Resource Centre Newsletter - Health in Emergencies

Issue 4 June 1999 � Editorial

� Disasters, Sustainable Development and WHO � In the News

� Changes at EHA: Fitting In � International Consensus forum held in Harare � RollBack Malaria: Network on Malaria Control in Complex Emergencies � Meeting of Advisory Group on Research in Emergencies � Comings and Goings � The New Director � Special Representative Appointed to Russia � Uppsala: New University Course on Rapid Health Assessment � Kombezia Exercise � IAPSO Meeting on Updating Emergency Compendium � Tranquillity Days � Director General Addresses Humanitarian Workers at IDHA Course � Horn of Africa Initiative: Internal Technical Review � WHO in the Executive Committee of Humanitarian Affairs � EHTP Midterm Review � Philippines to Launch Emergency Management Institute � 11th WADEM Congress

� Field Missions � Regions

� National Policy and Legislation Conference � Conference in Manila Focuses on Strengthening Emergency Preparedness � China Hosts Community Preparedness Workshops � Hurricane Mitch � Tunis Inter-country Workshop � UNDAC Training Course � African Ministries of Health Hold Conference � New Web Page Targets Disaster Mitigation in Hospitals � PAHO's New Web-site � Health as a Bridge for Peace � South Balkans Crisis: WHO Humanitarian Assistance Programme � EHA-EMRO Participates in Benghazi Congress

� Publications � Rapid Assessment Protocols � H.E.L.P. Cours de Sante Publique Pour la Gestion de l'Assistance Humanitaire � Management of Severe Malnutrition: a manual for physicians and other senior health

workers � Natural Disaster Mitigation in Drinking Water and Sewerage Systems � Mental Health of Refugees � In the Works: EHTP Emergency Health Management Training Modules � The Africa Live Database � Handbook on Emergencies in Preparation � The Humanitarian Times � Guiding Principles on Internal Displacement

� Training Events � Contacts

Health in Emergencies is a quarterly newsletter of The Division of Emergency and HumanitarianAction of the World Health Organization (WHO). This newsletter is not a formal publication ofWHO and all rights are reserved by the Organization. The document may, however, be freelyreviewed, abstracted, reproduced or translated in part or whole, but not for sale or for use inconjunction with commercial purposes. The views expressed in this newsletter do not necessarilyreflect those of WHO.

Publication of this newsletter has been made possible by the support of the Italian Government.

Correspondence and inquiries should be addressed to:

The EditorThe Division of Emergency and Humanitarian ActionWorld Health Organization1211 GenevaSwitzerlandPhone: (41 22) 791 4676Fax: (41 22) 791 4844E-mail: menuj@who.ch

Chief Editor: Dr Jean-Paul MenuEditors: Dr Alessandro Loretti, Therese DesorbayLayout: Therese DesorbayDesign: Jean-Claude Fattier

Disasters, Sustainable Development and WHO

Editorial by Mrs Poonam K Singh, Executive Director of WHO Cluster of SustainableDevelopment and Healthy Environments

Natural and human-induced disasters have become more frequent and severe. In 1998 theyaffected 418 million people worldwide. In Africa alone, 22 countries are currently involved inarmed conflicts and economic losses due to war are estimated at 13 billion US dollars per year.These figures illustrate the immediate human suffering as well as the long-term impact thatdisasters have on sustainable development, health and human potential. Countries likeBangladesh are periodically affected by disasters along predictable but apparently immutablepatterns. Others, like Angola have known no other state but one of protracted emergency for thelast 25 years.

Many of the hazards and vulnerabilities that precipitate disasters have been the target of morethan thirty years of development programmes: their persistence testifies of as many failures.Even the risk for "non-preventable" natural disasters can be reduced by good risk-mapping andjudicious policies for human settlement: e.g. discouraging urbanisation of volcanic slopes orflood-prone lowlands. Plans for sustainable development need to take into account contingenciesthat may jeopardise it.

Furthermore, the very qualification "sustainable" indicates that development per se cannot beseen as a mere positive, linear process of growth. Development is about change and change isfraught with risks for some and opportunities for others. Development implies growth of acommunity's capacities, but it may also originate new hazards, e.g. by introducing new toxicchemicals in the environment. Paradoxically, it may cause new vulnerabilities, e.g. by changingthe context where people's coping strategies are based or by excluding/secluding some sectionsof the society. This is especially true in a global context characterised by fast demographic,technological, social, political and institutional transitions. Developmental changes in theseconditions can have wider reaching and less predictable effects. They can engender crises thatcatch people unprepared, outstrip coping capacities of the vulnerable and progress into disasters.Managing crises or emergencies is essentially managing fast and therefore hazardous changes.

Operating environments have also become more difficult. How can we assist when statescollapse and access is denied? Do protracted crises and transitions require a "developmental" oran "emergency" approach? In many crises, developmental and/or humanitarian assistance areperceived as part of the problem and its goals are equivocated. Distinctions between "naturaldisasters" and "complex emergencies" are fading. Greater flexibility and higher performance arerequired of all organizations, whether involved in relief or in sustainable development. In theface of these challenges, the World Health Assembly in 1995 resolved that work in this area bestrengthened. Since Dr Brundtland began her reform process, various steps have culminated inthe integration of the Department of Emergency and Humanitarian Action (EHA) in the Clusterof Sustainable Development and Healthy Environments (SDE). EHA's mandate is optimised insynergy with other key departments. The same cluster includes the Department of Health inSustainable Development (HSD), Protection of the Human Environment (PHE), Nutrition forHealth and Development (NHD) and Health and Human Rights (HHR). Together thesedepartments provide the technical backstopping which is indispensable to tackle a vast range ofthreats and factors of vulnerability. EHA will retain the task of mobilizing additional expertise

from within WHO and from the broader health development community and of facilitating theirdeployment for emergency and humanitarian action. The Organization is fully committed to thisprocess, which can only remain open-ended. WHO's capacity to generate new knowledge in thisarea and to advise and support countries and other partners will need to be pushed towards newfrontiers.

