Perspective
Turning commitments into actions: perspectives on emergency preparedness in South-East Asia
Roderico H Ofrin, Anil K Bhola, Nilesh Buddha World Health Organization Health Emergencies Programme, World Health Organization Regional Office for South-East Asia, New Delhi, India Correspondence to: Dr Roderico H Ofrin ([email protected])
Abstract Emergency preparedness is a continuous process in which risk and vulnerability assessments, planning and implementation, funding, partnerships and political commitment at all levels must be sustained and acted upon. It relates to health systems strengthening, disaster risk reduction and operational readiness to respond to emergencies. Strategic interventions to strengthen the capacities of countries in the World Health Organization (WHO) South-East Asia Region for emergency preparedness and response began in 2005. Efforts accelerated from 2014 when emergency risk management was identified as one of the regional flagship priority programmes following the pragmatic approach “sustain, accelerate and innovate”. Despite increased attention and some progress on risk management, the existing capacities to respond to health emergencies are inadequate in the face of prevailing and increasing threats posed by multiple hazards, including climate change and emerging and re-emerging diseases. The setting up of a “preparedness stream” under the South-East Asia Regional Health Emergency Fund in July 2016 was an important milestone. The endorsement of the Five-year regional strategic plan to strengthen public health preparedness and response – 2019–2023 by Member States was another step forward. Furthermore, ministerial-level commitment, in the form of the Delhi Declaration on Emergency Preparedness, adopted in September 2019 in the 72nd session of the WHO Regional Committee for South-East Asia, is in place to facilitate Member States to invest resources in the protection and safety of people and systems and in overall emergency risk management through national action plans for health security. It is essential now to turn these commitments into actions to strengthen emergency preparedness in countries of the region.
Keywords: Delhi Declaration, emergency preparedness, regional strategies, South-East Asia
Background which clearly illustrates the high degree of vulnerability and exposure of people of the region to prevailing risks and The World Health Organization (WHO) South-East Asia Region hazards. Hardly a year passes without an emergency in is vulnerable to a varied range of natural hazards and human- the region. The drivers of risk are growing rapidly in south- induced disasters; it also has a high burden of outbreaks of east Asia. Unplanned urbanization, inequitable and risk- common diseases and emerging and re-emerging diseases, uninformed development planning, close human–animal including zoonoses. People in this region are frequently and wildlife habitations, variations in climatic conditions and exposed to seasonal floods, landslides, tsunamis, droughts, newly emerging environmental health emergencies such as earthquakes, volcanic eruptions and extreme weather air pollution are wake-up calls indicating that urgent corrective conditions.1 As noted in the World disasters report 2018, during measures are required to restore the public health ecology. 2008–2017, 79.8% of people affected by disasters lived in Asia “Emergency preparedness” is defined as the “capability of and 45.4% of estimated damages resulted from disasters in the public health and health-care systems, communities, and Asia.2 individuals, to prevent, protect against, quickly respond to, and Pathogens associated with recent outbreaks in countries recover from health emergencies, particularly those whose of the region include avian influenza A(H5N1) and A(H9N2), scale, timing, or unpredictability threatens to overwhelm influenza A(H1N1)pdm09, Zika virus, Middle East respiratory routine capabilities”.4 Emergency preparedness is a continuous syndrome coronavirus, Nipah virus and Crimean Congo process in which risk and vulnerability assessments, planning haemorrhagic fever virus.1 Hazards, outbreaks and resultant and implementation, funding, partnerships and political health emergencies are frequent,3 as set out in Annex Table 1, commitment at all levels must be sustained. It relies on all
