Health Emergency and Disaster Risk Management Framework

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Health Emergency and Disaster Risk Management Framework Health Emergency and Disaster Risk Management Framework ISBN 978-92-4-151618-1

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Printed in Switzerland iii

TABLE OF CONTENTS

FOREWORD v

ACKNOWLEDGEMENTS vi

LIST OF CONTRIBUTORS vii

ABBREVIATIONS viii

EXECUTIVE SUMMARY ix

01. INTRODUCTION 1

02. CONTEXT: THE HEALTH CONSEQUENCES OF EMERGENCIES AND 2 DISASTERS

03. HEALTH EDRM: AN INTEGRATED APPROACH TO MANAGE HEALTH 3 RISKS AND BUILD RESILIENCE 3.1 KEY CONCEPTS AND CHARACTERISTICS OF HEALTH EDRM 3

04. HEALTH EDRM: VISION, EXPECTED OUTCOME AND GUIDING 6 PRINCIPLES 4.1 VISION AND EXPECTED OUTCOME 6 4.2 GUIDING PRINCIPLES 6

05. COMPONENTS AND FUNCTIONS OF HEALTH EDRM 9 5.1 POLICIES, STRATEGIES AND LEGISLATION 9 5.2 PLANNING AND COORDINATION 9 5.3 HUMAN RESOURCES 10 5.4 FINANCIAL RESOURCES 10 5.5 INFORMATION AND KNOWLEDGE MANAGEMENT 10 5.6 RISK COMMUNICATIONS 10 5.7 HEALTH INFRASTRUCTURE AND LOGISTICS 10 5.8 HEALTH AND RELATED SERVICES 11 5.9 COMMUNITY CAPACITIES FOR HEALTH EDRM 11 5.10 MONITORING AND EVALUATION 11

06. WORKING TOGETHER TO IMPLEMENT HEALTH EDRM 12 6.1 KEY STEPS IN DEVELOPING HEALTH EDRM STRATEGIES AND IMPLEMENTING 12 PRIORITY ACTIONS 6.2 AREAS FOR MULTISECTORAL ACTION AS A FOUNDATION FOR HEALTH EDRM 13 HEALTH EDRM FRAMEWORK HEALTH iv

07. ROLES AND RESPONSIBILITIES FOR HEALTH EDRM 15 7.1 WHOLE OF GOVERNMENT, WHOLE OF SOCIETY 15 7.2 MINISTRY OF HEALTH 15 7.3 NATIONAL DISASTER MANAGEMENT AGENCY 16 7.4 COMMUNITIES AND COMMUNITY-BASED ORGANIZATIONS 16 7.5 WHO 16 7.6 INTERNATIONAL COMMUNITY 17

08. CONCLUSION 18

REFERENCES 19

ANNEXES 21

ANNEX 1. WHO CLASSIFICATION OF HAZARDS 22

ANNEX 2. COMPONENTS AND FUNCTIONS OF HEALTH EMERGENCY 24 AND DISASTER RISK MANAGEMENT

ANNEX 3. LIST OF STAKEHOLDER GROUPS FOR HEALTH EMERGENCY 30 AND DISASTER RISK MANAGEMENT HEALTH EDRM FRAMEWORK HEALTH v

FOREWORD

protect health. It outlines the need to work together – because EDRM is never the work of one sector or agency alone. It shows how the whole health system can and must be fundamental in all of these efforts.

The Framework also details the clear need for communities to be in the driving seat. While emergencies affect everyone, they disproportionately affect those who are the most vulnerable. The needs and rights of the poorest, as well as women, children, people with Emergencies and disasters take a profound toll on disabilities, older persons, migrants, refugees and people’s health, often well after the headlines fade. displaced persons, and people with chronic diseases must be at the centre of our work. Every year, over 170 million people will be affected by conflict, and another 190 million by disasters; yet the WHO is fully committed to working with Member full impact on people’s health is far greater than this. States and partners to ensure that the Framework is Some will be large national, regional or even global implemented effectively. crises, from cyclones and drought to major outbreaks. Others will be more localized, like traffic collisions and This document is the result of extensive consultations fires, but can still be devastating in their collective and inputs from Member States and partners, as well costs to human life. as WHO colleagues across offices and programmes around the world. I would like to thank each and every Too often these events set back development – one of those who have contributed to its development. sometimes for decades – and jeopardize universal health coverage along with other development agendas Moreover, I encourage everyone to use this Framework: of a country. They shatter the aspirations of children you should be able to see yourself and your role in and adults, and the communities they live in or call these pages. Not all emergencies can be predicted, home. They can overwhelm health systems and dec- but they can be prepared for. Let us act together to re- imate the economies that fund them. duce the risks they pose before, during and after emergencies, and achieve a safer, healthier world for all. Reducing these impacts is one of our most pressing priorities. It will be central to achieving the triple billion goals of the World Health Organization (WHO): for uni- Dr Tedros Adhanom Ghebreyesus versal health coverage, for health security, and health Director-General for all. World Health Organization

