A child receives oral medication.
For the first time ever, the World Health Organization (WHO) is leading the health response to five major humanitarian crises at the same time. More than 60 million people, from West Africa to Iraq, urgently require a wide range of healthcare services.
West Africa’s Ebola outbreak, and conflict-enflamed humanitarian crises in South Sudan, Central African Republic, Syria and Iraq, have stretched health services to the limit and caused many to collapse. This has required WHO and its health partners to fill increasingly widening gaps to ensure life-saving and routine care for millions of displaced persons and host communities.
“We are dealing with an unprecedented number of multiple humanitarian health crises concurrently. These are more complex and affecting more people than at any point since the end of the Second World War,” says Dr. Bruce Aylward, assistant director-general of WHO’s Polio and Emergencies Cluster.
The five crises have, due to their scale and the emergency health response required, each been categorized as Grade 3 (G3) emergencies, the highest grading determined by WHO as part of its Emergency Response Framework. The ERF grades emergencies across three levels, with Grade 3 being the most serious.
The scale of the emergencies is stark, including:
West Africa Ebola outbreak
22 million people living in the three worst-affected countries – Liberia, Sierra Leone and Guinea – are at risk.
20 million people affected, including 1.8 million who are internally displaced.
10.8 million people inside Syria, including 6.5 million people displaced within the country. Another 3 million people have fled the conflict to regional neighbours Lebanon, Turkey, Jordan, Iraq and Egypt.
5.8 million people need humanitarian assistance, including 1.3 million who have been displaced.
Central African Republic
2.5 million people are in need, including 425 000 displaced.
“Just two years ago, WHO developed the Emergency Response Framework (ERF) to guide our response in all types of emergencies,” explains Aylward. “The ERF ensures that the full resources of the organization are made available to support the response to the most severe crises. We are dealing with an unprecedented number of multiple humanitarian health crises concurrently. We felt comfortable that the ERF would help us manage two Grade 3 emergencies concurrently, and if we were running three responses, we expected to be exiting one before entering the next. But two years later, we are managing five Grade 3 emergencies based on their scale, complexity, urgency, and political, social or economic impact. This is unprecedented – not only for WHO, but for all humanitarian partners. And these will be long-term, sustained crises, not just a time-limited surge period."
WHO’s leaders across the various emergencies testify to the enormity of the challenge that the organization is responding to within their own country settings, and around the world.
In Iraq, WHO representative Dr. Syed Jaffar Hussain, says, “With the increasing number of crises, WHO has realized that response to emergencies, whether health or otherwise, is not an isolated effort. It requires an organization well equipped with technical knowledge and mechanisms to deliver.”
Dr. Francis Kasolo, who runs WHO’s West African Ebola control hub based in the Guinean capital of Conakry, says an organization-wide response has been mobilized in each of the outbreak-affected countries, drawing in staff from around the world.
“WHO’s internal resources have been over-stretched due to the Ebola outbreak and the response to the other humanitarian emergencies occurring concurrently,” Kasolo says. “We will do everything possible to stop this dreadful outbreak and alleviate human suffering.”
WHO plays a dual-pronged role in humanitarian emergencies. On one hand, it is the world’s prime technical guidance setting authority on the wide range of health issues. On the other, it is the lead agency for health in humanitarian crises, which involves a major coordination role as lead of the “cluster” of health care providers working in the various emergency settings.
“We will always be a technical specialized agency, but it must be recognised that we have and need to have a strong foundation to operate in crisis settings,” says Aylward. “In humanitarian crises, our leadership role obliges us to be the provider of health services as a last resort. This can mean anything from coordinating the running of multiple health strategies in communities, such as immunization drives to equipping health facilities, to, even in some situations, delivering actual healthcare services.”
This role is increasingly crucial for WHO due to the shrinking number of healthcare providers working in emergencies. As security risks increase, especially for healthcare workers, and as costs for operations rise, many organizations that once performed in-country services no longer do so. The case in Iraq provides a telling example. The WHO-led health sector response there involves just 13 partner organizations. More than 40 organizations work in the Water and Sanitation Cluster.
Dr. Rick Brennan, director of WHO's Department of Emergency Risk Management and Humanitarian Response, says besides these mega-emergencies, the Organization was still responding to multiple crises, including in Afghanistan, the Democratic Republic of the Congo, Gaza, Mali, Pakistan, Ukraine and Yemen.
“Despite the strains on the Organization, WHO has never worked more effectively across multiple emergencies,” says Brennan. “By paying the salaries of healthcare workers in CAR and South Sudan so they return to work, or procuring large volumes of supplies for the Ebola outbreak, to delivering medicines and health services in the middle of intense conflict in Syria and Iraq, the implications for us are huge.”
“There has never been a time when we are more dependent on the solidarity, generosity and determined commitment of the international community to assist those most in need of humanitarian health support around the world.”