Middle East Health eNews

After coming under siege and fire for 40 days, the city of Misurata, about 200 km east of Libya’s capital Tripoli, is facing a deteriorating health situation. This has put the lives of thousands of civilians at risk and as the fighting continues the humanitarian crisis is worsening the World Health Organisation (WHO) warns.

In statement issued today, Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, appealed for “days of tranquility” to allow WHO and partners to evacuate the injured and sick, and provide much needed medical and humanitarian assistance to the besieged people in Misurata and other parts of Libya.

“WHO calls upon the international community and donor agencies to provide immediate support to the people of Misurata to prevent further deterioration of the humanitarian crisis. Medical personnel and equipment, medicine, surgical kits, ventilators, sterilization equipment and water purification units are among the priority needs,” Dr Gezairy added.

“The city’s main polyclinic has become inaccessible to both doctors and the injured. Smaller and unequipped clinics are facing an influx of injured and patients who are in dire need of medical assistance. Privately owned medical facilities fall short on capacity, space, equipment and personnel to cope with the unprecedented number of casualties and regular patients”, a local doctor said.

“Routine vaccination programmes have been interrupted, as there is no stock of vaccines left in the city. Medicines for the treatment of communicable and chronic diseases are needed and the deployment of medical teams.”

The city’s water supply and sewage system have been interrupted and the roads to the nearby desalination station, as an alternative source for drinking-water, are under fire and not safe. Lack of safe drinking-water and poor sanitation may lead to epidemics with serious public health consequences, the WHO said in statement.

In addition to Misurata’s local residents, a large number of immigrants from Egypt, Chad, Niger, Bangladesh and other nationalities, are under siege in makeshift camps where access to basic human and medical necessities is very limited.

Despite the efforts exerted by WHO and partners in supporting relief efforts and providing medicines and medical supplies to those affected by the violence in Libya, there are still many areas in the west and the middle of the country, which are reported to be besieged and unfortunately out of reach of aid agencies. WHO warns of increasing health threats and reiterates its call for immediate action.

A World Food Programme (WFP) humanitarian vessel carrying life-saving food, medical supplies, doctors and other relief items has finally been able to reach Misrata port, opening up a new humanitarian lifeline to civilians trapped in the Libyan conflict.

“This is a breakthrough for the UN humanitarian operation in Libya and allows us to reach tens of thousands of people who are caught in one of the fiercest areas of conflict,” said WFP Executive Director, Josette Sheeran. “It is vital that we get these relief supplies to the vulnerable – especially women and children – and we are working with local partners, including the Libyan Red Crescent, to ensure their needs are met.”

The WFP-chartered vessel, Marianne Danica, docked in Misrata on Thursday 7 April carrying more than 600 tonnes of WFP food including wheat flour, vegetable oil and High Energy Biscuits – enough to feed more than 40,000 people for a month. The ship is also delivering medical supplies on behalf of UNICEF and the World Health Organisation (WHO). The UNICEF and WHO emergency health kits and surgical material will cover the urgent needs for 50,000 people for a month. Other materials will enable thousands of children to play in the relative safety of indoors. Two doctors are on board and will disembark at Misrata.

“The situation is urgent for tens of thousands of children in Misrata and across Libya, who are potential victims of the fighting or who have already paid a terrible price,” said UNICEF executive director Anthony Lake. “These supplies are a lifeline to them and all those trapped in the fighting.”

WFP began moving food supplies into Libya soon after the conflict erupted and has pre-positioned more than 17,000 tonnes of food stocks inside the country and across the region, as part of a US$42 million emergency operation that will provide food assistance to more than 1 million people in Libya and neighbouring countries. Working with partners such as the Libyan Red Crescent, WFP plans to provide food to more than 600,000 people inside Libya over the next three months.

“The operation in Libya is complex and dangerous, but we are exploring every possible avenue to get food to the hungry,” Sheeran added. “This means moving food assistance and other relief supplies by road from Egypt, and by sea into the main ports along Libya’s Mediterranean coastline.”

Today is World Health Day, a day celebrated around the world each year to mark the founding of the World Health Organisation, more than 60 years ago. Each year the WHO chooses an issue on which to focus – and this year it is “Combat Drug Resistance”.

The WHO warns that drug resistance is becoming more severe and many infections are no longer easily cured, leading to prolonged and expensive treatment and greater risk of death. The WHO calls for urgent and concerted action by governments, health professionals, industry and civil society and patients to slow down the spread of drug resistance, limit its impact and preserve medical advances for future generations.

“The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures,” said WHO Director-General Dr Margaret Chan. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.”

Dr Margaret Chan’s message for World Health Day 2011

In his message mark the occasion, Dr Hussein Gezairy, regional director WHO Eastern Mediterranean Region reiterated Dr Chan’s remarks: “We are seeing now a decline in the cure rates of diseases due to the development by all kinds of microorganisms – bacteria, viruses and parasites – of resistance against drugs, which results in a weakening of the response of antimicrobials and, consequently, reduction in their effect. This threatens to return the world to the era before the discovery of the medicines that are so essential in controlling infectious diseases, the heavy burden of which needs to be addressed urgently.”