WHO South-East Asia Journal of Public Health | April 2020 | 9(1) 5 Ofrin et al.: Turning commitments into actions: emergency preparedness in South-East Asia stakeholders working together effectively to plan, invest in and Fig. 1. Key strategic interventions for emergency preparedness implement priority actions. It bridges the gaps between health in the WHO South-East Asia Region, 2004–2019 systems strengthening, disaster risk reduction and operational readiness to respond to emergencies. Indian Ocean tsunami (2004)
Overview of emergency preparedness in the region Benchmarks, standards and indicators for emergency preparedness and response publishe (200 ) The Indian Ocean tsunami in 2004 alerted the whole world, South-East Asia e ional Health E er enc un and countries in South-East Asia in particular, to the need to establishe (200 ) reassess approaches to planning, designing and delivering E er enc ris ana e ent reco ni e as a health-care services and public health systems. It was re ional fla ship priorit pro ra e (201 )1 recognized that the prevailing risks, hazards and vulnerabilities of people and systems could no longer be considered in isolation and only in the aftermath of a disaster but instead WHO Health Emergencies Programme needed to be addressed and integrated into health systems 14,1 and services. Since then, significant work has been done launched (2016) to strengthen emergency preparedness in the region; key strategic interventions are shown in Fig. 1. The WHO Regional Office for South-East Asia began its Prepare ness strea of South-East Asia e ional efforts to develop comprehensive preparedness plans for each Health E er enc un launche (201 )1 country of the region in 2006, focusing first on public health et or of health e er enc operations centres workforce development.5 Guidance on benchmarks, standards stren thene (201 201 ) and indicators for emergency preparedness and response al eclaration a opte an Framework for action were produced in 2007 to assist countries in assessing their in building health systems resilience to climate change in outh- ast Asia Region, 201 –2022 capacities to respond to health emergencies.6 A key milestone publishe (201 )1 1 was the establishment of the South-East Asia Regional Health Roots for resilience: a health emergency regional Emergency Fund through Regional Committee resolution SEA/ risk profile of the outh- ast Asia Region 7 RC/60/R7 in 2007. The fund became effective in January 2008 publishe (201 )1 and is designed to provide immediate financial support for the Regional framework on operational partnerships for first 3 months in the aftermath of an emergency in countries emergency response outh- ast Asia Region of the region. Through the WHO country offices, the countries publishe (201 ) can obtain financial support from the fund within 24 hours of hir Asia acific strategy for emerging diseases an emergency. and public health emergencies (APSE ) 19 In 2011, the regional office decided to focus on capacity- publishe (201 ) building and training; addressing water and sanitation and WHO e ional o ittee for South-East Asia nutrition in emergencies; vulnerability assessments; and resolution on stren thenin e er enc e ical tea s (201 )20 available technologies. This work synergized efforts on risk ui eline on inte ration of care of people ith identification, mapping of health risks and multi-hazards, use of nonco unicable iseases into e er enc information technology and innovations in risk mitigation. The response an prepare ness publishe (201 )21 focused approach accelerated capacity-building in the health As of 2019 all 11 countries ha co plete State sector and related sectors for strengthening preparedness for Part annual reportin ei ht ha co plete oint and response to acute events. e aluation e ercises t o ha con ucte si ulation Sound risk management is essential for safeguarding e ercises fi e ha carrie out after action re ie s development and implementing local, national, regional and an se en ha ra n up national action plans for global strategies in the health sector and other sectors,8 health securit including the Sustainable Development Goals,9 the Sendai Five-year regional strategic plan to strengthen public Framework for Disaster Risk Reduction 2015–2030,10 the health preparedness and response – 2019–2023 22 International Health Regulations 2005 (IHR)11 and the Paris publishe Agreement on climate change.12 The lack of preparedness of Risk communication strategy for public health emergencies in the WHO outh- ast Asia Region: health systems in low- and middle-income countries revealed 2019–2023 publishe (2019)2 in 2014–2015 during the Ebola outbreaks in Guinea, Liberia, South-East Asia e ional no le e et or of Nigeria and Sierra Leone led to structural and operational nternational Health e ulations ational ocal reform in WHO’s emergency work. Lessons were learnt from Points establishe (2019) these events, and emergency risk management was identified as one of the flagship priority programmes of the WHO South- East Asia Region; these programmes were established in 2014 to sustain, accelerate and innovate approaches to regional Delhi Declaration on Emergency priority areas.13 The overarching strategy has been to sustain Preparedness endorsed (2019)24 ongoing efforts and step up implementation of such efforts, while
