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Young people and tobacco use |
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A growing epidemic of tobacco use among young people
Many of today’s children are tomorrow’s victims of tobacco. Tobacco use, which generally starts during adolescence, is rising among young people. Addiction to nicotine ensures that many continue to use tobacco into adulthood.
The Global Youth Tobacco Survey (1999–2008) shows that tobacco use among young people age 13–15 around the world is increasing. In the Eastern Mediterranean Region, 7% of boys and 2% of girls currently smoke cigarettes, while 14% of boys and 9% of girls currently use tobacco products other than cigarettes, including waterpipe and smokeless tobacco. As in the rest of the world, the gap between girls’ and boys’ rates of tobacco use is getting smaller in some countries in the Region.
Why do young people begin using tobacco?
Tobacco use tends to start in adolescence and addiction can set in quickly. Teenagers who begin smoking at a younger age are more likely to become regular smokers and less likely to quit than those who start later. Young people may use tobacco to bolster low self-esteem, manage stress, control body weight and as a buffer against negative feelings.
Tobacco use has become more socially acceptable at home and in public. Its use by parents, family members and friends influences young peoples’ tobacco use. Teachers are role models for students, but only around half of all schools in the Region have a ban on the use of tobacco products in schools by teachers. Additionally, only 16% of teachers in the Region have been trained to prevent youth tobacco use, while less than half have access to materials on how to do so.
Another key reason is tobacco advertising and promotion. The tobacco industry promotes its products to potential smokers, including young people, to ensure the market for tobacco continues to increase and that dying smokers and those who quit smoking are replaced. As tobacco rates decrease in many countries in the developed world, the industry is increasingly targeting young people in the developing world.
Tobacco marketing to young people
The tobacco industry targets young people through misleading messages that help shape attitudes to tobacco use. Tobacco promotion associates tobacco use with appealing images to lure young people into a lifetime of tobacco addiction. These encourage children to adopt a behaviour that is harmful to their physical, mental and social development.
This is done by advertising in youth magazines and designing brands, packaging and promotional items to appeal to young people. Advertisements target young people through their use of images of vitality, sports, sophistication, friendship, independence and beauty.
Tobacco marketing to young people includes both direct marketing through advertising of tobacco products and indirect marketing through promotions and sponsorship. The Global Youth Tobacco Survey has found high levels of exposure in the Region to advertising on billboards and in newspapers and magazines. It also found that 15% of 13–15 year olds in the Region own an object with a tobacco company logo or other cigarette branding, while 9% have been offered free cigarettes.
Health impact of tobacco use on young people
Tobacco use affects young people’s physical fitness. Young people who use tobacco have reduced lung function and are more likely to suffer from respiratory problems. Smoking at an early age increases the risk of lung cancer and as young people continue smoking into adulthood the risk of other cancers, heart disease and stroke increases.
Children are especially vulnerable to the harm of second-hand smoke. They have smaller lungs and absorb more tobacco smoke toxins. This makes them susceptible to many conditions, such as respiratory infections, asthma and ear infections. They are also less able to complain or remove themselves from exposure, especially at home.
Many young people are exposed to second-hand smoke in their homes and public places, including educational facilities. In the Region, 38% of 13–15 year olds live in a home where others smoke, and 46% are exposed to second-hand smoke in public places. This poses great risks for young peoples’ health and for their future well-being.
Further harms to young people from tobacco
Tobacco use by adults means that many households have reduced resources to spend on the food, health care, clothing and educational needs of their children. This can have a serious impact on their health, physical development and future employment opportunities.
Many young people from poor families are employed in the tobacco industry exposing them to the harms associated with nicotine poisoning and exposure to highly dangerous agrochemicals used in tobacco cultivation. It is hazardous work that impedes their rights to health, social development and education.
Best practices and the way forward
The UN Convention on the Rights of the Child was adopted by the UN General Assembly in 1989. Tobacco has since been identified by the Committee on the Rights of the Child as a human rights issue and States are legally bound to protect children from tobacco. Furthermore, implementation of the WHO Framework Convention on Tobacco Control (FCTC) requires Parties to take measures to protect youth against the harms of tobacco use. Article 16 specifically addresses the prohibition of the sale of tobacco products to legal minors.
