There are many types of anaemia. All are very different in their causes and treatments. Iron deficiency anaemia is the most common type and is easily treatable with dietary changes and iron supplements. The prevalence of anaemia, defined by low haemoglobin or haematocrit, is commonly used to assess the severity of iron deficiency in a population. The health consequences of anaemia can include poor pregnancy outcome, impaired physical and cognitive development, increased risk of morbidity in children and reduced work productivity in adults.

Iron deficiency anaemia is an important public health problem in the Eastern Mediterranean Region. It is estimated that more than one third of the population in the Region is anaemic. Pregnant women and young children are most at risk: about 50% of pregnant women and 63% of children under-5 have iron deficiency anaemia. Recent data on anaemia rates in preschool children, pregnant women and women of childbearing age show no improvement in the overall situation.

Anthrax is a disease caused by a bacterium called Bacillus anthracis. It has existed for hundreds of years and still occurs naturally in both animals and humans in many parts of the world, including Asia, southern Europe, sub-Sahelian Africa and parts of Australia. Anthrax bacteria can survive in the environment by forming spores. In its most common natural form, it creates dark sores on the skin, from which it derives its name.

Humans generally acquire the disease directly or indirectly from infected animals, or through occupational exposure to infected or contaminated animal products. Control in livestock is therefore the key to reduced incidence. The disease is generally regarded as being non-contagious. Records of person-to-person spread exist, but are rare.

Control of anthrax among humans depends on the integration of veterinary and human health surveillance and control programmes. Routine cross-notification between the veterinary and human health surveillance systems should be part of any zoonotic disease prevention and control programme, and close collaboration between the two health sectors is particularly important during epidemiological and outbreak investigations.

L'asthme est l'affection respiratoire chronique la plus courante, notamment chez l'enfant. Le taux de mortalité est relativement faible comparé aux autres maladies respiratoires chroniques, mais, selon les estimations de l'OMS, 300 millions de personnes sont atteintes et 255 000 décès ont été causés par ce problème de santé en 2005. Plus de 80 % de ces décès surviennent dans les pays en développement. D'après les données dont on dispose actuellement, près de 8 % de la population souffrirait d'asthme dans la Région de la Méditerranée orientale.

La prévalence de l'asthme est en hausse. L'OMS prévoit que, dans la Région, cette pathologie entraînera 20 000 décès d'ici 2015 et 27 000 d'ici 2030. De plus, nous savons que l'asthme est grandement sous-diagnostiqué et insuffisament traité, en particulier chez l'enfant. 

On ne guérit pas de l'asthme, mais une prise en charge appropriée permet de le maîtriser et d'avoir une bonne qualité de vie. La fumée (tabac, feu de bois ou de cheminée, gazinière au kérosène), les aérosols, les odeurs fortes (parfums, eaux de toilette, vapeurs d'essence), la poussière et la pollution de l'air peuvent déclencher des crises d'asthme en irritant les voies respiratoires sensibles.

Avian influenza (H5N1) also known as bird flu is primarily a disease of birds that is caused by several types of influenza viruses. The highly pathogenic avian influenza is a highly contagious disease affecting wild birds and poultry with occasional infections in human. All human cases have coincided with outbreaks in poultry. Since it was first reported in Vietnam in 2003, the disease has been responsible for human outbreaks and deaths in 15 countries in Asia, Europe, Middle East and Africa resulting in 603 human cases including 356 deaths.

The highly pathogenic H5N1 avian influenza has spread rapidly through the Eastern Mediterranean Region in 2006, with large epizootics reported in Iraq, Egypt, Jordan, occupied Palestine territories, Afghanistan, Pakistan, Djibouti and Sudan. Transmission of H5N1 from infected birds to humans has been confirmed in Iraq, Egypt, Djibouti and Pakistan. Egypt has been the most affected country in the EMR where the disease has remained endemic, with frequent epizootic and 167 human cases that include 60 deaths.

Symptoms of infection in humans include cough, muscle aches, runny nose and sore throat. Severe disease and death may result from a complication of pneumonia.

Biosafety is the safe working practices associated with handling of biological materials, particularly infectious agents. It addresses containment principles, technologies and practices that are implemented to prevent the unintentional exposure to pathogens and toxins, or their accidental release. Responsible laboratory practices, including protection, control and accountability for valuable biological materials will help prevent their unauthorized access, loss, theft, misuse, diversion or intentional release. The World Health Organization (WHO) Regional Office for the Eastern Mediterranean provides technical support to Member States in developing biorisk management strategies to minimize risks of infections through safe and secure practices in laboratory and transport environments in a cost-effective manner. It provides guidance on, and promotes the use of, safe and secure workplace practices, appropriate protective equipment, and engineering and administrative controls in the handling of pathogenic organisms.

En 2008, 7,6 millions de personnes sont décédées d'un cancer dans le monde. Près de 60 % de ces décès surviennent dans les pays à revenu faible ou intermédiaire et ce nombre devrait augmenter à l'avenir. On estime que cette maladie tue plus de 250 000 individus par an, rien que dans la Région OMS de la Méditerranée orientale.

C'est dans cette région que l'incidence du cancer devrait le plus s'accroître au cours des quinze prochaines années, si l'on tient compte de la prévalence de tous les facteurs de risque. Dans la Région, le cancer du sein chez la femme et le cancer du poumon et de la vessie chez l'homme sont les plus fréquents.

Cette hausse prévue du nombre de cancers peut être attribuée au vieillissement de la population, à l'amélioration du dépistage et de l'enregistrement des cas, mais aussi, ce qui est plus grave, à une exposition accrue aux facteurs de risque. Le plus important d'entre eux est le tabagisme, les autres étant l'alimentation malsaine, la sédentarité, les mauvaises habitudes dans le comportement et le mode de vie, la pollution et l'exposition accrue aux carcinogènes industriels et agricoles.

Le Bureau régional de l'OMS travaille en étroite collaboration avec les États Membres pour relever ces défis et atteindre les objectifs de la stratégie régionale de lutte contre le cancer, y compris au niveau des soins palliatifs.

Dans de nombreux pays de la Région, les bases de données nationales sur le cancer sont insuffisantes ou ne sont pas mises à jour. L'OMS collabore avec les États Membres pour mettre en place des registres nationaux du cancer, en collaboration avec le Centre international de recherche sur le cancer (CIRC).

Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally-adequate and safe complementary foods while breastfeeding continues for up to two years or beyond. Special attention and practical support is needed for feeding in exceptionally difficult circumstances.

WHO regional policy for breastfeeding is to implement the Global Strategy for Infant and Young Child Feeding by protecting, promoting and supporting breastfeeding and timely, adequate and safe complementary feeding of infants and young children. The circumstances where specific recommendations apply include: infants less than six months of age who are malnourished, low birth-weight infants, infants and children in emergencies, infants born to HIV-positive women and children living in special circumstances, such as orphans and vulnerable children or infants born to adolescent mothers.

Many countries in the WHO Eastern Mediterranean Region report high rates (>60%) of early initiation of breastfeeding of infants and more than 60% of infants continue to be breastfed at one year. However, rates of exclusive breastfeeding seem to have declined, with only 40% or less of infants under six months in countries of the Region being exclusively breastfed.

Une brûlure est la destruction d'une ou de plusieurs couches de cellules de la peau, généralement par contact avec une source chaude liquide, solide ou gazeuse. Il s'agit d'un grave problème de santé publique à l'échelle mondiale, les brûlures par flamme causant à elles seules plus de 195 000 décès par an. Les lésions dues au rayonnement ultraviolet, à la radioactivité, à l'électricité ou aux produits chimiques, ainsi que les dégâts que provoque l'inhalation de fumée sur l'appareil respiratoire, sont également considérés comme des brûlures.

Si l'on prend en compte toutes les formes de brûlures (électrisation, ébouillantement, etc.), le nombre de victimes est bien plus élevé, mais on ne dispose pas de telles données au niveau mondial. Les brûlures par le feu constituent la quinzième cause de mortalité chez l'enfant et le jeune adulte (5-29 ans).

Plus de 95 % des cas de brûlures par flamme ayant entraîné la mort surviennent dans les pays à revenu faible et intermédiaire. On observe les pics de mortalité chez les enfants de moins de 5 ans et les personnes de 70 ans ou plus. Outre le nombre important de victimes, des millions de personnes souffrent d'incapacité à long terme ou sont défigurées à vie, ce qui est souvent à l'origine de stigmatisation et d'exclusion.

Une telle situation est inacceptable car elle peut être évitée. Les pays développés ont réussi à réduire nettement le nombre de décès par brulûres à l'aide d'interventions de prévention efficaces et de services pour les personnes brûlées. S'ils sont adaptés aux conditions locales, ces interventions et services peuvent être mis en place dans les pays en développement par des efforts collectifs et concertés aux niveaux national, régional et mondial.

En 2008, 7,6 millions de personnes sont décédées d'un cancer dans le monde. Près de 60 % de ces décès surviennent dans les pays à revenu faible ou intermédiaire et ce nombre devrait augmenter à l'avenir. On estime que cette maladie tue plus de 250 000 individus par an, rien que dans la Région OMS de la Méditerranée orientale.

C'est dans cette région que l'incidence du cancer devrait le plus s'accroître au cours des quinze prochaines années, si l'on tient compte de la prévalence de tous les facteurs de risque. Dans la Région, le cancer du sein chez la femme et le cancer du poumon et de la vessie chez l'homme sont les plus fréquents.

Cette hausse prévue du nombre de cancers peut être attribuée au vieillissement de la population, à l'amélioration du dépistage et de l'enregistrement des cas, mais aussi, ce qui est plus grave, à une exposition accrue aux facteurs de risque. Le plus important d'entre eux est le tabagisme, les autres étant l'alimentation malsaine, la sédentarité, les mauvaises habitudes dans le comportement et le mode de vie, la pollution et l'exposition accrue aux carcinogènes industriels et agricoles.

Le Bureau régional de l'OMS travaille en étroite collaboration avec les États Membres pour relever ces défis et atteindre les objectifs de la stratégie régionale de lutte contre le cancer, y compris au niveau des soins palliatifs.

Dans de nombreux pays de la Région, les bases de données nationales sur le cancer sont insuffisantes ou ne sont pas mises à jour. L'OMS collabore avec les États Membres pour mettre en place des registres nationaux du cancer, en collaboration avec le Centre international de recherche sur le cancer (CIRC).