6 WHO South-East Asia Journal of Public Health | April 2020 | 9(1) Ofrin et al.: Turning commitments into actions: emergency preparedness in South-East Asia fostering innovation to protect the people of countries of the the State Party annual reporting tool,26 and three voluntary region from the adverse impacts of hazards and emergencies. mechanisms: simulation exercises,27 after action reviews28 and The global WHO Health Emergencies Programme was joint external evaluations.29 All countries of the region have formulated and became active in August 2016 to work with complied with State Party annual reporting, including with Member States in all phases of emergencies, from risk regard to use of the electronic reporting tool. The results to reduction and preparedness to response and recovery.14,15 date show that considerable progress has been achieved in The Global Preparedness Monitoring Board (GPMB) was the areas of legislation, coordination, surveillance, response, established in 2017 following recommendations made by risk communication, laboratory systems and zoonoses (see the United Nations Secretary-General’s Global Health Crises Fig. 2). However, there is constrained capacity of human Task Force in the same year.25 The GPMB comprises political resources in the IHR national focal points (NFPs) across leaders, agency principals and leading international experts. the region, especially in the areas of epidemiology, vector It provides independent and comprehensive appraisals for control, infection control, travel medicine, risk communication, policy-makers and the world of progress towards increased emerging and re-emerging diseases, and management of mass preparedness and response capacity for disease outbreaks gatherings and points of entry (i.e. international airports, ports, and other emergencies with health consequences. ground crossings). According to the joint external evaluations Following the setting up of the global programme, the of IHR capacities conducted in eight countries of the region, WHO Health Emergencies Programme was also established the existing capacities in relation to biological, chemical in the Regional Office for South-East Asia to support the or radionuclear threats, control of disease transmission at strengthening of the emergency preparedness and response ground crossings, biosafety and biosecurity in laboratories, capacity of Member States. antimicrobial resistance and management of cross-border conflict situations in the region are limited (see Fig. 2).30,31 Identifying risks Five countries of the region have conducted after action For a country or region to be prepared to minimize the impact of reviews, and Indonesia and Nepal have conducted simulation any hazard or emergency, its systems, plans and people must exercises involving various stakeholders including WHO. A be fully cognizant of prevailing risks, hazards and vulnerabilities, regional training workshop in September 2019 on how to design and it must have integrated risk-informed planning into all and conduct simulation exercises and after action reviews development processes. To enable evidence-informed planning, imparted required knowledge and skills to the participants, a comprehensive analysis was undertaken, resulting in 2017 who included representatives of the Member States and WHO in the publication of Roots for resilience: a health emergency country offices. regional risk profile of the South-East Asia Region.1 This was The region has acted upon its concerns about climate an important landmark on the path to strengthening emergency change and resultant extreme weather conditions detrimental preparedness and formed a baseline for mapping, monitoring, to health. In 2017, the WHO Regional Committee passed planning and reducing existing and potential risks, hazards resolution SEA/RC70/R1 endorsing the Malé Declaration and and vulnerabilities. The risk profile methodology included an the Framework for action in building health systems resilience assessment of five priority syndromes, each represented by a to climate change in South-East Asia Region, 