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Emergency preparedness and response PDF Print

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.

 

 

A member of a Rapid Response Team receives training on Ebola in Sudan (Photo: WHO). 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.

 

20181111_WHO_EMRO_WHE_IHM_Zika_1WHO experts identify mosquito breeding sites to guide vector control efforts (Photo: WHO).

Zika virus (ZIKV) disease is caused by a virus which is transmitted primarily by Aedes mosquitoes. Most infections are either asymptomatic or cause a mild illness including low fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache. Zika virus infection during pregnancy can cause microcephaly and other congenital malformations in newborns, known as congenital Zika syndrome. In adults and children it can cause rare but severe neurologic complications induding Guillain-Barré syndrome.

On 1 February 2016, WHO declared that recently reported clusters of microcephaly and neurological disorders potentially associated with ZIKV constituted a Public Health Emergency of International Concern (PHEIC). As of February 2018, 86 countries and territories around the world have reported transmission of Zika virus infection, of which 27 areas have ongoing transmission with new introduction or reintroduction reported since 2015.

As of August 2018, no cases of Zika have been recorded in the Eastern Mediterranean region. However, the Aedes aegypti mosquito is present in 8 countries in the Region (Djibouti, Egypt, Oman, Pakistan, Saudi Arabia, Somalia, Sudan and Yemen), so continued vigilance remains important.

There is no vaccine to prevent Zika virus infection, nor is specific anti-viral treatment currently available. Protection against mosquito bites during the day and early evening is a key measure to prevent Zika virus infection.

WHO is supporting countries to prevent and manage Zika and its complications according to the four main objectives outlined in the Zika Strategic Response Plan: detection, prevention, care and support, and research. 

 
Emergency preparedness and response PDF Print

Overview

2014 saw an escalation in emergencies and associated health needs of affected populations in a number of countries. A total of 58 million people are affected by emergencies in the Region, including 16 million refugees or internally displaced persons. More than half of the world’s refugees come from three countries of the Eastern Mediterranean Region (Afghanistan, Somalia and Syrian Arabic Republic) and are hosted in just four countries (Islamic Republic of Iran, Jordan, Lebanon and Pakistan). As a result of the Syrian crisis, in 2014 the refugee population in Jordan doubled and that in Lebanon tripled. Today, almost 25% of Lebanon’s total population comprises refugees. The Region also hosts the largest number of internally displaced persons as a result of conflict, with Iraq, Sudan and Syrian Arab Republic among the top five countries globally hosting internally displaced persons.

In Iraq, almost 5.2 million people across the country were in need of humanitarian assistance by May 2015, of whom more than 2.9 million were internally displaced, one of the largest internally displaced populations in the world. In security-compromised governorates an estimated 80% of health facilities were partially functional and 4% were non-functional as of December 2014. The departure of almost half of all health professionals, created a gap in the provision of primary health care, trauma surgery and obstetric care in areas where violence was ongoing. Supplies of medicines and equipment were irregular due to road inaccessibility and power/fuel shortages. In the three governorates forming the Kurdistan region, the rapid and massive influx of internally displaced persons overwhelmed the health system, causing critical medical shortages and overburdening health facilities. Due to the unprecedented scale, urgency and complexity of the conflict, in August 2014 the Inter-Agency Standing Committee declared the Iraq crisis a Grade 3 emergency, representing the highest level of emergency, and the second in the Region following the designation of the crisis in the Syrian Arab Republic as Grade 3 in 2012.

In the Syrian Arab Republic, by December 2014, almost 12.2 million people had been affected inside the country, including 7.6 million internally displaced and 4.8 million living in hard-to-reach or besieged areas. An additional 4 million were refugees taking shelter in Egypt, Iraq, Jordan, Lebanon and Turkey. By the end of March 2015, out of 113 pub¬lic hospitals assessed, 44% were reported fully functioning, 36% par¬tially functioning and 20% non-functioning. Populations had increasingly limited access to basic services, including life-saving health care, and functioning health facilities were unable to cope with the increasing needs of affected populations in conflict areas. Overcrowded living conditions, together with a significant drop in the overall vaccination coverage, left populations increasingly vulnerable to communicable diseases such as measles, typhoid and whooping cough.