On estime que 54 % des décès liés aux maladies non transmissibles dans la Région de la Méditerranée orientale sont dus aux maladies cardio-vasculaires. La mortalité par maladie cardio-vasculaire va de 13 %, en Somalie, à 49 % à Oman. La prévalence de ce type de pathologies s'explique par les modes de vie sédentaires et les principaux facteurs de risque, comme l'hypertension (de 28 % aux Émirats arabes unis à 41 % en Libye et au Maroc), le diabète (de 4 % en République islamique d'Iran à 19 % au Soudan) et l'hypercholestérolémie (de 14 % au Liban à 52 % en Iran).

Dans la Région, les données compilées chez l'adulte (à partir de 15 ans) indiquent que les plus forts taux de prévalence sont observés à Bahreïn, au Koweït, aux Émirats arabes unis et en Arabie saoudite, où la prévalence de l'obésité et du surpoids dépasse 70 %, notamment chez la femme. La progression rapide de ces deux problèmes de santé chez l'enfant est particulièrement inquiétante. Par ailleurs, les taux de sédentarité sont plus élevés dans la Région qu'aillleurs. Près de la moitié des femmes, et plus d'un tiers des hommes, ne font pas suffisamment d'exercice. Le tabagisme est également en hausse, avec un taux de prévalence chez l'homme allant de 7 % à 57 %.

On estime qu'à cause des maladies cardiaques, des accidents vasculaires cérébraux et du diabète, la plupart des pays à revenu faible ou intermédiaire verront leur produit intérieur brut diminuer de 1 % à 5 % d'ici 2015. L'accessibilité et la disponibilité des médicaments essentiels pour la prise en charge des maladies caridio-vasculaires courantes représentent un défi majeur dans les pays à faibles ressources de la Région.

Cataract is a butting of the lens in the eye that normally affects vision. Cataract, the most common cause of blindness and visual impairment, is often related to ageing. Occasionally children are born with the condition, or a cataract may develop following an eye injury, or as a result of inflammation or other diseases, such glaucoma and diabetes. Sometimes, the development of cataract is linked to steroid use or it may develop after exposure to some types of radiation.

Cataract is responsible for over 51% of blindness in the Eastern Mediterranean Region. Although cataract can be easily surgically operated , in many countries access to eye care is limited. As people in the world live longer, the number of people with cataract is anticipated to grow. Cataract is also an important cause of low vision.

There is no known prevention for the cataract. Reduction of cigarette smoking, ultraviolet light exposure may delay the development of cataract.

The WHO prevention of blindness programme provides technical support to Member States in the development of comprehensive eye care systems to address the burden of cataract.

According to the 2008 WHO/UNICEF World report on child injury prevention, "Injury and violence are a major killer of children throughout the world, responsible for approximately 950 000 deaths in children and young people under the age of 18 years each year. That is more than 100 children dying needlessly every hour of every day. Unintentional injuries, including road traffic injuries, falls, burns, poisoning and drowning, account for almost 90% of these cases. Road traffic injuries alone are the leading cause of death among 15–19 year olds and the second leading cause among 5–14 year olds."

In the Eastern Mediterranean Region, the burden of unintentional child injuries is one of the highest in the world, especially in low- and middle-income countries. The Eastern Mediterranean Region endures about 12% of all unintentional injury deaths of the world in those under 20 years of age, again differentially affecting the disadvantaged sections of the society.

Child health and development is an important aspect of public health in the Eastern Mediterranean Region. Children below five years of age represent 12% of the total population in the Region. In 2011, about half a million more children in the Region were able to reach their fifth birthday compared with 1990, thanks to country efforts to improve child health. Despite a remarkable reduction in child deaths in recent decades, more than 900 000 children under five still die in the Region each year. Over 40% of these deaths occur in the neonatal period, the first 28 days of life. Pneumonia and diarrhoea remain leading causes of mortality in countries with a high under-five mortality rate. Malaria is also a major killer in Sudan. Malnutrition is likely to contribute to a third of all under-five deaths in low-income countries. For the children who survive, it adversely affects their growth and cognitive development if untreated in the earliest months of life and before they reach their second birthday. This, in turn, translates into a reduced economic productivity for a nation. Recommended feeding practices, i.e. exclusive breastfeeding and timely introduction in the infant’s diet of solid and semi-solid foods in addition to breastmilk which help the child grow and develop healthy, are sub-optimal in many countries. Effective interventions exist which can prevent or treat the conditions mentioned above and help build the foundations for child health since birth. The regional child health and development programme assists countries in implementing those interventions.

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year there are an estimated 3 to 5 million cholera cases and 100 000 to 120 000 deaths due to cholera. The short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks.

Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. About 75% of people infected with Vibrio cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment, potentially infecting other people.

Globally, cholera incidence has increased steadily since the beginning of the millenium with cholera outbreaks persisting in Sub-Saharan Africa. There are a number of countries in the Eastern Mediterranean Region that are in a state of complex emergency. Lack of safe water supply and poor environmental sanitation in war ravaged countries are formidable challenges.

Chronic respiratory diseases are chronic diseases of the airways and other structures of the lung. Some of the most common chronic respiratory diseases are: asthma, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension. Chronic respiratory diseases constitute a public health problem that impose a substantial burden.

Although some chronic respiratory diseases cannot be cured, appropriate management can control the disease and enable people to enjoy a good quality of life. Smoke (tobacco smoke, smoke from wood-burning or kerosene stoves and fireplaces), aerosol sprays, strong odours (perfumes, cologne, gasoline fumes) and dust and air pollution can trigger attacks by irritating sensitive airways.

Smoking is very common in many countries of the Eastern Meditteranian Region. The WHO Framework Convention on Tobacco Control was developed in response to the globalization of the tobacco epidemic, with the aim of protecting billions of people from harmful exposure to tobacco. It is the first global health treaty negotiated by WHO, and has been ratified by more than 167 countries.

WHO also leads the Global Alliance against Chronic Respiratory Diseases, a voluntary alliance of national and international organizations, institutions, and agencies working towards the common goal of reducing the global burden of chronic respiratory diseases. Its vision is a world where all people breathe freely. The Global Alliance against Chronic Respiratory Diseases focuses specifically on the needs of low- and middle-income countries and vulnerable populations.

Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disease that interferes with normal breathing – it is more than a “smoker’s cough”. According to the WHO estimates (2004), currently 64 million people have COPD and 3 million people died of COPD. WHO predicts that COPD will become the third leading cause of death worldwide by 2030. Almost 90% of COPD deaths occur in low- and middle-income countries, where effective strategies for prevention and control are not always implemented or accessible.

The WHO Framework Convention on Tobacco Control (WHO FCTC) was developed in response to the globalization of the tobacco epidemic, with the aim to protect billions of people from harmful exposure to tobacco. It is the first global health treaty negotiated by World Health Organization, and has been ratified by more than 167 countries.

WHO also leads the Global Alliance against Chronic Respiratory Diseases (GARD), a voluntary alliance of national and international organizations, institutions, and agencies working towards the common goal of reducing the global burden of chronic respiratory diseases. Its vision is a world where all people breathe freely. GARD focuses specifically on the needs of low- and middle-income countries and vulnerable populations.

Dengue fever is a viral infection transmitted by mosquitos found in tropical and sub-tropical regions around the world. It is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. In recent years, transmission has increased predominantly in urban and semi-urban areas and has become a major international public health concern.

Dengue is the most rapidly spreading mosquito-borne viral disease in the world. In the last 50 years, incidence has increased 30-fold with increasing geographic expansion to new countries and, in the present decade, from urban to rural settings. An estimated 50 million dengue infections occur annually and approximately 2.5 billion people live in dengue endemic countries.

Since 1998, epidemics of dengue fever and dengue haemorrhagic fever have been reported in the Region with increasing frequency and expanding geographic distribution of both the viruses and mosquito vectors. Outbreaks have been reported from Djibouti, Pakistan, Saudi Arabia, Somalia, Sudan and Yemen. In 2009 and the first half of 2010, outbreaks of dengue fever and dengue hemorrhagic fever were reported from Saudi Arabia, Sudan and Yemen.

Au niveau mondial et régional, la dépression est l’une des dix causes principales des années de vie corrigées de l’incapacité perdues, et devrait être une des trois premières d’ici 2030. Elle se caractérise par le manque d'énergie, la tristesse, la perte d'intérêt ou de plaisir, le sentiment de culpabilité ou le manque d'estime de soi, des troubles du sommeil ou de l'appétit et des difficultés de concentration. La dépression, qui est l’un des plus grands facteurs de risque de suicide, touche particulièrement les adolescents et les femmes en âge de procréer. Les personnes souffrant d'affections chroniques, comme les maladies non transmissibles et les incapacités, sont plus exposées que la population générale ; de plus, la dépression risque d'aggraver leur autre problème de santé.

À la lumière de ces résultats, la stratégie régionale sur la santé mentale et le programme d'action de l'OMS Combler les lacunes en santé mentale (mhGAP) ont fait de la dépression une priorité à traiter dans l’ensemble des services de santé mentale, qui doivent être intégrés aux soins de santé généraux.

Le diabète est une maladie chronique qui survient si le pancréas ne produit plus assez d'insuline ou si l'organisme n'est plus capable de capter cette hormone, ce qui entraîne une concentration élevée de glucose dans le sang (hyperglycémie).

Le diabète de type 1 (appelé auparavant « diabète insulino-dépendant » ou « diabète juvénile ») se caractérise par une production d'insuline insuffisante. Le diabète de type 2 (autrefois appelé « diabète non insulino-dépendant » ou « diabète d'âge mûr ») est causé par l'incapacité de l'organisme à utiliser l'insuline. Il est souvent la conséquence du surpoids ou du manque d'exercice physique.

Dans la Région OMS de la Méditerranée orientale, la prévalence est très élevée, tant chez l'homme que chez la femme. D'un État à l'autre, elle va de 3,5 % à 30 %. Parmi les dix pays au monde où la prévalence du diabète est la plus forte, six sont situés dans la Région. Il s'agit de l'Arabie saoudite, de Bahreïn, des Émirats arabes unis, du Koweït, du Liban et d'Oman.