2017–2022.17,18 selected disease, for all 11 countries of the region. These were Damage to health-care infrastructure, physical injuries to (i) severe acute respiratory illness, represented by Middle East individuals and loss of or separation from family members respiratory syndrome; (ii) acute watery diarrhoea, represented may result in discontinuity of treatment and care of patients by cholera; (iii) acute haemorrhagic fever, represented by with noncommunicable diseases (NCDs). To ensure continuity Crimean Congo haemorrhagic fever; (iv) acute encephalitis of NCD care in emergencies, a comprehensive guideline, syndrome, represented by Japanese encephalitis; and (v) acute Integration of NCD care in emergency response and febrile illness with rash, represented by Zika virus disease. preparedness, was developed in 2018.21 To further ensure The risk assessment showed the region to be homogeneously continuity of treatment and disaster preparedness in hospitals, vulnerable to all five threats. With respect to natural hazards, the an innovative Hospital Safety Index plus mobile application analysis indicated that the countries of the region share a range was introduced in 25 hub hospital networks in and around of risks, with common vulnerabilities and capacities. The only Kathmandu, Nepal, in 2019, and training was provided to staff. differences lie in the types of risk and their magnitude, based Bhutan, India, Indonesia and Thailand have also introduced on geographical and geological parameters. The results of the initiatives to assess health facilities on their preparedness for analyses done for the Roots for resilience report clearly showed multiple hazards. that existing capacities in the WHO South-East Asia Region did not match the prevailing and ever-increasing threats.1 Implementing plans and initiatives The prioritization of emergency risk management under the Investing in people and systems for risk management regional flagship priority programme following the “sustain, Improved understanding of risks, hazards, vulnerabilities accelerate and innovate” approach since 2014 has driven the and the increasing exposure of populations in the region has development and implementation of various plans and initiatives facilitated investments in capacity-building in relation to IHR with a focus on emergency preparedness (see Table 1). Various compliance. The entry into force of the IHR in 2007 marked examples of prioritizing emergency preparedness by the a new era of international cooperation for the management Member States in the region are provided in Box 1. of international public health events and emergencies. Since A major milestone on emergency preparedness was the 2016, States Parties have been checking their progress on development of two regional strategic plans in consultation IHR compliance through mandatory self-assessment using with the Member States and the endorsement of these plans
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Fig. 2a. Regional average scores for joint external evaluations, 2016–2018a
ational le islation polic an financin H coor ination co unication a iation e er encies an a ocac
he ical e ents Anti icrobial resistance
Points of entr oonotic isease
0 is co unication oo safet 1 0
e ical counter easures 2 iosafet an biosecurit an personnel eplo ent 2 in in public health uni ation an securit authorities 9
E er enc response operations ational laborator s ste
E er enc prepare ness Sur eillance Hu an resources eportin
H nternational Health e ulations 200 aA era e scores across ei ht countries of the re ion in 19 technical areas
Fig. 2b. Regional average scores for State Party annual reporting in 2018a
e islation an financin
a iation e er encies H coor ination an P functions
1 0 oonotic e ents an he ical e ents hu an ani al interface 0
Points of entr oo safet 1 2
is co unication aborator
1 9 Health ser ice pro ision Sur eillance
ational health e er enc fra e or Hu an resources
H nternational Health e ulations 200 P national focal point aAcross all 11 countries of the re ion