This Health Emergency and Disaster Risk Manage- ment (EDRM) Framework is a substantial response to this challenge. It emphasizes the critical impor- tance of prevention, preparedness and readiness, together with response and recovery, to save lives and HEALTH EDRM FRAMEWORK HEALTH vi

ACKNOWLEDGEMENTS

The Health EDRM Framework is the culmination of with partners and countries led by WHO country and a process of face-to-face and virtual consultations regional offices and their respective Regional Emer- among WHO and experts from Member States and gency Directors: Ibrahima Socé Fall (African Region), partner organizations who have contributed to the Ciro Ugarte (Region of the Americas), Roderico Ofrin development, review and revision of the document. It (South-East Asia Region), Nedret Emiroglu (European is derived from the good practices and achievements Region), Michel Thieren (Eastern Mediterranean Re- in many related fields such as humanitarian action, gion), and Li Ailan (Western Pacific Region). multisectoral disaster risk management, and all-hazards emergency preparedness and response, including for The Health EDRM Framework was reviewed and fi- epidemics, health systems strengthening and com- nalized at a Technical Workshop on Concepts and munity-centred primary health care. The Framework Technical Guidance for Health EDRM (Geneva, 21–23 has drawn inspiration from World Health Assembly November 2018) with participation from countries, and regional committee resolutions, regional strate- WHO leadership at all levels and experts, including gies, national policies, international and national stan- from academia. The leadership of Mike Ryan, Jaouad dards and guidelines, the United Nations Sustainable Mahjour, Stella Chungong and Qudsia Huda at WHO Development Goals, the Sendai Framework for Disas- headquarters were very instrumental in finalizing the ter Risk Reduction 2015–2030, the Paris Agreement Framework. The contributions of Rick Brennan and on Climate Change, guidance on implementing the Rudi Coninx, and Jonathan Abrahams who coordinat- International Health Regulations (2005), and activities ed the development process, are gratefully acknowl- of the WHO Thematic Platform for Health EDRM and edged. its associated Research Network. WHO thanks the governments of Australia, Finland, The extensive process of developing this document Republic of Korea and the United Kingdom for their was based on the evidence gained from WHO’s work financial support. HEALTH EDRM FRAMEWORK HEALTH vii