Changes at EHA: Fitting In

The last nine months have seen EHA occupied with a dynamic process of change. The processstarted in August 1998, in a consultation with various external partners. Together they reaffirmedwhat they had expressed in a meeting in March, 1997 on the role of WHO in emergency andhumanitarian action: we do need WHO collaboration and we expect WHO to collaborateaccording to our needs.

Subsequently, Dr Tarantola, Senior Advisor to the Director-General, representatives of EHA,Regional Offices and other WHO-Headquarter Programmes worked on a "White Paper"outlining how EHA should fit in Dr Brundtland's vision of one WHO. It highlighted thatpreparedness, response and reconstruction are parts of a whole; EHA should act as a "gate-keeper" to facilitate the deployment of WHO for emergency and humanitarian action.

In November, the draft Budget Plan 2000-2001 spelled out EHA's strategic objective. It stated:through a concerted effort across WHO, (EHA should)increase the capacity and self-reliance ofcountries in the prevention of disasters, preparation for emergencies, mitigation of their healthconsequences and create a synergy between emergency action and sustainable development.

EHA was then integrated in the cluster of Sustainable Development and Healthy Environments(SDE). A retreat of EHA-Headquarters with its Regional focal points and other departmentsdebated how to operationalize its mandate. It concluded that EHA should focus on support tocountries and the transition from relief to development, where WHO has comparativeadvantages. Furthermore, EHA should improve its effectiveness by distributing responsibilities,decentralizing decision-making and working in synergy with other key departments.

In January 1999, the SDE cluster started its strategic planning process. The cluster has achallenging mandate and the process is far from finalized. EHA is in a unique position foroptimizing expertise and networking capacities with a team that addresses the wider economic,environmental, nutritional, human and societal determinants of disasters and sustainabledevelopment.

For more information please contact Dr Alessandro Loretti. e-mail: lorettia@who.ch

International Consensus Forum Held In Harare

An International Consensus Forum on Health and Human Security in Conflict and TransitionSetting: improving policies, strategies and programmes in Africa took place in Harare, April 15-17, 1999. It was organized by WHO, USAID and Tulane University, USA. 60 participantsattended including Member Countries, UNICEF, UNOCHA and the International Centre forMigration and Health.

26 African countries are experiencing armed conflicts and the potential exists for more crises.The Forum examined the human and economic costs of Africa's present state and the bleaklegacy that this represents for coming generations. New and creative measures are needed at alllevels to tackle crises and promote sustainable health and social development in the Region. TheForum recognized that development of an emergency preparedness programme at the countrylevel, which is multi-sectoral, decentralized and community-based, constitutes an opportunity toinvolve all interested partners in a co-herent framework for sustainable action. More effectivecollaboration is needed between countries that need human resources, information, cross-borderprogrammes and regional strategies. New alliances are needed between all governmental sectors,international agencies, NGOs, civil-military alliances and the private sector. Internationalpartners must invest in bridging from relief to development and strengthening the capacity ofcountries to face the challenges confronting them during crises and transitions.

For more information please contact: Dr Idrissa Sow. e-mail: sowi@who.afr.org

Roll Back Malaria: Network on Malaria Control in Complex Emergencies

Malaria kills more than one million people each year in the tropics and subtropics. Roll BackMalaria (RBM) is a new global partnership of malaria-affected countries, UN organizations,bilateral development agencies, NGOs and the private sector, that addresses this priority healthissue. RMB was launched in October, 1998 by WHO, World Bank, UNICEF and UNDP with thegoal of halving malaria mortality by the year 2010.

RBM has identified malaria control in complex emergencies as a priority. On April 15, 1999 a"Network" was set up that brings together malaria experts specializing in serving in complexemergencies, to ensure that operational agencies implement best practice and "state-of-the- art"policies. The Network has a secretariat currently based at EHA, Geneva. The Network willinitially target 16 countries including Angola, South Sudan, Somalia, Afghanistan, Sierra Leone,Cambodia, Myanmar and the Democratic Republic of Congo. Standard guidelines and trainingmaterials are being developed. Rapid Response Teams will be established to deal with malaria incomplex emergencies at the request of the countries, UN agencies or NGOs.

For more information please contact Dr Maire Connolly. e-mail: connollyma@who.ch

Advisory Group on Research in Emergencies

The second meeting of the Advisory Group on Research in Emergencies took place on April 16,1999 in Geneva. The group's working structure and potential funding mechanisms were on theagenda. Participants investigated various research ideas and proposals, especially in relation tothe epidemiology of human rights violations and the crisis in Kosovo. A draft ethics templatewas presented and discussed. An inventory of research in emergencies is being compiled andshould be available on the EHA Web-site soon.

For more information please contactDr Danielle Deboutte.e-mail: deboutted@who.ch

Comings and Goings

Dr Fabrizio Bassani is now Executive Director, WHO Office at United Nations, New York.

