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