LIST OF CONTRIBUTORS

WHO wishes to recognize particularly the following Member and Agriculture Organization of the United Nations (FAO), States, experts and partner organizations for their technical Switzerland; Kaisa Kontunen, International Organization contributions to the Framework. for Migration (IOM), Switzerland; Peter Koob, Consultant, Australia; Daniel Kull, World Bank, Switzerland; Shuhei Member States: Australia, Bangladesh, Cambodia, Canada, Nomura, University of Tokyo, Japan; Michel le Pechoux, China, Egypt, Ethiopia, India, Indonesia, Islamic Republic United Nations Children’s Fund (UNICEF), Switzerland; of Iran, Japan, Lao People’s Democratic Republic, Mexico, Czarina Leung, Hong Kong SAR, China; Gabriel Leung, New Zealand, Oman, Peru, Philippines, Qatar, Republic of Hong Kong SAR, China; Michael Mosselmans, World Moldova, Singapore, Sri Lanka, Sudan, Turkey, United Food Programme (WFP), Italy; Loy Rego, Asian Disaster Kingdom, United Republic of Tanzania, United States of Preparedness Center, Thailand; Panu Saaristo, International America (USA) and Viet Nam. Federation of Red Cross and Red Crescent Societies (IFRC), Switzerland; Valérie Scherrer, CBM, Belgium; Rahul National experts: Walid Abu Jalala, Qatar; Salim Al Wahaibi, Sengupta, UNDRR, Germany; Margareta Wahlstrom, Oman; Sergio Alvarez, Peru; Ali Ardalan, Islamic Republic of UNDRR, Switzerland; Chadia Wannous, United Nations Iran; Haithem El Bashir, Sudan; Paul Gully, Canada; Didier System Influenza Coordination (UNSIC), Switzerland. Houssin, France; Alistair Humphrey, New Zealand; Ute Jugert, Germany; Margaret Kitt, USA; Mollie Mahany, USA; Ahamada Experts from WHO: Usman Abdulmumini, Onyema Ajuebor, Msa Mliva, Comoros; Virginia Murray, United Kingdom; Yahaya Ali Ahmed, Nada Alward, Bruce Aylward, Nicholas Guilherme Franco Netto, Brazil; Sae Ochi, Japan; Somiya Banatvala, Maurizio Barbeschi, Samir Ben Yahmed, Rayana Okoud, Sudan; Peng Lim Steven Ooi, Singapore; Ravindran Bouhaka, David Brett-Major, Sylvie Briand, Nilesh Buddh, Palliri, India; Thierry Paux, France; Mihail Pîsla, Republic of Alex Camacho, Diarmid Campbell-Lendrum, Zhanat Carr, Moldova; Ossama Rasslan, Egypt; Nobhojit Roy, India; Mehmet Frederik Copper, Paul Cox, Stephane de La Rocque, Xavier Akif Saatcioglu, Turkey; Sri Henni Setiawati, Indonesia; John De Radigues, Linda Doull, Osman Elmahal Mohammed, Simpson, United Kingdom; Theresa Tam, Canada. Ute Enderlein, Florence Fuchs, Keiji Fukuda, Michelle Gayer, Andre Griekspoor, Kersten Gutschmidt, Fahmy Hanna, Experts from intergovernmental & partner organizations: David Harper, Dirk Horemans, Gabit Ismailov, Hamid Syed Vincent Lee Anami, International Medical Corps (IMC), Jafari, Kalula Kalambay, Kande-Bure Kamara, Nirmal Kenya; Paul Arbon, Torrens Resilience Institute, Australia; Kandel, Youssouf Kanoute, Ryoma Kayano, Hyo-Jeong Frank Archer, Monash University, Australia; Marvin Kim, Rebecca Knowles, Helena Krug, Ben Lane, Jostacio Birnbaum, World Association for Disaster and Emergency Lapitan, Vernon Lee, Jian Li, Matthew Lim, Tarande Manzila, Medicine, USA; Lourdes Chamorro, European Union; Emily Adelheid Marschang, Susana Martinez Schmickrath, Chan, Chinese University of Hong Kong (CUHK), Hong Kong Elizabeth Mason, Elizabeth Mumford, Altaf Musani, Maria Special Administrative Region (SAR), China; Gloria Chan, Neira, Tara Neville, Dorit Nitzan, Ngoy Nsenga, Isabelle CUHK, Hong Kong SAR, China; Massimo Ciotti, European Nuttall, Olushayo Olu, Heather Papowitz, Yingxin Pei, Centre for Disease Prevention and Control (ECDC), Sweden; Charles Penn, William Perea, Arturo Pesigan, Jean-Luc Ioana Creitaru, United Nations Development Programme Poncelet, Pravarsha Prakash, Jukka Pukkila, Adrienne (UNDP), Switzerland; Marcel Dubouloz, Consultant, Rashford, Gerald Rockenschaub, Guenael Rodier, Alex Ross, Switzerland; Mélissa Généreux, Sherbrooke University, Cathy Roth, Dalia Samhouri, Irshad Shaikh, Iman Shankiti, Canada; John Harding, United Nations Office for Disaster Rajesh Sreedharan, Ludy Suryantoro, Joanna Tempowski, Risk Reduction (UNDRR), Switzerland; Teodoro Herbosa, Lisa Thomas, Angelika Tritscher, Heini Utunen, Willem Van University of the Philippines, Philippines; Hossein Kalali, Lerberghe, Liviu Vedrasco, Elena Villalobos Prats, Kai von UNDP, USA; Mark Keim, DisasterDoc, USA; Wirya Khim, Food Harbou, Michel Yao, Nevio Zagaria, Wenqing Zhang. HEALTH EDRM FRAMEWORK HEALTH viii

ABBREVIATIONS

CADRI Capacity for Disaster Reduction Initiative EDRM emergency and disaster risk management GOARN Global Outbreak Alert and Response Network GPW General Programme of Work (WHO) IASC Inter-Agency Standing Committee IFRC International Federation of Red Cross and Red Crescent Societies IHR International Health Regulations JMP Joint Monitoring Programme (WHO/UNICEF) NDMA National Disaster Management Agency NGO nongovernmental organization SDGs United Nations Sustainable Development Goals SOP standard operating procedure UHC universal health coverage UN United Nations UNDP United Nations Development Programme UNDRR United Nations Office for Disaster Risk Reduction UNICEF United Nations Children’s Fund WHE WHO Health Emergencies Programme WHO World Health Organization HEALTH EDRM FRAMEWORK HEALTH ix