D'ici à 2025, le nombre de personnes diabétiques devrait plus que doubler dans les Régions OMS de l'Afrique, de la Méditerranée orientale et de l'Asie du Sud-Est. En outre, on observe que le diabète de type 2 apparaît aujourd'hui chez des individus de plus en plus jeunes dans beaucoup de pays de la Région, ce qui s'explique par la sédentarité accrue des modes de vie, l'amélioration de l'espérance de vie et la progression de l'obésité. L'hypertension artérielle et les maladies cardio-vasculaires sont elles aussi en augmentation.

Diarrhoeal disease is the second leading cause of death in children under five years old and is responsible for killing 1.5 million children every year. Diarrhoea is the passage of three or more loose or liquid stools per day, or more frequently than is normal for the individual. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. Diarrhoeal disease is treatable with a solution of clean water, sugar and salt, and with zinc tablets.

Diarrhoea can last several days and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. Children who are malnourished or have impaired immunity are most at risk of life-threatening diarrhoea.

The wide diversity of bacterial and viral infections that may cause diarrhoea complicates accurate surveillance and diagnosis, especially in developing countries with little or no access to modern laboratory procedures. The specific disease burden attributable to a particular infectious agent is particularly complex, given the multiplicity of these agents, their serotypes, and its accurate documentation depends largely on laboratory facilities.

Diphtheria is an acute infectious disease caused by the toxin produced by a bacterium named Corynebacterium diphtheriae. The disease affects the throat and the tonsils which is the commonest form of the disease, while the other forms include skin infections.

Les incapacités (ou le handicap) sont aujourd'hui définies comme une interaction entre l'individu et l'environnement. Le fonctionnement d'une personne dépend beaucoup des obstacles à la participation qu'elle rencontre dans son environnement et qui font de ce dernier un milieu facilitateur ou, au contraire, handicapant. Selon les dernières estimations OMS/Banque mondiale, près du quart de la population mondiale vit avec une incapacité, et les États Membres de la Région OMS de la Méditerranée orientale ne font évidemment pas exception.

Les principales causes d'incapacités sont liées aux problèmes de santé chroniques comme le diabète, aux cancers, aux maladies cardio-vasculaires et respiratoires, aux traumatismes (accidents de la route, par exemple), aux violences et aux chutes, aux déficiences mentales, aux maladies congénitales, à la malnutrition ainsi qu'aux maladies transmissibles. La croissance démographique, le vieillissement de la population et les progrès médicaux qui allongent l'espérance de vie ont également un impact sur l'incidence du handicap. En outre, les catastrophes naturelles et celles qui sont d'origine humaine entraînent un grand nombre d'incapacités. 

Près de 80 % de la population mondiale souffrant d'incapacités vit dans les pays à revenu faible. Ces personnes connaissent des difficultés sociales et économiques, et subissent des violations de leurs droits. La pauvreté est étroitement liée au handicap, puisqu'elle en est à la fois une cause et une conséquence, et constitue un obstacle aux services de santé et de réadaptation.

A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. Outbreaks are maintained by infectious agents that spread directly from person to person, from exposure to an animal reservoir or other environmental source, or via an insect or animal vector. Human behaviours nearly always contribute to such spread. Early detection and reporting of such events is crucial in minimizing their negative social and economic impact.

Epidemic-prone diseases, including emerging and re-emerging diseases constitute the greatest threat to public health security and the disruption of social and economic developments of the countries of the Eastern Mediterranean Region.

In the past 20 years, the Region has witnessed a marked increase in the number of outbreaks and pandemics caused by emerging and re-emerging diseases, such as Alkhurma haemorrhagic fever, chikungunya, cholera, dengue, A/H5N1 influenza, pandemic A/H1N1 (2009) and Rift Valley fever, among others. This situation has been exacerbated by acute and chronic humanitarian crisis in many countries of the Region.

Dracunculiasisis, otherwise known as guinea worm disease, is an eradicable disease caused by the parasitic worm Dracunculus medinensis. Infection occurs when a person drinks water containing infected cyclops with the intermediate host being D. medinensis.

The disease was widespread at the beginning of the 20th century. In 1980, transmission was limited to 20 countries only. By the end of 2009, only four countries (Ethiopia, Ghana, Mali and Sudan) had indigenous cases, and the annual incidence was 3190 cases compared to 3.5 million in 1986. Sudan alone accounted for 86% of all cases reported in 2009. Dracunculiasis transmission, after the separation of Sudan, is limited to South Sudan only.

Ethiopia, Ghana and Mali are expected to have interrupted transmission in 2010. South Sudan still needs a few years to interrupt transmission.

Several donors are supporting activities of eradication, including The Bill and Melinda Gates Foundation and The United Kingdom’s Department of International Development. Both WHO and The Carter Center are campaigning to secure funds to fill the gap between the estimated amount needed for eradication (US$ 72 million) and the pledged amount by the donors.

Dysentery is bloody diarrhoea, i.e. any diarrhoeal episode in which the loose or watery stools contain visible red blood. It can be caused by a number of infectious agents ranging from viruses and bacteria to protozoa and parasitic worms; it may also result from chemical irritation of the intestines. Dysentery can be fatal as it can cause severe dehydration. Proper management of cases and of the environment, including safe water and sanitation is essential in affected areas.

Medical education is education related to the practice of being a medical practitioner. Gaining a basic medical degree may take from five to eight or even nine years, depending on jurisdiction and university. Medical doctors include generalists and specialists. Medical training completed by internship qualifies a medical doctor to become a physician or a surgeon. The educational development and training programme of the WHO Regional Office for the Eastern Mediterranean provides technical support to countries in the Region in strengthening national capacity and aligning the education of health workers with population health needs.

WHO defines e-Health as the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research.

Clear evidence exists on the growing impact that eHealth has on the delivery of health care around the world today, and how it is making health systems more efficient and more responsive to people's needs and expectations.

The Eastern Mediterranean Region includes different levels of maturity and readiness to utilize e-Health as a key enabler in the delivery of health care services. Experience shows that harnessing ICT for health requires strategic and integrated action at the national level, to make the best use of existing capacity while providing a solid foundation for investment and innovation

Emerging diseases are diseases that appear in a population for the first time, or that may have existed previously but are rapidly increasing in incidence or geographic range.

Environmental changes, human and animal demography, pathogen changes and changes in farming practice are among the factors that lead to emerging diseases. Social and cultural factors such as food habits and religious beliefs play a role too.

Emerging diseases have economic repercussions well beyond their immediate health costs. They may impede trade and travel or cause disproportionate alarm, especially if rumours of intentional use become widespread. The answer to the international threat from these diseases is through well coordinated global surveillance and response.

Epilepsy is among the three most frequently encountered neurological disorders in primary health care settings in 20 of the 23 countries of the Eastern Mediterranean Region. An estimated 4.7 million people with epilepsy live in this Region. Although epilepsy is a largely treatable brain disorder and relatively cheap medication is available, between 60% and 98% of patients in developing countries receive no treatment. In response to this huge gap, the Global Campaign against Epilepsy was launched in 1997 as a joint initiative of WHO, the International League Against Epilepsy and the International Bureau for Epilepsy. Under the auspices of the global campaign, the Regional Office for the Eastern Mediterranean specifically formulated a declaration calling upon countries to take strong actions. Additionally, the WHO mental health Gap Action Programme (mhGAP) and regional mental health and substance abuse strategy, has included epilepsy among the disorders to be prioritized for inclusion in the primary health care package of services for mental health.

Escherichia coli (abbreviated as E. coli) are a large and diverse group of bacteria commonly found in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless however, specific strains such as enterohaemorrhagic E. coli, can cause severe foodborne disease.

An increasing number of outbreaks are associated with the consumption of fruits and vegetables (sprouts, spinach, lettuce, coleslaw, salad) whereby contamination may be due to contact with faeces from domestic or wild animals at some stage during cultivation or handling. Waterborne transmission has been reported, both from contaminated drinking water and from recreational waters. Person-to-person contact is an important mode of transmission through the oral-faecal route. An asymptomatic carrier state has been reported, where individuals show no clinical signs of disease but are capable of infecting others.

The prevention of infection requires control measures at all stages of the food chain, from agricultural production on the farm to processing, manufacturing and preparation of foods in both commercial establishments and household kitchens.

Lymphatic filariasis is one of the oldest and most debilitating neglected tropical diseases. Lymphatic filariasis is caused by parasitic worms of nematodes family of Filariodidae that are transmitted to humans by mosquitoes of the genus Culex, Anopheles and Aedes.

An estimated 120 million people from 81 countries are infected with lymphatic filariasis. An estimated 1.43 billion live in areas where filariasis is endemic and are at risk of infection. Approximately 65% of those at risk reside in WHO’s South-East Asia Region, 30% in the African Region and the remainder in other parts of the tropical world.

The most common clinical manifestations of lymphatic filariasis include lymphoedema and scrotal hydrocele. These two manifestations adversely affect personal and social life, and limit occupational activities, making lymphatic filariasis the second leading cause of chronic disability worldwide.

In 1998, a pharmaceutical company announced its commitment to collaborate with WHO by providing albendazole free of charge for as long as needed to eliminate the disease. The donating pharmaceutical company expanded its donation programme for onchocerciasis to provide ivermectin for lymphatic filariasis elimination in all countries where lymphatic filariasis and onchocerciasis were co-endemic.

Lymphatic filariasis in the Eastern Mediterranean Region

Eastern Mediterranean region has an estimated at-risk population of 12.6 million people, accounting for approximately 1% of the global disease burden.

Lymphatic filariasis is endemic in Egypt, Sudan, South Sudan and Yemen. In Sudan, South Sudan and Yemen, lymphatic filariasis is co-endemic with onchocerciasis. The situation in four other countries remains uncertain and needs epidemiological investigation: Djibouti, Islamic Republic of Iran, Saudi Arabia and Somalia.

In 2000, the Regional Committee for Eastern Mediterranean approved resolution (EM/RC47/R.11) urging Member States with present transmission or a history of transmission to make national epidemiological assessments of the disease, to strengthen filariasis management, surveillance, information and evaluation systems, and to develop a time-bound national plan for eliminating the disease in line with the strategies adopted by WHO.

Viral haemorrhagic fevers (VHF) are among the important public health emergencies of international concern as defined by the International Health Regulations (2005). They are characterized by sudden onset, muscle and joint pain, fever, bleeding and shock from loss of blood. In severe cases, a prominent symptom is bleeding, or haemorrhaging, from orifices and internal organs. The most important VHFs in the Eastern Mediterranean Region are yellow fever, Rift Valley fever, dengue haemorrhagic fever, Crimean–Congo haemorrhagic fever and Ebola haemorrhagic fever.

