6.15 WHO’s response, and role as the health cluster lead, in meeting the growing demands of health in humanitarian emergencies

Secretariat note

At the request of a Member State, the Secretariat provides an overview of the evolution of humanitarian systems and performance since the humanitarian reform process and the cluster approach were launched in 2005, and a proposal of how WHO will meet the growing demands of health in humanitarian emergencies. The Board is invited to provide guidance.

• Background document by WHO Secretariat EB130/24
• Resolution adopted - with amendments made during EB in track changes
• PHM report of the discussion

Watchers' notes of EB discussion

WHO’s response, and role as the health cluster lead, in meeting the growing demands of health in humanitarian emergencies (EB130/24, EB130/Conf.Paper No.9 and EB130/Conf. Paper No.9 Add.1)

While recognizing progress made by WHO as health cluster lead, Member States expressed the need to improve quality, predictability, fastness and coordination of WHOs response.

The EU, Canada, Norway and the UK urged WHO to work together with OCHA and fully participate in the IASC reform agenda.

Mozambique for the African Region called for more intersectoral cooperation at country level, as the current multiplicity of actors is complicating joint planning.

Dr. Chan said this was difficult because of the reluctance of some (I)NGOs to be coordinated by WHO. She called upon donors to hold these actors accountable, as they were doing for WHO.

Mozambique and Norway urged for more involvement of local and national NGOs and

Bangladesh called for more participatory and community-based approaches to engage affected populations. Almost all acknowledged national capacity strengthening as the highest priority.

While the US was calling to increase WHOs surge capacity, Bangladesh, China, Chile, Turkey and Norway stressed its role in supporting countries, who should remain in the driving seat. The importance of disaster risk reduction and preparedness was emphasized.

India stated that increasing community resilience is of utmost importance and called for the integration of a PHC approach in WHOs response.

Turkey pointed out the possibility of using existing country-expertise for rapid deployment instead of bringing in expats.

Libya mentioned problems with timely delivery of medicines because of the complicated WHO procurement process.

Mozambique noted the lack of exit-strategy and difficulties in the transition period.

This was recognized by Bruce Aylward (ADG) as one of the major shortcomings of WHOs work in emergencies and in the IASC reform agenda. It was put on the to-do-list for next year.  Another important area of concern was the chronic lack of funding WHO is facing, always around 40% of what is required. This has led to the closure of the health cluster in many African countries.

The EU and Bangladesh called upon Member States to increase the predictability and flexibility of resources.

India noted that the Regional Emergency Response Funds should be further strengthened.

The UK supported mainstreaming of cluster coordination costs and would like to see this reflected in the draft budget for the next biennium.

Norway expressed concern about the critical staff situation at HQ, Bruce responded that the reform of WHOs emergency department has actually led to an increase in staff in critical areas (more at regional and country level).

The World Medical Association took the floor to complain about attacks on health-care workers.

Dr. Chan and the US agreed that humanitarian space was a critical issue. Unfortunately this did not spark a debate on civil-military cooperation and integrated missions, one of the important drivers of increasing attacks on humanitarian personnel.

The PHM comment that was shared with some delegates.

The draft resolution introduced by the EU, Norway, Japan, US, Australia, Argentina and Mexico was adopted. Amendments made during the week were reported by EU without further comments.

PHM comment

 We are concerned that the lack of accountability of humanitarian actors is not reflected in the report, nor in the draft resolution. The lack of involvement of affected populations has been identified as one of the major shortcoming of the current humanitarian response by the Cluster Evaluation Phase 2, released last April. We recall that the Terms of Reference for cluster leads at country level gives cluster leads the responsibility to “ensure utilization of participatory and community based approaches” and urge WHO to increase efforts in this regard. [1]

The report further gives insufficient recognition of the need to ensure access to PHC during emergencies. Following the humanitarian principle of impartiality and the right to health PHC services should be provided free of charge at the point of delivery during a humanitarian crisis. While this is generally respected in sudden-onset crises or camps, the practice often has been to introduce or maintain user fees when prescribed by national policy in other humanitarian contexts. [2]

We are deeply concerned about the lack of resources WHO is facing as health cluster lead as it might threaten the independence of the organization and thus the humanitarian principles [1,3]. We urge MS to ensure adequate untied funding, so that it can be used both for the immediate response phase, as well as the transition to recovery.

Finally, we want to stress the need for a humanitarianism that goes beyond the relief of human suffering to include the prevention of human suffering. This includes not only strengthening of national capacity and building resilient health systems, but also addressing the root causes of conflict and ensuring sustainable development.

References:
[1] Cluster Evaluation Phase 2 Report
[2] IASC Global Health Cluster - Removing user fees for primary health care services during humanitarian crises.
[3] IASC Global Health Cluster - Civil-military coordination during humanitarian health action

Background

Last year, the 20th anniversary of UN res 46/182 was celebrated within the humanitarian community. The resolution was established to strengthen humanitarian coordination in response to the uncoordinated and duplicated efforts of the humanitarian actors at that time. The resolution affirmed the humanitarian principles of humanity, neutrality, impartiality and independence and appointed an Emergency Relief Coordinator (ERC) within the UN system. It also set up the Inter-Agency Standing Committee (IASC) as the primary mechanism for inter-agency coordination of humanitarian assistance. It is a unique inter-agency forum for coordination, policy development and decision-making involving the key UN and non-UN humanitarian partners.In 2005, the ERC initiated an ambitious reform of the humanitarian system based on a thorough review of its operations.

The reform aims at strengthening the effectiveness of humanitarian response to emergencies across the globe. It builds on four pillars: (1) humanitarian financing, (2) the Humanitarian Coordinator system, (3) partnership among all humanitarian actors and (4) the cluster approach.The cluster approach is a system of coordination under which UN agencies are designated as “lead organization” for priority areas of humanitarian response; such as education, protection, health, early recovery etc. Lead agencies are responsible for strengthening system-wide preparedness and technical capacity and ensuring predictable leadership, accountability and partnership. Lead agencies convene coordination meetings at global and country level and are supposed to act as “providers of last resort” where gaps arise in the response.

Useful links

• What is the role of WHO in crises?
• What is the Humanitarian Reform and how does it affect WHO’s work?
• What is WHO’s role within the humanitarian framework?
• What is the Health Cluster?
• Health and Nutrition Tracking Service (HNTS): an interagency initiative hosted by WHO [.pdf]
• Strengthening WHO's Capacity for Humanitarian Health Action (2009-2013) [.pdf]
• The four pillars of humanitarian reform (OCHA) [.pdf]
• Humanitarian reform: a progress report (Dec 2009) - Humanitarian Exchange Magazine

PHM in health and humanitarian emergencies

The members of the People's Health Movement (PHM) have been actively involved in providing health assistance in humanitarian emergencies across the world. Their experience and reflections provide relevant insights on the demands of health in humanitarian emergencies. To know more, click here