In March 2015, the conflict in Yemen escalated, with violence reaching 19 out of Yemen’s 22 governorates. By June, more than 20 million people were affected, with almost 15 million people requiring health care services. The number of internally displaced persons almost doubled in May, reaching more than 1 million people. Serious shortages of medicines and medical supplies, as well as lack of fuel to operate hospital generators and maintain the vaccine cold chain, resulted in a gradual collapse of the health system. Fuel shortages also resulted in an estimated 9.4 million people with no or limited access to safe water. Surges in suspected cases of malaria and dengue fever were reported, with more than 3000 suspected cases and a number of deaths. Lack of access prevented WHO and partners from assessing the situation and providing vector control measures. Significant incidence of diarrhoeal diseases and pneumonia also continued to be reported. Delays and cancellations of vaccination campaigns increased the risk of measles outbreaks, and risked the reintroduction of polio into the country, although as of June, no polio cases were reported. A 5-day humanitarian pause in May allowed WHO and partners to scale up the response around the country. However, calls for a second pause during the month of Ramadan failed.

In Pakistan, military operations in the North Waziristan Agency resulted in the displacement of 500 000 people in June 2014, bringing the total number of displaced persons to 1 million, 74% of whom were women and children. Bad weather conditions, overcrowded housing in host communities, and poor nutrition increased the risk of waterborne diseases, such as cholera, dehydration, diarrhoea and heat stroke, as well as airborne diseases, such as pneumonia and measles.

In Libya, in June 2014, clashes between rival forces erupted in the cities of Tripoli and Benghazi. By December 2014, more than 2.5 million people were in need of humanitarian aid, including 400 000 displaced. Shortages in medicines and medical supplies, together with the evacuation of many of the country’s international health workforce left the health system weak and functioning health facilities overwhelmed.

In Palestine, 51 days of fighting in Gaza during July and August 2014 left 2333 Palestinians dead and 15 788 injured. Half a million people were displaced and up to 22 000 homes were destroyed or rendered uninhabitable, with 100 000 people remaining homeless at the end of the year. The conflict caused widespread damage to infrastructure, including hospitals, clinics and ambulances, as well as water and sanitation facilities, resulting in limited access to basic services.

In Afghanistan, as the armed conflict grew in intensity and geographical scope, the number of people in need of access to health services rose from 3.3 million in 2013 to 5.4 million in 2014, with the conflict continuing to cause critical disruptions to the provision of health services. More than 30% of the population in Afghanistan still has no or difficult access to essential health care.

In Somalia, the United Nations warned in June 2014 of a “looming humanitarian emergency”. Almost half of the country’s population lack access to basic services and about 3.2 million women and men require emergency health services. The health care system remains weak and there is a critical shortage of qualified health workers. The impact of this lack of basic services is felt most strongly among the internally displaced people who continue to be affected by disease outbreaks due to overcrowded and unsanitary living conditions and limited health services.

Natural disasters claimed additional lives. In September 2014, floods in Sudan resulted in the displacement of more than 320 000 men, women and children, while monsoon rains and flash floods in Pakistan affected almost 1.8 million people and resulted in 282 deaths and 489 injuries. More than 42 000 houses were estimated to be damaged or destroyed, while an estimated 2413 million acres of farmland were flooded at a time when crops were almost ready to be harvested. Some areas affected were those that had previously experienced flooding in 2013.

WHO has been fully mobilized in responding to the above mentioned emergencies by leading the work of the humanitarian health cluster and implementing its functions in strengthening disease surveillance and early warning systems, strengthening other public health functions including control of disease outbreaks and immunization and helping to sustain basic health care and life-saving services.