Young people need to be provided with information about the harms of tobacco use and tobacco industry marketing tactics. They have a right to protection from tobacco marketing and second-hand smoke. To achieve this:
Young people need to be empowered with information about the harmful effects of tobacco use and their right to live in a smoke-free environment. They should also be provided with tobacco cessation services.
The sale and marketing of tobacco to young people must be stopped. A full ban on tobacco advertising, promotion and sponsorship is needed, in accordance with Article 13 of the WHO FCTC.
Young people are especially sensitive to rises in the price of tobacco. Taxing tobacco products effectively will prevent many young people from a lifetime of tobacco addiction.
Adults should restrain from tobacco use around young people, including in the home.
Schools must become smoke-free environments. Teachers must be supported in preventing tobacco use among young people. |
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Emergency preparedness and response |
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Overview
Humanitarian action in 2013 entered uncharted territory in terms of the scale, magnitude and number of people requiring assistance. This was mainly as a result of the crisis in the Syrian Arab Republic, where almost 6.8 million people inside the country and 2.3 million Syrian refugees in the neighbouring countries were in need of humanitarian assistance by the end of December 2013. Overall, more than 42 million people in 13 countries in the Region are currently affected by natural hazards or violence resulting from political conflict.
Flooding affected parts of Afghanistan, Palestine, Pakistan and Sudan, while earthquakes struck areas of Afghanistan, Islamic Republic of Iran and Pakistan, affecting millions of people and threatening public health s. WHO contributed to relief actions in disaster-affected countries by participating in assessment missions to identify health needs, ensuring the provision of essential medicines and technical support, enhancing disease surveillance, and coordinating activities of health partners on the ground.
Impact of protracted emergencies
Some populations in countries and territories facing protracted emergencies continue to lack access to basic health services as a result of weakened health systems, including shortages of qualified health workers and of medicines and medical supplies. Up to 8.6 million people lack access to health services in Yemen and 13 million – more than half the population – have no access to improved water sources. As a result, Yemenis run a high risk of outbreaks of water-borne disease, such as cholera and dysentery.
In the Gaza Strip, shortages in basic supplies are straining the health system’s ability to maintain a good standard of health care for the population of 1.7 million Palestinians. Lack of access is impeding people’s right to health. WHO’s office for West Bank and Gaza released a report on the difficulties faced by thousands of Palestinian patients in obtaining Israeli permits to access specialized health care in East Jerusalem, Israel and Jordan. One in five West Bank applicants were denied health access permits in 2012. The study used available data from the Palestinian National Authority and from non-profit health providers to show how Israeli-imposed restrictions on movement in the West Bank and Gaza reduce access to health services for Palestinian patients and health providers, especially to East Jerusalem where the main Palestinian referral centres are located.
Maternal and child morbidity and mortality remain unacceptably high in Somalia. According to WHO, one out of five children in Somalia dies before their fifth birthday, and one out of 12 women dies due to pregnancy-related causes, with haemorrhage and hypertension the leading causes of maternal death. One of the key contributing factors is the low access to quality health services, especially in rural communities and remote areas. WHO and the Saudi National Campaign for the Relief of the Somali People initiated an 18-month project to provide life-saving interventions for women and children, including the establishment of mobile clinics in remote areas; provision of medicines and medical supplies; immunization activities for children below the age of 5 years; and capacity-building for maternal and child health care workers.
Health care in danger
In countries where conflict is ongoing, one of the main challenges facing humanitarian aid workers is the threat to their safety. Despite international humanitarian laws and the Geneva Conventions calling for their protection, humanitarian aid workers and health facilities remain at risk. This is especially acute in the Eastern Mediterranean Region, where the majority of attacks in recent years have taken place. Health workers in Pakistan and Somalia continue to face serious threats of violence, while in Yemen and the Syrian Arab Republic, health facilities have been bombed, ambulances burned or stolen, and hundreds of health care workers killed, attacked or kidnapped. Patients are also at risk.