Dr Louisa Chan will be joining the Executive Director, Martin Griffiths, at the Henri DunantCentre with a new team which will pursue the centre's new mission Promoting HumanitarianDialogue.

The Director-General appointed Dr Harald Siem to work with the Ministry of Health and a UNteam in Moscow until May 31, 1999

Dr Idrissa Sow has been transferred to AFRO responsible for the Regional EHA Unit based inHarare.

Dr Yonas Tegegn from Addis Ababa has joined EHA-Headquarters as a short-term professionalas of January, 1999.

The New Director

Dr Xavier R Leus, a national of Belgium, earned his Degree in Medicine and a Master's Degreein Public Health from the Catholic University of Leuven, Belgium. He carried out postgraduatestudies in Tropical Medicine and Hygiene at the Prince Leopold Tropical Institute in Antwerp.During 1987 and 1988, he was a Sloan Fellow at the Alfred P Sloan School of Management atthe Massachusetts Institute of Technology in Boston, obtaining a Master's Degree inManagement.

Dr Leus started his career in Belgium as a General Practitioner. In 1979 he joined PAHO as anAssociate Professional Officer at the Caribbean Epidemiology Centre (CAREC) in Trinidad&Tobago. In 1981 he was reassigned to Surinam as an Epidemiologist, and in 1983 he becamethe PAHO/WHO Representative to that country. In 1988 he was appointed PAHO/WHORepresentative to Haiti, and in 1993 he joined the WHO/EURO as Regional Advisor for ExternalRelations and Coordination. As Acting Regional Advisor for Emergency Preparedness andHumanitarian Assistance he oversaw WHO relief in former Yugoslavia. In September 1995 hebecame Managing Director for the EURO Health Group, an International Health ConsultancyFirm. In 1996, Dr Leus returned to PAHO, where he was named the Chief of the Field Office forthe U.S.-Mexico Border in El Paso, Texas. He began his new role as Director of EHA as of May3, 1999.

Special Representative Appointed to Russia

A Special Representative has been appointed by the Director-General to work with the Ministryof Health and the UN team in Moscow. The team provided immediate assistance to Russia forthe winter and began to establish the foundation for long-term development assistance. Proposalshave been developed in the areas of Tuberculosis Control (TB), Health in Prisons, Control ofSexually Transmitted Diseases and Improved Availability of Pharmaceuticals. Operationalassistance for the programme and activities is organized from the Regional Office for Europe(EURO) in Copenhagen. The government of Finland has given financial support for the TBControl Project.

For more information please contact Dr Edouard Kossenko. e-mail: kossenkoe@who.ch

Uppsala: New University Course on Rapid Health Assessment

On February 1-12, 1999, a course on Rapid Health Assessment in Complex Emergencies washeld at the University of Uppsala, Sweden. It was organized by the Nutrition Unit of theDepartment of Medical Sciences of the University, with the collaboration of Sida (SwedishCooperation), the Swedish Board of Health and Welfare and the United Kingdom's CranfieldDisaster Management Centre. WHO's EHA-Headquarters and EHTP-Addis Ababa participatedin the didactic planning, training sessions and in the preparation of training materials. The"backbone" of the course was a country case study and series of desk-simulation exercisesknown as the "Kombezia Exercise". 16 participants attended the course including physicians,nurses and nutritionists all working in Sweden with varying levels of service abroad.

For more information please contact: Dr Alessandro Loretti.e-mail: lorettia@who.ch

Kombezia Exercise

"Kombezia" was the name given to a fictional country created for a series of exercises in theRapid Health Assessment Course recently held at Uppsala University. The country was "created"by taking an African country's geographical and population profile and combining it withpolitical and historical background of two major conflicts in Africa. Participants were given pre-defined character roles each with a profile and agenda of the Organization they represented. Thecharacters were also given individual agendas to make the exercise more realistic. They thenproceeded with exercises focused on mission readiness, various aspects of initial rapid healthassessment and nutritional assessment and information analysis and oral reporting.

More exercises of this sort are envisaged for future courses.For more information please contact Dr Yonas Tegegn. e-mail: tegegny@who.ch

IAPSO Meeting on Updating Emergency Compendium

A meeting was held at WHO on October 7, 1998 by IAPSO (Inter-Agency Procurement ServicesOffice)ÿ and EHA to review and update the Emergency Relief Items Compendium of BasicSpecifications. The purpose of the Compendium is to make available common basicspecifications for medical equipment required in the first phase of an emergency. It is a usefultool for field staff requesting items and commodities for emergency relief and for donor agenciesproviding relief items during emergencies. 21 participants representing nine organizationsreviewed and proposed changes to the present 1996 edition. The 1999 edition is now available.

For more information please contact: Maud Hynes Munthe.e-mail: maud.munthe@iapso.org

Tranquillity Days

Days of tranquillity are truces negotiated to immunize children and offer the opportunity todeliver important preventative care to children living in war zones. With the destruction of theprimary health care system, population movements and inadequate food supply, children livingin countries affected by conflict are among the most vulnerable in the world. For several years,Days of Tranquillity for polio eradication have been negotiated and agreed upon in Afghanistan,El Salvador, the Philippines, Sri Lanka, Sudan and Tajikistan. At the request of the Director-General of WHO and the Executive Director of UNICEF, Secretary-General Annan is supportingnegotiations for Days of Tranquillity for polio immunization between July and September, 1999in the Democratic Republic of Congo. In El Salvador and the Philippines, Days of Tranquillitywere an important step on the road to a permanent solution of the conflict.