Challenges and WHO response to emergencies in the Region

One of the biggest challenges impeding WHO’s ability to respond is limited access as a result of insecurity. In the Syrian Arab Republic, limited access has required more innovative ways to reach populations in need. In Yemen, restricted access into the country via all ports delayed the delivery of urgently needed health supplies. Inside the country, violence and insecurity made some areas inaccessible, and increased the risk of diseases such as malaria and dengue fever as patients lack access to health care and thus timely diagnosis and treatment. Additional challenges included repeated and targeted attacks on health care workers, health facilities and health infrastructure. In 2014, WHO’s Regional Office publically condemned such attacks in Afghanistan, Iraq, Palestine, Sudan, Syrian Arab Republic and Yemen. Lack of sustainable funding for health in emergency response also posed a key challenge, impeding WHO and health partners’ capacity to respond, and risking the closure of existing health services and health programmes. In 2014, health was funded at 45.6% in the Region while coordination was funded at 84.8% and food at 61.8%. Despite increasing needs, health was only funded at 12.5% for 2015 as of May. There continues to be a heavy dependence by countries in crisis on external humanitarian and financial aid, which may not always arrive when it is most critically needed.

While trauma care needs have increased, there is decreasing capacity among partners to respond due to the insecurity. In the Syrian Arab Republic, where 1 million people were injured in the first quarter of 2015, health partners have been forced to completely withdraw from “hot” areas, leaving a critical gap in the provision of trauma care. Mass population movement, coupled with low immunization rates and vaccine shortages place the entire region at risk of disease outbreaks. The outbreak of polio and measles in the Syrian Arab Republic as a result of the crisis led to the re-introduction of polio in Iraq in 2014 after 14 years of being polio-free.

Operational challenges faced by WHO and health partners included disrupted health systems, an increasing number of patients requiring trauma care (especially in hard-to-reach areas), growing numbers of internally displaced persons, severely reduced health workforces as health staff fled with their families, disrupted referral systems as a result of insecurity and blocked roads, and critical shortages of essential medicines and vaccines. Mass population movements increased the risk of communicable diseases as IDPs sought shelter in overcrowded camps and public spaces, and damaged water and hygiene infrastructure increased the risk of water-borne diseases. Disease surveillance systems were disrupted as a result of limited data and information. Patients with chronic noncommunicable diseases were forced to find alternate locations for treatment as health facilities shut down or reported shortages in essential medicines. As a result of the violence, mental health needs also increased.

Following the Grade 3 designation of the crisis in Iraq, which signified a global organizational response, WHO’s country office was scaled up with the deployment of more than 21 international staff in all areas of expertise, as of May 2015 and WHO hubs and/or focal points were established in all 19 provinces. Through funding from Saudi Arabia, WHO procured and operationalized 10 mobile clinics in northern Iraq covering 300 000 internally displaced people and host communities. The project is part of WHO's broader response of providing a timely basic package of primary and secondary health care services. As of May 2015, 3.5 million people in Iraq had been provided with direct access to essential drugs and medical equipment procured and supplied by WHO.

Two cases of poliomyelitis were confirmed in Iraq in early 2014. Together with national and United Nations health partners, WHO was able to vaccinate more than 5 million children against poliomyelitis in three national immunization campaigns, as of May 2015.

In the Syrian Arab Republic in 2014, WHO delivered more than 13.8 million medical treatments to people in need across the country, with more than 32% of the deliveries distributed to hard-to-reach and opposition-controlled areas. WHO also mobilized more than 17 000 health care workers to vaccinate approximately 2.9 million children against poliomyelitis through 10 immunization campaigns and 1.1 million children immunized against measles.

In Yemen, from March to June 2015, WHO distributed almost 130 tonnes of medicines and medical supplies and more than 500 000 litres of fuel to maintain the functionality of main hospitals, vaccine stores, ambulances, national laboratories, kidney and oncology centres, and health centres in 13 governorates, reaching a total of more than 4.7 million beneficiaries, including 700 000 internally displaced people and 140 000 children under the age of 5 years. WHO also provided safe water and sanitation kits and supplies to health facilities and to internally displaced people hosted in affected communities, as well water trucking services to health facilities and communities with high numbers of internally displaced people. WHO also delivered medicines for tuberculosis and malaria and supported disease outbreak response and control.

During and after the Gaza conflict, WHO facilitated the delivery of medicines and medical supplies to hospitals and health facilities for hundreds of thousands of patients. The health cluster system was reactivated and led by WHO, together with the Ministry of Health. WHO took the lead in conducting the health component of the multi-cluster assessment, and led the health cluster in completing the joint health sector assessment. Despite the conflict, WHO ensured ongoing advocacy for access for patients with referrals abroad, working at a policy level to facilitate access for these patients.