EXECUTIVE SUMMARY

All communities are at risk of emergencies and di- Large-scale events due to natural and technological sasters including those associated with infectious dis- hazards in the Caribbean, Japan, Mozambique and ease outbreaks, conflicts, and natural, technological Nepal, disease outbreaks in the Democratic Republic and other hazards. The health, economic, political of the Congo, Republic of Korea and Saudi Arabia, and and societal consequences of these events can be protracted crises in many countries have highlight- devastating. Climate change, unplanned urbanization, ed that no country is immune from emergencies and population growth and displacement, antimicrobial disasters. While these events may have the great- resistance and state fragility are contributing to the est impact, the cumulative effect of smaller-scale increasing frequency, severity and impacts of many events also has a significant impact on communities types of hazardous events that may lead to emergen- worldwide. All of these events demonstrate the public cies and disasters without effective risk management. health imperative to scale up risk-informed actions to reduce hazards, exposures and vulnerabilities, and Reducing the health risks and consequences of emer- build capacities to protect public health from emergencies is vital to local, national and global health gencies and disasters. security and to build the resilience of communities, countries and health systems. Sound risk manage- In order to address current and emerging risks to ment is essential to safeguard development and public health and the need for effective utilization and implementation of the Sustainable Development Goals management of resources, the conceptual frame (SDGs), including the pathway to universal health or paradigm of “health emergency and disaster risk coverage (UHC), the Sendai Framework for Disas- management” (Health EDRM) has been developed to ter Risk Reduction 2015–2030 (Sendai Framework), consolidate contemporary approaches and practice. International Health Regulations (IHR) (2005), Paris Agreement on Climate Change (Paris Agreement) and The Health EDRM Framework provides a common other related global, regional and national frameworks. language and a comprehensive approach that can be adapted and applied by all actors in health and other While countries are have strengthened capacities to sectors who are working to reduce health risks and reduce the health risks and consequences of emer- consequences of emergencies and disasters. The gencies and disasters through the implementation Framework also focuses on improving health out- of multi-hazard disaster risk management, the IHR comes and well-being for communities at risk in different (2005), and health system strengthening, many com- contexts, including in fragile, low- and high-resource munities remain highly vulnerable to a wide range of settings. hazardous events. Fragmented approaches to different types of hazards, including over-emphasis on Health EDRM emphasizes assessing, communicating reacting to, instead of preventing events and preparing and reducing risks across the continuum of preven- properly to be ready for response, and gaps in coordi- tion, preparedness, readiness, response and recovery, nation across the entire health system, and between and building the resilience of communities, countries health and other sectors, have hindered the ability of and health systems. Drawing on the expertise and communities and countries to achieve optimal devel- field experience of many experts who contributed to opment outcomes including for public health. the development of this Framework, Health EDRM is HEALTH EDRM FRAMEWORK HEALTH x

derived from the disciplines of risk management, Health EDRM functions are organized under the fol- emergency management, epidemic preparedness lowing components. and response, and health systems strengthening. It {{ POLICIES, STRATEGIES AND is fully consistent with and helps to align policies and LEGISLATION: Defines the structures, actions for health security, disaster risk reduction, roles and responsibilities of governments humanitarian action, climate change and sustainable and other actors for Health EDRM; includes development. Effective implementation of Health strategies for strengthening Health EDRM EDRM is therefore critical to achieve UHC in all coun- capacities. try contexts. {{ PLANNING AND COORDINATION: Emphasizes effective coordination The vision of Health EDRM is the “highest possible mechanisms for planning and operations standard of health and well-being for all people who for Health EDRM. are at risk of emergencies, and stronger communi- {{ HUMAN RESOURCES: Includes planning ty and country resilience, health security, universal for staffing, education and training across health coverage and sustainable development”. The the spectrum of Health EDRM capacities at expected outcome of Health EDRM is that “countries all levels, and the occupational health and and communities have stronger capacities and sys- safety of personnel. tems across health and other sectors resulting in the {{ FINANCIAL RESOURCES: Supports reduction of the health risks and consequences as- implementation of Health EDRM activities, sociated with all types of emergencies and disasters”. capacity development and contingency funding for emergency response and Health EDRM is founded on the following set of core recovery. principles and approaches that guide policy and practice: {{ INFORMATION AND KNOWLEDGE {{ risk-based approach; MANAGEMENT: Includes risk assessment, {{ comprehensive emergency management surveillance, early warning, information (across prevention, preparedness, management, technical guidance and readiness, response and recovery); research. {{ all-hazards approach; {{ RISK COMMUNICATIONS: Recognizes {{ inclusive, people- and community-centred that communicating effectively is critical approach; for health and other sectors, government {{ multisectoral and multidisciplinary authorities, the media, and the general collaboration; public. {{ whole-of-health system-based; {{ HEALTH INFRASTRUCTURE AND {{ ethical considerations. LOGISTICS: Focuses on safe, sustainable, secure and prepared health facilities, critical Health EDRM comprises a set of functions and com- infrastructure (e.g. water, power), and ponents that are drawn from multisectoral emergency logistics and supply systems to support and disaster management, capacities for implement- Health EDRM. ing the IHR (2005), health system building blocks, and {{ HEALTH AND RELATED SERVICES: good practices from regions, countries and commu- Recognizes the wide range of health-care nities. The Framework focuses mainly on the health services and related measures for Health sector, noting the need for collaboration with many EDRM. other sectors that make substantial contributions to reducing health risks and consequences. HEALTH EDRM FRAMEWORK HEALTH xi