The emergence and re-emergence of VHF is a growing concern worldwide. They are associated with occurrence of major epidemics with high case-fatality rates. Lack of timely laboratory diagnosis, functional epidemiological surveillance, inadequate infection control practices at health care facilities and weak vector control programmes could result in prolonged outbreaks of VHF. In the past two decades, the Region has witnessed several major outbreaks of different VHF. To date, VHFs have been reported from more than 12 countries in the Region.

Haemophilus influenzae type b (Hib) is bacteria that commonly cause bacterial meningitis and pneumonia and the leading cause of other invasive diseases as septic arthritis (joint infection), epiglottitis (infection and swelling of the epiglottis) and cellulites (rapidly progressing skin infection which usually involves face, head, or neck). Pericardiatis (infection of the sac covering the heart) and Osteomyelitis (bone infection) are less common forms of invasive disease.

Health workers are all people primarily engaged in actions with the primary intent of enhancing health. At the heart of each and every health system, the workforce is central to advancing health. Developing capable, motivated and supported health workers is essential for overcoming bottlenecks to achieve national and global health goals. Health care is a labour-intensive service industry. Health workers are not just individuals but are integral parts of functioning health teams in which each member contributes different skills and performs different functions. Health workers in the Region are often overworked, poorly paid, and not provided with the necessary equipment and supplies to do their jobs. Their work performance can also suffer due to a lack of adequate training, supervision and feedback. The human resources development programme of WHO Regional Office for the Eastern Mediterranean provides technical support to Member States in strengthening national capacity and achieving balanced deployment and access to more motivated and skilled health workers, particularly in underserved areas.

Soil-transmitted helminthiases are widely distributed in tropical and subtropical areas. Worldwide, it has been estimated that more than one billion people are infected with soil-transmitted helminthiases infections, of whom more than 300 million suffer from severe morbidity.

There are four species of helminth causing soil-transmitted helminthiases: hookworms Ancylostoma duodenale and Necator Americans, roundworm Ascariasis lumbricoides, and whipworm Trichuris trichura. Each species is responsible for a separate set of signs and symptoms, in fact for a separate disease. Symptoms include nausea, tiredness, abdominal pain and loss of appetite. These infections aggravate malnutrition and amplify rates of anaemia.

In the Eastern Mediterranean Region, the population requiring preventive chemotherapy for soil-transmitted helminthiases constituted 14% of those requiring the chemotherapy worldwide in 2008. In 2003, estimates of cases of soil-transmitted helminthiases infections were 23 million for ascariasis, seven million for trichuriasis and 10 million for hookworm disease.

Hepatitis is an inflammation of the liver. It is mainly caused by viral infection. The four most common hepatitis viruses are hepatitis A, B, C and E. In addition, there is hepatitis D, which is rarer.

Other causes of hepatitis include bacterial infection, liver injury caused by a toxin and certain medical conditions.

L'hépatite virale est causée par un groupe de virus (hépatite A, B, C, D et E) à l'origine d'une infection aiguë ou chronique et d'une inflammation du foie. Les virus de l'hépatite B et C sont des causes importantes de morbidité et de mortalité.

L'hépatite A et E est causée par la consommation d'aliments ou d'eau contaminés. L'hépatite B, C et D se transmet par contact avec le sang et les autres fluides corporels d'une personne infectée. Les modes de transmission courants sont les transfusions à risque et les procédures médicales invasives à l'aide d'équipement infecté. L'hépatite B peut se transmettre par la voie périnatale (de la mère à l'enfant pendant l'accouchement), par les infections pendant la petite enfance (résultant du contact étroit avec des proches infectés) et par les rapports sexuels non protégés.

L'hépatite est devenue un important problème de santé publique dans la Région de la Méditerranée orientale. Au niveau régional, plus de 75 % des cirrhoses et des carcinomes hépatocellulaires sont dus aux infections par le virus de l'hépatite B ou C. Malgré les stratégies de prévention efficaces, la transmission perdure dans toute la Région. De plus, un grand nombre de ces infections résultent d'une transmission nosocomiale ; c'est pourquoi il est crucial de mettre en œuvre les programmes de lutte contre les infections et de sécurité tranfusionnelle.

Proper infant and young child feeding is of fundamental importance for human survival, growth, development, health and nutrition. The role of proper feeding of infants and young children over the first two to three years of life is crucial, because this age period is a critical time for organ growth, development and metabolic programming, with windows of opportunity that may be irreversibly closed once it has passed. Around 50% of deaths in children under five in the WHO Eastern Mediterranean Region are attributable to mild to moderate malnutrition.

The vast global burden of malnutrition in its major forms is telling evidence of failed infant feeding worldwide. Inappropriate feeding practices may account for around a third of all cases of malnutrition, depending on population, place, time and season, and in combination with other causes such as infection and food shortage. The WHO Regional Strategy on Nutrition (2010–2019) seeks to improve the nutritional status of the population, particularly in early life, by preventing and treating malnutrition among pregnant women and children aged up to two years.

Infection prevention and control measures aim to ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of settings. Health care Associated Infections (HAIs) are considered the most frequent adverse events that threaten patient safety around the world. Around 5% to 15% of patients admitted to acute care hospitals in developed countries acquire health care associated infections at any given time. The risk of acquiring infection is 2 to 20 times higher in developing countries. The WHO Eastern Mediterranean Region has one of the highest frequencies of HAIs in the world. The prevalence of HAIs in several countries in the Region is reported to vary from 12% to 18%. The burden of transmissible infections among health care workers due to unsafe health care practices is also considerably high in the Region. Although a substantial proportion of infections and deaths attributable to HAIs can be prevented and low cost interventions for infection prevention and control are available, progress in this field remains slow.

Les maladies infectieuses sont causées par les agents pathogènes (bactéries, virus, parasites et champignons) et se propagent, directement ou non, d'une personne à une autre. 

On peut répartir ces maladies en trois catégories : celles qui ont un fort taux de mortalité, celles qui entraînent des incapacités importantes dans la population et celles qui, étant donné la rapidité et l'imprévisibilité de leur propagation, peuvent avoir de graves conséquences à l'échelle mondiale.

Une grande partie des principaux déterminants de la santé et des causes de maladies infectieuses échappent au contrôle direct du secteur de la santé. D'autres secteurs sont concernés, comme l'assainissement et la gestion des eaux usées, les changements environnementaux et climatiques, l'éducation, l'agriculture, le commerce, le tourisme, les transports, le développement industriel et le logement.

Influenza pandemic occurs when a new influenza virus emerges and spreads around the world, and most people do not have immunity. Viruses that have caused past pandemics typically originated from animal influenza viruses.

Some aspects of influenza pandemics can appear similar to seasonal influenza while other characteristics may be quite different. For example, both seasonal and pandemic influenza can cause infections in all age groups, and most cases will result in self-limited illness in which the person recovers fully without treatment. However, typical seasonal influenza causes most of its deaths among the elderly while other severe cases occur most commonly in people with a variety of medical conditions.

For both seasonal and pandemic influenza, the total number of people who get severely ill can vary. However, the impact or severity tends to be higher in pandemics in part because of the much larger number of people in the population who lack pre-existing immunity to the new virus. When a large portion of the population is infected, even if the proportion of those infected that go on to develop severe disease is small, the total number of severe cases can be quite large.

Road traffic crashes and injuries are responsible for the majority of morbidity and mortality caused by all types of injuries. Each and every year about 1.3 million people are killed and 20–50 million suffer moderate to severe injuries due to road traffic crashes.

In the Eastern Mediterranean Region, Road traffic injury is a major threat to the health and development in the Eastern Mediterranean Region. Road traffic injuries are the sixth leading cause of disease burden in the Region, resulting in an estimated 150 000 deaths and 2.8 million non-fatal injuries annually. Modelling exercises show that high-income and middle-income countries of the Region have the highest road traffic injury fatality rates in the world, along with the African Region (32 per 100 000 population, up from 26.4 per 100 000 in 2002).

The road traffic injury death rate in the Region among men in the age group between 15 and 29 years is highest in the world (34.2 deaths per 100 000 population). Road traffic injuries also have significant economic costs (1%–1.5% of gross national product), disproportionately affecting the poor and the vulnerable segments of society (pedestrians, public transport users, motorcyclists and cyclists).

Injuries whether intentional (due to acts of violence against others or oneself) or unintentional (due to road traffic crashes, burns, drowning, falls and poisoning) claim about 5.8 million lives across the world every year - more than malaria, tuberculosis and HIV/AIDS combined. In the Eastern Mediterranean Region the number of deaths in 2008 due to injuries was almost 445 000. Deaths however are only the tip of the iceberg.

Hundreds of thousands suffer non-fatal injuries that need different levels of care such as hospitalization, emergency treatment and even care in the community, and may end in various forms of disabilities. Besides the devastating human toll, the socioeconomic implications cannot be overrated, rendering violence not only a public health problem but a development issue as well.

The International Health Regulations (IHR) are a set of regulations legally binding on 194 States Parties, including all WHO Member States. They contribute to global public health security by providing a new framework for the coordination of the management of events that may constitute a public health emergency of international concern, and will improve the capacity of all countries to detect, assess, notify and respond to public health threats.

The Regulations (2005) were adopted at the Fifty-eighth World Health Assembly on 23 May 2005 and entered into force on 15 June 2007. They require States Parties to notify a potentially wide range of events to the WHO. Implementing IHR (2005) is an obligation for WHO and States Parties to the Regulations.

The Regional Office for the Eastern Mediterranean supports the implementation of the IHR requirements by providing technical and legal coordination and services to Member States and relevant organizations across the Region.

Leishmaniasis is a major public health problem in the Eastern Mediterranean Region where cutaneous and visceral leishmaniasis are both endemic.

Up to 60% of the worldwide burden of cutaneous leishmaniasisis is in the Region. Two forms of leishmaniasis exist – anthroponotic and zoonotic. Anthroponotic tends to occur in densely-populated urban settings, mainly in Afghanistan, Islamic Republic of Iran, Morocco and the Syrian Arab Republic. Zoonotic leishmaniasis tends to occur in rural settings across the Region.

