WHO Eastern Mediterranean Region

Emergency response and health security top agenda at annual meeting in Cairo

21st International AIDS Conference (AIDS 2016), Durban, South Africa. Ending AIDS with the Voices of Youth. Panel discussion (L-R) Kgomotso Matsuanyane, Elton John, HRH Prince Harry, Loyce Maturu, Brian Ssensalire, Carlo Andre Oliveras Rodriguez.

The WHO Eastern Mediterranean Regional Committee held their 63rd annual meeting in Cairo in October. Highlights from the packed agenda included global health security and emergency health response in the region. Middle East Health reports.

Health ministers and high-level representatives of the 22 countries and territories of the WHO Eastern Mediterranean Region, partner organizations and civil society met at the 63rd Session of the WHO Eastern Mediterranean Regional Committee in Cairo from 3-6 October.

On the first day, WHO’s Regional Director Dr Ala Alwan presented his annual report on the work of WHO in the Eastern Mediterranean Region. The report focuses on developments and actions taken within the context of the five strategic priorities set for the Region in 2012. The priorities are:

  • strengthening health systems for universal health coverage
  • maternal and child health
  • noncommunicable diseases
  • health security including communicable diseases, and
  • emergency preparedness and response.

Presenting his report, Dr Alwan said: “The five priorities that we identified five years ago included all health-related issues in the Millennium Development Goals, led by the United Nations to boost economic and social development.

“We are now in the first year of a new 15-year effort to achieve a new set of targets, the Sustainable Development Goals. The health priorities included in the new United Nations goals are much more comprehensive than those of the MDGs and are identical with the five strategic priorities we set for this region in 2012.

“Universal health coverage is at the heart of SDG3 and strengthening health systems towards achieving universal coverage will remain the key pillar of all our work. If we can ensure, together, that everyone, no matter where they live, no matter what their background or income level, has equal access to a minimum standard of health care, not only do we save lives, but we also support productivity of society, and sustainable and equitable development in general. In this context, we have a clear and evidence-based regional framework for action for universal health coverage.”

Dr Alwan highlighted two areas: eradication of poliomyelitis and health security.

With regards the eradication of polio, he noted that over the past 5 years, realprogress has been made against polio as the two remaining endemic countries, Afghanistan and Pakistan, put national emergency plans into action. “Although we faced setbacks in some crisis countries as outbreaks occurred in 2013, Member States and partners pulled together in support of massive supplementary immunization campaigns that are today regarded by the international community as a model of successful outbreak control.”

“This year we have seen the outcomes: just 9 cases in Afghanistan and 14 (as at end September) in Pakistan since January this year and eradication is now in sight,” he remarked.

Health security
Dr Alwan pointed out that several experiences in recent years show how health security in any country is an integral part of national and global security.

“Viruses know no borders. Our emphasis on ensuring the necessary conditions are in place in each country to implement the International Health Regulations proved to be strongly justified in the wake of the Ebola outbreak in west Africa and the subsequent rapid assessments we undertook with each country of their readiness to deal with an imported case. This led us, as a region, to take a major role in the past year in pushing for global harmonization of the independent assessment process and a new globally agreed-upon mechanism, known today as joint external evaluation (JEE).

“I’m pleased to say that process is now firmly in place in the Region, with Pakistan, Qatar, Morocco, Lebanon, Jordan and Bahrain having been among the first to assess their IHR implementation using the JEE, and planning now well ahead for the other Member States of the Region to undertake the evaluation. Once complete each country will have a very clear idea of what needs to be done to protect their population,” he said.

Antimicrobial resistance
Dr Alwan stressed that of particular concern to global health security is the issue of antimicrobial resistance. He noted that the recent UN General Assembly in September, Heads of State and Government recognized the critical importance of addressing antimicrobial resistance. They committed to develop and implement multisectoral national action plans, programmes and initiatives, in line with the global action plan on antimicrobial resistance. “In our region, we have already put together an operational framework for action, and I look forward to seeing all countries moving ahead with the agenda, working jointly with the agriculture and animal production sector. It is indeed an urgent issue and one that no country can afford to ignore.”