For more information please contact Dr Khalid Shibib. e-mail: shibibk@who.ch

Director General Addresses Humanitarian Workers at IDHA Course

The International Diploma in Humanitarian Assistance (IDHA) is a one-month course forhumanitarian workers run by the International Federation of the Red Cross, the College ofSurgeons, Dublin and the Center for International Health and Cooperation, New York. Thecourse was held in February, 1999 near Geneva. A broad range of participants attended includinghealth workers, lawyers and media experts.

EHA and the Communicable Disease Cluster (CDS) collaborated in the IDHA course with a one-day module on Communicable Diseases and Epidemic Emergencies. The module consisted oflectures and a case study on communicable disease control in a refugee setting. Dr Brundtland,WHO Director-General, addressed the participants challenging them to be ambassadors forhealth in future missions. She renewed WHO's commitment to be a powerhouse of technicalexpertise in prevention, mitigation and emergency preparedness for health. The next IDHAcourse is scheduled to take place in Dublin in July, 1999.

For more information please contact Dr Maire Connolly. e-mail: connollyma@who.ch

Horn of Africa Initiative: Internal Technical Review

Civil unrest and natural disasters in the Horn of Africa have led to massive populationmovements within and across borders resulting in famine and spread of communicable diseases.In March 1998, the countries of Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan and Ugandaagreed to overcome their differences and to develop a protocol of cooperation to strengthen inter-country management for priority health problems. Since then six of the countries (Djibouti,Eritrea, Ethiopia, Kenya, Sudan and Uganda) have signed the protocol. Health Ministers of thesecountries had requested that WHO facilitate implementation of the agreement. With support ofthe Italian Government, WHO has established the "Health Emergency Intervention Project in theHorn of Africa."

A review of the initiative was held In Alexandria, February 28-March 1, 1999. The WHOrepresentatives of the countries involved, the regional offices of EMRO and AFRO and EHA-

Headquarters participated. The participants looked at the project's progress to date and concludedthat some valuable results have been achieved: cross-border dialogue has been established, fourcountries have developed joint plans of action for the management of major health problems andcollaboration has been initiated with UN Agencies. Participants acknowledged the need toextend the project and to expand activities at least to the Sudan-Ethiopia border.

For more information please contact Dr Alessandro Loretti.e-mail: lorettia@who.ch

WHO in the Executive Committee of Humanitarian Affairs

The Executive Committee of Humanitarian Affairs (ECHA) was created in early 1997 by the UNSecretary-General. It is one of four Executive Committees created in the framework of UNreform with the goal of improving coordination between UN Agencies. It is an important forumof coordination of the UN's humanitarian activities. Since December 22, 1998, WHO has beeninvited to attend its meetings as observers on an ad hoc basis. The monthly meetings are chairedby the Emergency Relief Coordinator and focus on several different humanitarian crises.Discussions center on issues of coordination, policy and reform. To date, WHO has participatedin all of the 1999 monthly meetings in New York. Important issues related to health inemergencies have been shared resulting in ECHA making critical decisions with a direct impacton WHO. Examples of actions taken include nutritional surveys that were conducted in theDemocratic Republic of Korea and the return of international staff to Afghanistan.

For more information please contactMs Monette van Lith. e-mail: lith@un.org

EHTP Midterm Review

The Emergency Health Training Programme for Africa (EHTP) began in 1997. In December1998, representatives from the United Kingdom's Department for International Development(DFID), the Swedish Cooperation (Sida), EHA-Headquarters and AFRO met in Addis Ababa toreview the achievements of the programme and make recommendations for the future. Theyconcluded that although only a few countries will have received training by the end of the currentfunding period, the project will be in a good position to provide much needed services to othercountries. The value of the programme will only be fully realized if national focal points are ableto access the programme for training and advice. This will require national or bilateral funds thatwill be used to directly purchase the services of EHTP.

For more information please contactDr Magnus Grabe.e-mail: who/ptc@telecom.net.et

Philippines to Launch Emergency Management Institute

On February 16, 1999 Secretary of National Defense Orlando S. Mercado approved a"Memorandum of Cooperation in Disaster and Risk Management" to establish the EmergencyManagement Institute of the Philippines (EMIP). In addition to serving as the country's centre ofexcellence on disaster and risk management training, EMIP will also enable the Philippines toimprove cooperation in disaster reduction among ASEAN countries. EMIP is an initiative of theNational Disaster Coordinating Council (NDCC), the National Defense College of the

Philippines (NDCP) and the Manila-based Asia Pacific Disaster Management Centre (APDMC).EMIP will be located at the National Defense College of the Philippines.

For more information please contact John Barrett. e-mail: apdmc@nsclub.net

11th WADEM Congress

The 11th Congress of the World Association for Disaster and Emergency Medicine (WADEM)took place in Osaka, May 10-13, 1999. The gathering of several hundred participants providedan opportunity to compare and develop long-term cooperative efforts towards disaster preventionand mitigation. Papers on the WHO programme of emergency preparedness and response in theWestern Pacific Region and on WHO's overall approach to health and disasters were presented.