{{ COMMUNITY CAPACITIES FOR HEALTH The Framework proposes the following areas for action EDRM: Focuses on strengthening local that could be considered by the health sector as the health workforce capacities and inclusive foundation of a comprehensive strategy: surveillance, community-centred planning and action. early warning and alert systems; emergency {{ MONITORING AND EVALUATION: Includes preparedness for response across all hazards, the processes to monitor progress towards health system and all sectors, including operational meeting Health EDRM objectives, including readiness and mass casualty management systems; monitoring risks and capacities and and resilient hospitals and health facilities that are evaluating the implementation of strategies, safe, secure and sustainable, and that can continue to related programmes and activities. function in emergency or disaster situations. Strong advocacy and participation by the health sector in The success of Health EDRM relies on joint planning international and national forums, including through and action by ministries of health and other government the National Disaster Management Agency (NDMA), ministries, the national disaster management agency, is needed to ensure that the health of the populations the private sector, communities and community- remains central to multisectoral policy, planning, and based organizations, assisted by the international resource allocation dialogues, and in operational community. At the core of effective Health EDRM are coordination at local, subnational and national levels. efforts to strengthen a country’s health system with a strong emphasis on community participation and WHO is committed to working with Member States action to build resilience and establish the foundation and partners to support implementation of the IHR for effective prevention, preparedness, response and (2005), the Sendai Framework, the SDGs and the recovery from all types of hazardous events including Paris Agreement. Effective management of the risks emergencies and disasters. of emergencies and disasters by all stakeholders will make a substantial contribution to strengthen All countries require multidisciplinary and multisectoral community and country resilience, health security, policies, strategies and related programmes to UHC and sustainable development. It will also reduce health risks of emergencies and disasters enable all communities at risk of emergencies and and their associated consequences. The design disasters to attain the highest possible standard of of Health EDRM strategies requires a systemic health and well-being. Implementation of the Health approach that takes account of the risks, capacities EDRM Framework provides a solid foundation for and the availability of resources to implement risk all stakeholders to work together and achieve these management measures at local, subnational and objectives. national levels. Strategic health emergency risk assessments, assessments of capacity across Health EDRM components and functions, and reviews of existing plans and past experience can assist the development of comprehensive strategies and identification of priorities for action. HEALTH EDRM FRAMEWORK HEALTH

1 INTRODUCTION People across the world are faced with a wide and types of hazards. While its leadership in managing in- diverse range of risks associated with health emer- fectious risks and responding to outbreaks is clear, the gencies and disasters. These comprise infectious health sector also has a critical role in preventing and disease outbreaks, natural hazards, conflicts, unsafe minimizing the health consequences of emergencies food and water, chemical and radiation incidents, due to natural, technological and societal hazards. It building collapses, transport incidents, lack of water can only fulfil these responsibilities in close collab- and power supply, air pollution, antimicrobial resis- oration with at-risk communities and other sectors. tance, the effects of climate change, and other sources of risk (Annex 1). Small-scale hazardous events with limited health consequences occur on a regular basis, while other events may lead to emergencies “Universal health coverage and health or disasters with significant consequences for public security are two sides of the same health, well-being and for health development. The coin.” health, economic, political and societal consequences of these events can be devastating, both in the acute Dr Tedros Adhanom Ghebreyesus, phase and in the longer term. Developments such as Director-General, WHO, climate change, unplanned urbanization, population 17 May 2018 growth, migration and state fragility are increasing the frequency, severity and impacts of many types of emergencies throughout the world.

The management of these risks is vital to protect The aim of this document is to provide ministries of people’s health from emergencies and disasters, to health and other stakeholders with a summary of ensure local, national and global health security, to policy considerations to reduce the risks and con- attain UHC and to build the resilience of communi- sequences of emergencies and disasters, and build ties, countries and health systems. Sound risk man- the resilience of health systems, communities and agement is essential to safeguard development and countries. The Health EDRM Framework provides the implementation of local, national, regional (1, 6) an overview of risk management concepts, guiding and global strategies in health and other sectors. principles, the components and functions of effec- This is particularly important for implementing the tive Health EDRM, and guidance on implementing the SDGs, including the pathway to UHC and target 3d to Framework. This document does not replace existing “strengthen the capacity of all countries, in particular regional or global frameworks or strategies, including developing countries, for early warning, risk reduction the IHR (2005). Rather, it builds on these to incorpo- and management of national and global health risks” rate multiple hazards and to embrace a comprehen- (7); the Sendai Framework (8); IHR (2005) (9);1 and the sive approach to risk management. Policy guidance Paris Agreement (10). also aims to assist countries to take joint action and promote coherence in implementing the IHR (2005), Health systems at all levels have a central role in the Sendai Framework, the Paris Agreement, the managing the risks and reducing the consequences SDGs and other related national, regional and global of both routine and emergency situations due to all strategies and frameworks.