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Table 1. Flagship priority programme on emergency risk management: sustain, accelerate and innovate Sustain Accelerate Innovate Continued strengthening of the health Thailand type 1 EMT verified and recognized Establishment of South-East Asia Regional emergency operations centres (HEOC) under the WHO EMT initiative on 31 July Knowledge Network of IHR National Focal network during 2016–2018 through training 201932 Points and experts to: and on-site support to national HEOCs in all • create an IHR-focused community of countries of the region practice Continued strengthening of national • host a regional knowledge repository emergency medical teams (EMTs) on IHR implementation, best practices, research and innovation IHR monitoring and evaluation (as of 2019): Partnerships and resource mobilization for Development of a regional road map for high- • 100% compliance with State Party annual countries, focusing on: threat pathogens, with expert consultations reporting • leveraging domestic funding on Nipah virus and cholera conducted in • 8 of 11 countries conducted joint external • preparedness and response streams October–November 2019 evaluations of the South-East Asia Regional Health • after action reviews (5 countries), simulation Emergency Fund exercises (2 countries) and regional training • other sources (e.g. donors, development conducted banks) Resource mobilization strategy developed and in implementation New partnerships in areas such as HEOCs, EMTs, chemical, biological and radionuclear events, and the Global Outbreak Alert and Response Network One Health Asia-Pacific regional tripartite Linking/integration of pandemic Training in emergency response operations: coordination mechanism, with a secretariat in preparedness plans with national action • Inter-Agency Standing Committee Bangkok33 plans for health security Health Cluster coordination, information Monitoring and evaluation of the management implementation of national action plans for • training consortium on operational combating antimicrobial resistance partnerships Mapping operational partnerships for Promotion and implementation of the Piloting and roll-out of the Hospital Safety emergency preparedness and response One Health approach through National Index plus (HIS+) mobile application in Nepal Capacity development in emergency risk International Health Regulations– management scaled up and integrated Performance of Veterinary Services into WHO country offices’ emergency workshops (Bangladesh, Bhutan, Indonesia, preparedness and response plans Myanmar) Uninterrupted emergency logistics and supply chain system Coordinating complex ongoing protracted As of 2019, national action plans for health Roll-out of Go.Data 2.0,an innovative data Grade 2 emergency response to the Rohingya security developed and under implementation management, analysis and decision-making crisis in Cox’s Bazar, Bangladesh in Bhutan, Indonesia, Maldives, Myanmar, Sri tool34 Lanka, Thailand and Timor-Leste Continued operational readiness training in Implementation of strategies for 2019–2023: WHO country offices and ministries of health35 • Five-year regional strategic plan to strengthen public health preparedness and response22 • Regional risk communication strategy for public health emergencies in the WHO South-East Asia Region23 by the WHO Regional Committee in 2019. The Committee then the capacities of IHR NFPs on public health preparedness and approved and launched two key regional strategies strategies response through refocusing on identified gaps, developing to guide Member States and for them to adapt. robust monitoring mechanisms, and improving networking and The Five-year regional strategic plan to strengthen public collaboration. health preparedness and response – 2019–202322 was The Risk communication strategy for public health prepared based on a situational analysis of progress on IHR emergencies in the WHO South-East Asia Region23 aims to implementation in the region, gaps and opportunities identified ensure that each Member State builds and uses a multilevel, from the eight joint external evaluations done during 2016– multisectoral and multifaceted risk communication plan to 2018, and a regional consultation with the IHR NFPs and enable individuals, families and communities to make informed partners in New Delhi in March 2019. It is aligned with the global decisions to mitigate the effects of emergencies and take strategic plan and one of the three strategic priorities – 1 billion protective and preventive actions. It lays down a framework more people better protected from emergencies – of WHO’s for Member States and WHO to strengthen critical capacity Thirteenth general programme of work 2019–2023.36 It is also in five key areas: risk communication systems, internal and in line with the Bangkok principles for the implementation of partner coordination, public communication, community the health aspects of the Sendai framework for disaster risk engagement, and public preparedness, risky behaviour and reduction 2015–2023 of March 2016.37 It aims to strengthen misinformation.