For more information please contactDr Jean-Paul Menu. e-mail: menuj@who.ch

Field Missions Mission Purpose Contact

ThailandOctober 1998

assessment of communicable diseaseand malaria control activities

contact : Dr MaireConnollye-mail :connollyma@who.ch

NepalNovember 1998

assessment of communicable diseasecontrol in camps

contact: Dr MaireConnollye-mail:connollyma@who.ch

Harare, ZimbabweNovember 1998

presentation of HINAP to AFROstaff and exploration of possible areasof collaboration

contact: Ms JaneWallacee-mail:wallacej@who.ch

Federal Republic ofYugoslaviaand Bosnia HerzegovinaDecember 1998

preliminary field testing of WHOEmergency Handbook

contact: Dr AlessandroLorettie-mail: lorettia@who.ch

MoscowFebruary 1999

discuss humanitarian emergency situationwith other agencies and donors and to extendWHO's emergency activities

contact: Dr Etsuko Kitae-mail: kitae@who.ch

WashingtonFebruary 1999

presentation of HINAP to US governmentagencies, World Bank and UN Foundation

contact: Dr Eric Nojie-mail: nojie@who.ch

NamibiaMarch 1999

presentation of workshop on HospitalEmergency Preparedness

contact: Dr ReinaldoFlorese-mail: floresr@who.ch

TunisiaMarch 1999 presentation at Risk Management Course

contact: Dr ReinaldoFlorese-mail: floresr@who.ch

TanzaniaMarch 1999

Joint mission with UNHCR, UNICEFand WHO's Department of Child andAdolescentHealth on integrated management ofchildhood illnesses

contact: Dr MaireConnollye-mail:connollyma@who.ch

Somalia and KenyaMarch 1999

preliminary field testing of WHOEmergency Handbook

contact: Dr AlessandroLorettie-mail: lorettia@who.ch

SomaliaMarch 1999

study the planning for provision ofprimary health care in chronic emergenciesusing Somalia as case study

contact: Dr DanielleDebouttee-mail:deboutted@who.ch

MacedoniaApril 1999 setting up humanitarian surveillance system contact: Dr Eric Noji

e-mail: nojie@who.ch

National Policy and Legislation Conference

In October 1998, SEARO (South-East Asia Regional Office) organized its second regionalconference in Sri Lanka entitled "National Policy Development and National Legislation inEmergency Preparedness and Management". Seven Member States participated includingBangladesh, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. The goal of theconference was to share and review existing national legislation and national policy foremergency preparedness and management and to encourage further development in these areas.

During the conference technical presentations were made on the role of policy and legislation inemergency preparedness and participants reviewed sample legislation and policies.Recommendations to WHO and Member States were proposed for the future. SEARO willtechnically and financially support Bangladesh and Indonesia in conducting national conferenceson the Role of Policy and Legislation in Emergency Preparedness and Management in 1999.

For more information please contact Dr Johanna Larusdottir.e-mail: larusd@who.ernet.in

Conference in Manila Focuses on Strengthening Emergency Preparedness

An Emergency Preparedness Workshop was held November 9-13, 1998 by WHO RegionalOffice for the Western Pacific (WPRO) and EHA. The workshop brought together for the firsttime national focal points for health emergency management in the eleven most disaster-pronecountries in the Western Pacific Region.

The workshop addressed two levels of emergency preparedness training. The first level includedan overview of the most important topics in the field with individual "country disaster profiles"being defined. The second level was more specific and covered hospital emergency plans andhealth logistics management. The workshop was part of the programme "Preparing forEmergencies" supported by the United Kingdom's Department for International Development(DFID).

For more information please contact Dr Reinaldo Flores. e-mail: floresr@who.ch

China Hosts Community Preparedness Workshops

Two national workshops on community preparedness for emergency situations were conductedin Shanghai in April 1998. 100 participants from over 19 provinces attended the three-dayworkshops that covered disaster management with a focus on earthquake preparedness. Theconferences were organized by WHO in collaboration with China's Ministry of Health.Presenters represented various agencies in Shanghai including WHO's Collaborating Centre, theShanghai Medical Emergency Centre. Those attending included hospital directors, physicians,professors and nurses. Discussions during the workshops highlighted the need to furtherstrengthen the emergency preparedness activities of the health sector.

For more information please contact: Dr Shigecki Asahi. e-mail: asahis@who.org.ph

Hurricane Mitch

Hurricane Mitch struck the Central American subcontinent October 26, 1998. Five countries,Honduras, Nicaragua, Guatemala, El Salvador and Belize were severely affected in terms ofvictims and human and economic development. In terms of emergency preparedness,coordination and response mechanisms were already in place when the hurricane hit. Advancedcommunication technologies facilitated the response in all sectors which included the SupplyManagement System (SUMA) developed by PAHO.

The magnitude of the hurricane rapidly exhausted the national response capacities and assistancefrom outside was urgently needed. Rapid assessment missions were immediately deployed bygovernments and their partners including WHO. The UN Appeal addressed needs ofrehabilitation and reconstruction in all sectors. In the health sector, continued assistance througha package of communicable disease control measures and primary health care rehabilitation iskeeping the health situation in the affected countries under control. Although sporadic cases ofcholera, malaria and dengue have been and continue to be reported no widespread epidemic hasoccurred. The transition objective for the health sector is now to regain the pre-disaster level ofservices. This means further investment in countrywide public health interventions such asimmunization campaigns, water quality control, vector control and sanitation, nutrition and foodsafety as well as primary health care services and hospital rehabilitation.

