HEALTH TOPICS A TO Z

Over the past 10 years, WHO has taken an increasingly active role in helping to ease the impact of natural and manmade disasters on the health of millions of people around the world.

Within WHO, the Department of Emergency and Humanitarian Action co-ordinates inputs from the Organization's technical departments with those of governmental, UN and non-governmental (NGO) organizations to address 10 core health issues in emergencies.

• Assessment of health risks: WHO works to improve analysis of health information, health risks and needs that is essential for effective planning of the public health interventions needed to prevent or alleviate the impact of emergencies on physical and mental health.
• Health co-ordination: WHO works to co-ordinate the health activities of governments, UN agencies and non-governmental organizations to ensure they are in line with international standards and local priorities and do not compromise or damage longer term health development.
• Epidemic and nutritional surveillance: WHO works to strengthen national health surveillance systems and integrate information from external partners so that the earliest possible action can be taken against communicable diseases, common childhood illnesses, malnutrition, conditions related to childbirth and damage to mental health.
• Control of preventable causes of illness and death: WHO offers the services of specialists and internationally tested standards and guidelines to help all health actors in an emergency to identify and address health priorities. Areas of support include prevention and response to infectious diseases from HIV/AIDS and tuberculosis to measles and other childhood diseases, mental health, environmental health, water, food, shelter, sanitation and the violence and injury prevention as well as all aspects of health care delivery. WHO also carries out evaluations of the effectiveness of health programmes in the field.
• Access to basic preventative and curative care: Together with other health partners, WHO works to ensure basic preventative and curative care is available, including access to good quality essential drugs and vaccines, surgical supplies and health information, to all affected and particularly to the especially vulnerable such as the very young, elderly, pregnant women, the disabled and the chronically ill.
• Prevention of malnutrition: WHO seeks to ensure actions taken by all partners to support nutrition during an emergency are technically sound, guided by international standards and well evaluated.
• Management of health risks in the environment: WHO analyses environmental health risks in emergencies, and supports activities which deal with threats ranging from water and sanitation to the effects of pollutants and munitions.
• Protection of health workers, services and structures: WHO acts as an advocate for national and international health workers in situations of crisis, and is a key partner in negotiating secure humanitarian access and protecting the neutrality of health workers, services and structures.
• Human rights to health: Where basic human rights such as access to health, food, nutrition or education are unfulfilled, people are more vulnerable to the negative health impact of natural or man-made disasters. WHO works to ensure that humanitarian health activities combine the best public health practice with adherence to human rights principles regardless of adverse political or natural environments.
• Reducing the impact of future crises: Beyond the acute crisis, WHO works to help health authorities in disaster-prone and vulnerable countries prepare for and prevent the worst health outcomes of disasters whether manmade or natural. This includes developing strategies for rapid response, building up an experienced cadre of national staff resilient to emergencies, and crucially taking action to reduce the impact of disaster before it strikes. In humanitarian crises, what often makes the difference is thinking ahead and having people on the ground who know what to do at the local level. Sadly, the countries most likely to need these skills are also those where capacity is weakest. WHO works to evaluate the 'lessons learned' from acute crises and disseminate best practice and information to all involved whether local partners, governments, health and civil institutions, or international agencies.

WHO's advantage in humanitarian action in emergencies lies in its long-term presence, its knowledge of the field, and its ties and partnerships with local communities and national authorities. These allow the Organization to move fast and deep in places where trust builds slowly. WHO is also an agency without exit strategies. It is in the country before, during and after conflict or crisis and, as such, is a guarantee to the community and to donors that humanitarian action, post conflict rehabilitation and long term development take place in a healthy continuum.

To put this into context: in 1999, 2 billion people of the world's 6 billion population were affected by natural disasters, 13.75 million were living as refugees and 20 million people were displaced within their own countries, largely by conflict.

In 2000-2001, WHO is involved in emergency and humanitarian action in 35 countries across the globe. The following are brief examples of its work.