Ensuring the provision of health care services and supplies in emergencies
To ensure that the needs of countries experiencing emergencies are met immediately and efficiently, WHO currently manages US$ 94 million worth of emergency medicines, medical supplies and equipment in Dubai’s International Humanitarian City, under agreement with the World Food Programme. In 2013, these stocks were replenished three times to reach populations affected by emergencies in the Syrian Arab Republic and neighbouring countries (Egypt, Iraq, Jordan and Lebanon) as well as Afghanistan, Somalia and Sudan.
Decades of neglect and the 2011 conflict in Libya have resulted in reduction in the availability of mental health services. WHO and the Libyan Ministry of Health launched two post-graduate diplomas in primary mental health care and clinical psychotherapeutic interventions in 2013, based within the national centre for disease control, with the goal of filling the human resource gap in mental health and psychosocial support, especially in remote and underserved areas.
Health impact of the crisis in the Syrian Arab Republic and WHO response
March 2013 marked the beginning of the third year of the crisis in the Syrian Arab Republic, the scale and impact of which is unprecedented in recent history. According to the United Nations, by the end of December 2013, an estimated 120 000–130 000 lives had been lost and over 625 000 persons injured. Inside the country, 9.3 million people are estimated to be in need of assistance, including 6.5 million internally displaced persons.
Much of the impact of this crisis can be seen in the collapse of health services and the deteriorating health outcomes, either directly due to death and injury or indirectly through exacerbation of disease and escalation of mental health problems. The health system has been severely disrupted, compromising the provision of primary and secondary health care, the referral of injured patients, treatment of chronic diseases, delivery of maternal and child health services and the provision of mental health care, vaccination programmes and infectious disease control.
In the first quarter of 2013, the early warning system for disease outbreaks, which covers all 14 governorates, reported significant increases in acute watery diarrhoea, hepatitis A and enteric fever (typhoid). New cases of vaccine-preventable diseases have also reappeared due to a fall in national vaccination coverage from 95% in 2010 to an estimated 45% in 2013. As vaccination coverage rates decrease inside the country, cases of communicable diseases are being reported among Syrians and host communities outside the country, leading to an increased risk of outbreaks. A clear demonstration of the consequences of the deteriorating health indicators and living conditions among Syrians is the polio outbreak. This required multicountry, regionally-coordinated surveillance and multiple rounds of mass vaccinations in the largest-ever immunization response in the Middle East, aiming to vaccinate more than 23 million children in 2013 and 2014 across several countries.
Key prevention and control measures by WHO and partners to respond to public health threats from infectious diseases included supplying safe drinking-water and sanitation, strengthening early warning systems for the detection of diseases, and pre-positioning medicines and medical supplies, in addition to emergency mass vaccination campaigns, both inside the Syrian Arab Republic and in neighbouring countries.
The increasing number of Syrians with chronic diseases, destruction of local pharmaceutical capacity and embargo on imports have led to shortages in life-saving, essential medicines. With the support of experts in the Region, the national essential medicines list was updated to reflect needs based on updated patient profiles and demand as a result of the crisis, and taking into consideration the stocks already available in the country and planned WHO supplies. Beside supplies for treatment of conflict-related injuries, the list includes life-saving medicines and medical supplies needed for cardiovascular conditions, diabetes and reproductive health, as well as critical hospital equipment. Following reports that chemical weapons had been used against civilians, WHO supported the UN chemical weapons inspection missions to Syrian Arab Republic with two health experts, as well the provision of health equipment. WHO also distributed information and guidance to partners and the general public on chemical exposure, symptoms and protection, and held a series of trainings for health professionals to build capacity in chemical weapons awareness and case management.