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for enabling peer-to-peer learning through an IHR-focused Box 1. Examples of successful emergency community of practice. It provides opportunities for exchanging preparedness priority activities by Member States ideas, consultation and discussion on IHR notifications and Bangladesh Cyclone shelters; early warning and problematic issues in an informal online environment. evacuation for Cyclone Fani in 2019 Efforts to build partnerships and collaborations have not been limited to the WHO South-East Asia Region and have Bhutan Seismic assessment of a hospital and non- been expanded through the Asia Pacific strategy for emerging structural corrective interventions diseases and public health emergencies (APSED III) in relation 19 Democratic People’s Republic of Korea Pandemic to all hazards. influenza preparedness planning; laboratory strengthening India Management of Nipah virus outbreak in Kerala in Challenges 2018; response to Kerala floods in 2018; early warning and evacuation for Cyclone Fani in 2019 Strengthening emergency preparedness is not limited to risk Indonesia Investment in recovery, capacity-building identification, risk mapping and development of strategic plans. and preparedness after the Indian Ocean tsunami of It requires time and resources to make any population, system, 2004; strengthening of IHR capacities in 2008, following country or region resilient to prevailing risks and threats. The influenza A(H5N1) outbreak following key challenges are indicative of the constraints on this regional flagship priority: Maldives Management of influenza A(H1N1)pdm09 outbreak in 2017; rapid response teams established at ● the need for repetitive spending by Member States and atoll level partners on emergencies of a seasonal nature (e.g. floods, Myanmar Capacities in surveillance strengthened through cyclones, landslides) and the danger of not investing linking with District Health Information Software 2 enough to prevent or mitigate prevailing risks; ● lack of investment in addressing the drivers of risks, all-hazard Nepal Comprehensive earthquake risk mitigation and emergency preparedness, and building back better because: preparedness in the health sector, with linkages to relevant ● there are competing priorities within and outside the sectors; hospital safety assessments and use of a mobile health sector; application for hospital preparedness ● investors are not always rewarded with results and greater visibility within a limited time period; Sri Lanka Integration of mental health care in emergency response; legislation and policies related to IHR; ● lack of resilience of health systems at subnational and local strengthened systems and capacities at district level levels; ● lack of risk-informed development planning for the long term Thailand Investment in IHR core capacities and their at national and regional levels; overall integration into health systems; type 1 national ● lack of interest from private sector stakeholders in building emergency medical team verified by WHO; risk resilient systems, despite the existence of laws on corporate communication systems and plans social responsibility; ● inadequate budgetary allocation for and domestic funding of Timor-Leste Recovery from the 1999 East Timorese crisis and setting up systems for preparedness at district level the health sector; ● innovative financial instruments for financing preparedness not yet fully explored; ● limited use of technology for preparedness and response in Interlinking sectors and networks the health sector. In order to strengthen intersectoral synergies and partnerships and collaboration among public and private stakeholders Financing of health emergency preparedness has been a and operational partners for emergency preparedness and key challenge. To address it, an important strategic decision response, the Regional framework on operational partnership for was taken in 2016 to embolden emergency preparedness emergency response (South-East Asia Region)3 was developed in the region. Regional Committee resolution SEA/RC69/R6 in 2017; it guides Member States, WHO country offices and endorsed the expansion of the mandate of the South-East partners on building operational partnerships in pre-emergency, Asia Regional Health Emergency Fund to include an additional emergency and post-emergency phases. Efforts to develop, financing stream focused on preparedness.16 It needs further foster and strengthen partnerships and networks through the financial support from donors to help and assist countries in engagement of emergency medical