Health risk management

The Regional Committee endorsed the need to strengthen emergency preparedness and response through an all-hazard and multisectoral approach (EM/RC61/R.1) and requested enhanced technical support from WHO to scale up national emergency risk management capacity. By the end of 2014, 19 countries had received support in reviewing their existing national plans for emergency preparedness and response, with a view to adopting the comprehensive approach. Two countries finalized a national plan for all-hazard emergency preparedness and response for health. To support the planning process, the comprehensive all-hazard risk assessment protocol was piloted in the Islamic Republic of Iran, along with comprehensive vulnerability analysis. In Afghanistan mass casualty management capacity was scaled up, in collaboration with partners.

In 2014, WHO’s work in emergencies in the Region was made possible with the support of many donors, including Australia, Canada, China, the European Commission, Finland, Italy, Japan, Korea, Kuwait, Norway, Russian Federation, Saudi Arabia, Switzerland, Turkey, United Arab Emirates, United Kingdom and United States of America.

Implementing the strategies endorsed by the Regional Committee

Progress was made in regard to implementing resolutions endorsed by the Regional Committee. The process of establishing a regional emergency solidarity fund was initiated with the aim of ensuring predictable financing of surge/rapid response to natural and man-made disasters in the Region. This was strengthened by the Regional Committee which urged Member States to contribute to the Fund by allocating to it a minimum of 1% of the WHO country budget, in addition to other voluntary contributions whenever possible.

With the goal of establishing a regional roster of trained experts who are able to quickly and effectively respond to any emergency, including disease outbreaks, capacity-building of emergency focal points was supported on surge training in emergencies , and will continue to be supported each year. To ensure the timely procurement and provision of critical medical supplies and equipment to countries experiencing emergencies in the Region and beyond, WHO has finalized an agreement with the Government of the United Arab Emirates to establish a dedicated WHO humanitarian operations/logistics hub.

WHO will continue to work with Member States to strengthen the capacity of health systems to prevent, mitigate, prepare for, respond to and recover from emergencies and crises following a whole-health and multisectoral approach, with special emphasis on reinforcing technical capacity in preparedness.

 
Implementing WHO management reforms PDF Print

Programmes and priority-setting

WHO continued to strengthen its implementation of reform in programme strategy and priority-setting, with the objective of improving global and regional health outcomes by focusing on its comparative advantages. The Regional Office provided support for the strategic aspects of WHO’s work at country level through regular liaison with WHO country offices and relevant regional stakeholders in developing, monitoring and evaluating the country cooperation strategies (CCS). New CCS guidelines were launched. An initial pilot group of four countries was established and training conducted. The new guidelines advocate for strong national ownership and an inclusive and consultative process of negotiation and development. Development of partnerships was promoted, including with the League of Arab States, the regional United Nations Development Group, the Organization of Islamic Cooperation, and regional UN organizations and institutions. The regional bottom-up operational planning process took place in good time for the WHO Financing Dialogue held in Geneva in November 2015 and was thus operational for an equally early start to implementation for the 2016–2017 biennium. 

The outcome of the end-of biennium reporting on the Programme Budget Performance Assessment for 2014–2015 showed that the regional base budget of US$ 268 million had been funded to the level of 84% while the allocated emergency budget of US$  585 million had been funded at 89%. The base programme budget utilization (expenditures and encumbrances) was 83% and utilization of actual available funding reached 99%. Budget utilization in the emergency programme for the Region as a whole was 85% and utilization of funding was 96%, leaving WHO at the regional level with a high overall funding utilization of 97% at the close of the biennium. The investment in priority work at the country level saw 85% of flexible funding allocated to country priorities.

Delivery of technical outputs was also high, particularly when viewed against the continued efforts of the regional and country offices to respond to and support event-driven emergency situations, with 78% of outputs fully achieved and 22% partially achieved.

The Regional Office was an active partner in the strengthening of the global category and programme area networks which contribute to programmatic and technical coherence at global, regional and country level. Both the category and programme area networks play a key role in harmonizing the priorities from the country level bottom-up planning with commitments emanating inter alia from regional and global resolutions to ensure the comprehensiveness and completeness of work plans.