Inside the county , WHO works in government- controlled areas and also across lines, using a network of nongovernmental organizations and the Syrian Red Crescent Society. Such an approach has been key in reaching the maximum number of civilians in need, especially children for immunization during the polio vaccination campaign. While generally successful, the approach, conducted in conformity with humanitarian principles, has faced setbacks on several occasions when access to vulnerable populations in opposition- controlled areas has been denied or made difficult and vital medicines have been withdrawn from humanitarian convoys.
With the above in mind, and in order to provide an effective health response to the crisis, WHO identified five strategic priorities for 2014: ensuring that patients have access to the health services they need, and that health care workers can report for work in areas where they are most needed, as well as protection of health facilities (through advocacy); ensuring the provision of trauma and injury care (including mental health trauma); monitoring and controlling infectious diseases through establishment of early warning systems; ensuring the continuous provision of vital essential medicines and medical supplies as well support to the supply chain; and addressing gaps in the provision of health care services, such as mother and child health services, chronic illnesses and water and sanitation services.
Regional impact of the crisis in the Syrian Arab Republic and WHO response
In neighbouring countries, the increasing number of refugees, reaching 2.3 million by the end of 2013 according to UNHCR, has placed an immense strain on the host communities in terms of infrastructure and resources. In addition to the Syrians needing assistance, an estimated 2.7 million people among the host populations of neighbouring countries are also at risk.
The high financial costs associated with hosting an increasing number of displaced persons poses a risk to the social stability of countries such as Iraq, Jordan and Lebanon. As pressure on health services, water, sanitation, shelter, jobs and education continues, tensions between displaced communities and host communities are also high, especially in Jordan and Lebanon where the majority of refugees live within host communities. Political insecurity and unpredictability in Iraq and Lebanon have further added to the challenges in the provision of humanitarian aid and health services to affected populations.
WHO’s response in the neighbouring countries in 2013 included supporting health authorities by: strengthening the early warning, alert and response system (EWARS) in order to minimize outbreaks of communicable diseases among refugees and host communities; supporting immunization campaigns for refugees and host communities; building the capacity of primary health care health professionals, ; assisting in health facility assessments, strengthening health information systems; and supporting the provision of essential medicines and medical equipment.
WHO’s Emergency Support Team (EMST), which was established in January 2013 in Amman, Jordan, with the goal of aligning and harmonizing regional response activities for the Syrian crisis in six affected countries, continues to coordinate health sector inputs with other regional humanitarian organizations. Almost 12 months after its establishment, EMST went through a major reform in terms of its structure and focus in order to enhance its ability to support WHO’s regional response and the evolving health needs.
Donor support
In 2013, WHO was able to continue its activities and life-saving humanitarian relief in countries experiencing emergencies through the support of the Governments of Kuwait and Saudi Arabia, charitable organizations in Saudi Arabia, and the League of Arab States (Council of Arab Ministers of Health). However, the need for increased funding continues to have an impact on WHO’s efforts to reach affected populations. Pledging conferences, such as those hosted by Kuwait for the regional humanitarian response to the Syrian Crisis and by Qatar for reconstruction and development in Darfur, have supported resource mobilization for humanitarian efforts in those countries. C ountries facing ongoing emergencies, such as Afghanistan, Somalia and Yemen, remain critically underfunded. In Somalia and Yemen, for example – both of which are experiencing among the worst humanitarian crises – only 24% to 27% of the funding requirements for the health sector were met in 2013, leaving millions still struggling to gain access to even the most basic health services.
The Syria Humanitarian Assistance Response Plan (SHARP) and the Regional Response Plan for the Syrian crisis was launched at the end of 2013 and discussed with Member States and international donors at a WHO donor meeting in Geneva. WHO requires a total of US$ 246 million in 2014 (US$ 186 million for the Syrian Arab Republic and US$ 60 million for the surrounding countries) to meet the urgent life-saving needs of the Syrian people and the host communities. These requirements are part of the biggest UN appeal to date for a single humanitarian emergency at a total cost of US$ 6.5 billion. More than US$ 450 million is needed to provide essential and life-saving medicines and medical supplies to 9.3 million people in both in government- and opposition-controlled areas.