For more information please contact Dr Michel Thieren. e-mail: thierenm@who.ch

Tunis Inter-country Workshop

The Regional Office for the Eastern Mediterranean (EMRO) conducted its second Inter-CountryWorkshop on Emergency Preparedness and Response from November 28-December 2, 1998.The workshop was held in Hammamet, Tunisia and was organized with the support of theGovernment of Tunisia, the WHO Mediterranean Centre for Vulnerability Reduction (WMC),EHTP (Emergency Health Training Programme for Africa) and EHA-Headquarters. Participantsrepresented Governments of Egypt, Iran, Lebanon, Oman, Pakistan, the Palestine NationalAuthority, Sudan Syria and Tunisia. WHO-Sudan and Somalia were also represented.

During the workshop, participants presented their countries' disaster profiles and emergencymanagement capacities. EMRO presented the regional priorities and strategies for capacitybuilding in Emergency Health Preparedness 2000-2004. EMRO also reaffirmed interest instrategic and technical collaboration with EHA-HQ and in facilitating exchanges andcoordination between PTC/EHTP and WMC. The workshop concluded with participatingcountries agreeing on a common standard format for a national/regional disaster database andoutlining priorities for EMRO/EHA country assistance.

For more information please contact Dr Alessandro Loretti. e-mail: lorettia@who.ch

UNDAC Training Course

Staff of the Regional Office for the Western Pacific (WPRO) participated in the UNDAC(United Nations Disaster Assessment and Coordination) Pacific Training Course March 21-31,1999 held in Apia, Samoa. One goal of the course was to strengthen national and regional

disaster response capacity in the Pacific Region. A second goal was to strengthen the ability ofOCHA (Office for the Coordination of Humanitarian Affairs) to mobilize and coordinateinternational relief through further development of the UNDAC system.

For more information please contact Dr Shigeki Asahi. e-mail: asahis@who.org.ph

African Ministries of Health Hold Conference

The 6th annual conference of African Ministries of Health (CAMP VI) is to be held in Cairofrom June 25-28. It is organized by the Organization of African Unity (OAU). One of the itemsfor discussion is Management of Health in Emergencies.

For more information please contact Dr Ghulman Raban Popal. e-mail: popalg@who.sci.ed

New Web Page Targets Disaster Mitigation in Hospitals

PAHO's Emergency Preparedness Programme in Latin America has created a new web page onDisaster Mitigation in Hospitals. The site contains various information on disaster mitigationincluding guidelines, training materials, selected bibliography as well as publications availablefrom PAHO. The Web-site is in Spanish, with some publications available in English. The site isupdated continually and can be found at:

www.disaster.info.desastres.net/PED-Ecuador/desastre/mitigacion

PAHO's New Web-site

The Pan American Health Organization (PAHO)'s Emergency Preparedness and Disaster ReliefCoordination Program has a new, redesigned Web-site which includes:

� an overview of the program � a section on "Dealing With Disasters" � a catalogue of publications, including full-text on-line documents and newsletters from

PAHO � a link to the Regional Disaster Centre in San Jose, Costa Rica � an extensive database of hazards/disaster literature � information on PAHO's Humanitarian Supply Management System (SUMA) � extensive links to other disaster management resources on the Internet � a special section on El Niño � links to World Health Organization Collaborating Centres � the latest issue of the "Disasters" newsletter � findings from the PAHO/WHO conference on "Health Crises, Disasters and the Internet"

held last Fall in Bogota, Colombia.

The Web-site is available in English and Spanish and can be found at:

www.paho.org/english/ped/pedhome.htm

Health as a Bridge for Peace

The first training course on Health as a Bridge for Peace was held in Colombo, Sri Lanka fromMarch 8-12, 1999. It was organized by WHO-EHA/SEARO in collaboration with the Scuola

Superiore S. Anna of Pisa, Italy. The course is part of an initiative undertaken by WHO toincrease health professionals' capability, within their areas of responsibility, to implement actionsand strategies that can contribute to peace building and conflict resolution.

The purpose of the training course was to transmit basic skills and knowledge on human rights,international humanitarian law, medical ethics, negotiation, conflict resolution and analysis. Italso allowed the trainers to test the learning package objectives. Participants were healthprofessionals from six different countries of the South East Asia Region. Their response andevaluation of the course allowed organizers to identify weak points in the training and to betterdefine the learning needs of health professionals. The feedback received in Colombo is beingused to improve the training package for the second Training Course to be held in Addis Ababanext summer.

For more information please contact: Dr Alessandro Loretti. e-mail: lorettia@who.ch

South Balkans Crisis: WHO Humanitarian Assistance Programme

When the South Balkans conflict erupted into a massive refugee crisis, WHO internationalpresence was already established in five offices (Belgrade, Pristina-now evacuated, Kukes-recently staffed, Tirana, Podgorica and Skopje). This played a positive role in setting up sectorcoordination mechanisms throughout the region. Through sustained dialogue with all healthpartners, national and international, WHO adopted a humanitarian strategy entirely directed atstrengthening local health capacities.

The objective of the health sector in this crisis is to alleviate the human suffering, preserve lifeand avoid illnesses among the displaced and host population groups. After more than a month thehealth sector has developed an integrated approach in essential areas such as immunization andcontrol of communicable diseases, epidemiologic surveillance, drug supplies, water andsanitation, mental health, noncommunicable diseases, reproductive health, health informationmanagement and technical support to local authorities.