10 facts on antimicrobial drug resistance

Drug resistance

The discovery and use of antimicrobial drugs to treat diseases such as leprosy, tuberculosis, gonorrhea and syphilis changed the course of medical and human history. Now, those discoveries and the generations of drugs that followed them are at risk, as high levels of drug resistance threaten their effectiveness.

Last year, at least 440 000 new cases of multidrug-resistant tuberculosis were detected and extensively drug-resistant tuberculosis has been reported in 69 countries to date. The malaria parasite is acquiring resistance to even the latest generation of medicines, and resistant strains causing gonorrhea and shigella are limiting treatment options. Serious infections acquired in hospitals can become fatal because they are so difficult to treat and drug-resistant strains of microorganism are spread from one geographical location to another in today’s interconnected and globalized world. Resistance is also emerging to the antiretroviral medicines used to treat people living with HIV.

Measures to combat drug resistance
Today, WHO is publishing a policy package that sets out the measures governments and their national partners need to combat drug resistance. The policy steps recommended by WHO include:

• develop and implement a comprehensive, financed national plan
• strengthen surveillance and laboratory capacity
• ensure uninterrupted access to essential medicines of assured quality
• regulate and promote rational use of medicines
• enhance infection prevention and control
• foster innovation and research and development for new tools.

WHO Global Strategy for Containment of Antimicrobial Resistance – 2001 publication

“WHO has established many initiatives to understand and address drug resistance over the last decade, particularly in relation to some of the world’s most deadly infectious diseases,” said Dr Mario Raviglione, Director of WHO Stop TB Department, who has been leading the preparations for World Health Day 2011. “Those measures must now be further strengthened and implemented urgently across many diseases and across many sectors. New collaborations, led by governments working alongside civil society and health professionals, if accountable, can halt the public health threat of drug resistance.”

WHO EMR World Health Day 2011 website

Other Links Worth Looking at:

Disease specific drug resistance

World Health Day 2011 videos

The World Health Organization (WHO) is pleased to announce the launch of a web-based public hearing from 21 March to 17 April 2011 on the draft guidelines for monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Guidelines”). WHO invites you to contribute to this public hearing on the Guidelines.

All persons concerned with the international recruitment of health personnel are invited to contribute to this web-based public hearing on the draft Guidelines – Member States, health workers, recruiters, employers, academic and research institutions, health professional organizations, and any relevant subregional, regional and international organizations, whether governmental or nongovernmental.

Input received during the course of this web-based public hearing will contribute to a revised draft of the Guidelines. Complementary documents concerning the Code are also available for download from the WHO website.

Contributions can be submitted in any of the six official languages (Arabic, Chinese, English, French, Russian and Spanish). Please note that at this stage, comments should not focus on the formatting of the documents and WHO says they are not expecting any data to be provided. Contributions should be limited to 2,000 words.

The draft Guidelines

Comments can be emailed to: draft_guidelines@who.int

The WHO calls upon all governments, civil society and individuals to participate in the relief efforts to support people in Libya

The World Health Organization, through its Regional Office for the Eastern Mediterranean, continues its efforts to provide humanitarian relief and health support to people affected by the current intensifying events in a number of countries of the Region, especially the Libyan Arab Jamahiriya.

WHO reiterates the importance of urgent action to contain the catastrophic situation in most of the Libyan cities, and to avoid the emergence of potential pandemics due to the severe lack of food items and clean drinking-water, in addition to the setback in routine immunization services against the killer childhood diseases in the tense areas. WHO warns that the nutritional and health situation may jeopardize the country’s health security.  Violence against protesters threatens their fundamental right to life.

The Regional Office has taken major steps to ensure the provision of essential medicines and basic medical requirements to the affected areas through a humanitarian corridor. Currently a WHO field team is coordinating relief action in collaboration with health development partners in the Libyan Arab Jamahiriya and on the border areas. 

In this regard, a preliminary assessment of the health situation in five Libyan cities has been made in collaboration with other health partners. It covered the availability of health workers, and the health care facilities that can provide routine and first aid services. The assessment demonstrated an urgent need for medical teams of different specialties, including bone surgery, eye surgery and cardiac surgery, in addition to anaesthesia specialists and radiologists. This is attributed mainly to the departure of expatriate physicians who left the country because of the current events. The assessment also showed that the structure of the two main hospitals in Benghazi and Al-Bayda’, like other health facilities in other cities, suffered damage.

WHO, in collaboration with the Arab Medical Union, continues to provide medical assistance. Around 100 physicians from different specialties are currently working to compensate the shortage in health services, and to provide care for the injured and to patients affected by the lack of health services.

WHO urges all Member States and other concerned parties to take part in providing the essential requirements to immediately equip and operationalize the medical teams in order to guarantee the availability of preventive and medical care in the Libyan cities which are passing through these difficult circumstances. Partners can contact the WHO Regional Office for the Eastern Mediterranean which has established a list of priorities.