• East Timor: In the wake of East Timor's bloody crisis in August 1999, WHO seconded staff to assist the local authorities in creating the health department and set up a supporting country office which is working with other agencies to rebuild health services from epidemic surveillance systems to personnel and physical structures.
• Sierra Leone: WHO has maintained a wide ranging programme here despite repeated troubles and evacuations. In collaboration with international NGOs, and making use of 'pockets' of peace, the team is supporting local health authorities to monitor, prevent and control epidemic disease (including in 2000 outbreaks of shigella dysentery, Lassa and Yellow fevers) Projects addressing appalling infant and maternal mortality and the threat of HIV/AIDS are also underway and the Roll Back Malaria programme is being introduced. WHO has also been involved in negotiating with humanitarian cease-fires to allow polio vaccination in rebel-controlled area, and in guiding public health care for the many accumulations of internally displaced people.
• Afghanistan: in a country where drought has come on top of civil strife and hundreds of thousands of displaced, WHO is working through its eight sub-offices to maintain access to basic health care and essential drugs, to intervene rapidly in the face of disease outbreaks, and to offer protection from common curable diseases to the vulnerable including infants, pregnant women and the elderly wherever possible. Efforts to anticipate what has become annual devastating cholera epidemic through surveillance, training and treatment stockpiling are slowly beginning to bear fruit with a slow reduction in deaths and illness.
• Sudan: WHO works in both the government and rebel-controlled areas of this country, and focuses on the enormous threats of communicable disease. A pilot radio-linked early warning system for outbreaks of epidemic diseases has been set up in the Southern region where communication is extremely poor and epidemics can killed thousands before authorities are aware. WHO has also placed public health doctors in four sub-offices to help train health workers who have struggled against war for almost 20 years and, with UNICEF, continues to mobilise for polio immunization in one of the most challenging countries still to eradicate the virus.
• El Salvador: In the wake of this year's double earthquakes in El Salvador, WHO supported the Ministry of Health by immediately sending disaster mitigation engineers to assess the condition and safety of hospitals located in the most affected areas and identify measures to restore the minimum capacity. The team also helped strengthen the syndrome/symptom-based surveillance system, improved the capability of the laboratory network, and set up the Pan American Health Organization's Supply Management System (SUMA) to manage the influx of donations in the aftermath. The WHO county office actively coordinated with the health authorities and the National Emergency Committee and the UN agencies.
• Ethiopia: WHO continues to guide partners in carrying out the most effective nutritional surveillance and feeding activities in this country where drought and food shortage are a constant problem. At the same time, WHO is working to extend and dramatically improve rates of immunization against childhood diseases, help the government deal with a rising tide of HIV infection, and rebuild health services in areas affected by the recent war.
• Kosovo: As in East Timor, WHO has provided the backbone staff for the UN administered province's health department and set up an extensive office to underpin and co-ordinate the rebuilding of the health service in Kosovo. Development of health policy for primary care, and the training of general practitioners has been a major activity as has re-establishing surveillance systems and the Institute of Public Health. The Organization is also introducing key programmes to improve mother and child health, community mental health, recovery from violence, key public health interventions such as HIV/AIDS and tuberculosis control, the development of the 'healthy village' concept (focused on water, sanitation and refuse) and pharmaceutical reform.
• Burundi: Even as armed conflict was taking place in the capital in February 2001 WHO, as co-ordinator of the national emergency management committee for health, brought together all the key national and international players to review sites and health facilities for the displaced, allocate responsibility for essential health services, drugs and supplies, and set up an early warning system for epidemics. In following weeks, WHO provided central co-ordination of health activities aimed at both the displaced and those starting to return to their homes. Earlier, WHO also mobilised emergency teams together with partner NGOs to help the country combat the biggest malaria epidemic in Africa for the past 10 years -- some 1.4 million cases between November 2000 and end January 2001.
• India: Immediately after the earthquake on 26 January 2001 in Gujurat, India, personnel from the WHO country office, the Regional Office for South East Asia, from Nepal, Indonesia, and from the Regional Office for the Americas travelled into the area to provide technical assistance to state and local health authorities. The existing polio surveillance system was expanded into a post-disaster syndromic surveillance system, and an information system was developed to collate and present data. Sanitary engineering specialists were also sent to help. At the request of the Indian Government, WHO is co-ordinating external humanitarian health assistance and assistance in public health and health sector coordination and restoration of health services and health facilities.
• Palestinian Self Rule and Autonomous Territories: WHO is monitoring the effects of crisis on the health situation, providing health co-ordination and advocacy and working to ensure essential supplies continue to reach primary care and hospital facilities despite heightened conflict. In addition the Organization provides essential public health advice and guidance to ameliorate increasing vulnerability of the population to ill health and disease.