WHO’s Responsibilities WHO’s Responsibilities in Emergenciesin Emergencies

WHO’s Responsibilities WHO’s Responsibilities in Emergenciesin Emergencies

20 August 1998

Today’s ChallengesToday’s Challenges

Key QuestionsKey Questions

Should WHO be involved in emergency

and humanitarian work?

How should WHO be engaged?

DefinitionsDefinitions

Emergencies - immediate action Disasters - external assistance Complex Emergencies - highly politicised

WHO has an obligationWHO has an obligation

Emergencies make a difference to health Stake holders demand Member states demand Effect on WHO’s new goals and targets

Numbers Affected

20m or more

Current Complex Emergencies 81m Natural Disasters of 1998 85m

Numbers of people affected0 - 10m11 - 20m

Total 166 million people Total 166 million people

- data source UNOCHA, EHA

Number and location of peoples affected by emergencies (for 1998 only)

Number and location of peoples affected by emergencies (for 1998 only)

Increasing impact of war on global burden of disease

Increasing impact of war on global burden of disease

1 Lower respiratory infections2 Diarrhoeal diseases3 Perinatal conditions4 Unipolar major depression5 Tuberculosis6 Measles7 Malaria8 Ischaemic heart disease9 Congenital anomalies10 Cerebrovascular disease11 Road traffic accidents12 Chronic obstructive pulmonary disease13 Falls14 Iron-deficiency anaemia15 Protein energy malnutrition16 War

1 Unipolar major depression2 Road traffic accidents3 Ischaemic heart disease4 Chronic obstructive pulmonary disease5 Cerebrovascular disease6 Tuberculosis7 Lower respiratory infections8 War9 Diarrhoeal diseases10 HIV11 Perinatal conditions12 Violence13 Congenital anomalies14 Self-inflicted injuries15 Falls16 Bipolar disorder

19901990 20202020

Source:Global burden of disease, Murray & Lopez, 1996

8998 95

138162

205

39 54 5699

116139

16 15 3155 58 66

0

50

100

150

200

Num

ber

of D

isas

ters

1963-67 1968-72 1973-77 1978-82 1983-87 1988-92

Significant Damage (1% or more of annual GNP)

No. of Affected People (1% or more of total population)

No. of Deaths (100 or more)

Major Disasters 1963-1992Major Disasters 1963-1992

7.112.6 13.8

50.7

16.523

13.73 2.9

0

10

20

30

40

50

60

Liberia 1990 Iraq 1991 Somalia(Merca)1991-2

Somalia(Baidoa)

1992

Somalia(Afgoi) 1992

Sudan(Ayod)1992-3

Sudan(Akon)1992-3

Bosnia(Zepa)1992-3

Bosnia(Sarajevo)Apr 1993

Baseline CMR IDP CMR

Crude Monthly Mortality Rates Internally displaced persons 1990-1994

Crude Monthly Mortality Rates Internally displaced persons 1990-1994

CMR = Deaths per 1000 per month

Communicable diseases in complex emergencies

Communicable diseases in complex emergencies

Cost of complex emergenciesMozambique

Cost of complex emergenciesMozambique

Under-5 Mortality

331

269

297

250260270280290300310320330340

1960 1980 1991

Primary School Enrolment

37

99

68

30

50

70

90

110

1965 1980 1988

Primary School Enrolment

37

99

68

30

50

70

90

110

1965 1980 1988

Pre-Independence Post-Independence Complex Emergency

Daily Calorie Supply

1.74

1.798

1.665

1.6

1.65

1.7

1.75

1.8

1.85

1961-63

1979-81

1987-89

Population Per Nurse

5.37

4.783

5.76

4

4.5

5

5.5

6

1965 1975 1989

Economic Impact of Natural Disasters

Economic Impact of Natural Disasters

Average per annum cost over last 25 years US$ 87 billionUS$ 87 billion

Average per annum humanitarian response funds US$ 3 billionUS$ 3 billion

0

10

20

30

40

50

60

70

80

90

Cost Response

US$ Billions

Volume of Humanitarian AidVolume of Humanitarian Aid

In the last ten years, the percentage of humanitarian aid has risen from 1.5% to 10% of the total ODA

Source: DAC/OECD

Threat to Poverty Reduction GoalsThreat to Poverty Reduction Goals

Countries emerging from conflicts are some of the poorest countries in the world

‘The sustainable reconstruction of countries emerging from long periods of conflict is a challenge we ignore at our peril. James Wolfensohn, President, World Bank

Effect of Emergencies on WHO’s

new goals and targets

Effect of Emergencies on WHO’s

new goals and targets

Poverty reduction Roll back Malaria Disease eradication Equitable access to health services

Emergencies as Opportunities for

the ‘new’ WHO

Emergencies as Opportunities for

the ‘new’ WHO Moral stance & technical leadership in

humanitarian crisis

Health services & system reform

Visibly demonstrate the ‘new’ WHO

Stakeholders’ demandsin Complex EmergenciesStakeholders’ demands

in Complex Emergencies WHO as vital partner

•Technical Advice

•Guidelines

•Information

•Advocacy on priority health needs

Stakeholders’ demandsin Complex EmergenciesStakeholders’ demands

in Complex Emergencies WHO as vital partner Disaster Management Team - in country