Visceral leishmaniasis, anthroponotic and zoonotic are both endemic. Anthroponotic visceral leishmaniasis occurs mainly in South Sudan and Sudan representing 12% of the worldwide burden. Zoonotic visceral leishmaniasis occurs across the Mediterranean basin. Iraq represents 85% of cases in the entire Region.

Leprosy is a chronic slightly contagious disease. It is not easily transmitted from one person to another. It is caused by bacillus bacteria called Mycobacterium Leprae. It affects skin and peripheral nerves, mucosa of the upper respiratory tract and the eyes. Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes. Involvement of certain peripheral nerves may result in characteristic patterns of disabilities leading to ulceration of skin and deformity of some joints.

The global prevalence rate of leprosy is less than one case per 10 000 persons. Elimination was achieved in 2000.

The leprosy situation in the Eastern Mediterranean Region

The Eastern Mediterranean Region reports a small proportion of the global new cases. The disease has been eliminated from all countries of the Region, except South Sudan, where the situation still needs to be reviewed following separation in 2011. Some countries still have a few districts which have not achieve elimination, such as Sudan, Egypt and Yemen. South Sudan is the only country from the Region among the 17 countries globally reporting more than 1000 new cases annually. Most of the countries report a very small number of cases. Sudan, Egypt, Pakistan and Yemen report between 300 and 900 new cases per year. Morocco, Afghanistan, Islamic Republic of Iran and Somalia report less than 100 new cases annually. Some member countries of the Gulf Cooperation Council report non-national cases.

Macronutrients are nutrients that provide calories or energy and are required in large amounts to maintain body functions and carry out the activities of daily life. There are three broad classes of macronutrient: proteins, carbohydrates and fats. The food situation in the WHO Eastern Mediterranean Region has improved over the last four decades. However, the changes in food habits are not the same in all countries, which can be divided into three groups.

1. In low-income countries, the food consumption characteristics are the same as in many poor countries around the world. The daily caloric intake is insufficient (between 2000 kcal and 2300 kcal) and cereals contribute 60%–80% of total calorie intake.
2. In intermediate-income countries, the average per capita calorie supply is between 2700 kcal and 3000 kcal. Cereals contribute more than half of the calorie intake. Sugar consumption has risen considerably to reach an average level of 30 kg–40 kg/per capita/annum. Similarly, fat consumption has increased in several countries and contributes 20%–25% of the daily energy supply. The change in habitual dietary intakes in these countries is mainly due to increases among the upper and middle social classes in the last two decades following economic growth and the development of industry and services.
3. In high-income countries, the traditional diet, which consisted of dates, milk, fresh vegetables and fruits, whole wheat bread and fish, has changed to a more diversified diet with an excess intake of energy-dense foods rich in fat and free sugars and deficient in complex carbohydrates.

Le paludisme est une maladie causée par un parasite (Plasmodium), transmis par la piqûre d'un moustique infecté. Dans l'organisme, ce parasite se multiplie au niveau du foie avant d'infecter les globules rouges.

Aide-mémoire sur le paludisme

Dans la Région de la Méditerranée orientale, la diversité géographique détermine la variabilité du paludisme concernant l'endémicité, l'intensité de la transmission et le type de la maladie. Les pays d'endémie palustre de la Région sont situés dans les trois zones éco-épidémiologiques suivantes : la région afrotropicale, la région orientale et le Paléarctique. En Arabie saoudite, au Yémen et en Afrique subsaharienne (Djibouti, Somalie, Soudan, Soudan du Sud), P. falciparum est prédominant. Dans les autres pays d'endémie, notamment en Afghanistan, en République islamique d'Iran et au Pakistan, P. falciparum et P. vivax sont tous deux transmis.

En 2011, les pays de la Région de la Méditerranée orientale ont signalé 3 058 639 cas, dont seulement 37 % étaient confirmés par examen parasitologique. Cinq pays représentaient plus de 98 % des cas confirmés en 2011 : le Soudan (44 %), le Pakistan (29 %), le Soudan du Sud (10 %), le Yémen (8 %) et l'Afghanistan (7 %). Le nombre total de cas en 2011 ne comprend pas les cas cliniques survenus au Pakistan avant 2010 (près de 4 millions par an). L'OMS estime à 10,4 millions (entre 6,4 et 16,6 millions) le nombre de cas dans la Région, dont 83 % sont des infections à P. falciparum.

L'OMS estime qu'en 2010, le paludisme a causé 15 000 décès (entre 7 000 et 24 000) dans la Région de la Méditerranée orientale, dont 70 % chez l'enfant de moins de cinq ans. Seuls 1 148 d'entre eux ont été signalés, dont 53 % au Soudan.

Measles is a highly contagious respiratory infection that is caused by a virus that infects only humans. It is transmitted by respiratory droplets and direct contact with nasal or throat secretions of infected persons.

A medical device is an article, instrument, apparatus or machine that is used in the prevention, diagnosis or treatment of illness or disease, or for detecting, measuring, restoring, correcting or modifying the structure or function of the body for some health purpose. Typically, the purpose of a medical device is not achieved by pharmacological, immunological or metabolic means. The health and biomedical devices programme in the Eastern Mediterranean Region was established in 2009 to deal with all issues related to health technology assessment and management, in particular medical devices. The programme aims at supporting countries in all phases of the health technology life cycle, including assessment and prioritization of needs, management of procurement and donation, installation and training, maintenance and disposal. Sustainable access to essential medical devices and health technologies remains a huge challenge in the Eastern Mediterranean Region. Lack of appropriate selection of biomedical technology, and of maintenance budget, are serious issues. National regulatory institutions, with a few notable exceptions, remain fragmented and inadequate and the private sector is ineffectively regulated.

Meningitis is inflammation of the meninges, the covering of the brain and spinal cord. It is usually caused by a virus or bacterium (meningococcus). It is transmitted through droplets of respiratory or throat secretions. It is most often caused by infection (bacterial, viral, or fungal), but can also be produced by chemical irritation, subarachnoid haemorrhage, cancer and other conditions.

Several different bacteria can cause meningitis. The bacteria are transmitted from person-to-person through droplets of respiratory or throat secretions from carriers. Close and prolonged contact – such as kissing, sneezing or coughing on someone, or living in close quarters (such as a dormitory, sharing eating or drinking utensils) with an infected person (a carrier) – facilitates the spread of the disease.

The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms.

Mental well-being is an integral part of health and is defined as "a state of well-being in which the individual realizes his/her own abilities, can cope with normal stresses of life, can work productively and fruitfully and is able to make a contribution to his/her community". Mental well-being provides the substrate for positive emotions, thoughts, perceptions, cognitions, communications and behaviours. Mental well-being is therefore not only desirable in itself but is also a resource for generation, protection and accumulation of human, physical, natural and social capital.

Mental health is determined by a complex and diverse interaction of biological, social, psychological and structural determinants of health, conferring differential resilience or vulnerabilities to develop disorders and disabilities. The regional strategy on mental health recognizing the importance of intersectoral, coordinated action to promote mental health and prevent mental disorders provides a template for action across the range of sectors to realize this.

Meningococcal disease includes meningococcal meningitis and meningococcaemia. Meningococcal meningitis is a severe bacterial infection of the membrane that covers the brain and spinal cord. Meningococcaemia is an infection of the blood. Meningococcal meningitis and meningococcaemia are caused by the bacterium Neisseria meningitidis (N. meningitidis), which is known as the meningococcus and infects humans only.

Neurological disorders affecting the central and peripheral nervous system, most frequently reported in primary care include headache, epilepsy, cerebro-vascular disorders, neuropathies, infectious disorders, Alzheimer's disease and other forms of dementia, and Parkinson's disease. They are responsible for around 6.29% of all disability adjusted life years (DALYs) lost due to disease and injury worldwide, and 5.34% in the Eastern Mediterranean Region. Considering the global scenario and specific health challenges in the Region, the regional strategy aims at enhancing the capacity of Member States in providing integrated care for priority neurological disorders, using the mhGAP intervention guide and training material, as well as increasing public awareness about neurological disorders and their treatment through development of partnerships with public and private sectors and nongovernemntal organizations and collaboration with related social sectors such as education, social security, etc.

Nursing and midwifery encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people.The nursing and midwifery workforce is central to managing and delivering health services. The ability of health systems to perform well and respond appropriately to new challenges is strongly influenced by the availability of nursing staff with relevant skills, in sufficient numbers, located where they are needed, and working in an environment that motivates and engages them. The Regional Office for the Eastern Mediterranean supports its Member States in responding to the challenges by focusing on the vital areas of nursing and midwifery education, training, performance and management.

Malnutrition remains one of the most serious health problems in the Eastern Mediterranean Region. It is the single biggest contributor to child mortality: 15% of the global burden of newborn and child mortality occurs in countries of the Region. Futhermore, the regional burden of disease associated with inadequate nutrition is growing.

The Region is experiencing unprecedented demographic and nutritional changes, with a related shift in the disease burden. While the problem of undernutrition continues to exist, diet-related chronic diseases resulting from overweight and obesity are increasing. This nutritional transition is leading to a "double burden" of disease that is having a negative impact on the health systems of the Region. To address these problems, systematic nutritional surveillance systems are needed that produce accurate and up-to-date information.

La nutrition est en lien direct avec l'alimentation, qui sert à couvrir les besoins nutritionnels de l'organisme. Il est nécessaire d'avoir une bonne alimentation pour rester en bonne santé. À l'inverse, une mauvaise alimentation peut entraîner une productivité et une immunité réduites, une vulnérabilité accrue à la maladie et un maldéveloppement physique ou mental. La nutrition a des effets sur le développement de l'organisme à tous les stades de la vie, de la conception jusqu'à la mort. Ne pas souffrir de la faim ni de la malnutrition est un droit fondamental, qu'il faut faire respecter avant toute chose, au nom du développement humain et national.

