The mission of the WHO Department of Emergency and Humanitarian Action is to increase, through a concerted effort across WHO, the capacity and self-reliance of countries in the prevention of disasters, preparation for emergencies, mitigation of their health consequences, and the creation of a synergy between emergency action and sustainable development.
New documents available on the EHA website (http://www.who.int/eha/disasters)

• Weekly Update Afghanistan, 23 February
• North Caucasus Briefing, Update Activity Report, 4 February (Russian Federation)
• East Timor weekly epidemiological bulletins, weeks 1 to 6 (January and February)
• Health Update, Guinea crisis, 12 February
• Health Situation in Guinea, Briefing Note, 13 February
• Health Update: Guinea Refugees, 24 February=B7
• Health Situation Among Refugees in the Areas of Guinea Bordering Sierra Leone and Liberia, Briefing Note, 27/2
• Situation in India, Gujarat, situation reports n.1 to 5, January and February
• Situation Update, Montenegro (Federal Republic of Yugoslavia), 24 January
• Situation in Mozambique, Situation Report n. 1, 28/2
• Returnees, Displaced and New Windows of Opportunity Challenge Sierra Leone's Health Workers, Information Note, 20 February
• Human Resources Development Report on East Timor
• Report of the Joint Government of the State of Eritrea and United Nations Annual Needs Assessment for Humanitarian Assistance (January 2001)
• Health Sector Assessment and Intervention After the Gujarat Earthquake (India), 16 February
• Report on the "Health as a Bridge for Peace" Workshop in Ambon, Malukus (Indonesia), 30 January-4 February
• Health Situation in Iraq, paper presented by the Executive Director, WHO Office of the European Union, at the hearing "Iraq and the International Community", Committee on Foreign Affairs, Human Rights, Common Security and Defence Policy, Brussels, 26 February
• The Role of UN System: Assessments and Efforts to Alleviate Hardships, paper presented by the WHO Health Coordinator in the Palestinian Self-rule Areas, UN Seminar on Assistance to the Palestinian People, UN Office at Vienna, 20 and 21 February

Strengthened Aid Needed for Conflict-stricken Guinea

The health situation in Guinea, following the refugee and displacement crisis in West Africa started in September 2000 has greatly deteriorated in the last few weeks. An outbreak of yellow fever has already killed some 250 persons and affected more than 700 persons in 20 districts, and measles outbreaks erupted among the displaced and host population in various areas. While immunization activities are ongoing, carried out by WHO, UNICEF and NGOs with the support of the European Union, WHO decided to dispatch a mission to Guinea. The purpose of the mission is to assess the health situation and the needs of the refugees and displaced, identify immediate needs and priorities for the delivery of emergency response, promote media interest at the local and international level, help the country office strengthen its information capacity and define WHO's role in addressing the health implications of the UNHCR approach for community absorption of the IDPs in Sierra Leone. Three major health concerns were identified during the mission, which need urgent attention by the donor community:

• the risk of outbreaks of water-borne diseases, due to the limited water supplies and sanitation facilities in refugee camps;
• pregnant womens' vulnerability, in conditions of dehydration, tiredness, under-nourishment and exposure to malaria;
• nutrition: the most malnourished are those refugees arriving from areas where humanitarian workers have been unable to deliver food, but all refugees, already weakened by walking, dehydration, infections and post-trauma anxiety, are at stake. It was observed during some recent food distributions that women and children tend to be overwhelmed by hungry men in the rush for scarce survival resources. In the meanwhile, efforts to return refugees are also stretching resources in Sierra Leone, of which the health care system needs extra support. Guinea is part of the WHO emergency programme for West Africa, which will be included in the forthcoming UN consolidated appeal for the region. Total needs for the region have now been updated to some US$ 4 million (not including the requirements for Sierra Leone, which is the object of a separate UN consolidated appeal).

For information: Rayana Bu Hakah, EHA, tel. +41 22 7913748, e-mail; buhakahr@who.ch or Luzitu Simao, EHA, tel. +41 22 7912720, e-mail: simaol@who.ch

New contributions for WHO emergency activities

Canada: US$ 32,500 for El Salvador (PAHO)

Italy: 700 million liras (US$ 339,400) for emergency interventions, medicines and first aid for the Federal Republic of Yugoslavia - Serbia (January 2001)

Italy: US$ 102,000 in kits for Afghanistan

Luxembourg: US$ 91,136 for Cambodia (pledge November 2000)

Norway: US$ 219,486 for the district health system in the Democratic People's Republic of Korea (December 2000)

Sweden: SEK 4 million (US$ 414,800) for the Democratic People's Republic of Korea

United Kingdom (pledge) =A3 430,000 (US$ 634,600) for assistance to Gujarat, India