Preparing countries for disaster and emergency risk management
In the area of disaster and emergency preparedness, a range of challenges affect the ability to implement actions on the ground. Overall regional instability is a major factor, while at national level shifting priorities, high turnover of personnel and lack of allocation of resources are factors. In some countries, the need to respond to acute emergencies overshadows development of emergency risk management in the health sector.
Nevertheless, progress was made in moving from policy to action. Most countries have embraced the all-hazard based risk management approach within their national emergency preparedness and response actions. WHO is providing technical support to countries to develop and review their national plans for emergency preparedness and response as required by the International Health Regulations to enhance health security in the Region.
Ensuring the safety and preparedness of health facilities and health workforces in the response to any public health emergency remained a priority in all countries. Five countries are implementing the hospital safety programme. Considering the critical nature of this issue, WHO joined the Health Care in Danger Network set up by the International Committee of the Red Cross.
WHO continued to advocate in countries for linking the health sector within the disaster risk reduction framework. It is working with regional and global partners to support countries aiming to establish national health platforms to coordinate health actions for disaster risk reduction. The first Arab conference on disaster risk reduction was held in Jordan to launch the Arab Platform for Disaster Risk Reduction. At the same conference, a multisectoral forum underscored health as a priority area for the post-2015 development framework.
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Emergency preparedness and response |
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The Eastern Mediterranean Region has a high risk for natural hazards such as earthquakes (Islamic Republic of Iran), floods (Pakistan) and drought (which has resulted in famine in Djibouti, Somalia and South Sudan since 2011 and is expected to re-emerge in 2013). Political instability and civil conflict in countries such as South Sudan, Sudan, Syrian Arab Republic and Yemen have resulted in millions of people in need of emergency and basic health services, especially the most vulnerable populations, such as women, children and the elderly. More than 50% of the world’s refugees originate from the Eastern Mediterranean Region. In light of the increasing number and magnitude of emergencies in the Region, in March 2012 the Regional Director identified the area of emergency preparedness and response as one of five priority areas with the goal of increasing the resilience of countries to emergencies, disasters and other crises, and subsequently ensuring effective public health response to risks and threats. A new set of strategic priorities was defined to outline the way forward, including offering support to countries in developing clear policies and legislation based on an all hazard and ‘whole health’ approach, and paying special attention to safeguarding health facilities and the health workforce in times of emergency.
In all countries facing emergencies, there was a highlighted need in 2012 to ensure that health services for vulnerable populations, especially women and children in the most affected areas, were made available. Priorities included the provision of obstetric and gynaecological health services, as well as vaccinations for children below the age of 5 years. In countries with on-going conflict and violence, mental health services were largely unavailable due to a lack of qualified health staff. Increasing numbers of refugees and internally displaced persons in countries such as South Sudan, Syrian Arab Republic and neighbouring countries, Sudan and Yemen highlighted the need for effective disease monitoring and response systems for the prompt control of communicable disease outbreaks. In both acute crises and protracted emergencies, the burden of noncommunicable disease also came to the fore as patients lost access to essential drugs and life-saving treatment.
Reform in WHO’s work in emergencies, specifically the Emergency Response Framework, stressed the need for strengthening country office capacity to prepare for and respond to crises. To ensure a more rapid response, an emergency surge roster was developed with identified expertise on standby. Additionally, the process of establishing a regional WHO hub for medicines and medical supplies and equipment was initiated. On a regional level, medicines, medical supplies, logistics, and office and laboratory equipment worth almost US$ 120 million were provided to six countries facing emergency (Afghanistan, Libya, Pakistan, Somalia, Sudan and Syrian Arab Republic), amounting to almost 40% of WHO procurement on a global level.
Despite an increase in the funding of health activities in emergencies, only 38% of the Region’s health funding requirements was met in 2012. The health sector continues to be severely underfunded, emphasizing the need for a more coordinated approach by traditional and non-traditional partners to address the health needs of affected populations in the Region.