On répartit les pays de la Région de la Méditerranée orientale en quatre groupes selon leur situation en matière de nutrition :

• Les pays en situation d'urgence et de crise humanitaire, où la sous-nutrition infantile et maternelle est sévère et les carences en micronutriments répandues dans la population. Ce groupe comprend l'Afghanistan, la Somalie et le Soudan.
• Les pays où la sous-nutrition est importante (en particulier la sous-nutrition infantile chronique et aiguë), les carences en micronutriments répandues, et où le surpoids et l'obésité apparaissent dans certaines sous-catégories socioéconomiques. Ce groupe comprend les pays suivants : Djibouti, l'Iraq, le Pakistan, le Territoire palestinien occupé et le Yémen.
• Les pays entamant la transition nutritionnelle, qui affichent un taux de surpoids et d'obésité modéré, un taux de sous-nutrition modéré dans certaines populations ou tranches d'âge et des carences en micronutriments répandues. On trouve les pays comme l'Égypte, la Jordanie, le Liban, la Libye, le Maroc et la République arabe syrienne.
• Les pays à un stade avancé de la transition nutritionnelle, où le surpoids et l'obésité sont élevés, la sous-nutrition modérée, et où les carences en micronutriments ne concernent que certaines sous-catégories de la population. Ce groupe comprend les pays du Conseil de coopération du Golfe, la République islamique d'Iran et la Tunisie. 

Micronutrients enable the body to produce enzymes, hormones and other substances essential for proper growth and development. Although only needed in tiny amounts, even moderate levels of deficiency can have serious detrimental effects on human function. Micronutrient malnutrition has many adverse effects on human health, not all of which are clinically evident. In addition to the direct health effects, micronutrient malnutrition has profound implications for economic development and productivity, including potentially huge public health costs and the loss of human development. Micronutrient malnutrition is widespread globally, but especially in developing countries. It can affect all age groups, but young children and women of reproductive age are among those most at risk. The three major micronutrient deficiencies in Eastern Mediterranean Region are in iodine, vitamin A and iron. In the Region: 45% of the total population has iron deficiency anaemia 54% of the total population has insufficient iodine intake 22% of preschool children have vitamin A deficiency.

Macronutrients are nutrients that provide calories or energy and are required in large amounts to maintain body functions and carry out the activities of daily life. There are three broad classes of macronutrient: proteins, carbohydrates and fats. The food situation in the WHO Eastern Mediterranean Region has improved over the last four decades. However, the changes in food habits are not the same in all countries, which can be divided into three groups.

• In low-income countries, the food consumption characteristics are the same as in many poor countries around the world. The daily caloric intake is insufficient (between 2000 kcal and 2300 kcal) and cereals contribute 60%–80% of total calorie intake.
• In intermediate-income countries, the average per capita calorie supply is between 2700 kcal and 3000 kcal. Cereals contribute more than half of the calorie intake. Sugar consumption has risen considerably to reach an average level of 30 kg–40 kg/per capita/annum. Similarly, fat consumption has increased in several countries and contributes 20%–25% of the daily energy supply. The change in habitual dietary intakes in these countries is mainly due to increases among the upper and middle social classes in the last two decades following economic growth and the development of industry and services.
• In high-income countries, the traditional diet, which consisted of dates, milk, fresh vegetables and fruits, whole wheat bread and fish, has changed to a more diversified diet with an excess intake of energy-dense foods rich in fat and free sugars and deficient in complex carbohydrates.

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. The body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2). A person with a BMI of 25 or more is considered by WHO to be overweight, while obesity is defined as having a BMI of 30 or more. Overweight and obesity are potent risk factors for cardiovascular diseases and type 2 diabetes and are major contributors to premature deaths.

These metabolic disorders are dramatically increasing among adults in the Eastern Mediterranean Region. Data for adults aged 15 years and older from 16 countries in the Region show the highest levels of overweight and obesity in Egypt, Bahrain, Jordan, Kuwait, Saudi Arabia and United Arab Emirates. The prevalence of overweight and obesity in these countries ranges from 74% to 86% in women and 69% to 77% in men. These data indicate a much higher prevalence of obesity among adult women, while overweight is more marked among adult men. Escalating levels of overweight and obesity among children and adolescents is of particular concern given recent evidence linking childhood and adolescent obesity to increased risk of obesity and morbidity in adulthood.

Pertussis, also known as whooping cough, is an acute respiratory tract infection caused by the bacterium Bordetella pertussis. After an incubation period of 9 to 10 days, the clinical symptoms of the disease start with a catarrhal phase followed by paroxysmal cough and ending with persistent cough and whooping. The cough and whooping are characteristic of the diseases and make the clinical diagnosis easy to establish.

Les produits pharmaceutiques et les médicaments sont des préparations médicales utilisées dans la médecine moderne et traditionnelle, qui sont indispensables pour prévenir et traiter les maladies ainsi que pour protéger la santé publique.

L'utilisation de produits inefficaces, de qualité inférieure ou dangereux peut causer l'échec thérapeutique, aggraver la maladie, entraîner une pharmacorésistance, voire se révéler mortelle. Un tel usage sape également la confiance du public envers les systèmes et les personnels de santé, ainsi que les entreprises qui fabriquent et distribuent les médicaments.

Assurer l'accès régulier à des médicaments de qualité, sûrs et abordables reste une difficulté pour de nombreux pays. Le Bureau régional de l'OMS pour la Méditerranée orientale fournit une expertise et un appui technique aux États Membres de la Région dans les domaines suivants : assurance de la qualité, réglementation et législation, innocuité et efficacité des médicaments.

Plague is a zoonotic disease caused by enterobacteria Yersinia pestis. It is primarily carried by rodents and spreads to humans and other animals via fleas. Direct person-to-person transmission does not occur except in the case of pneumonic plague, when respiratory droplets may transfer the infection from the patient to others in close contact.

Infected persons usually start with “flu-like” symptoms after an incubation period of 3 to 7 days. Patients typically experience the sudden onset of fever, chills, head and body aches and weakness, vomiting and nausea. Clinical plague infection manifests itself in three forms depending on the route of infection: bubonic, septicaemic and pneumonic.

There are natural foci of plague infection in rodents in many parts of the world. Wild rodent plague is present in central, eastern and southern Africa, South America, the western part of North America and in large areas of Asia. In some areas, contact between wild and domestic rats is common, resulting in sporadic cases of human plague and occasional outbreaks.

Pneumonia is a form of acute respiratory infection that affects the lungs. It is caused by a number of infectious agents including viruses, bacteria and fungi. Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth.

Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first six months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

Poliomyelitis (polio) is an infectious disease caused by a virus. The severity of the disease ranges from inapparent infection to paralytic disease and possibly death when paralysis affects vital muscles such as those responsible for respiration. Inapparent infection far exceeds paralytic illness by more than 100:1.

Infection is spread by direct contact or through food or drink contaminated by faeces of infected persons.

There is no cure or treatment for polio but there are very effective vaccines for prevention. Polio vaccines need to be given several times to ensure immunity, which is always for life.

Permanent paralysis in the limbs can be alleviated by physiotherapy, rehabilitation and use of orthotic devices.

The provision of psychotropic medications is an important element for a health system. These medications can be used to treat the symptoms of mental disorders, reduce disability and prevent relapse. Anti-psychotics, anti-depressants, mood stabilizers and anti-epileptic medications comprise the main categories of psychotropic medications.

In the Eastern Mediterranean Region, almost all countries have pyschotropic medications in their national essential medicines lists, however, according to an assessment carried out using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), only in 36% of countries in the Region do primary health care facilities have a regular supply of essential pyschotropic medications. As reflected in the regional strategy, countries need to ensure a regular supply of essential pyschotropic medications to all health facilities, including primary health care facilities to facilitate integration of a mental health component in primary health care. WHO has recently developed guidelines for pharmacological treatment of mental disorders in primary health care which can be adapted by countries to their local context.

Public health surveillance is the continuous and systematic collection, orderly consolidation and evaluation of pertinent data with prompt dissemination of results to those who need to know, particularly those who are in a position to take action.

Effective disease control programmes rely on effective surveillance and response systems. Strengthening disease surveillance capacity makes countries better identify disease prevention priorities, plan for the best possible health of their populations, sensitize beneficiaries, focus evidence based interventions that work and monitor the trends to show impact as well as to detect issues to address.

Surveillance should be a common public service using similar structures, processes and resources, while recognizing that different diseases may have specialized surveillance needs and exploiting opportunities for synergy when carrying out core functions (detection, confirmation, analysis, response) and support functions (training, supervision, communications, resource management).

The World report on disability defines rehabilitation as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments”. Rehabilitation is an essential first step that empowers persons with disabilities and enables their interaction with other people and participation in different activities including education, work, leisure etc. Article 26, Habilitation and Rehabilitation, of the United Nations Convention on the Rights of Persons with Disabilities calls for: “... appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life”.

Respiratory tract diseases are diseases that affect the air passages, including the nasal passages, the bronchi and the lungs. Respiratory conditions include acute respiratory infections as well as chronic respiratory diseases, such as asthma, chronic obstructive pulmonary disease and lung cancer.

The burden of respiratory conditions is aggravated by multiple determinants. The direct and indirect exposure to tobacco smoke is the principal risk factor for its development. Other important factors include heavy exposure to air pollution derived from indoor and outdoor sources, occupational related disorders, malnutrition and low birth weight, and multiple early lung infections.

Socioeconomic factors play an important role in increasing the prevalence and severity of disease through environmental determinants, and can be related to lack of access to appropriate care.

Rotavirus gastroenteritis is caused by rotavirus that infects the stomach and bowel. Rotavirus gastroenteritis is common in infants and young children. Children under five years of age, especially those between 6 months and two years are most vulnerable to the disease.

Rubella is contagious infectious disease caused by the rubella virus. The infection is usually mild sub-clinical. Possible presenting symptoms are fever, red rash blotchy and swollen lymph glands

Schistosomiasis is a parasitic disease that leads to chronic ill-health. People infected with schistosomes expel the parasite’s eggs in their faeces or urine depending upon the type of the infecting parasite. In communities where no proper latrines or sanitation exist, freshwater resources in these communities may become contaminated with faeces or urine containing the eggs. Eggs hatch when they come in contact with water, thus releasing larvae called miracidia. If miracidia find the right type of snail, they use it to multiply in several cycles, eventually producing thousands of new parasites, called cercariae, which are then released from the snails to the surrounding water. When humans come into contact with water-containing cercariae, cercariae penetrate the skin and infect those humans.

Schistosomiasis is characterized as either intestinal or urogenital, depending on where the adult flukes are located. In intestinal schistosomiasis, adult worms occupy mesenteric veins, and their eggs pass into the lumen of the intestine and reach the faeces. There are four species that cause intestinal schistosomiasis: S. intercalatum, S. japonicum, S. mansoni and S. mekongi. S. haematobium causes urogenital schistosomiasis, and adult worms reside in veins draining the urinary tract, and their eggs pass out of the body in the urine.