teams,38 the Global Outbreak investing more in disaster risk reduction (e.g. in hospital safety Alert and Response Network,39 the Standby Partnership,40 the assessments), preparedness and operational readiness. During Inter-Agency Standing Committee Health Cluster41 and private the 72nd session of the Regional Committee in September stakeholders are being pursued continuously. In September 2019, the Union Minister of Health and Family Welfare, 2018, the WHO Regional Committee for South-East Asia Government of India, pledged a contribution of US$ 200 000 passed resolution SEA/RC71/R5 on strengthening national and to the preparedness stream for strengthening disaster and international emergency medical teams in the region.20 emergency preparedness.42 The WHO Regional Office for The establishment of the regional knowledge network of IHR South-East Asia has also developed a resource mobilization NFPs and domain experts created an innovative online platform strategy and orientation manual to accelerate its fundraising.43
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Despite all the progress on emergency risk management and for health security and mobilize domestic funding and support strategic interventions to boost emergency preparedness, the from partners to implement the plans. Innovative financial countries’ existing capacities to respond to health emergencies mechanisms need to be tapped to raise funds from donors do not seem to be adequate in the regional context of high and bilateral agencies in the region to finance emergency burden of disease, frequent disease outbreaks, and a growing preparedness and risk reduction. number of risks and hazards, as illustrated in Annex Table 1. Member States must fulfil their commitment to thefour I’s of This raises the question “Are we adequately prepared to the Delhi Declaration: (i) identify risks, (ii) invest in people and withstand any unexpected emergency or disaster?” building resilient systems, (iii) implement plans and (iv) interlink human, animal, wildlife and environmental sectors, following an ecological public health approach and strengthening networks. Delhi Declaration on Emergency Emergency preparedness is continuous work and a top priority Preparedness for achieving comprehensive development and health security in the region and the world. A continued push following the “sustain, accelerate and innovate” approach on emergency risk management under the regional flagship priority programme since 2014 has sustained Source of support: None. a focus on strengthening emergency preparedness in the region. This culminated in the adoption of the ministerial-level Conflict of interest: None declared. Delhi Declaration on Emergency Preparedness at the WHO Regional Committee for South-East Asia meeting in 2019.24 It Authorship: RHO conceptualized the design of the paper and reflects the strong political commitment of the Member States provided overall guidance, AKB prepared the first draft, NB provided to increase investment in building resilient health systems, substantial input, and RHO, AKB and NB together worked on versions implementing national action plans for health security, and of the draft and finalized the manuscript. strengthening networks and intersectoral coordination mechanisms following the One Health approach. How to cite this paper: Ofrin RH, Bhola AK, Buddha N. Turning Various strategies, plans and political commitments have commitments into actions: perspectives on emergency prepared been made since 2006. Now it is time to convert these ness in South-East Asia. WHO South-East Asia J Public Health. commitments into actions. 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Annex Table 1. Major health emergencies in the WHO South-East Asia Region, 2001–2019 Year Public health emergency Member State(s) affected Reported morbidity and/or Reported mortality other effects 2001 Gujarat earthquake (Richter India 6.3 million affected; 167 000 25 000 deaths scale 7.7) injured 2003–2004 Avian influenza A(H5N1) outbreak Bangladesh, Indonesia, 228 cases 181 deaths in humans Myanmar, Thailand 2004 Indian Ocean tsunami Bangladesh, India, Indonesia, 125 000 injured > 230 210 deaths Maldives, Myanmar, Sri Lanka, Thailand 2005 Kashmir earthquake (Richter India 4 million made homeless 86 000 deaths scale 7.6) 2006 Chikungunya outbreak India 1.39 million cases 2944 deaths 2006 Yogyakarta earthquake (Richter Indonesia 37 000 injured > 5700 deaths scale 6.4) 2007 Cyclone Sidr Bangladesh 7.5 million affected; 55 000 injured > 5000 deaths 2008 Cyclone Nargis Myanmar 2.4 million affected 138 000 deaths 2008–2009 