WHO is also working through its offices in Egypt, Libyan Arab Jamahiriya and Tunisia and in collaboration with other humanitarian organizations to assess the situation and needs inside the Libyan Arab Jamahiriya and on the border areas, and provide health care for nationals of these and other countries who have had to leave. WHO confirms its readiness to provide humanitarian and health supplies to the Libyans affected by the events. In this regard, it calls upon all governments, civil society and individuals to participate in the relief efforts to support people in the Libyan Arab Jamahiriya and to work closely with the Regional Office to respond to their calls for assistance and alleviate their suffering.

Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, receives the Gold Medal of Honour from Ali Abdullah Saleh, the President of Yemen

On Saturday 16 October 2010, Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, received the Gold Medal of Honour from Ali Abdullah Saleh, the President of Yemen. The Gold Medal of Honour, one of the most prominent awards in Yemen, was given to Dr Gezairy in recognition of his long years of international humanitarian service, particularly the support he has extended to Yemen in the field of public health.

During the event attended by Dr Abdulkarim Yehia Rasae, Minister of Health, Yemen and Ghulum Popal, WHO Representative to Yemen, the President paid recognition to Dr Gezairy’s efforts and leadership during his years of service as WHO Regional Director.

The Regional Director extended his gratitude for this honorable recognition. He pointed out the many improvements he had witnessed in Yemen’s health sector. In particular, he praised Yemen’s national immunisation campaigns to reduce child mortality and also the country’s tireless fight against polio, malaria, tetanus, measles and schistosomiasis. He said that it was a source of pride that the country had stopped polio virus circulation and measles was on its way towards being eliminated. He also noted Yemen’s exemplary achievements in reducing the prevalence of malaria and also the considerable progress that had been made in eradicating schistosomiasis. The Regional Director added that the partnership between WHO and Yemen’s Ministry of Health had resulted in many achievements in primary health care and basic development needs, all of which were in line with Yemen’s national strategies and needs.

Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, has appealed to the international community to double its response effort to the floods hitting parts of Pakistan. Dr Gezairy called for preventive measures to be undertaken to halt the outbreak of infectious and waterborne diseases among nearly 20 million flood-affected people, suffering from severe illness, hunger and loss of shelter and property.  

credit: © Abdul Majeed Goraya/IRIN

The Regional Director is expected to make a field visit to Pakistan to assess the situation and follow up on the relief work and health services being provided by WHO, in collaboration with other UN agencies and humanitarian organisations in flood-stricken provinces.

He pointed out that in previous floods, many deaths among victims had not resulted from drowning or directly from the disaster, but rather from the terrible situation following the floods, particularly the acute shortage of food and potable water, disease outbreaks such as cholera and typhoid, deteriorating healthcare services, insufficient numbers of health personnel and increasing mortality among children as a result of measles and polio.

Dr Gezairy added that there had been nearly 1,600 deaths, in addition to tens of thousands of people inflicted with diarrhea, malaria, skin diseases, respiratory and eye infections, reptile bites and insect stings.

He said that the disaster in Pakistan was an example of the perils of man-made climate change of which WHO and environmental activists have been warning. He noted that victims of the Pakistani flood outnumbered the total number of victims of the 2004 Tsunami, the 2005 earthquake in Kashmir and the 2010 earthquake in Haiti combined.

It is expected that this phenomenon will increase globally with  tens of millions of  people vulnerable to malaria, hunger and water shortages over the next decades.

“To reduce the risks [of climate change] greenhouse gas emissions have to be reduced which requires a reversal of global bad practices contributing to the problem,” said Dr Gezairy.

Speaking at a virtual press conference yesterday evening Dr Margaret Chan, the director-general of the World Health Organisation, said the new H1N1 virus has largely run its course and that the world is no longer in phase 6 of influenza pandemic alert. “Put simply,” she said, “the pandemic is over.”

“We are now moving into the post-pandemic period,” she said.

She reiterated that these were the views of the Emergency Committee, which met earlier yesterday.

The Committee based its assessment on the global situation, as well as reports from several countries that are now experiencing influenza.

However, she warned that as we enter the post-pandemic period, this does not mean that the H1N1 virus has gone away.

“Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period.

“Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come.

“Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics,” Dr Chan said.

She said that during the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

“In addition, a small proportion of people infected during the pandemic, including young and healthy people, developed a severe form of primary viral pneumonia that is not typically seen during seasonal epidemics and is especially difficult and demanding to treat. It is not known whether this pattern will change during the post-pandemic period, further emphasizing the need for vigilance.

“Pandemics are unpredictable and prone to deliver surprises. No two pandemics are ever alike. This pandemic has turned out to be much more fortunate than what we feared a little over a year ago. This time around, we have been aided by pure good luck. The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile,” she said.

In reply to a question from Reuters about the implications for countries holding remaining stockpiles of oseltamivir vaccine Dr Chan reiterated that the virus was still sensitive to the vaccine. “So they would continue to be useful. And WHO strongly recommends where vaccines are available, high risk groups should be immunized.”

Dr Chan added in response to another question that vaccines that have a shelf life that has expired should be destroyed in keeping with best practice. 

• WHO recommendations for the post-pandemic period