An estimated 207 million people may have schistosomiasis in the world. The disease is endemic in tropical and subtropical areas. It is most prevalent in sub-Saharan Africa, where more than 90% of those infected live.

Psychosis is characterized by disturbance of thought, perception and emotions. Psychosis is a severe mental disorder which can be acute, transient, chronic or episodic, occurring as a primary disorder, such as schizophrenia, or as part of a mood disorder, such as depression or bipolar disorder, or secondary to conditions such as alcohol or drug abuse, medical illnesses (e.g. HIV/AIDS, cerebral malaria), or neurological disorders (e.g. dementia and stroke).

Worldwide, 25 million people suffer from schizophrenia, the most common psychotic disorder. Schizophrenia has a relatively low incidence but high prevalence. Despite severity, the evidence from low-income countries shows that treatment halves the chance of relapse of schizophrenia after one year, with up to 77% being relapse free. Considering this fact, psychosis is one of the priority conditions in the WHO mental health Gap Action Programme (mhGAP) and for inclusion in integrated mental health services for primary health care advocated by the regional strategy for mental health and substance abuse.

Severe Acute Respiratory Syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). It is considered the first emerging epidemic of the 21st century. SARS was first reported in Asia in February 2003 and spread to more than two dozen countries in North America, South America, Europe, and Asia before it was contained.

SARS is spread by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets. In general, SARS symptoms include high fever, headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset.

About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.

Smallpox is an acute contagious disease caused by Variola virus, a member of the orthopoxvirus family. It was one of the world's most feared diseases until it was eradicated by a collaborative global vaccination programme led by the World Health Organization.

Early symptoms include high fever and fatigue. The virus then produces a characteristic rash, particularly on the face, arms and legs. The resulting spots become filled with clear fluid and later, pus, and then form a crust, which eventually dries up and falls off. Smallpox was fatal in up to 30% of cases.

The last known natural case was in Somalia in 1977. Since then, the only known cases were caused by a laboratory accident in 1978 in Birmingham, England, which killed one person and caused a limited outbreak.

The global eradication of smallpox was certified, based on intense verification activities in countries, by a commission of eminent scientists in December 1979 and subsequently endorsed by the World Health Assembly in 1980.

En cas d'accident vasculaire cérébral (AVC), le risque de décès est élevé. S'il n'entraîne pas la mort, l'AVC peut causer des pertes de la vision ou de la parole, une paralysie et une confusion. On parle d'accident car celui-ci survient de manière brutale. Après un premier accident vasculaire cérébral, il existe un risque de récidive accru. Le risque de mortalité dépend de la nature de l'AVC. En cas d'accident ischémique transitoire, les symptômes disparaissent en vingt-quatre heures et l'issue est la plus favorable. L'AVC causé par la sténose carotidienne (rétrécissement de l'artère du cou qui irrigue le cerveau) est plus grave. L'obstruction d'une artère est encore plus dangereuse, mais le plus redoutable reste la rupture d'un vaisseau cérébral.

Chaque année, 15 millions de personnes font un accident vasculaire cérébral : 5 millions d'entre elles meurent et 5 millions souffrent d'une incapacité permanente, ce qui représente un poids pour la famille et la communauté. L'AVC est rare chez les moins de 40 ans et, s'il survient, c'est principalement à cause de l'hypertension artérielle. Il frappe cependant près de 8 % des enfants atteints de drépanocytose.

L'hypertension et le tabagisme sont les deux grands facteurs de risque modifiables. Sur dix personnes décédées d'un AVC, quatre auraient pu être sauvées si leur tension avait été maîtrisée. Chez les plus de 65 ans, 40 % des décès par AVC sont liés au tabagisme. La fibrillation atriale, l'insuffisance cardiaque et la crise cardiaque sont d'autres facteurs de risque importants. L'incidence de l'AVC baisse dans de nombreux pays développés, ce qui est en grande partie dû à l'amélioration de la lutte contre l'hypertension et à la réduction de la consommation de tabac. En valeur absolue, le nombre d'accidents vasculaires cérébraux continue toutefois d'augmenter du fait du vieillissement de la population.

Selon l'Atlas OMS sur la toxicomanie, 3,5 % à 5,7 % des 15-64 ans consommeraient des drogues illicites dans le monde et l'on estime que 10 % à 15 % d'entre eux deviennent dépendants ou en font un usage nocif. Dans la Région de la Méditerranée orientale, la prévalence des troubles liés à l'utilisation de susbtances psychoactives touchent 3 500 personnes sur 100 000. Les troubles liés aux injections concernent 172 individus sur 100 000 et représentent 4 années de vie corrigées de l'incapacité perdues ainsi que 9 décès, contre 2 années et 4 décès au niveau mondial (sur une population de 1 000 personnes).

Le programme OMS Santé mentale et toxicomanies fournit un soutien technique aux États Membres pour mettre en œuvre des politiques, des plans et une législation fondés sur des bases factuelles, promouvoir des services de prévention, de soins et de traitement les plus efficaces possibles, y compris les programmes de maintenance à long terme visant à remplacer les opioïdes par des agonistes, et intégrer ces services aux systèmes de soins de santé primaires.

Suicide is the act of deliberately killing oneself. Risk factors for suicide include mental disorder, especially depression, and neurological disorders, cancer and HIV infection. Every year, almost one million people die from suicide, 86% of whom are in low/middle-income countries. Suicide is among the three leading causes of death for young people under 25 and accounts for 10%−20% of deaths in women up to one year after giving birth. The median suicide rate for the countries of the Eastern Mediterranean Region is 4.90 per 100 000 people, compared with 6.55 for all countries of the world.

It is one of the priority conditions identified as part of the WHO mental health Gap Action Programme (mhGAP) and the regional strategy recommends development of a recording and reporting system, development of services for early recognition and management of mental, neurological and substance abuse disorders in primary care, special programmes for vulnerable populations such as adolescents, older people and women and reducing access to the means of committing suicide.

Tetanus is an infectious disease caused by anaerobic bacteria, Clostridium tetani, the spores of which are widespread in the environment.

The incubation period between exposure to the bacteria and development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.

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. Tobacco use among young people age 13–15 around the world is increasing. In the Eastern Mediterranean Region, 14% of boys and 9% of girls currently use tobacco products other than cigarettes, including shisha and smokeless tobacco; making this the Region with the second highest rate in the world of girls’ use of tobacco products other than cigarettes. Young people need to be empowered with information about the harmful effects of tobacco use, their right to live in a smoke-free environment and be provided with cessation services. Implementation of the WHO Framework Convention on Tobacco Control can protect young people against the harms of tobacco use. Article 16 specifically addresses the prohibition of the sale of tobacco products to legal minors.

In the WHO Eastern Mediterranean region, neglected tropical diseases represent a major public health problem. Some diseases such as leishmaniasis are endemic and highly prevalent in most countries while others, such as leprosy, lymphatic filariasis, schistosomiasis and soil-transmitted helminthiases, affect only some countries in the Region or have low prevalence in most of them. Dracunculiasis (Guinea worm) and human African trypanosomiasis (sleeping sickness) are only endemic in South Sudan.

Neglected tropical diseases worldwide affect mainly populations in developing countries with millions of new cases every year. The lack of access to health services, low levels of literacy, inadequate nutrition and poor personal hygiene aid the spread of infections. Neglected tropical diseases are rarely given high priority by decision-makers in endemic countries.

Human African trypanosomiasis, also known as sleeping sickness, is only endemic in South Sudan within the WHO Eastern Mediterranean Region. Foci of T.b. gambiense occur in the Equatoria region, a belt bordering the Central African Republic, Democratic Republic of Congo and Uganda. In South Sudan, Western Equatoria is the most affected state, followed by Central Equatoria and Eastern Equatoria states. Historically, cases of T.b. rhodesiense were anecdotally reported in Eastern Equatoria (Torit County) and Jonglei (Akobo County), but there is no recent evidence of cases being reported there.

Nine counties are endemic for the disease, namely Tambura, Ezo, Yambio, Maridi, Mundri, Juba, Yei, Kajo Keji and Magwi. The number of people at risk of human African trypanosomiasis is estimated at 1.8 million.

Large epidemics of human African trypanosomiasis have periodically occurred in South Sudan since the early 20th century. When outbreaks occur, large-scale control reduces the number of cases but when the programme scales down disease resurgence occurs. After the latest epidemic registered in the mid-1990s control programmes were re-initiated by a number of international nongovernmental organizations in several counties.

Typhoid fever is a bacterial infection of the intestinal tract and bloodstream caused by Salmonella typhi, the typhoid bacillus. It is characterized by the sudden onset of sustained fever, severe headache, nausea, loss of appetite, constipation or sometimes diarrhoea.

It’s transmitted from faeces to ingestion. Clean water, hygiene and good sanitation prevent the spread of typhoid and paratyphoid. Contaminated water is one of the pathways of transmission of the disease.

Typhoid fever is common in less-industrialized countries, principally owing to the problem of unsafe drinking-water, inadequate sewage disposal and flooding.

Control measures to combat typhoid include health education and antibiotic treatment. A vaccine is available, although it is not routinely recommended except for those who will have prolonged exposure to potentially contaminated food and water in high-risk areas. The vaccine does not provide full protection from infection.

Violence has become one of the leading public health issues of our time. It is defined by the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. No country or community is untouched by violence. The Eastern Mediterranean Region is definitely no exception. Not only is violence often seen as an inevitable part of human life that cannot be prevented, but even when and if prevention is considered, it is commonly perceived as an issue for law and order, not for health. The role of the health sector is not seen beyond addressing the consequences related to health, particularly physical health. However this set-up is rapidly changing with the success of public health approaches to other environmental and behaviour-related health problems, such as heart diseases, smoking and HIV/AIDS. Besides the human toll a substantial proportion of the costs incurred by violence are health-related. This gives the health sector a big stake both in prevention and response to violence and its consequences. Along this line, the World Health Organization launched the first World report on violence and health in 2002. The report aimed to raise awareness about the problem of violence, to make the case that violence is preventable, and to highlight the crucial role of public health in addressing its causes and consequences. The Regional Office for the Eastern Mediterranean is following the guidelines and recommendations of the World Report on Violence and Health to implement programmes and draft strategies to address this menace in the Region and its countries.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. The yellow fever virus is an arbovirus of the flavivirus genus, and the mosquito is the primary vector. It carries the virus from one host to another, primarily between monkeys, from monkeys to humans, and from person-to-person.