Conflict/civil war Sri Lanka 60 000 wounded > 20 000 deaths 2008 Koshi River floods India, Nepal 2.5 million people affected 434 deaths 2009 Cyclone Aila Bangladesh, India 3.8 million affected 190 deaths (Sundarbans) 2009 Chikungunya outbreak Thailand 42 000 cases None 2010 Dengue outbreak India, Indonesia, Sri Lanka, > 120 000 cases 1500 deaths Thailand 2011 Floods Thailand 13.6 million affected 815 deaths 2013 North India floods India, Nepal > 300 000 affected, mainly in > 1000 deaths Uttarakhand, India 2015 Earthquake (Richter scale 7.8) Nepal 22 303 injured; 41 199; 9000 deaths hospitalized; 462 health facilities completely damaged, 765 partially damaged 2015 Influenza A(H1N1)pdm09 outbreak India 33 000 cases > 2000 deaths 2015 Floods India (Chennai) 1.8 million people affected > 500 deaths 2015 Floods Myanmar 1 million people affected 103 deaths 2016 Floods and landslides Sri Lanka 52 500 people affected > 100 deaths 2016 Typhoon Lionrock and floods Democratic People’s Republic 100 000 made homeless 138 deaths of Korea 2016 Cyclone Roanu Bangladesh, Sri Lanka 300 000 people affected 26 deaths in Bangladesh, 204 deaths in Sri Lanka 2016 Mount Sinabung volcanic eruption Indonesia 28 536 people internally displaced 20 deaths 2016 Aceh earthquake (Richter scale Indonesia 1000 injured 100 deaths 6.5) 2016 Zika virus outbreak Bangladesh, India, Indonesia, Number of cases: Bangladesh (1), None Maldives, Thailand India (4), Indonesia (1), Maldives (1), Thailand (> 360 plus 2 of microcephaly)
2017 Dengue outbreak Sri Lanka > 185 000 cases 250 deaths 2017 Cyclone Mora Bangladesh 3.3 million people affected; 6 deaths 260 000 people internally displaced; 17 000 houses damaged 2017 Influenza A(H1N1)pdm09 outbreak Maldives 277 laboratory-confirmed cases 6 deaths 2017 Influenza A(H1N1)pdm09 outbreak Myanmar 1198 cases of severe acute 60 deaths respiratory infection and 401 laboratory-confirmed influenza A(H1N1)pdm09 cases 2017 Floods and landslides Sri Lanka 683 821 people affected; 15 897 224 deaths houses damaged
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Year Public health emergency Member State(s) affected Reported morbidity and/or Reported mortality other effects 2017 Drought Democratic People’s Republic 18 million people with food 400 deaths of Korea insecurity; 200 000 children with acute malnutrition 2017 Rohingya crisis; ongoing protracted Bangladesh, Myanmar Approximately 1 million Rohingya 273 deaths (including Grade 2 emergency (as of March people displaced to Bangladesh; 105 children under 2020) public health risk of outbreaks 5 years of age) in of cholera, measles, diphtheria, the first 4 months of tuberculosis, malnutrition; many the crisis (August– cases of gender-based and sexual December 2017) violence 2018 Nipah virus outbreak India (Kerala) 19 cases, 18 of which were 17 deaths laboratory confirmed 2018 Lombok earthquake Indonesia 3 512 689 people affected; 417 529 463 deaths people internally displaced 2018 Sulawesi earthquake and tsunami Indonesia > 200 000 people affected; > 4300 deaths > 10 600 people injured; 2019 Cyclone Fani Bangladesh, India (Odisha) > 1.2 million people evacuated in 17 deaths in Bangladesh; 1.2 million people Bangladesh, 64 deaths evacuated in Odisha, India in Odisha, India 2019 Vaccine-derived poliovirus type 1 Indonesia 1 case (January–June 2019) None outbreak 2019 Avian influenza A(H5N1) in humans Nepal 1 case (March); first human 1 death infection with avian influenza A(H5N1) in the WHO South-East Asia Region since September 2017; first-ever case in Nepal 2019 Vaccine-derived poliovirus type 1 Myanmar 4 cases (June–July 2019) None outbreak 2019 Floods and landslides Thailand 418 000 people affected; 23 000 33 deaths people evacuated; 4000 houses damaged (at 19 September 2019) 2019 Floods India (Assam, Bihar and Assam: > 2.6 million people 11 deaths in Assam, Kerala) affected; Bihar: > 1.45 million 29 deaths in Bihar, 175 people affected; Kerala: > 100 000 deaths in Kerala people affected in 13 districts 2019 Typhoon Lingling Democratic People’s Republic 5.3 million people affected; 460 5 deaths of Korea houses and 15 public buildings damaged (at 2 September 2019) 2019 Forest fires Indonesia (Kalimantan and > 400 schools closed; 885 026 None Sumatra) cases of severe respiratory illnesses (as of September 2019) 2019 Dengue outbreak Bangladesh 100 000 cases (July–December 93 deaths 2019)
Source: Adapted from Regional framework on operational partnerships for emergency response (South-East Asia),3 with updated data from the WHO Health Emergencies Programme.
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