Welcome to this consultation on Planning Ahead for the Health Impact of Complex Emergencies.

Recently, I attended the launch of the UN Consolidated Inter-Agency Appeal (CAP) for the year 2000. There, I underlined that Health is the cornerstone of humanitarian assistance, its ultimate objective and the true yardstick against which one can evaluate the needs for, and the overall performance of humanitarian assistance. The same message applies today, but I am here to invite you to put greater emphasis on what Health can contribute to prevention and preparedness for humanitarian emergencies.

WHO has embarked in a process of reflection on health priorities in response to humanitarian emergencies.

Today we want to look at what we can do for those countries that are on the brink of acute crisis and for those emerging from them. We feel that these are the contexts where WHO can really make a difference.

There is consensus that, in order to facilitate stabilisation and recovery, humanitarian aid must be accompanied by investment in building civil society. WHO fully endorses this view. We also feel that investing in civil society, in vulnerability reduction and preparedness through Health before crises explode, may help defuse them. Placing health and social services high on the political and economic agenda can help maintain social cohesion, national unity and stability and ultimately reduce the need for humanitarian assistance.

We see poor countries undergo periodical disasters along apparently immutable patterns. Economic downturns combine with natural disasters and trigger off emergencies in those countries that lack the capacity to cope with them. International consensus is growing that the distinction between natural disasters and human-induced emergencies is artificial and that there are no "Natural" Disasters. There are natural hazards, which can impact upon human vulnerabilities that are mostly determined by human causes. In this sense, all emergencies can be said to have political causes: either by commission or by omission.

These reflections are important for the way WHO is carrying out its work and mandates. WHO has an often unique, long-term presence in almost two hundred countries, local partnerships and knowledge of the context where disasters take place and of their impact on the people’s health. We cannot ignore phenomena of this magnitude. It cannot ignore the mortality and morbidity associated with complex emergencies. It cannot ignore the risk of many countries losing costly and scarce health assets and opportunities for development.

Nor, as a UN Specialized Agency accountable to our Member States, can WHO ignore the global trends. International funding declines faster for areas where political solutions continue to fail or that donors do not consider of strategic importance. Unfortunately, these very areas are often those where the needs are the greatest. In 1998, 93% of the UN appeal for Kosovo was funded, but only 41% of the one for Africa's Great Lakes, down from 84% in 1997. As humanitarian aid tends to concentrate in countries that are closer to the donors' doorstep, ways must be found to strengthen resilience and capacities in other more distant, vulnerable countries.

These thoughts are not new to WHO, and have materialised in a number of global and regional programmes and initiatives. Recently, the Directors for Programme Management from all WHO Regions agreed on the need for the Organization to face the growing number of man-made and natural disasters. They pointed to the vulnerability of the poor, to the need for consensus, stronger leadership and greater capacities within WHO for mitigation and preparedness. Man-made disasters and other humanitarian emergencies will be one key theme of the 10^th General Programme of Work that will be presented to the World Health Assembly in May 2000.

WHO’s ultimate goal is to increase the self-reliance of its Member States. This consultation will look at the country level, where emergencies originate, and where WHO offices are tasked to deliver the Organization's technical cooperation.

We need options on how WHO can best bring its corporate expertise to strengthen local health systems. WHO wants them to be more resilient during a crisis, prepared to absorb humanitarian assistance without being overwhelmed by it and capable to move towards recovery, once the crisis is over, without repeating the old mistakes.

We have important experts in the field of emergencies. But we can always do better and let us not shy away from close scrutiny of our own performance. Our ability to work effectively at country level is a key measure of our work. There is still room for improving our performances and we should be open to new ideas and new ways of working.

We need your opinion on which countries should be given priority attention, in terms of need and opportunities for action. You have to define what health systems may require in order to withstand a crisis and what are the essentials that these systems should be able to deliver in spite of the circumstances. We also need your advice on What can be identified as a health system and on Who can be the relevant partners in situations of social disarray.

We have to search together for the "common goods" that can catalyse dialogue and collaboration in spite of mistrust. We have to see how an ideal country framework for analysis and action could interface with the international systems for development assistance and humanitarian aid. Finally, we will need to consider how all this would impinge upon WHO's current modus operandi and what should be the next steps of the process.

Our vision in this area of work is of a world where communities can understand their vulnerability and prepare for the unexpected and where, when the unexpected happens, impact on health is minimal. WHO has the obligation to assist its Member States to develop health systems that can withstand crises. We have to see together whether we have the capacities for this, and, if not, identify how to develop and apply them.