United Kingdom: US$ 384,380 for health coordination at Myanmar/Thailand border (pledge November 2000

Health Alert in Afghanistan, While the UN Appeal Remains Underfunded

According to a joint WHO/UNICEF assessment, the situation of IDPs in Baghlan and Kunduz Provinces in north-east Afghanistan is alarming. Health agencies and NGOs are coordinating assistance efforts and providing food, shelter, water, sanitation and health services in the area. The UN has renewed its plea for support to the severely under-funded appeal, warning that the Afghan people are "at the edge of an abyss", both in country and in refugee camps in Pakistan. The conditions in the six displaced camps surrounding Herat, in west Afghanistan, are appalling, due to freezing temperatures and overcrowding. At least 20 refugees, most of them children, are reported to die per week due to the extreme conditions. WHO in Afghanistan focuses its activities on essential medical supplies and training on the use of drugs, epidemic preparedness and response, promotion of safe motherhood, particularly in areas of refugee returns, rehabilitation of the water supply system, tuberculosis, malaria and leishmaniasis control, development of medical human resources, the expanded programme on immunization. In-kind contributions received since December last year from Norway and Italy have helped alleviate the suffering of the population, but US$ 4.14 million are still required for this year. On a positive note, WHO, UNICEF and the Regional Department of the Expanded Programme on Immunization have just completed a synchronized polio immunization campaign in five districts bordering Pakistan.

For information: Khalid Shibib, EHA, tel. +41 22 7912988, e-mail: shibibk@who.ch

Plan of Action for Meningitis Outbreak in Ethiopia.

Recent data confirmed that a new meningococcal meningitis outbreak started in late January 2001, with at least five regions involved, including the western part of the country, along the Sudan border, and the eastern part, close to Somalia. The northern Amhara region has been the hardest hit, with 104 cases and nine deaths over a period of eight weeks. Various outbreaks have occurred in the country, affecting some 1,100 cases (of which 100 died) between October 2000 and end of February 2001. Immunizations are being carried out in several districts. WHO, in collaboration with the Ministry of Health and other partners, has taken measures to revitalize and strengthen regional and national epidemic committees. Norway and Belgium have pledged some US$ 690,000 for WHO in Ethiopia. However, additional, urgent support is needed to assist in the implementation of the recently issued plan of action focusing on surveillance, mass vaccinations, procurement of drugs and medical supplies, coordination, public awareness, for total US$ 1,904,800. These requirements are now being integrated as a new WHO project in the UN consolidated inter-agency appeal for Ethiopia.

For information: Lianne Kuppens, EHA, +41 22 7912516, e-mail: kuppensl@who.ch

Upcoming ...

Second Global WHO Representatives' Meeting, Geneva, 26 to 30 March

... and recent events

EHA Donor Briefing on Guinea, 19 February

Inter-Agency Standing Committee Working Group, 15/16 February (agenda items on "Health of Humanitarian Workers" and "In-kind Donations")

EHA Working Meeting with WHO Representatives from Emergency Countries, Bogotá, Colombia, 12/13 February

Other New Emergency Appeals

UN Consolidated Inter-Agency Appeal for Ethiopia

WHO Focus: Health services rehabilitation, immunization, provision of emergency health kits and essential drugs, HIV/AIDS programmes, control of malaria and communicable diseases, technical support for water quality control, physical rehabilitation of landmines victims, mental health

WHO Requirements: US$ 10,282,700 (including requirements for meningitis outbreak the is being integrated in the appeal)

UN Consolidated Inter-Agency Appeal for Eritrea

WHO Focus: Technical support and guidance for disease control and surveillance, essential drugs, basic equipment and transport to restore basic health services.

WHO Requirements: US$ 1,900,200=B7

UN Inter-Agency Donor Alert for the Drought in Kenya

WHO Focus: Strengthening integrated diseases surveillance, early detection and containment of communicable diseases outbreaks

WHO Requirements: US$ 890,800

Developing approaches to evaluate WHO in emergencies

In such volatile environments as emergencies, WHO, as the leading public health agency, has a responsibility to monitor and analyze its own performance, as well as the health impact of humanitarian efforts. Evaluation helps decision making, technical quality control and accountability. Therefore, WHO is working at strengthening and integrating evaluation as a regular feature of its program management. An external review of the WHO emergency programmes in the Democratic People's Republic of Korea was carried out in September and October last year in cooperation with SIDA. This year, an extensive evaluation of the WHO program in Iraq will take place in March, while preparations are almost finalized for the internal evaluation of WHO programmes in East Timor and Kosovo. These evaluations will take place in April and May, and some interested donors have been invited to participate.

