by David Nabarro, Jóhanna Lárusdóttir, Rayana Bu-Haka, Claire Chaignat and Fadela Chaib of the World Health Organization, joined by Nils Kastberg of UNICEF
What is the problem?
At least 60 million people in Southern Africa - mainly Malawi, Zambia, Lesotho, Zimbabwe, Swaziland, and Mozambique - are facing a large scale humanitarian crisis. Currently 12 million people are severely affected and at risk: 2-3 million of them are under 5 years of age.
Why is it happening?
- Dry weather and erratic rainfall over
the past two years have led to severe food shortages in the region.
- This is compounded by instability and
population displacement in some countries.
- The governments of the region try to
provide crucial services on very small budgets - for example, health care
for less than $20 per person per year in at least two countries: there
are severe shortages of essential medicines in health centres.
- Low salaries and difficult conditions
for health workers have resulted in a "skills drain".
- The underlying high prevalence of HIV infection, and AIDS, has resulted in reduced production in household units and affected communities, and reduced numbers of health workers, teachers, etc. . In Lesotho it is estimated that the prevalence of HIV/AIDS is 24%, in Mozambique 13%, in Swaziland 26%, in Zambia 20%, in Zimbabwe 25%(UNAIDS 2000) and in Malawi it is 30%.
The conditions are resulting in increased malnutrition levels particularly among children (one Malawi survey showed child malnutrition levels increasing from 6% to 19% in three months). This is associated with increased susceptibility to illness which is already resulting in higher mortality rates in all groups, with a crude mortality in some areas exceeding one per 10,000 people per day. This indicates that there is now a severe humanitarian crisis.
We are particularly concerned about the doubling of life-time risk of maternal mortality in some areas, the continuing rise in tuberculosis and acute respiratory infections and the risk of severe measles. The crisis could be reflected in at least 300,000 "excess" deaths during the next six months.
- If death rates in a setting exceed one
per ten thousand per day, it is recognised as an emergency situation. A
recent community survey in Malawi reported a crude mortality of 1.9 per
10,000 per day. Many people had died in their homes, unable to reach
health facilities. The number of women who delivered in health facilities
decreased by 7%. But those mothers who made it to the health facilities
were faced with a 71% increase in mortality rates. This means that
the lifetime risk for a mother to die in childbirth increased from 1 in
21 in 1995 to 1 in 12.3 over a few months.
- Mortality rates in Zimbabwe for tuberculosis
and acute respiratory infections rose markedly over the last three years
- for TB from 25.47 per 10,000 in 1998 to 41.87 in 2001 and for respiratory
infections from 19.35 in 1998 to 36.15 in 2001.
- The importance of clear water being available to those who need it cannot be over-stressed. Most of the population living in the rural areas of the countries affected have limited access to water. This problem is exacerbated in Lesotho and Swaziland. The national coverage for safe water in Lesotho is 77.1% and 53.6% for sanitation: as a result nearly half of the population is at high risk of outbreaks of feaco-oral disease.
What does WHO plan to do?
The strategy is planned as follows: First, provide food which is a critical need, but - on its own - is not sufficient to ensure survival. So, second, we need to address health needs.
1. We must focus on enabling people to survive this crisis through
- health care targeted to priority problems
- food rations designed for those at risk (eg for children)
- increased access to water, with the promotion of hygiene and sanitation
- assessment of people's health status (with a focus on the status of poor people, and especially women and children)
- surveillance of changes in health over time
- a response tailored to need - e.g. on infectious diseases and safer pregnancy
- access to essential medicines
- vaccines and cold chains
- encouragement to critical staff to stay in post and provide services
4. We must help coordinate and support effective responses
- working closely with national Governments and NGOs able to respond to people's needs
- ensuring effective information systems (again, working with governments, NGOs and other agencies)
- responding promptly to disease outbreaks, such as cholera
- focusing on safer pregnancy, child health, people affected by HIV/AIDS
- helping ensure that water is of adequate quality and quantity
- building up the capacity of WHO country teams
By working in a way which offers careful analysis of issues, support for Governments, NGOs and others who are implementing responses, monitoring of the health situation - particularly of mothers and children - and coordinating effectively with other key participants in the response (UNICEF, WFP, bilateral donors and international NGOs), WHO will make a significant contribution to a successful response.
The World Food Programme is seeking $500m for food for the region. This is vital. The regional appeal will also include $40m for health and nutrition activities of which $19m is requested by WHO. This financial support is essential if WHO is to coordinate efforts to ensure the survival of affected people in this serious humanitarian crisis.
Further information: Rayana Bu-Hakah, EHA, tel. +41 22 7913748, e-mail: email@example.com