Bulletin of the World Health Organization

Emergency doctor says WHO has key role in health crises.

BULLETIN INTERVIEW
1 February 2005

David Nabarro

Since Dr David Nabarro was appointed Representative of the Director-General for Health Action in Crises in July 2003, the work of his team has hardly been out of the headlines and their website has become an important source of comprehensive health information on crisis-hit regions.

In the last 18 months, WHO has responded to more than 12 major health crises across the world from natural and man-made disasters to armed conflict and barely functioning health systems in regions with a very high burden of HIV/AIDS.

WHO’s Health Action in Crises helps governments reconstruct vital health services after a war or conflict, for example in Afghanistan, Iraq and Liberia; it provides basic health care to people who are being displaced by conflict, for example in Darfur, Sudan, and helps governments provide emergency health care, monitor disease and rebuild broken health systems in regions struck by
natural disasters, most recently in tsunami-hit parts of south-east Asia.

Q: What is a health crisis and what is WHO’s role in such situations?

A: WHO has a special role in times of crises. These are moments when large numbers of people can’t get basic requirements for life: water, sanitation, food, shelter, public health services. That means their risk of disease, disability and death rises. They suffer illness and die and that is a correct concern for WHO. It doesn’t mean it’s our job to deal with all the underlying causes. We serve as a barometer
in the progress of a relief effort.

For example, we look at how they can improve shelter, change the layout of camps: that’s why health people have a role. You need one organization that provides the gold standard. It could be ICRC (International Committee of the Red Cross) or MSF (Médecins sans Frontières), but most countries prefer it to be WHO because they look to us for reliable statements about what’s going on.

Q: Is WHO competing with other organizations providing emergency health relief in emergencies, such as the ICRC?

WHO/Dermot Tatlow
Personnel from WHO, the Indonesian government, the UN and the United States military conducted rapid health assessments

A: WHO uses its convening power to coordinate different organizations as they respond to crisis. If you have lots of different agencies trying to respond to health with different approaches and strategies, the result can be chaotic and bad. One of the moral duties of the world’s relief agencies is to coordinate when it comes to health. The only organization with authority in this field is WHO. People feel we haven’t done it well enough, but the issue is whether anyone else can do it and the answer is “no”.

Q: Did WHO get involved sufficiently quickly in response to the tsunami and what sort of assistance have affected countries been requesting?

A: We got in quite quickly: in Sri Lanka in the first few hours, in Indonesia a bit later. In emergencies and humanitarian disasters, we look at the situation on the ground, at what’s being provided, we identify gaps and make sure someone else fills the gaps or – if necessary — we fill the gaps. We did that in the tsunami crisis providing water purification tablets and emergency medical kits. We also do measure, surveillance and coordination work with local groups to make sure supply lines are open for medicines and food. One gap area in the tsunami crisis which we have helped to fill is to provide consistent public health information and advice. Countries and communities look to us to help their own personnel get back on their feet and start providing health services again.


One WHO emergency medical kit contains three-months supply of essential drugs and equipment for 1000 people. Each kit is divided into 10 packages, which are intended for use by community health workers in remote areas, and a supplementary kit for doctors.

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"You need one organization that provides the gold standard … most countries prefer it to be WHO because they look to us for reliable statements about what’s going on."