who’s responsibilities in emergencies 20 august 1998 today’s challenges
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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
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
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
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
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
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