Dr Alwan emphasised that the rising burden of noncommunicable disease is of great concern in this region, and in particular heart disease, cancer, chronic respiratory disease and diabetes which are increasing in epidemic proportions in most countries.

“Our framework for action covers basic, effective and high impact measures, aimed at reducing the incidence of these diseases and their effects. Despite successes in some countries, implementation of these measures has generally been inadequate and uneven. In this respect, working with offi cials in government and parliament to put these measures in place is a critical step forward,” he said.

Health emergencies programme
Three countries in the Region – Iraq, Syria and Yemen – are coping with emergency situations at the highest level designated by the United Nations, Level 3. Dr Alwan noted that the impact of these crises on health is catastrophic.

“Despite major operational and fi nancial challenges, in the past year we have provided much support to maintain functionality in health facilities in Iraq, Syria, Yemen and other countries, and we have worked closely with partners to reach as many people as possible with essential health care. We have substantially revised our own response structures and capacity, and will continue to do so. I am confi dent that the new WHO global health emergencies programme will benefi t the Region, in both emergency and outbreak preparedness and response. It is expected to boost the resources available to manage responses on the ground and will enable us to devote more efforts to preparedness,” Dr Alwan said.

“The fact remains that the humanitarian situation is worsening and the Region is home to 30 million displaced [internally displaced people] and refugees and over 60 million in dire need of health care. We face a major constraint in the lack of adequate funding to maintain our response and support to countries which will undoubtedly have an inevitable impact on health equity, in the Region and beyond. But let me take this opportunity to thank our donors for their support and let us hope and pray that solidarity with crisis countries is strengthened and, ultimately, peaceful resolution will prevail.

Deteriorating security

During the opening session, WHO’s Director-General Dr Margaret Chan, in her speech, highlighted the deteriorating security situation which was forcing an increasing number of aid agencies to leave, increasing the burden on WHO and its remaining partners.

“The humanitarian situation in the Eastern Mediterranean Region has deteriorated significantly over the past year. The numbers are staggering.

“At the end of 2015, more than 62 million people affected by emergencies in the region needed access to health services. More than 60% of all refugees and internally displaced persons worldwide originate from this region,” she said.

“The war in Syria has entered its sixth year. Each month, at least 25,000 people suffer conflict-related injuries, creating a tremendous need for health care and trauma care. Civilians on all side must have access to the care they need.

“In Iraq, millions of displaced civilians can find no safe place to stay. WHO is using mobile clinics to extend health care to these fluid populations.

“The health system in Yemen is collapsing. That country has recorded the world’s highest number of deaths and injuries. We need to do our best for the Yemeni people. As the security situation forces more aid agencies to leave, the burden on WHO and remaining partners escalates.

Attacks on hospitals
Dr Chan noted that in the three level 3 emergencies in the region, staff in hospitals that are still able to function are overwhelmed, with caseloads increasing in some areas by more than 200%. We must admire these staff for their courage and tenacity.

“The situation is getting worse, not better. Since the beginning of this year, WHO has recorded hundreds of attacks, including deliberate attacks, on hospitals, health facilities, and health care workers, at a time when they are needed most.

“This must stop. Nothing sets hard-won health gains backwards so dramatically as humanitarian crises on this scale. The consequences are felt throughout the region,” Dr Chan said.

“Attention focused on the refugee crisis in Europe often fails to note that the vast majority of people forced to flee their homes are generously being accommodated in your countries.

“WHO staff at all levels of the Organization, together with humanitarian partners, have worked heroically to get essential life-saving medical assistance to many millions of people. I commend them for their courage, their commitment, and their compassion.

“The logistical challenges are immense. Unmet needs are vast. In Iraq, the immunization status of children in Mosul, besieged for two years, is simply unknown. We are doing our best to reach as many children as possible,” Dr Chan said.

“In Syria, many health facilities have no medicines to manage diabetes, let alone heart attacks, strokes, and cancer.