An evolving leadership role in health emergencies
In all countries experiencing emergencies, WHO supported health authorities to lead a coordinated and effective health sector response together with the national and international community, in order to save lives and minimize adverse health effects, with specific attention to vulnerable populations. One of the main challenges was lack of accessibility and humanitarian space. The delivery of health services to affected populations in Palestine, South Sudan and Syrian Arab Republic was impeded by the limited access by health humanitarian partners and by health care workers to their place of work due to insecurity. Twenty-three months into the crisis in the Syrian Arab Republic, for example, 70% of health workers in heavily affected areas reported difficulties in accessing their workplace. Similar challenges associated with inaccessibility and insecurity that impeded the delivery of emergency and basic health services were faced in Afghanistan, Somalia, South Sudan and Yemen.
The delivery of basic and emergency health care services was also impeded as an indirect result of economic sanctions on countries such as Islamic Republic of Iran, Libya and Syrian Arab Republic. For example, pharmaceutical plants in the Syrian Arab Republic that had previously produced almost 90% of the country’s medicines were forced to halt production due to the combined effects of economic sanctions, fuel shortages and damage to infrastructure. Consequently, health facilities received insufficient supplies from the central authorities due to critical shortages in life-saving essential medicines.
To ensure that urgently needed medicines and medical supplies were available, WHO worked with governments and partners to broker the procurement and provision of supplies. Examples of these partnerships included those with the League of Arab States for the provision of medicines and medical supplies to Syrian Arab Republic and Yemen, and with local authorities and the Organization of Islamic Cooperation to coordinate access of the population to health services in Somalia.
In countries such as Afghanistan, Libya, Pakistan and Syrian Arab Republic, where health care workers and health facilities were intentionally targeted or indirectly affected, WHO condemned the attacks in the regional and international media and through advocacy campaigns, referring to World Health Assembly resolutions and human rights laws prohibiting the targeting of health staff in times of conflict.
Saving lives and meeting health needs
Incapacitated health systems in countries experiencing emergencies often result in vulnerable populations having little or no access to health care services. In the Syrian Arab Republic, more than 50% of public hospitals had been damaged or destroyed as a result of the conflict as of December 2012. To ensure the continuity of health care services, WHO partnered with 13 local nongovernmental organizations to ensure the provision of treatment, medicines and medical supplies. By the end of 2012, WHO had provided medicines and medical supplies for 1.2 million treatments, and more than 195 000 blood safety kits to the national blood bank, trauma surgery and emergency care supplies, intravenous nutrition fluid and intravenous supply sets to hospitals in affected areas.
Vulnerable populations in Afghanistan and Somalia, especially women and children, were reached through field hospitals and mobile clinics. In Somalia, children and women of childbearing age in remote communities and underserved areas were reached thorough health interventions on Child Health Days, in partnership with the national authorities and UNICEF. Nationwide emergency vaccination campaigns were conducted with health partners in Afghanistan, South Sudan and Sudan, as well as in Syrian Arab Republic where WHO and UNICEF supported the Ministry of Health in measles and polio vaccination campaigns for 2 million and 2.5 million children under 5 years of age, respectively. WHO provided vaccines, paracetamol and multivitamin syrups, as well as ensured capacity-building for national staff to implement the campaign effectively and efficiently.
In order to detect, and provide a timely and effective response to confirmed outbreaks, ministries of health strengthened the Early Warning Alert and Response (EWAR) systems in six countries (Afghanistan, Iraq, Jordan, Pakistan, Somalia and Sudan). These systems allowed WHO and partners to detect and manage outbreaks of cholera in southern and central Somalia, yellow fever in Sudan, acute watery diarrhoea in South Sudan, cholera in Iraq and tuberculosis among Syrian refugees in Jordan. As a result of the deteriorating heath situation in the Syrian Arab Republic, WHO established an early warning and response system and provided training to national surveillance focal points from around the country. Data collection began in September 2012 and enabled WHO and national authorities to monitor and control reported cases of hepatitis A, typhoid and leishmaniasis.
