Health security: is the world better prepared?

Four famines: the worst crisis since 1945

WHO has also become more directly operational during humanitarian crises. Working through ministries of health, WHO coordinates the work of partners and conducts rapid assessments of needs, delivers large quantities of medical supplies, and operates mobile laboratories and clinics.

Food distribution to children in Nigeria

The scale of needs is unprecedented. On 11 March 2017, the UN humanitarian coordinator informed the Security Council that more than 20 million people were at risk of starvation and famine across four countries in Africa and the Middle East: north-eastern Nigeria, Somalia, South Sudan and Yemen. The situation was described as the world’s worst humanitarian crisis since 1945.

In all four countries, already fragile hand-to-mouth survival has been crushed by the deadly combination of drought and fierce fighting. Drought caused farmers to abandon their fields and families to flee as livestock died off and water supplies dried up. The threat from fighting keeps people displaced by drought constantly on the move. Between starvation and death nearly always lies disease. Severe undernutrition compromises immune functions. Diseases that a well-nourished body can ward off turn fatal. Displaced people living in crowded unsanitary camps are vulnerable to outbreak of multiple diseases.

In South Sudan, where nearly three years of conflict have left the health system in tatters, life expectancy has dropped to 55 years and health needs have risen exponentially. In February 2017, the UN declared a famine in parts of the country and warned that almost half of the total population was in need of urgent food assistance. Given the strict criteria used, the declaration of a famine means that people are already dying from starvation . Together with the Ministry of Health, WHO coordinates the work of 35 partners, sounding alerts to hot spots and investigating dozens of disease outbreaks, including a cholera outbreak confirmed in July 2016. In 2016, three million children were vaccinated against polio and more than 200 000 against measles. A nation-wide vaccination campaign against cholera began in April 2017.

"The declaration of a famine means that people are already dying from starvation."

Dr Chan, WHO Director-General

In Somalia, the greatest concern is the ongoing cholera outbreak fuelled by a severe drought that has, as elsewhere, forced people to consume contaminated water. Since the start of 2017, 22 000 cholera cases have been reported, representing a nearly five-fold increase over the previous year. To contain the rapidly spreading outbreak, Gavi, the Vaccine Alliance, delivered nearly a million doses of oral cholera vaccine; 450 00 people received their first dose in mid-March 2017. The vaccines are being administered by the government with support from WHO and UNICEF. A recent investigation of 12 cholera treatment centres and units found that none had adequate water and sanitation facilities. While WHO has delivered badly needed emergency medical supplies and equipment to the hardest-hit areas, more will be needed if the number of cases continues to rise.

The eight-year conflict in north-eastern Nigeria led to a deepening humanitarian crisis, displacing farmers from their land and leaving a massive food shortage in its wake. Despite the challenging security situation, WHO and its partners have targeted 8.2 million people across the region, including nearly six million in north-eastern Nigeria, for emergency health assistance. Borno is the most severely affected state, with 35% of health facilities destroyed and another 30% damaged. Childhood mortality is off the charts.

WHO has deployed 35 mobile teams to the most remote and insecure parts of the state, where travel on poor roads requires a military escort. Apart from offering general health care, these teams have provided treatment for malaria, the biggest killer in the severely undernourished population. Given the precarious immunization status resulting in the emergence of new polio cases, WHO supported vaccination campaigns which protected nearly three million children from measles and more than 1.8 million from polio. In March 2017, Borno State reported its first Lassa fever outbreak since the disease was first detected 48 years ago, again illustrating the vulnerability created when health systems collapse.

In its 2017 response plan for Yemen, WHO and its partners will be providing targeted assistance to 10.4 million people living in the country’s most vulnerable districts. The focus is on the health needs of young children, pregnant and lactating women, people injured in the conflict, and patients with chronic diseases. In 2016, WHO and its partners received financial support to sustain the functionality of more than 400 health facilities in 145 districts. Essential medicines and supplies, also for surgery and acute care, were delivered to support the health needs of more than 3 million people.

WHO also established 26 centres for cholera treatment and expanded an electronic early warning system for outbreaks from 440 sites in 2015 to nearly 2000 sites the following year. As further operational support, WHO delivered more than two million litres of fuel to keep hospital generators and ambulances running. In April 2017, WHO announced that nearly five million children in the war-torn country had been vaccinated against measles and polio in a nation-wide campaign that took two months and required more than 5000 rented vehicles.