“The issues are highly politicized. I thank Dr Alwan and all EMRO staff for remaining steadfast in your support and neutral in your position. Humanitarian assistance must always be motivated by compassion, not politics.”



Dr Mahmoud Fikri nominated for new Regional Director

Dr Mahmoud M. Fikri was nominated to take the place of Dr Ala Alwan as Regional Director for the Eastern Mediterranean Region during the 63rd Regional Committee meeting. The nomination will be submitted to WHO’s Executive Board which meets in January 2017 when the election for the Regional Director will be conducted. Once officially elected, the new Regional Director will take office on 1 February 2017.

Currently, Dr Fikri is the Adviser to the Minister of Health of United Arab Emirates, and was previously the Undersecretary for Preventive Medicine and Health Policies Affairs in the Ministry (1995–2013). He served as member of the Board of Directors of the WHO Centre for Health and Development and Research in Japan (Kobe) and a member of the Advisory Board of the Gulf Cooperation Council Health Council to 2005. He was also a member of the WHO Executive Board from 1997 to 2000.


92% of world population live with air pollution

A new World Health Organization (WHO) air quality model confi rms that 92% of the world’s population lives in places where air quality levels exceed WHO limits. Information is presented via interactive maps, highlighting areas within countries that exceed WHO limits.

The situation is even worse in the Eastern Mediterranean Region where the percentage rises to 98%.

“The new WHO model shows countries where the air pollution danger spots are, and provides a baseline for monitoring progress in combatting it,” says Dr Flavia Bustreo, Assistant Director General at WHO.

It also represents the most detailed outdoor (or ambient) air pollution-related health data, by country, ever reported by WHO. The model is based on data derived from satellite measurements, air transport models and ground station monitors for more than 3000 locations, both rural and urban. It was developed by WHO in collaboration with the University of Bath, United Kingdom.

Air pollution’s toll on human health
Some 3 million deaths a year are linked to exposure to outdoor air pollution. Indoor air pollution can be just as deadly. In 2012, an estimated 6.5 million deaths (11.6% of all global deaths) were associated with indoor and outdoor air pollution together.

Nearly 90% of air-pollution-related deaths occur in low- and middle-income countries, with nearly two out of three occurring in WHO’s South-East Asia and Western Pacifi c Regions.

Ninety-four per cent are due to noncommunicable diseases – notably cardiovascular diseases, stroke, chronic obstructive pulmonary disease and lung cancer. Air pollution also increases the risks for acute respiratory infections.

“Air pollution continues take a toll on the health of the most vulnerable populations - women, children and the older adults,” adds Dr Bustreo. “For people to be healthy, they must breathe clean air from their fi rst breath to their last.”

Major sources of air pollution include ineffi cient modes of transport, household fuel and waste burning, coal-fi red power plants, and industrial activities. However, not all air pollution originates from human activity. For example, air quality can also be infl uenced by dust storms, particularly in regions close to deserts.

Improved air pollution data
The model has carefully calibrated data from satellite and ground stations to maximize reliability. National air pollution exposures were analysed against population and air pollution levels at a grid resolution of about 10 km x 10 km.

“This new model is a big step forward towards even more confi dent estimates of the huge global burden of more than 6 million deaths – one in nine of total global deaths – from exposure to indoor and outdoor air pollution,” said Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health. “More and more cities are monitoring air pollution now, satellite data is more comprehensive, and we are getting better at refi ning the related health estimates.”

Interactive map
The interactive map provides information on population-weighted exposure to particulate matter of an aerodynamic diameter of less than 2.5 micrometres (PM2.5) for all countries. The map also indicates data on monitoring stations for PM10 and PM2.5 values for about 3000 cities and towns.

“Fast action to tackle air pollution can’t come soon enough,” adds Dr Neira.

“Solutions exist with sustainable transport in cities, solid waste management, access to clean household fuels and cook-stoves, as well as renewable energies and industrial emissions reductions.”

Global ambient air pollution map



Date of upload: 20th Nov 2016

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