1The IHR (2005) is legally binding and provides an international mechanism for the effective management of biological, chemical and radiological events, especially those that have the potential to cross international borders. HEALTH EDRM FRAMEWORK HEALTH 2

2 CONTEXT: THE HEALTH CONSEQUENCES OF EMERGENCIES AND DISASTERS

Globally, the commonest hazardous events are trans- The financial costs of emergencies are also stagger- portation crashes, floods, cyclones/ windstorms, ing. Emergencies caused by natural and technologi- outbreaks, industrial accidents, and earthquakes cal hazards cost an average US$ 300 billion annually (11). Approximately 190 million people are directly (14), while the cost of armed conflicts can run into affected annually by emergencies due to natural and trillions. The expected annual losses from pandem- technological hazards, with over 77 000 deaths (11). A ic risk through its effects on productivity, trade and further 172 million are affected by conflict (12). From travel have been calculated at about US$ 500 billion 2012 to 2017, WHO recorded more than 1200 out- or 6% of global income per year (15). It is estimated breaks in 168 countries, including those due to new that premature deaths associated with air pollution or re-emerging infectious diseases. In 2018, a further caused about US$ 225 billion in lost labour income to 352 infectious disease events, including Middle East the global economy in 2013 (16). respiratory syndrome coronavirus (MERS-CoV) and Ebola virus disease (EVD), were tracked by WHO (13). Most countries are likely to experience a large-scale emergency approximately every five years (17), and In addition to increasing morbidity, mortality and many are prone to the seasonal return of hazards disability, emergencies may result in severe disrup- such as monsoonal floods, cyclones and disease tions of the health system. They interfere with health outbreaks. Although most international attention service delivery through damage and destruction of focuses on high-consequence disasters, hundreds health facilities, interruption of health programmes, of smaller-scale emergencies and other hazardous loss of health staff, and overburdening of clinical ser- events occur locally each year, such as outbreaks, vices. A single emergency can set back development floods, fires, and transportation crashes. Cumulatively, gains in public health and other sectors by decades. these account for a high number of deaths, injuries, illnesses and disabilities. HEALTH EDRM FRAMEWORK HEALTH 3

3 HEALTH EDRM: AN INTEGRATED APPROACH TO MANAGE HEALTH RISKS AND BUILD RESILIENCE

Strengthening health systems, implementing the IHR 3.1 KEY CONCEPTS AND (2005), and developing multi-hazard disaster risk CHARACTERISTICS OF HEALTH management strategies – together with increased EDRM attention to climate change adaptation – are good Policies and programmes to minimize the examples of progress made to improve management health risks and consequences of emergen- of the health risks associated with hazardous events. cies and disasters should be based on a risk Nevertheless, many communities, subpopulations management approach. Health EDRM is a and countries remain highly vulnerable to emergen- continuum of measures in which the emphasis cies and disasters. The ability to achieve optimal is placed on managing the risks of the potential health outcomes related to emergencies has been emergency or disaster, and not solely respond- hindered by fragmented approaches to different types ing to the event or crisis, and on building the of hazards; over-emphasis on reacting to, rather than resilience of communities and countries. preventing and preparing for events; and by gaps in coordination across the entire health system, and be- {{ Risk is defined as “The combination of tween health and other sectors. the probability of an event and its negative consequences” (18). More specifically, In view of current and emerging risks to public health emergency or disaster risk is defined as and the need for more effective coordination, utiliza- “[T]he potential loss of life, injury, or destroyed tion and management of resources, there is a need to or damaged assets which could occur to a consolidate contemporary approaches and practice system, society or a community in a specific through the conceptual framework or paradigm of period of time, determined probabilistically as “health emergency and disaster risk management”. a function of hazard, exposure, vulnerability and capacity” (19). Hazard-related risks can never be completely eliminated, but they can – and should – be managed. When EDRM activities are designed specifically to reduce “Prevention and preparedness is the the probability of events and to minimize heart of public health. Risk manage- health consequences, the term “health ment is our bread and butter.” emergency and disaster risk management” can be used. Dr Margaret Chan,

