WHO and the crisis in Darfur Dr A. Loretti Health Action in Crises DGR/World Health Organization/Geneva 6 May 2004
WHO and the crisis in Darfur
Dr A. LorettiHealth Action in Crises
DGR/World Health Organization/Geneva
6 May 2004
WHO
1. The contextThe Greater Darfur: three states 6.7 million peopleA very harsh environmentA poor and underdeveloped region Subsistence farmers and nomad pastoralists in competition Two contiguous foci of conflict: the South of Sudan and Chad Two rebel movements, the Sudanese Army and the Janjaweed militiaA cease-fire agreement in April The “Peace in the South”Rainy season approachingTuesday, 4 May: 35,000 new IDPs on the move in Malakal
WHO
1.1 Humanitarian highlights
Affected: at least 1.2 million (100,000 refugees in Chad)
Planning horizon: 18 months
Three-phased displacement
WHO
1.1 Humanitarian highlights (cont.)
Extreme insecurity
Food: only 500,000 reached by food aid
Water: 5-10 liters/person/day
Shelter, sanitation, non-food items: poor
WHO
Health care: Network dilapidated (no investment since 1990) National systems for care delivery, support, supply and administration severely disruptedUser-fees as important source of funds for running costs of health facilitiesFew NGOs on the ground
Information base: poorCoordination: poor
WHO
1.2. Inter-Agency highlights
Protection v. humanitarian action: dilemmasBeneficiaries refusing aid out of fear of becoming a more appetizing targetBringing relief and thus rewarding violenceImproving camps and thus legitimizing displacementParticipating in assisted return and thus legitimizing forced villagization
Need to improve interaction between Health, WatSanand Nutrition coordination mechanisms
WHO
1.3. Health highlights Crude mortality rates estimated between 3 and 45 x 10.000/day Acute Severe Malnutrition 6 – 15 %Rape and public tortureEach phase of displacement carries its own health risks Camps grow fast and newcomers risk “dying under the trees”Pressure on the health services is heavyMeasles is the priorityOther threats are looming: malaria and acute watery diarrhoeaNo evidence to disprove USAID catastrophic forecasts
WHO
2.1. Field information and coordination
Weekly meetings in Khartoum and in the three states Participating, and leading in assessmentsMain issues: information, vaccines, ACT for malaria and contingency plansDecentralizing health coordination around assessments and contingency plansRHA forms adapted and circulatedPreparing health database: mapping IDPs and health systems
WHO
2.2. Disease and outbreak control
Collaboration with CDS/CSR: Lyon, Cairo and GenevaWHO brokered consensus among UNICEF, MOH and NGOs for measles immunization Working at cholera preparedness Preparing for the malaria seasonStrengthening/establishing inclusive EWARN systems for surveillance, confirmation and outbreak response
WHO
2.3. Environmental health
UNICEF deals with water and latrines; WHO deals with vector control and solid wasteProviding support to 172 environmental health workers, and expertise and funds for local purchases and servicesImportant complement to disease and outbreak control, and expanding access to PHCGood work in North and South DarfurOn engineer from EMRO/CEHA is visiting the three WHO state teams to improve plans of work
WHO
2.4. Expanding access to PHC
Providing technical support for good camp management and complementing it with health promotionE.g., enlarging PHC post in campPosting staff to manage PHC at night Having local NGOs provide laboratory services for IDPsAssisting UNICEF to increase the stock of drugs in the campUrging NGOs to establish TFC in campsAssisting NGOs in case management and training
WHO
2.5. Referral Care
Providing fuel for ambulancesProviding drugs and basicequipment from the local marketDistributing Trauma Kits“Adopting” eight rural hospitals WHO sponsoring
medical/surgical registrars in rural hospitals “mentoring” surgical/medical teams
Main pending issue: how to provide budget support to hospitals that agree to waive user-fees
WHO
2.6. Programme management, advocacy and support
Regular contacts with the teams at state level and daily programmemeetings in Khartoum
Tasks distributed and tracking sheets introduced
Focal points in EMRO and Geneva to coordinate surge support
Programme Coordinator
PH officer
Information/Media officer
Thematic consultants
Administrative Officer
Two Logisticians
Info/GIS data manager
PHofficer
PHofficer
Adm/logistician,drivers&secretary
PHCtrainers
Hospitaladm.s
Surgical/Medical
TeamEnv.talhealth
Rapidassessments
Nyala WHO Team El Fashir WHO Team
Same setting and functions
as in Nyala
Geneina WHO Team
Same setting and functions
as in Nyala
Plans of workand local projects
•Senior Epidemiologist
•Environmental Engineer•Senior Surgeon•Senior Health ManagerSecretary
(other WHO programmes)
Other WHO programmes Health partners
in Khartoum
Healthpartners
atState level
Delivery of healthcare
EHA-Sudan
WR-Sudan
SurveillanceEWARN
WHO
2.6.1. Staff, equipment, funds, resource mobilization
2.6.1. Staff: Strong PH all-rounder teams in each State supported by Roving experts and provisions for contracting local services Preferential recruitment of female staff
2.6.2. Equipment: MOSS-Compliance, local purchases as far as possibleSharing facilities and schedules with OCHA sub-offices
2.6.3. Supplies: already on the ground or progressing well in pipelineStrong logistics to service the WHO programme and build national capacities
2.6.4. Funds: transferred from Khartoum to banks in the capitals of the three Darfur States; budget for local cost and ample delegation of authority
2.6.5. Resource mobilization: USD 1.2 million confirmed out of the 5.4 million requested
WHO
3. Programme priorities reviewed weekly
4. All togetherA massive humanitarian crisisWHO proving itself at State levelWHO well positioned in KhartoumGood programme coordination and support through Cairo and GenevaIntegration of Darfur programme in WHO/EHA country plan, which includes recovery planning in the Naivasha process
WHO
Programme Coordinator
PH officer
Information/Media officer
Thematic consultants
Administrative Officer
Two Logisticians
Info/GIS data manager
PHofficer
PHofficer
Adm/logistician,drivers&secretary
PHCtrainers
Hospitaladm.s
Surgical/Medical
TeamEnv.talhealth
Rapidassessments
Nyala WHO Team El Fashir WHO Team
Same setting and functions
as in Nyala
Geneina WHO Team
Same setting and functions
as in Nyala
Plans of workand local projects
•Senior Epidemiologist•Environmental Engineer•Senior Surgeon•Senior Health Manager
Secretary
(other WHO programmes)
Other WHO programmes Health partners
in Khartoum
Healthpartners
atState level
Delivery of health care
EHA-Sudan
WR-Sudan
SurveillanceEWARN
WHO in the Greater Darfur
WHO
VULNERABILITY
THOSEWHO
HAVE NEVER BEEN ACCESSED
OR COVERED
THE INACCESSIBLE
THOSE ACCESSIBLE ONLY BY
SPECIAL OPERATIONS
ASSISTED IDPs
ASSISTED REFUGEES
THE POOR
ALL SUDANESE
Affected populationIDPs GoS areas 2,732,720
Non-GoS areas 1,585,000 sub-total IDPs 4,317,720
In-countryrefugees
in 18 Easter Sudancamps
102,180
urban based refugees 218,682 sub-total refugees 320,862
Total 4,638,582 Vulnerable populationHIV/AIDS 500,000 HIV/AIDSorphans
3,500
Food insecure 2,967,112 Flood affected 25,000 Total 3,495,612 source: OCHA Khartoum, September 2002
++++
Vulnerability in SudanNOTE: Statistics are from September 2002