Once contracted, the virus incubates in the body for 3 to 6 days, followed by infection that can occur in one or two phases. The first acute phase usually causes fever, muscle pain with prominent backache, headache, shivers, loss of appetite, and nausea or vomiting. Most patients improve and their symptoms disappear after 3 to 4 days.

WHO recommends that every at-risk country have at least one national laboratory where basic yellow fever blood tests can be performed. One confirmed case of yellow fever in an unvaccinated population should be considered an outbreak and a confirmed case in any context must be fully investigated, particularly in any area where most of the population has been vaccinated.

Civil registration systems are used to record vital events, including births, deaths, and marriages. They have the potential to serve as the main source of national vital statistics. However, in many developing countries, civil registration and vital statistics systems are weak or nonexistent; as a result, key demographic, fertility and mortality statistics are not available on a continuous basis and do not cover large segments of the population.

Biorisk reduction combines expertise and advice on high consequence pathogens with guidance and training on safe handling and control of disease agents that pose significant health risks, with potential for adverse economic impact and public concern. 

Biorisk management includes analysis of ways and development of strategies to minimize the likelihood of the occurrence of biorisks. The goal of biorisk reduction is to ensure that current scientific knowledge regarding viral hemorrhagic fevers, epidemic-prone orthopoxviruses, and emerging severe zoonotic diseases affecting humans, is maintained in order to apply the most appropriate guidance for treatment, control, and safety to mitigate the risks regardless of the source of the disease event.

Laboratory quality is the accuracy, reliability and timeliness of reported test results. The laboratory results must be as accurate as possible, all aspects of the laboratory operations must be reliable, and reporting must be timely in order to be useful in a clinical or public health setting. In a quality management system, all aspects of the laboratory operation, including the organizational structure, processes and procedures, need to be addressed to assure quality.

There are many procedures and processes that are performed in the laboratory, and each of these must be carried out correctly in order to assure accuracy and reliability of testing.

Laboratory information management systems (LIMS) improve access to quality diagnostic testing and provide accurate, timely information for patient care, public health planning and policy decisions. LIMS are recognised as a powerful tool to improve laboratory data management within the laboratories and reporting of data externally. They are widely used by medical laboratories in high-income countries. While some hospital-based microbiology laboratories in developing countries have been equipped by electronic systems to record test ordering, laboratory findings and billing processes, the market for public health LIMS remains underdeveloped.

Existing LIMS are often expensive, designed for clinical laboratories and do not address some important public health laboratory needs, such as communication with national health information management or surveillance systems. As a result, LIMS have not been deployed in a significant proportion of public health laboratories in developing countries, limiting their capacity to contribute adequately to the surveillance of and response to public health events of international concern such as epidemics.

Ebola virus disease (EVD) is a severe, often fatal illness in humans. The case fatality rate is around 50%. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. EVD first appeared in 1976 in 2 simultaneous outbreaks, one in Sudan, and the other in Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name. The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, have been associated with large outbreaks in Africa. The virus causing the current outbreak belongs to the Zaire species.

The Rift Valley Fever (RVF) virus of the genus Phlebovirus and family Bunyaviridae is a cause of zoonotic viral disease that primarily causes abortion and death among domestic ruminants. Infection in humans is acquired through mosquito (mainly Aedes is the responsible vector for animal and also human transmission with other mosquitos (like Anopheles and Culex and also other haematophagous flies) bites or through contact with tissues of infected animals, and it is usually associated with uncomplicated acute febrile illness. Till now, no human to human transmission reported. The incubation period of the diseases is between 3 to 6 days. Symptoms of uncomplicated infections may include fever, headache, generalized weakness, dizziness, weight loss, myalgia and back pain. Some patients also have stiffness of the neck, photophobia and vomiting. Most people recover spontaneously within two days to a week. However, severe complications, such as hemorrhagic disease, meningo-encephalitis, and retinitis, occur in less than 3% of the cases. 

Coronaviruses are a large family of viruses that cause a range of illnesses in humans, from the common cold to the Severe Acute Respiratory Syndrome (SARS). Viruses in this family also cause a number of animal diseases. 

Middle East respiratory syndrome coronavirus (MERS-CoV)
This strain of coronavirus that causes MERS was first identified in 2012 in Saudi Arabia. Our understanding of the virus and the disease it causes is continuing to evolve.

Antimicrobial resistance (AMR) develops when microbes become resistant to medicines. They are widely recognized as significant global health security threat and may return the humanity back to a pre-antibiotic era, where effective treatment of common infections was not available. AMR expands through many infectious diseases and in all parts of the world. It seriously impacts economies and development process particularly in developing world. It is of utmost concern that emergence of new multi-drug resistant pathogens is fast outpacing available solutions.

The health of women and children is key to progress on all development goals and investment in their health not only reduces poverty but leads to healthier, more productive societies. There is wide variation in maternal mortality ratios in the Eastern Mediterranean Region with over 90% of the burden of maternal deaths shared by just 7 of the Region’s 22 countries – Afghanistan, Iraq, Morocco, Pakistan, Somalia, Sudan and Yemen. Mortality rates are particularly high among pregnant adolescents. 

Zika virus is a mosquito-borne virus transmitted by Aedes mosquitoes. The same mosquito also transmits 3 other vector-borne diseases -- dengue, chikungunya and yellow fever – across tropical and subtropical regions around the world. The most common symptoms of Zika virus are headache, muscle and joint pain, mild fever, rash, and inflammation of the underside of the eyelid. To lower the risk of being infected with Zika virus: use insect repellent; cover as much of the body as possible with long, light-coloured clothing; empty, clean or cover containers that can hold water to remove places mosquitoes can breed; and sleep under mosquito nets

Ebola virus disease is a severe, often fatal illness in humans. The case–fatality rate is around 50%. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

The virus first appeared in 1976 in two simultaneous outbreaks, one in Sudan, and the other in Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

The virus family Filoviridae includes three genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are five species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first three have been associated with large outbreaks in Africa. The virus causing the current outbreak belongs to the Zaire species.

Reliable and timely health information is essential for policy development, proper health management, evidence-based decision-making, rational use of resources and monitoring and evaluation of the public health situation, health care delivery and outcomes. While the demand for health information is increasing in terms of quantity, quality and levels of disaggregation, the response to these needs is hampered because of fragmentation and major gaps and weaknesses in national health information systems.

The global health initiatives collaborative work in the Region covers several areas: AIDS, tuberculosis and malaria, immunization programmes, maternal and child health, tobacco use, human resources, emerging diseases, nutrition, health promotion and health system strengthening. The Global Fund and Gavi, the Vaccine Alliance are the main institutions that provide substantial funding to eligible countries in the Region. Seven countries – Afghanistan, Djibouti, Pakistan, Somalia, Sudan, Syrian Arab Republic and Yemen – are eligible for Gavi support on immunization and health system strengthening, and 12 are eligible for Global Fund grants, including the seven supported by Gavi.

The blood safety, laboratory and imaging programme of the WHO Regional Office for the Eastern Mediterranean works with governments and health authorities in the Region to ensure that populations have access to safe and affordable blood and blood products.

The programme aims to ensure that blood is transfused only when necessary and is provided as part of a sustainable blood programme within the existing health care system.

Early warning systems for disease outbreaks are surveillance systems that collect information on a selected list of epidemic-prone diseases in order to trigger prompt public health interventions. They function in humanitarian emergency situations when the routine public health surveillance systems of a country are underperforming, disrupted or non-existent. Early warning systems are often set up to fill such temporary gaps, while the routine systems recover from the effects of the disaster or a crisis. During humanitarian emergencies, detecting and responding swiftly to epidemics is key in order to reduce unecessary illness and death, especially among refugees and displaced people. 

The Regional Emerging and Dangerous Pathogens Laboratory Network (EDPLN) was established in August 2017, to enhance capacities of laboratories in the Region to detect and diagnose outbreaks of emerging and dangerous pathogens (EDPs). The list of dangerous and high threat pathogens that the EDPLN covers include new and emerging ones, as well as existing pathogens causing repeated outbreaks in the Region such as avian influenza, cholera, dengue, and yellow fever. 

In 2011 the World Health Assembly through resolution no WHA64.5 adopted the Pandemic Influenza Preparedness (PIP) Framework, with the objective to improve preparedness and response for the next influenza pandemic. As a unique public-private partnership, the framework has three major comonents-virus sharing, benefit sharing and governance. The PIP Framework aims to make the international response to pandemic influenza nimble, flexible, effective and equitable as such 70% of partnership contribution funds from the PIP framework are allocated to enhance preparedness amongst the low and middle-income countries.  Among the beneficiary countries of the PIP Partnership Contribution, there are seven countries from the Region-Afghanistan, Egypt, Jordan, Lebanon, Morocco, Sudan and Yemen. These countries were selcted based on its geographic distribution in influenza transmission zones, countrt development status and country needs for enhancing influenza epidemiological and laboratory surveillance capacity . 

Crimean-Congo haemorrhagic fever (CCHF) is the most widespread tick-borne viral disease affecting humans. The causative agent, CCHF virus (a Nairovirus of the Bunyaviridae family) is transmitted mainly by ticks (Hyalomma) and livestock animals. Human-to-human transmission can occur, usually in the health care setting, resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. The disease begins with a sudden onset of influenza-like symptoms which may progress to severe bleeding and can be fatal (current case fatality rate is 10-40%) if not treated.

Chikungunya is a viral disease transmitted to humans by Aedes mosquitoes. It causes fever and severe joint pain, which is often debilitating and may persist for several months, or even years. Other symptoms include muscle pain, headache, nausea, fatigue and rash. Joint pain is often debilitating and can vary in duration. The disease shares some clinical signs with dengue fever and zika virus infection, and can be misdiagnosed in areas where these are common.

Marburg virus disease is a highly virulent disease that causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Two large outbreaks that occurred simultaneously in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, in 1967, led to the initial recognition of the disease. The outbreak was associated with laboratory work using African green monkeys (Cercopithecus aethiops) imported from Uganda. Subsequently, 15 outbreaks and sporadic cases have been reported until 2022. Of which, 11 reported in Africa, and this year adding two countries: Equatorial Guinea and Tanzania.