One can expect the epidemiological situation to remain precarious as long as populations are onthe move. Over the coming months, continued support to maintain essential primary health careservices for the host and refugee populations through the existing health care systems will berequired. At the same time, the health sector has to create conditions for return as soon assecurity allows. Returning populations must be guaranteed immediate access to health servicesand adequate health conditions in areas of return.

For more information please contact Dr Michel Thieren. e-mail: thierenm@who.ch

EHA-EMRO Participates in Benghazi Congress

EHA's Regional Office for the Eastern Mediterranean (EMRO) presented "Management ofDisasters and Emergencies" at the 4th Jamahirya Congress on Medical Sciences in Benghazi,Libya November 1-4, 1998.

For more information please contact

Dr Ghulam Raban Popal. e-mail:popalg@who.sci.eg

Rapid Assessment Protocols

Disaster has many forms. Epidemics and outbreaks of disease, famine, natural catastrophes,chemical accidents and population displacements are just some of the disasters that may affectany or all of us. Disasters cause death and destruction, yet the amount of damage they do tohuman life and health can be reduced considerably if we are prepared and we respond rapidlywhen a disaster happens. Making a rapid assessment of health status and health needs is anessential first step in responding to disaster. Taking stock of the situation without delay enablespriorities to be set and aid organized efficiently, so that time and resources are not wasted. Whena disaster occurs there is unlikely to be a team of experts on hand to give advice so the healthassessment will have to be carried out by local health staff. The protocols in this book can beused to train all kinds of health workers who may be involved in emergency response so that,when disaster strikes, they are able to keep the toll of death and disease to a minimum.

Available in English e-mail: publications@who.ch

H.E.L.P. Cours de Sante Publique Pour la Gestion de l'Assistance Humanitaire

ICRC has just published this 970-page book with all the training materials developed and utilizedfor the H.E.L.P. (Health Emergencies in Large Populations) Course. The book is written by DrPierre Perrin and is available in French.

English in preparation. Price: 95 CHF

Available through ICRC Library in Geneva. e-mail: pkammer.gva@icrc.org

Management of Severe Malnutrition: a manual for physicians and other seniorhealth workers

This WHO manual provides expert practical guidelines for the management of severelymalnourished children. Addressed to doctors and other senior health workers, the manualexplains exactly what must be done to save lives, achieve successful management andrehabilitation, prevent relapse, and thus give these children the greatest chance of full recovery.Throughout, the importance of treating severe malnutrition as both a medical and a socialdisorder is repeatedly emphasized. As successful management does not require sophisticatedfacilities and equipment or highly qualified personnel, the manual also performs a persuasivefunction, encouraging health professionals to do all they can to save these children and meet theirgreat need for care and affection. The manual includes brief advice on the management ofseverely malnourished children in disaster situations and refugee camps and of severelymalnourished adolescents and adults.

Available in English.

e-mail: publications@who.ch

Natural Disaster Mitigation in Drinking Water and Sewerage Systems

PAHO has just published Natural Disaster Mitigation in Drinking Water and Sewerage Systems:Guidelines for Vulnerability Analysis. This is a second book of a series that PAHO has publishedthis year on lessening the impact of disasters in drinking water and sewerage systems. This

publication specifically focuses on vulnerability analysis, an essential step in determining how toprotect drinking water and sewerage systems and on appropriate response procedures when adisaster occurs. The guidelines are to be used as an analytical tool by engineering and technicalpersonnel working with drinking water and sewerage services to diagnose the behaviour of thesesystems in the event of a natural disaster.

Available in Spanish.

English in preparation

e-mail: disaster@paho.org

Mental Health of Refugees

This WHO publication provides a guide to the recognition and management of mental healthproblems in refugees and other displaced persons. Prepared by WHO in collaboration withUNHCR, the manual responds to growing awareness that trauma, terror, loss, bereavement andgeneral psychosocial disorientation experienced by refugees can pose serious threats to theirmental health. With this concern in mind, the manual aims to help non-specialist relief workersbecome alert to common mental health problems and become more competent in theirmanagement, by involving community support services or referring to a specialist.

The manual consists of ten training units wherein the emphasis is placed on the many things thatcan be done to ease the suffering of refugees, even when conditions are crowed and resourcesscarce. Types of assistance covered include counselling, self-help groups, modern drugs andtraditional medicine.

Available in English, French.Spanish in preparation

e-mail: publications@who.ch

In the Works: EHTP Emergency Health Management Training Modules

During the past two years, PTC/EHTP has developed over 70 different training modulescovering Emergency Health Management (EHM). The modules consist of overheadtransparencies covering basic concepts, definitions and principles of EHM. A trainer's guide isbeing developed to complement the modules. For each module, the guide will provide objectives,mode of use, key message and essential WHO readings.

Step-by-step instructions accompanying each transparency will encourage creativity andinteraction of participants. The complete package of EHM training modules will be availablemid-99.

