David Nabarro, Representative of the WHO Director General, Health Action in Crises
Dear Mr Chair, Distinguished Guests, Ladies and Gentlemen, Friends and Colleagues,
Welcome. It gives me great pleasure to make this address on behalf of WHO at this seminal meeting. The IFRC Global Health and Care Forum provides a unique platform for discussing challenges in public health in crises and for identifying opportunities for reaching our beneficiaries.
The topics you will cover in the next three days are particularly relevant to our collective work in disasters and crises.
I start by highlighting five themes:
- community mobilization is the key,
- without partnership we achieve next to nothing,
- we must see ourselves as global promoters,
- the fight against poverty is at the heart of our work, and
- the major motive for our work is the prevention of human suffering.
Community mobilization is a key component of effectively reaching beneficiaries in a timely manner. Volunteers are most important to reach the most vulnerable and difficult to access people. More financial resources need to be directed at volunteer systems.
Partnerships are essential. Working alone is not an option. Only working together will reduce the risks among affected communities in crisis situations and bring forward better public health outcome and to reduce avoidable loss of life, burden of disease and disability in crises.
WHO and IFRC already work together in a number of fields within the context of the International Federation’s Strategy 2010 and the WHO's '3 by 5' strategy and the WHO Three Year Performance Improvement Programme of the Department of Health Action in Crises. More about that later.
Cooperation also builds upon ongoing efforts in the area of HIV/AIDS, Tuberculosis and Malaria, as well as first aid, road safety and other work in disaster prevention, emergency, and recovery situations. WHO and IFRC are also part of the Inter-Agency Standing Committee, which brings together the UN system agencies, the Red Cross and Red Crescent Movement, IOM and three NGO Consortia, ICVA (International Council of Voluntary Agencies, SCHR, (Steering Committee for Humanitarian Response) and InterAction.
We must see ourselves as Global Promoters. The Inter-Agency Standing Committee (IASC), its Working Group and subsidiary bodies provide an excellent spring board for keeping heath high on the political agenda as health for all, especially the poorest, is one of the central purposes of any humanitarian response.
The Red Cross and Red Crescent Movement plays a vital role. It is the voice of the most vulnerable, advocating for marginal populations. National Societies are well placed to influence public policy.
Eradicating poverty is at the heart of our work. Three of the Millennium Development Goals are directly health related: reducing child mortality, improving maternal health and combating HIV/AIDS, malaria and other diseases.
The recent UN report "In larger Freedom" describes health as a contributor to peace and security, establishing a firm basis for sustained, focused and complementary actions.
The way the United Nations works to improve public health and eradicate poverty is changing. The key is to join forces and contribute to equity, justice and peace.
Advocating for mother and child health was the theme of both the World Health Day and the World Health Report.
The primary motive for our work is to prevent suffering.
We must 1) uphold the right to health and the basic need for heath care in all settings, 2) advocate for the sanctity of health care institutions, and the vital importance of health workers being able to reach health centres and do their work, 3) ensure ambulances have free and unrestricted access to patients and to health centres and 4) enhance communication networks and coordination so that we are able to speak out about the health needs of suffering people.
Five commitments are needed to make our partnership work:
- predictable collaboration,
- explicit commitments,
- co-operation at country level,
- practical action to tackle priority issues (mental health and psychological trauma; water, hygiene and sanitation, women's ill health, HIV/AIDS, TB and malaria),
- The need to apply lessons from the field.
Predictable collaboration. We are here today to reinforce the already sound collaboration among our staff in the field.
Three of WHO's regional offices, the WHO Regional Office for the Americas, Pan American Sanitary Bureau, the WHO Regional Office for the Eastern Mediterranean and the WHO Regional Office for South East Asia, already signed agreements for joint collaboration in a number of areas of mutual concern, in general to improve the lives of vulnerable people, more specifically to work for improved access to health services, capacity building in the area of public health and to respond in a coordinated way to emergencies and crisis, among others.
The Letter of Commitment we will refer to later informs our staff at country and regional level of the commitment of our principals to reduce avoidable loss of life, burden of disease and disability.
The IFRC Strategy 2010, WHO's 3X5 and the three years performance improvement program for health action in crisis are the reference for this endeavour.
At the country level we can capitalize on our complementary strengths, more than anywhere else.
WHO, with its close link to the national authorities, and the IFRC, with it community out reach and spirit of voluntarism, have an exiting opportunity to jointly enhance public health outcomes for the most vulnerable and poorest.
Key challenges are in the field of 1) mental health and psychosocial support, 2) water, hygiene and sanitation, 3) preventing disease outbreaks, 4) women's health, 5) HIV/AIDS-TB and malaria and 6) funding for health in crises.
Mental Health and Psychosocial support in crises. These stressors could pose serious mental health problems and disorders. Psychosocial and mental health concerns should complement humanitarian work starting in the first days and weeks of the relief, but should continue and be translated into substantial interventions through the phase of rehabilitation.
To this end, WHO will facilitate the work of an inter-agency task force on mental health and psychosocial support in crises to develop agreed guidance.
Health, water, hygiene and sanitation. To avoid increased mortality and morbidity levels, special attention must be given to health, water and sanitation in crises. Local capacity is key to rapid and effective interventions in water and sanitation: communities can prepare by building capacities at the local level.
To satisfy needs in health, hygiene, water and sanitation, especially in settings marked by instability and volatility, strict synergies are needed between different disciplines, sectors and agencies. Only working together can reduce the risk and bring forward better health outcomes.
Women's health. Women and girls often bear the brunt of conflicts today, facing daily deprivation and insecurity. Many face the threat of violence including when they engage in basic survival daily tasks such as fetching water or gathering firewood. They lack access to health services that address the physical and mental consequences of conflict and displacement and may die in childbirth because basic reproductive health services are not available. Increased attention to the specific issues that they face is part of the answer. The protection, diagnosis and treatment of women's health needs, particularly in situations of violent conflict is of vital importance during humanitarian crises.
HIV/AIDS and malaria. Community outreach and functioning health services are key elements of reaching the goal of having 3 million people on antiretrovirals by the year 2005. The numbers available for the end of 2004 indicate that 700.000 people are receiving treatment. Still a long way to go but not an impossible one.
The need to learn - always. Lessons learned are crucial for continuous improvement. To this end, the WHO conference on the health impact of the tsunami disaster in Asia, Pukhet, Thailand, 4-6 May 2005, focused on lessons learnt during the immediate response and the early recovery phase. The event was organized in cooperation with the Royal Thai Government and with co-funding from the Government of Italy.
We have learnt from the Tsunami Disaster of the need for strong platforms for coordination. It also brought to the fore that people affected by a catastrophic event like the tsunami are exposed to extreme stressors not only immediately but over a period of years.
Relationships are built at the local level
Everywhere I go, I meet Red Cross and Red Crescent people: National Society Officials on the ground have an extraordinary visibility and influence. We build relations through which we may work "sur le terrain". Meetings like this strengthen the relationship. We in WHO salute you.
Mr Chair, Distinguished Guests, Ladies and Gentlemen, Friends and Colleagues, we look forward to a long lasting and fruitful cooperation with the IFRC.