WHO Director-General, 30 October 2012 Comprehensive Health EDRM addresses a wide scope of natural, biological, technological and societal hazards: a range of risk management measures are employed (e.g. primary prevention and recovery in addition to emer- HEALTH EDRM FRAMEWORK HEALTH 4

prevention and recovery in addition to emergen- collectively contribute to the resilience of cy preparedness and response) with the broad communities and countries. Health EDRM engagement of the health system and multi- builds on past achievements and the trends ple sectors, and a strong community focus. evident in public health and emergency risk management practices worldwide. It is fully {{ Progress has been made by countries to consistent with, and helps to align policies reduce the health and other consequences and action for health security, disaster risk of emergencies. The most successful and reduction, humanitarian reform, climate cost-effective strategies often employ a change and sustainable development comprehensive risk management approach agendas. that aims to prevent, mitigate, prepare for, respond to, and recover from emergencies. {{ Health EDRM reinforces implementation This overall approach should be applied in of the IHR (2005) – an essential building all emergency circumstances regardless of block for the development of national Health the cause, while incorporating specificities EDRM capacities – and other relevant relevant for each hazard (e.g. biological, international and regional agreements and geological, chemical, hydrometeorological, initiatives such as the SDGs (with a focus societal). Countries have also used on target 3d), the Sendai Framework, and after-action reviews and recovery from the Paris Agreement. To be most effective, emergencies and disasters to catalyse policy these agreements should not be applied in change, strengthen the health systems at all isolation but considered as interrelated levels of care, and build capacities in ways and mutually reinforcing. to reduce the risk of future emergencies, applying the Build Back Better principle. Health EDRM is built on the foundation of health system capacities for the management Health EDRM is derived from a range of disci- of routine or day-to-day risks. plines, principally risk management, emergency and disaster management, epidemic pre- {{ Health systems play a significant role paredness and response, and health systems in reducing hazards, exposures and strengthening. Health EDRM serves as a bridge vulnerabilities, and in establishing capacities between the multisectoral EDRM community to prevent the occurrence or reduce the and the health community. It aims to provide a consequences of hazardous events that may common language and an adaptable approach lead to emergencies. Such capacities include that can be applied by all those in the health and primary care, disease surveillance, pre- other sectors who are working to improve health hospital care, mass casualty management, outcomes and well-being for communities at chemical and radiological safety, mental risk of emergencies and disasters. health, and risk communication. Health systems should also ensure that they have {{ In order to minimize health consequences additional capacities in place to manage and improve health, well-being and societal non-routine or emergency-related risks, outcomes, concerted efforts from many e.g. event-based surveillance, specialized systems and sectors are required to prevent emergency health teams, standards for and mitigate risks, prepare for emergencies, infrastructure in high-risk areas, emergency ensure effective response and recovery, and response plans, and simulation exercises. HEALTH EDRM FRAMEWORK HEALTH 5

As such, Health EDRM recognizes the roles, Table 1: Summary of change in approach through Health responsibilities and contributions of all health EDRM system actors, the critical role of primary health care, and the delivery of primary, secondary and tertiary care, in effectively FROM TO reducing the health risks and consequences of emergencies and disasters. Event-based Risk-based

{{ Large-scale emergencies, such as Reactive Proactive prolonged conflicts, often have significant health consequences and pose challenges to the delivery of even the most basic of Single-hazard All-hazard health services. Health systems must Vulnerability therefore adapt and prioritize services, Hazard-focus and capacity focus including assistance from national and international actors, to address the health Single agency Whole-of-society needs of affected populations and respective subpopulations. This assistance is most Separate Shared responsibility likely required in fragile, conflict-affected responsibility of health systems and vulnerable settings. Health systems will also be required to plan and implement Response-focus Risk management strategies to support, strengthen and restore local capacities during protracted crises and Planning for Planning with in post-disaster or post-conflict periods. communities communities

In summary, Health EDRM is a significant step forward in the transformation of the prevailing policy, practice and culture to promote and protect health, keep the world safe and serve people with vulnerabilities so that “no one is left behind”. The essence of the change in approach is summarized in Table 1. HEALTH EDRM FRAMEWORK HEALTH 6