For more information please contact Hedwig Deconinck. e-mail: who/ptc@telecom.net.et

The Africa Live Database

The Africa Live Database (LDB) is a computer-based data tool developed by the Africa Regionof the World Bank. The system consists of:

� local data base: a tool for in-depth economic work � query: a tool for storing and manipulating economic and sectoral variables � Africa briefings: presorted ready-to-use data. �

To check it out, go to

www.worldbank.org/aftdr/findings/grhtmap.htm

Handbook on Emergencies in Preparation

A handbook on Emergency Field Operations is being prepared by EHA Headquarters as a toolfor WHO staff. It is to be used together with the WHO Manual and other technical manualsaddressing specific health issues. The Handbook deals with regulations, procedures andbehaviours relevant to the field. The 5 chapters deal with everything from preparing for themission through to the final stage when the crisis is over and rehabilitation begins. Checklistsand formats for information management and reporting are also included. The preparation of theHandbook began in January of 1998. A full draft has been tested in the field and is presentlyunder review by WHO Regional Offices and individual experts. A final version is expected to beready for publication in June 1999.

For more information please contact Dr Alessandro Loretti. e-mail: lorettia@who.ch

The Humanitarian Times

The Humanitarian Times is an independent, non-profit e-mail publication sent free of charge toNGO Offices in over 100 countries.

To subscribe:

e-mail: HTimes@msn.com

Guiding Principles on Internal Displacement

Guiding Principles on Internal Displacement has been issued by UN OCHA.

You can download a copy at:www.reliefweb.int/ocha_/pub/idp.html

Training Events

International Decade for Natural Disaster Reduction (IDNDR) ProgrammeForum 1999.

July 5-9, 1999. Geneva, Switzerland

Contact IDNDR Secretariat. e-mail: marianne.muller@dha.unicc.org

H.E.L.P.Health Emergencies in Large Populations. Offered by the International Committee ofthe Red Cross and World Health Organization. "Designed to develop and improve skills ofpersons and organizations providing emergency health services in humanitarian emergencies."July 12-July 30, 1999. Baltimore; MarylandJuly 19-August 6, 1999. Honolulu, HawaiiAugust 23-September 10, 1999. Göteborg, SwedenNovember 1-19, 1999. Pretoria, South AfricaContact Dr Pierre Perrin. e-mail: pperrin.gva@icr.org

Third Regional Training Course on "Community Based Approaches to DisasterManagement"Offered by Asian Disaster Preparedness Center (ADPC)July 19-30, 1999. Bangkok, ThailandContact ADPC, Asian Institute of Technologye-mail: adpc@ait.ac.th

Twelfth International Disaster Management Course.Offered by the Cranfield Disaster Management Centre.July 27-August 26, 1999. Swindon, Wiltshire, U.K.Contact administrator, Disaster Management Centree-mail: disprep@rmcs.cranfield.ac.uk

Fifth International Congress on DisastersSponsored by Pan American Health Organization, UN International Decade for Natural DisasterReduction and others.September 7-10, 1999. Havana, CubaContact Migdalia Luna Cisneros, Palacio de Convenciones de la Habanae-mail: migdalia@palco.get.cma.net

Second International Disaster and Emergency Readiness Conference andExhibition and Fifth International Emergency Planning ConferenceOffered by Andrich International Ltd.October 12-14, 1999. The Hague, The NetherlandsContact Andrich International Ltd.e-mail: ider@andrich.com

Australian Disaster Conference 1999: " Disaster Prevention for the 21st Century"November 1-3, 1999. Canberra, AustraliaContact Conference Logisticse-mail: conference@conlog.com.au

Contacts

Division of Emergency and Humanitarian ActionWorld Health Organization1211 Geneva 27, Switzerland.Phone: (41 22) 791 2752/2727/2987.Fax: (41 22) 791 48 44Emergency Health Training for AfricaPan African Emergency Training CentrePO Box 60035, Addis Ababa, Ethiopia.Phone: (25 11) 517 600.Fax: (25 11) 513 264e-mail: who/ptc@telecom.net.et

Regional Office for Africa (AFRO)Emergency and Humanitarian Action (EHA)Temporary LocationMedical School, C wardParirenzatwa HospitalMazoe StreetPO Box BE 773BelvedereHarareZimbabwePhone: (263) 4 70 69 51 or 4 70 74 93.Fax: (263) 4 70 56 19 or 4 70 20 44e-mail:chellouchey@whoafr.org

Regional Office for the Americas (AMRO)/Pan American Health Organization (PAHO)Emergency Preparedness and Disaster Relief Coordination Programme (PED)525, 23rd Street, NWWashington, DC 20037USA.Phone: (202) 861 4325 or (202) 861 3399.Fax: (202) 775 4578e-mail:disaster@paho.org

Regional Office for Europe (EURO)Coordination and Resource Mobilization (COR)8, Scherfigsvej2100 Copenhagen ODenmark.Phone: (45) 39 17 17 17.Fax: (45) 31 17 18 18e-mail:jth@who.dk

Regional Office for the Eastern Mediterranean (EMRO)Coordination, Resource Mobilization and Emergency Relief (CMR)PO Box 1517Alexandria 21511Egypt.Phone: (20 3) 48 202 23/24 or 48 300 90.Fax: (20 3) 48 389 16e-mail: mojadidin@who.sci.eg

Regional Office for the Western Pacific (WPRO)Division of Health Infrastructure (DHI)PO Box 29321099 ManilaPhilippines.Phone: (63 2) 528 80 01.Fax: (63 2) 521 10 36 or 536 02 79e-mail:asahis@who.org.ph

Regional Office for South East Asia (SEARO)Health Services Development (HSD)World Health HouseIndraprastha EstateMahatma Gandhi RoadNew Delhi 110002IndiaPhone: (91 11) 331 7804/7823.Fax: (91 11) 331 8607 or 11 332 7972e-mail:larusd@who.ernet.in