In addition, WHO is developing approaches to evaluate, in a wider context, the health-related outcomes of emergency operations. These efforts will for example include facilitating joint evaluations with other partners, as well as introducing a learning function during the relief phase. First practical, small-scale experiences in North Caucasus and Tajikistan, in form of surveys and technical analysis of interventions, are promising. By developing a health system evaluation function in humanitarian response, and by integrating this aspect in its coordination role, WHO plans to enhance the effectiveness and coherence of disaster reduction.

The 2001 programme of evaluation initiatives in emergencies, which is being proposed to interested donors, is part of the EHA core needs for emergency health intelligence and capacity building, and will be included in the forthcoming "Global Appeal for Health Emergencies and Humanitarian Action".

For information: André Griekspoor, EHA, tel. +41 22 7912761, e-mail; griekspoora@who.ch

Flash Update on Recent Emergencies=B7

Earthquake in India: 20,000 deaths, 165,500 injured and 15 million affected. WHO requirements: 6.24 million (as of 28 February) for health coordination, water quality control, rehabilitation of health services, disease surveillance. Current donors: Italy, UK, USA.

Earthquake in El Salvador: second earthquake on 13 February, total 1,100 people dead, 700 injured and 1.3 million affected. In some municipalities, 50 to 70 percent of buildings destroyed. WHO requirements: US$ 5.6 million for rehabilitation of health facilities, provision of potable water, waste management. Current donors: Canada, Italy and Norway.

Ebola Outbreak in Uganda: WHO and the Government of Uganda declared the outbreak over, after the last person infected by the Ebola virus recovered in mid-January. 224 people died during this outbreak. Donors: Canada, ECHO, Germany, Ireland, Japan, the Netherlands, Norway.

FOCUSHealth in South-east Asia

The recent clashes in the Borneo region added a further complication to the still ongoing conflicts in Malukus and instability in West Timor. While the health system in the whole country seems to be in crisis, in east Timor the fragile achievements still need to be strengthened.

Borneo Conflict Causes New Displacement and Health Hazards

Clashes between the Dayak tribesmen and Madurese migrants in Central Kalimantan are causing some 25,000 residents, mainly Madurese, to flee, mainly towards the provincial capital Palangkaraya. The health situation of the displaced continue to deteriorate, diarrhoea is spreading and six people have already died since the beginning of the crisis. The Humanitarian Coordinator organized at the end of February two rapid needs assessment missions, one to Palangkaraya and Sampit, the other to Surabaya, Madura, and Semarang. The first team, which was led by OCHA staff and comprised a field security officer and representatives from WHO and WFP, highlighted that the most urgent humanitarian needs are for food and medicine. Provisional findings from the second mission anticipate that, although all displaced are currently hosted in families, the influx of large numbers would pose a burden on the local communities in Madura, which will exceed their coping mechanisms. Among urgent needs are food, medicine, clothing (most evacuees left without any belongings), and family kits. WHO has put forwards requirements for US$ 545,700 to expand the emergency management capacity of the Indonesian Ministry of Health and strengthen the WHO office in the country to deal with the health challenges posed by the volatile situation. These requirements will be highlighted in the forthcoming "Global Appeal for Health Emergencies and Humanitarian Action".

Health as a Bridge for Peace in the Malukus

Following a first workshop in October 2000 in Yogyakarta, WHO organized from 30 January to 4 February a second training session at local level in Ambon, which included 35 health professionals from both Government and NGOs. The workshop aimed to sensitize health professional to the potential peace-building effects of health programs and the roles of health workers in conflicts. The exercise was well received by the participants and the local authorities, which are now looking at the operational implications of the training. Overall, the health care system in the Maluku Province has experienced dramatic reductions in the workforce as well as marked reductions in availability of essential drugs and supplies. In 2001, WHO is asking for US$ 1,136,800 for emergency interventions through the UN consolidated appeal, for which Sweden has already provided some US$ 63,000. US$ 145,500 are requested to continue for the Health as a Bridge for Peace initiative.

2001 Health Programme in East Timor

The UN Security Council extended on 31 January the mandate of the United Nations Transitional Administration in East Timor (UNTAET) until end January 2002. The decision followed the presentation of the report of the UN Secretary-General for the period July 2000 to January 2001, which, inter alia, highlighted the importance of the health activities managed by the Division of Health Services'. The programme, supported by WHO, comprises two main components: a) restoring access to basic services while addressing the immediate needs of the population of East Timor, including urgent reconstruction of health infrastructure; and b) developing appropriate medium- and long-term health policies. WHO has compiled all requirements in its document "Role and Function of WHO in East Timor. Plan for 2001", which has been widely distributed to donors.

For information: Lianne Kuppens, EHA, +41 22 7912516, e-mail: kuppensl@who.ch

For comments and further information on the content of this bulletin, please contact: Silvia Ferazzi, EHA External Relations, tel. +41 22 7912707, e-mail: ferazzis@who.ch