A New Role for WHO in Emergencies
by Dr Jean-Paul Menu,
Emergency Coordinator
Division of Emergency and Humanitarian Action
17 December 1996
Emergencies of all kinds have markedly increased in recent years resulting in considerable and often dramatic effects on human life and health. The involvement of international organizations is also sharply expanding both in magnitude and complexity. WHO, being the specialized UN agency for health matters, recently undertook a comprehensive review of its strategy and organization to better meet the fast changing needs of emergency and humanitarian action
WHO Mandate
The WHO constitution states that WHO will "act as the directing and coordinating authority on international health work" and "furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments". The Constitution also gives WHO a mandate "to provide, or assist in providing, upon the request of the United Nations, health services and facilities to special groups..."
In accordance with this mandate, WHO health assistance responds to the health needs of all affected groups of population, local residents or displaced as well as to the communities hosting refugees and IDPs, irrespective of political boundaries.
Historical developments.
Since the foundation of the Organization , individual technical programmes have issued norms and guidelines relevant to their disciplines and which are applicable to emergency situations. A specific Emergency Preparedness Programme was created in the 1970s and enlarged later on to an Emergency Relief Operations Division. WHO involvement in emergency management chiefly took the form of response to specific emergencies considered of high priority for WHO's attention.
In 1993, the World Health Assembly, as the main governing body of the Organization, underscored the need for WHO to assume a more proactive role in emergencies. Consequently, the former structures were replaced by a new Division of Emergency and Humanitarian Action which incorporated the programme of Safety Promotion and Injury Control. Simultaneously, the Director General set up a Task Force to recommend how the Organization could best adapt to the requirements of a fast evolving emergency environment.
Objectives and strategies
The Task force concluded that the ultimate objective of WHO in emergency and humanitarian action is to help countries coordinate, implement and monitor health policies, infrastructure development and health relief operations in order to meet health challenges of wide-scale emergencies, such as epidemics, natural and man-made disasters, including complex emergencies caused by civil unrest and armed conflict. The self-reliance of affected countries is the ultimate goal. This objective can be reached first of all by strengthening the national preparedness capability of disaster-prone countries. In providing relief and humanitarian action in disaster situations, the primary concern of WHO is to ensure that health relief activities will further the rehabilitation of health care systems, emphasizing the primary health care approach. WHO will also cooperate with Member States in the development and implementation of policies and programmes of safety promotion and injury control.
The strategy to achieve those objectives follows several key principles:
- WHO's traditional normative and technical guidance functions will be intensified. Its operational and technical capabilities for rapid health assessment and for effective coordination will be strengthened.
- In all its activities, WHO will adopt a full partnership approach with the governments concerned, the donor agencies, the other organizations of the United Nations system and the non-governmental organizations with a view to ensuring complementarity of action under a common plan.
- It will implement and advocate the concept of "development continuum", i.e. the need to ensure an unbroken chain of congruent activities throughout emergency preparedness, emergency relief, rehabilitation and long term health development.
- WHO will optimize the utilization of all resources of the Organization and of its collaborating centres and will secure their effective mobilization. In that respect, the Division of Emergency and Humanitarian Action will act as the facilitator and focal point for the preparation of WHO's unified response to complex emergencies.
- It will promote international awareness of the public health aspects of safety promotion and protection against violence.
- It will advocate the respect and protection of health personnel and infrastructure in conflict situations.
In May 1995, the World Health Assembly formally endorsed the proposals of the Task Force and requested the Director General to introduce the changes required. A document outlining the new approach was distributed to partner agencies.
Results and activities
Definite progress has already been achieved in implementing the strategy as shown in the annual reports issued by the Division of Emergency and Humanitarian Action.
Country and regional emergency preparedness programmes were expanded, in parallel with the preparation of technical guidelines and the conduct of training programmes for health personnel. Similarly, safety promotion and injury control used an approach associating guidelines and protocols, demonstration projects and training activities.
WHO response activities increased considerably during the biennium 1994-1995. WHO was involved in relief and rehabilitation programmes in 43 Member States in 1994 and 55 in 1995 (figure). Major activities took place in Afghanistan, Angola, Armenia, Azerbaidjan, Burundi, Ethiopia, Eritrea, Georgia, Democratic People's Republic of Korea, Iraq, Lebanon, Liberia, Mozambique, Myanmar, Palestine self rule areas, Rwanda, Sierra Leone, Somalia, Tajikistan, Former Yugoslavia and Zaire.
