major technicalpublications. Among the highlights figure Guidelinesto use Lot Quality Assessment Techniques to AssessPrimary Health Care Services; the Evaluation ofImmunization Services in Kosovo using the LotQuality Technique Overview of the Mental HealthSituation in Kosovo and activities of WHO MentalHealth Unit, as well as Guidelines on EssentialNewborn Care and Breastfeeding. All publicationsare available in English, Albanian and Serbian.
In Albania, WHO undertook an Evaluation of theAlbanian Communicable Diseases SurveillanceSystem. The findings were published in November2002. Also, a Base Manual on Diagnostic Micro-Biological Methods was published in Albanian, and a manual on Epidemiological Background of InfectiousDiseases in Albania 1996-2000 was printed in English.
Technical publications distributed in the EasternMediterranean Region focused on how to ensurehealth standards in emergencies. EMRO also trans-lated a number of guidelines from English intoPashtun and Dari and made them available to a largenumber of health staff in Afghanistan.
A significant amount of training material was devel-oped in 2002 in the Americas to strengthen theRegion’s efforts to reduce the vulnerability of healthand health-related facilities. PAHO/AMRO alsoexpanded its strategic use of information technology todistribute technical, training and advocacy materialmore effectively and to create greater awareness ofhealth issues in emergencies. Currently, all AMROpublications, as well as the complete collection of
newsletters are available electronically, on CD-ROMand on the Internet. Feedback from users on theadvantages of the use of information technologystresses that it has become much easier for them tolocally reproduce and adapt materials to their needs. Itwas also highlighted that CD-ROMs permit distributionof materials to regions lacking easy access to theInternet.
Inter-regional knowledge exchange was actively pro-moted by SEARO when translating and distributingPAHO training material at the two PHEMAP courses inThailand. PAHO’s SUMA software and the emergencyhealth library were also presented at the PHEMAPcourse. In addition to that, WHO Nepal developed andpublished a training manual on mass casualty manage-ment, as well as a training guide on structural and non-structural vulnerability assessments.
In the Western Pacific Region, in 2002, WPROdeveloped an Emergency Response Manual. TheWHO publication Community Emergency Prepared-ness: a Manual for Managers and Policy-Makers wastranslated into Chinese and distributed. In Cambodia,WHO developed and published a Khmer version ofRapid Health Assessment Protocols for Emergen-cies. The PAHO publication Natural Disasters:Protecting the Public’s Health was translated intoKhmer, and distributed to districts in Cambodia.
PAHO/PED most recent publications
Recognizing that it is critical that water and sanitationsystems remain functional in the aftermath of disasters,the Economic Commission for Latin America and theCaribbean (ECLAC), and PAHO developed new modulesand updated existing training material on health, water and sanitation for the Guide for Evaluating the Socio-Economic and Environmental Effects of Disasters. Thetechnical output in 2002 was substantial and multifaceted.Highlights include guidelines on Emergency and Disasteron Drinking Water Supply and Sewerage Systems, a pub-lication on Volcanoes: Protecting the Public’s Health and atraining course on how to handle the impact of chemicalaccidents.
The WPRO Emergency Response Manual
This manual is intended to help WHO staff in theWestern Pacific Region to respond effectively and effi-ciently to emergency situations which impact on people’shealth and on health services. The manual focuses on pre-paredness and response to emergencies that are com-mon in the WPR region, i.e. natural and technological dis-asters.
It provides fact sheets and check-lists on:• How to assist the Government and the international
community in assessing and responding to publichealth needs in different types of situation;
• How WHO country offices should be prepared to beready to respond when needed;
• Best public health practice in emergencies;• Actions to be taken to facilitate appropriate WHO
action and support to local responses.
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CONCLUSIONS WHO’s greatest asset is having well organized and
timely public health information, the capacity to ana-
lyze its implications and the expertise to tell others
how to use it.
WHO works constantly to improve the processes
aimed at bringing this asset to bear benefits for those
most in need. In this, WHO's decentralized structure
can provide the most appropriate channels. WHO
has about 150 Country Offices worldwide and evi-
dence is that every year one out of five WHO offices
must face an emergency. It is in the Country Office
that WHO's responsibilities for health in crisis start:
national and international staff at field level must be
safe and prepared to carry out their work for the
health of the people - even in the most difficult and
unexpected circumstances.
Emergencies can happen anywhere, and when-
ever they happen they are everybody's priority. WHO
Country Offices are the frontline of the Organization
and are responsible for implementing the most
appropriate response within a strategy agreed and
coordinated with the other health partners at field
level and with the other levels of the Organization.
The primary support to WHO offices in countries in
crisis comes from the Regional Office (RO). The
RO/EHA facility should have the capacity to recruit
experts rapidly, to purchase vital items speedily, to
provide country-based epidemiological intelligence,
to respond to logistics difficulties and to share data
promptly with the rest of WHO.
The EHA facility at Headquarters (HQ) supports
Regional Offices as and when requested, undertakes
advocacy with concerned partners and raises funds
in ways that respect, and respond to, the needs
expressed by the WHO Country Office and do not
bypass the Regional Offices.
In order to ensure a well coordinated and timely
emergency response, it is indispensable to have a
common understanding at all levels of the
Organization about each crisis. All are kept up to date
with changes so that this understanding remains rel-
evant, credible and of high quality. To this end, we
maintain regular communications across all levels
and departments of WHO. We react rapidly while
bearing in mind the importance of respecting proce-
dures and protocols.
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THE CHALLENGES In 2002, we faced a crisis of "unfolding develop-ment" in Southern Africa. We assisted Afghanistanduring the crisis in a context of extreme poverty. Weworked in the Balkans in critical environmentsmarked by extreme mistrust. We assisted WestAfrica in a severe crisis that had been forgotten bythe media and donors.
If a country is in crisis, this usually means thatnational and local health systems are not able to pro-vide the services people need. As a UN specializedagency, WHO works with national authorities andpublic, voluntary and private actors who work withthem, promoting sustained improvements in healthand well-being. Our Country and Regional Officesare geared to working on crises prevention,response, long-term health policy and programissues.
So when public health is threatened by an excep-tional situation, WHO has to initiate exceptional actionfor health. This calls for reorientation from develop-ment work to a crisis-mode, especially when there ismajor violent conflict. There will be settings whereviews of the causes and features of the crisis will dif-fer according to the perspectives of national andexternal actors. But WHO is not alone in having toface these dilemmas: we must work more closelywith the UN and improve our collaboration with agen-cies that seek to respond to the crisis. At all times werespect the humanitarian principles of impartiality andneutrality, while working with authorities responsiblefor health systems in our Member States.
The work ahead
Based on these reflections, what are the practical impli-cations for 2003 onwards?
We will further develop the WHO-wide, standard pro-cedures for crisis operations.
For future crisis we plan to develop:
• a WHO-wide strategy, with preparedness milestonesand quality standards;
• an operational plan that shows what is to be achievedby when and by whom;
• a weekly update on preparedness which shows whathas been achieved against those milestones and iden-tifies variance and seeks to explain it;
• daily situation reports. We will produce regular updatesof what different agencies are doing, and expect to do,within the health sector as part of our coordinationfunction.
We will evaluate the progress involving the most seniormanagment levels. We will continue to build human andfinancial capacity so that it can be done in close coopera-tion with national authorities and partners.
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World Health OrganizationDepartment for Health Action in Crises
Geneva, October 2003
Graphic Design: Arvid Ellefsplass
This report was written by: Dr David NabarroDr Alessandro LorettiMelanie Zipperer