In anticipation of the adoption in September 2015 by the United Nations General Assembly of the new development agenda for the period 2016–2030 expressed within the 17 Sustainable Development Goals (SDG) including one specific goal (Goal 3) for health with 13 targets, work was initiated to prepare plans for addressing the unfinished MDGs and the integrated SDG agenda. This was presented at the 62nd Session of the Regional Committee. 

As part of ongoing periodic programmatic reviews, an expert consultation was held in early 2016 on the Global Arabic Programme. Regional participants with expertise in translation, publishing and public health reviewed the work of the programme and the achievements of the past two decades. Taking into account the current context, the pressure on available resources and the need to streamline the strategic focus of the programme, it was recommended that resources should be concentrated on translation of WHO publications in the strategic priority areas, and on updating of the Unified Medical Dictionary. 

Governance

In keeping with the practice of the past few years, a high-level meeting for ministers and representatives of Member States and permanent missions in Geneva was held prior to the World Health Assembly. These meetings continue to provide an opportunity to review, with ministers of health and senior government officials, progress in addressing key priorities since the previous Regional Committee and to strengthen Member States’ engagement in global discussions on health and WHO reform. Daily meetings during the Executive Board meeting and Health Assembly provided additional opportunities for Member States from the Region to interact and agree on common positions that affect the Region. 

At its 62nd Session in October, the Regional Committee endorsed five resolutions in relation to the regional strategic priorities. Immediately prior to the session, a day of technical meetings was held to discuss current issues of interest. Where pertinent, the outcome of the discussions was taken forward to the Regional Committee for further discussion. This process, which follows from the revised rules of procedure endorsed by the Regional Committee at its 59th session, has proved to be a useful forum for high-level technical discussion with Member States.

Management

The Regional Office continued to develop essential instruments for the enhancement of the WHO reform process, with special emphasis on managerial reform, working closely with all other levels of the Organization to achieve the goals of the 12th General Programme of Work. It also continued to improve its planning, forecasting, implementation, monitoring and evaluation capacity aimed at more efficient use and distribution of limited resources, with a view to making WHO in the Region more fit for purpose.

The managerial actions associated with the reform process with respect to staff mobility and rotation, performance management and human resources planning and management were complemented by the promotion of an accountability culture.

Accountability and controls continued to be at the heart of improvement efforts with focus on the five compliance areas, which were repeatedly mentioned in internal and external audit observations of preceding years: direct financial cooperation, direct implementation, imprest purchase orders, asset inventories and non-staff contractual arrangements. These areas were closely monitored throughout the year by means of the monthly compliance dashboards. The aim of reducing audit observations to a minimum, and of closing all long-standing audit observations, was fully achieved by year end, with over 230 recommendations closed. This was accomplished while welcoming an unprecedented number of audit missions to the Region (seven, of which two in the Regional Office) within the same year. All audits resulted in satisfactory or partially satisfactory ratings, showing a clear improvement in controls compared to previous years, and a deep commitment to zero tolerance to non-compliance across the Region.

A number of initiatives have been undertaken in the past two biennia that have also proved useful to other regions. These include: a dedicated compliance and risk management role; improved compliance monitoring and reporting through dashboards; accountability compacts with budget centre managers and administrative officers tied in with performance management mechanisms; self-assessment questionnaires for managers in support of the management assertions on internal control; capacity-building initiatives, such an integrated training programme for budget centres, compliance forums and many more outreach initiatives; pilot projects as a basis for programmatic and administrative reviews; establishment of surge support capacity in the Region, with special focus on emergency countries; targeted country visits to provide on-site support; and strengthened managerial support to emergency preparedness and response, including the establishment of a regional solidarity fund.

WHO will address a number of specific challenges in 2016–2017, including the need for: capacity-building in institutions to support Member States in remaining aligned with evolving requirements; strengthening country level perspectives in responding to acute and protracted emergencies; consideration to deploy and deliver on a no-regrets basis; a regional risk register in addition to the corporate risk register; and continual improvement in accountability and control, as embedded in the regulatory frameworks. 

 


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