This expansion of activities was made possible by the trust of donors which resulted in a significant increase of extra-budgetary funding.
Challenges Ahead
The emergency scene is constantly changing and the mandate assigned to WHO by its governing bodies calls for continuous improvements in implementing its strategy. Several critical areas deserve particular attention.
Improving the internal delivery capability of WHO
The organization is progressively adding an "emergency culture" to its long term development vision. More and more technical programmes and collaborating centres contribute their expertise to specialized areas of emergency response and preparedness. Their inputs will form part of an integrated and well focused set of policies, approaches, strategies and guidelines representing the contribution of the entire Organization to the solution of emergency health problems.
Defining WHO's operational role
In carrying out its emergency operations, WHO makes full use of its decentralized structure of country, regional and headquarters offices. Emergency preparedness programmes as well as the response to natural, technological and health emergencies continue to be handled by country and regional offices with support and broad strategic directions from Headquarters. In the case of complex emergencies, however, the establishment of highly centralized coordination mechanisms within the United Nations system calls for parallel mechanisms in WHO Headquarters.
WHO does not intend to undertake extensive operations requiring heavy logistic support. It has a precise but, in most cases, limited role in providing medical supplies and in managing large relief programmes on its own. On the other hand, the credibility of its technical guidance and its authority in coordinating health programmes depend for a large part on the effective presence of qualified emergency staff on the spot. The Organization should therefore be ready to mobilize at short notice experts and managers that are both technically qualified and capable of working effectively under emergency situations.
Training of nationals in emergency management
Member States give high priority to increasing the capacity of their national personnel for managing health emergencies. WHO is progressively setting up training programmes to enhance the capability of national staff to design emergency preparedness programmes and to respond to actual emergencies. Trained national staff will thus be in a better position to cooperate effectively with external assistance.
Linking relief to development
The division between humanitarian response, emergency preparedness and rehabilitation is no longer clear-cut. The necessity of a continuum between disaster relief and development is now well accepted by the international community. As a long term adviser to national health authorities with a permanent presence in the country, WHO has gained a unique understanding of their development priorities. Based on the experience it already acquired, it will be able to play an increasingly strong role in post-conflict rehabilitation of the health sector.
Strengthening its partnership with the UN and with other organizations:
The UN Department of Humanitarian Affairs (DHA) was created in 1992 to enhance the coherence of the UN system response to emergencies and disasters. An Inter-Agency Standing Committee (IASC) regrouped the heads of agencies involved in humanitarian action.
Within the United Nations system, WHO is responsible for coordinating the international response to emergencies in the health sector. To fulfill this task, it needs to maintain effective relationships with UN bodies including UNICEF, UNHCR, WFP and other major organizations such as ICRC, IFRC and IOM. WHO stands ready to be part of a coordinated global response and is expected to provide specific health expertise. This coordination is facilitated by the preparation of "Memoranda of Understanding" between organizations.
In 1995, in order to further strengthen the coordination of emergency humanitarian assistance of the UN, the Economic and Social Council requested the UN system organizations to review their respective roles and responsibilities for providing emergency and humanitarian aid, taking into consideration both their mandates and operative capacities7. Within this framework, WHO will continue to strengthen its particular expertise and will collaborate with other organizations in order to avoid duplication of efforts.
In parallel with the enhancement of coordination within the UN system, coordination with other major partners, particularly humanitarian NGOs and scientific centres, is being further developed in a spirit of partnership and complementarity.
Conclusion
In the world of humanitarian action and emergencies, established mechanisms and approaches are constantly challenged. WHO will always strive to provide the most appropriate answer to those challenges so as to prevent, mitigate and respond to the health consequences of emergencies.
(1)World Disasters Report 1996, International Federation of Red Cross and Red Crescent Societies, Geneva 1996
(2) Resolution WHA46.6 May 1993
(3) Resolution WHA48.2; 8 May 1995
(4)Coping With Major Emergencies, WHO strategies and approaches to Humanitarian action; WHO document WHO/EHA/95.1; 1995
(5) Emergency and Humanitarian Action - 1994 Activities; WHO document WHO/EHA/95.2; 1995
(6) Emergency and Humanitarian Action - 1995 Activities; WHO document WHO/EHA/96.3; 1996
(7) Resolution 1995/56 of the United Nations Economic and Social Council; Official Records of the General Assembly. Forty eighth Session, Supplement No.3
(8) Resolution WHA49.21; 25 May 1996