•Technical support to other agencies•Ready to lead in health sector

WHA ResolutionWHA Resolution

Emergency preparedness Emergency response Advocacy

WHA 48.2 (May 1995)

EHA Modus OperandiEHA Modus Operandi

Response

Advocacy

Preparedness

EHA has comparative advantages:

EHA has comparative advantages:

Sectoral rather than target group approach Geographic focus Addresses prevention, preparedness, response

and rehabilitation Meets needs of those affected and those at risk National and international partners

CongoCongo

Palestine/Occupied Palestine/Occupied territoriesterritories

WHO response in the fieldWHO response in the field

AlbaniaAlbaniaAfghanistanAfghanistan

AngolaAngola

BosniaBosnia

BurundiBurundi

CaucasusCaucasus

TanzaniaTanzania

DR CongoDR Congo

DPR KoreaDPR KoreaIraqIraq

Sierra LeoneSierra Leone

LiberiaLiberia

Guinea-BissauGuinea-Bissau RwandaRwanda

TadjikistanTadjikistan

Yugoslavia/KosovoYugoslavia/Kosovo

US$ 42 US$ 42 million in million in projectsprojects

WHO field responseWHO field response Rapid Needs Assessment Technical Support Monitoring & Surveillance Information Rehabilitation & reconstruction

WHO is NOT an emergency medical services and reliefsupplies agency, except:

- to fill a life saving gap- to lead the way to policy change

What triggers EHA action What triggers EHA action

United Nations Special

Representativeand/or

Humanitarian Coordinator

World Health Assembly Resolution

United Nations General

Assembly or Security Council

Resolution

Government Request

(i.e. Natural Disaster)

Response Mechanism

Task force - HQ/Divisional, Regional, Country Rapid assessment team Inter-agency plans - country, HQ Resource mobilisation (UN CAP) Surveillance, monitoring and evaluation Expert missions Inter-agency policies - IASC-WG

AdvocacyAdvocacy

Health as a Bridge to Peace

Rights for equitable access

Promoting best Public Health services

Promoting local capacities in relief

PreparednessPreparedness Risk mapping

Information

National legislation

Institutional support

Capacity building

Community participation

Networking with CC, UN, Red Cross, NGOs

Research

PreparednessPreparedness AdvocacyAdvocacy

ResponseResponse

Emergency and Humanitarian Action

Overcoming constraints Institutional

– commitment and central back up for policies and actions

– common stance on humanitarian principles

– consistent engagement with UN, NGOs, red Cross etc

Structural– single line of command for emergency response

– team work at all levels

Administrative– fast track procedures for emergencies

– recruitment policies adapted

– delegation to field

– regular vs extra-budgetary resources

Main Points

WHO must be engaged in emergency and humanitarian action

WHO has the capacity

Emergencies: how should the new WHO be engaged?

Emergencies: how should the new WHO be engaged?

Presence in the field– on time– highest quality staff– predictable

Support to countries– national preparedness in priority countries

Information– policy– planning– best practices

Out-reach to partners Speak out on ethical & moral principles

Options

Modify HQ structure in coming months in consultation with cluster team

Decentralise normative technical core tasks

Links to other clustersDirector General’s Cabinet

Communicable Diseases• Epidemic preparedness & response

• Guidelines in Complex Emergencies

Sustainable Development & Health Environments• Natural & Technological emergencies, disasters • Emergency management/emergency preparedness• Post-conflict health system

reconstruction

Non-Communicable Diseases• Policy to practices in acute and chronic

emergencies

Evidence & Information for Policy• Policy, financial and institutional reform in post-conflict situations• Epidemiology, health burden of

emergencies External Relations & Governing Bodies• Inter-agency mechanisms on humanitarian policy, response, advocacy• Relationship with IASC, OCHA & other humanitarian agencies• Fundraising - CAP and foreign

ministries Social Change and Mental Health• Mental health in emergencies• Technical inputs and field feedback on

conflict, violence, landmines

Emergency& Humanitarian

Action

Roll Back Malaria

• Malaria in countries affected by conflict

Constitution Chapter II - Functions, Article 2Chapter II - Functions, Article 2

Constitution Chapter II - Functions, Article 2Chapter II - Functions, Article 2

(d) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments

(e) to provide, or assist in providing, upon the request of the United Nations, health services and facilities to special groups, such as the peoples of trust territories;”

“In order to achieve its objective, the functions of the Organisation shall be:

EHA in Family & Health Services cluster

MissionMission

PrinciplesPrinciples

Cluster ComponentsCluster Components

• Improving quality of health services in emergencies

• Equity of access,eg - displaced populations

• Technical quality• Provider Institutions• Management & Support• Participation & Governance