Incapacitated health systems and shortages in medicines also increase the burden of noncommunicable diseases as populations are no longer able to get regular treatment or access to essential, life-saving medicines. This has highlighted the need to update national lists of urgently required essential medicines in emergency countries based on disease profiles, current gaps and critical needs, with the Syrian Arab Republic identified as a priority country in early 2013.
Ensuring the collection and dissemination of health information in emergencies
One of the biggest challenges faced during emergencies is obtaining timely information on the health system so that health risks, needs and gaps can be accurately assessed. This challenge can be further aggravated during complex emergencies where access to this information is hindered. To ensure an efficient approach in managing health information, WHO worked with national authorities and health partners to establish emergency health information management systems and coordinated the collection, analysis and dissemination of essential information.
In the Syrian Arab Republic, WHO participated in two interagency assessment missions and conducted rapid assessments of public health facilities in all governorates to determine accessibility and functionality. In the neighbouring countries of Iraq, Jordan and Lebanon, nutrition assessments were conducted among Syrian refugees living in both the refugee camps and within the host communities. Nutrition assessments were also conducted in Afghanistan, Pakistan and Yemen to ensure capacity-building for response to severe and acute malnutrition.
In Pakistan, the Health Resources Availability Mapping System (HeRAMs) was integrated into the national health system to ensure good practice in the mapping of health resources and services availability in emergencies and to strengthen informed based decision-making by the Health Cluster. Inter-agency partnerships were also strengthened through WHO support of the assessment of 65 UNHCR-administered health facilities.
Strengthening country office capacity
Natural disasters and political unrest can occur at any time and are often difficult to predict. In order for WHO’s country offices to efficiently support country response operations, the deployment of health experts and procurement of medicines during emergencies must be as rapid and streamlined as possible. Challenges encountered at the onset of emergencies include the need to be able to identify and deploy qualified expertise rapidly and the lengthy procurement procedures within WHO for medicines and medical supplies.
To address these challenges, a regional emergency roster of public health experts was developed to enable WHO to respond in a more timely and effective manner to emergencies in the Region, with a number of public health experts identified and on standby. Negotiations were initiated in December 2012 with the United Arab Emirates Government to establish a dedicated hub for WHO in Dubai’s Humanitarian City. This hub will ensure that standard medical kits and supplies are stockpiled for more rapid deployment as needed in emergencies, and streamline the procurement process for WHO’s health relief operations in the Region and around the world. The standard operating procedures, developed in 2010 to streamline WHO’s work in emergencies, continued to be adhered to in addressing these challenges.
Emergency risk management
The growing number of large-scale emergencies enhanced the momentum of engaging Member States in multisectoral emergency risk management in the Region. It also highlighted the need to strengthen the emergency preparedness and response capacity of health systems, including the coordination among national and private sector partners.
Advocacy continued throughout 2012 in order to ensure that health is one of the priorities addressed in the global, regional and national development and disaster risk management agendas, in partnership with UNISDR, League of Arab States and UNDP. As a result, health has been underscored as one of the priority areas in the policy guidance for disaster risk reduction for Arab, African and Asian Member States, developed by all key partners. WHO was invited to participate in the First Arab Conference on Disaster Risk Reduction in 2013, where the regional disaster risk reduction platform was planned to be launched. A side meeting on multisectoral health is planned to be held during the conference for representatives/delegates of participating Member States.
Recognizing that incapacitated health systems impede national ability to respond to emergencies in a timely and efficient manner, emergency risk management was one of the areas highlighted for action within the context of the regional strategic priorities endorsed by the Regional Committee. This has spearheaded the impetus towards building national capacity with an all-hazard risk management approach incorporating the International Health Regulations (2005). As a result, the regulations have been included in national and regional training curricula for public health emergency management. To meet the challenges, even countries with protracted emergencies (Afghanistan, Pakistan and Sudan) are developing capacity in managing crises in a more institutional manner. This has also become evident in Islamic Republic of Iran, Oman and Pakistan, which are managing acute emergencies at the national level with minimal external support.
So far, seven countries (Afghanistan, Bahrain, Islamic Republic of Iran, Oman, Pakistan, Qatar and Sudan) are on track to institutionalize emergency risk management within the health sector. In light of this, preparation was undertaken to launch comprehensive risk assessment in Qatar and Sudan in the coming year. While establishing emergency risk management programmes remains a priority, simultaneous training in the areas of hospital preparedness, public health emergency management and disaster risk reduction also remain in focus in many countries. Recognizing that the safety of health facilities and health workforce is of utmost importance in the response to any public health emergency, several countries, including Bahrain, Islamic Republic of Iran, Lebanon, Oman and Sudan, are continuing to implement the hospital safety programme. WHO also worked with partners to develop a training programme on hospital preparedness in conflict situations.
To harmonize the national capacity-building activities from an all hazard approach at WHO, preparedness activities for emergencies, including epidemic and pandemic preparedness and core capacities for implementation of the International Health Regulations, were merged into one technical body ensuring optimum use of resources within the framework of health security and regulations under the auspices of of the Department of Communicable Disease Control. This was done in alignment of 2014–2015 biennium planning priorities.
Scaling up emergency response in the Region
With the deterioration of the situation inside the Syrian Arab Republic and the increasing scale and complexity of health issues and response in the neighbouring countries, the emergency was designated Grade 3 by WHO in December 2012 – the first time a Grade 3 was announced in the history of the Organization. As outlined in WHO’s Emergency Response Framework, a Grade 3 emergency called for the establishment of an emergency support team (EmST) to provide a consolidated, dedicated response to the crisis at the regional level by reinforcing WHO’s four critical functions: 1) coordination; 2) information; 3) technical expertise; and 4) core services. Plans for the immediate establishment of the EmST were finalized in December 2012 in a meeting in Beirut attended by senior representatives from all three levels of the Organization.
In addition to consolidating WHO’s response on a regional level to the Syrian crisis, the establishing of the EmST also reinforced the one-WHO model as other regions expressed their support. Despite its own financial limitations, the Regional Office for Africa donated US$ 100 000 to support EmST operations while WHO headquarters and the Regional Office for Europe deployed technical expertise as part of the emergency team. |
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 A member of a Rapid Response Team receives training on Ebola in Sudan (Photo: WHO).
Ebola virus disease (EVD) is a severe illness that is often fatal in humans if untreated. Ebolavirus is a genus of the virus family Filoviridae, which also includes the genera Cuevavirus, and Marburgvirus, and includes 5 species of Ebola: Zaire, Bundibugyo, Sudan, Reston and Taï Forest.
First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
The virus is transmitted to people from wild animals and spreads in the human population via direct contact with blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD, through close contact with patients when infection control precautions are not strictly practiced. Burial ceremonies that involve direct contact with the body of the deceased can also contribute to the transmission of Ebola. More surveillance data and research are needed on the risk of sexual transmission, and particularly on the prevalence of viable and transmissible virus in semen over time.
EVD on average kills half of those it infects, though fatality rates have varied from 25% to 90% in past outbreaks. The virus first appeared in 1976 in two simultaneous outbreaks in what is now South Sudan, and in the Democratic Republic of Congo, near the Ebola River from which the disease takes its name. The 2014–2016 outbreak in Sierra Leone, Liberia and Guinea, which was caused by the Zaire species, was the largest and most complex Ebola outbreak ever, with over 28,000 cases and more than 11,000 deaths. In addition to the direct health impact, the outbreak and associated fears and stigma caused severe damage and disruption to local economies and daily life. The same virus species re-emerged in the Democratic Republic of the Congo in 2017 and again in May and August of 2018.
To date, no EVD cases have been recorded in the Eastern Mediterranean Region. Between October 2014 and February 2015, 20 out of 22 countries in the Region conducted a rapid assessment of their preparedness and readiness measures for Ebola. Any gaps were addressed through a 90-day action plan addressing leadership and coordination, capacities at border crossings, surveillance and contact tracing, laboratory detection and diagnosis, case management and infection prevention and control, risk communication, and safe burials.
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