4 HEALTH EDRM: VISION, EXPECTED OUTCOME AND GUIDING PRINCIPLES

4.1 VISION AND EXPECTED Comprehensive emergency management: OUTCOME The comprehensive approach refers to a se- The conceptual basis of Health EDRM com- ries of closely interrelated prevention/mitiga- prises the vision, expected outcome, guid- tion, emergency preparedness (including op- ing principles and approaches, components erational readiness), response, and recovery and functions. The vision of Health EDRM is measures. It is based on the premise that pre- “the highest possible standard of health and vention and mitigation measures can reduce well-being for all people at risk of emergencies, the likelihood and severity of emergencies; that and stronger community and country resilience, sound preparedness will lead to more timely health security, universal health coverage and and effective response; that coordinated re- sustainable development”. The expected out- sponse will result in appropriate targeting of come is that “countries and communities have health services to the needs of those affect- stronger capacities and systems across health ed with a focus on the most vulnerable; and and other sectors resulting in the reduction of that recovery and reconstruction should be the health risks and consequences associated designed to reduce the risks of future emer- with all types of emergencies and disasters”. gencies (Build Back Better approach, including strengthening of health systems). 4.2 GUIDING PRINCIPLES Effective Health EDRM policies, strategies, re- All-hazards approach: Different types of haz- lated programmes and practice are guided by ards are associated with similar risks to health, the following core principles and approaches. and many EDRM functions are similar across hazards (e.g. planning, logistics, risk communi- Risk-based approach: The risks that emer- cations). It is neither efficient nor cost-effective gencies pose to communities are directly re- to develop separate, stand-alone capacities lated to the communities’ exposure to hazards, or response mechanisms for each individual their vulnerabilities to those hazards, and their hazard. Health EDRM policies, strategies and risk management capacity both before, during related programmes should therefore be de- and after events. Countries and communities signed to address common issues with com- can therefore most effectively minimize the mon capacities, supplemented by risk-specific health and other consequences of emergen- capacities. cies by preventing or mitigating hazards, reducing exposure to those hazards, minimizing Inclusive, people- and community-centred their vulnerabilities, and/or strengthening their approach: Community members are central capacities. to effective Health EDRM, as it is their health, HEALTH EDRM FRAMEWORK HEALTH 7

livelihoods and assets that are at risk of any Multisectoral and multidisciplinary collabo- hazardous event including emergencies and ration: Effective management of the risks that disasters. They are often well placed to man- emergencies pose to health requires strong, age their own risks through actions that provide ongoing intersectoral collaboration. The One protection to themselves, their families and Health approach, for example, is based on col- communities; and are often the first respond- laboration, communication, and coordination ers to an emergency. Health EDRM employs an across public health, animal health and other inclusive approach based on accessible and relevant sectors and disciplines to address a non-discriminatory participation. It addresses health threat at the human–animal–environ- the needs and capacities of people at greatest ment interface with the goal of achieving opti- risk and disproportionately affected by emer- mal health outcomes for both people and an- gencies and disasters, especially the poorest, imals. While the health sector takes a leading as well as women, children, people with dis- technical role in managing the risk of infectious abilities, older persons, migrants, refugees and diseases, for most types of hazards and events displaced persons, people with chronic diseas- other sectors will play lead technical roles (e.g. es, and other subpopulations with higher levels agriculture for food insecurity, meteorological of risks. All Health EDRM policies and practices services for early warning of cyclones, civil should integrate gender, age, disability and cul- protection for emergency response to floods). tural perspectives, in which the leadership of Many EDRM activities required to protect women, youth and other at-risk groups should health are also managed by other sectors, e.g. be promoted. maintenance of critical infrastructure, water and sanitation for human needs and function- The resilience of communities can be strength- ing of health facilities, transportation, logistics, ened by assisting them to identify relevant haz- emergency services, and food security. ards and vulnerabilities, and by building their capacities to mitigate, prepare for, respond to, The health sector needs to have strong rela- and recover from emergencies. Building on the tionships with the many actors who have a role “whole-of-society” concept, effective Health to play in managing risks of emergencies to EDRM can only be achieved through the active health. These include urban planners, civil en- participation of local governments, civil society gineers, operators of hazardous facilities, cli- and volunteer organizations, the private sector, mate information providers, animal health pro- and individual citizens. fessionals, the media and emergency services. Effective coordination among many disciplines in the health community is also required, such as emergency medicine, disease surveillance, Health emergency and disaster risk mental health, nutrition, water and sanitation, management is everybody’s business. health information management and many more. HEALTH EDRM FRAMEWORK HEALTH 8

Whole-of-health system-based: Many gener- Governments, intergovernmental and nongov- al health system strengthening measures are ernmental organizations (NGOs) should take among the most effective for Health EDRM. account of the diverse needs of populations, High baseline coverage rates for essential especially those with higher levels of vulner- health services, e.g. through implementation of ability who should be included in participatory UHC policies, will improve overall health status, approaches to planning, design and delivery contribute to the prevention of outbreaks, and of services that affect them. People should mitigate the health consequences of emergen- have ready access to accurate, up-to-date cies. Improved baseline health and nutritional and easily understood information about risks status is one of the most important contribut- of emergencies, and appropriate local and in- ing factors to community resilience. Integra- dividual actions. The best available scientific tion of Health EDRM principles and practices and socioeconomic evidence, analyses and in national, subnational and local health poli- disaggregated data should be used to inform cies, plans, programmes and services relevant planning, implementation and evaluation of the to Health EDRM components and functions effectiveness and impact of policies and ac- (Annex 2) is vital to reduce the health risks and tion, especially with respect to disadvantaged consequences of emergencies and disasters. groups, so that corrective adjustments can be made in a timely manner. Ethical considerations: Multiple sources of ethical challenges arise throughout Health EDRM. Decisions about priorities in reducing risks or responding to disasters include up- holding health as a human right (20),1 ethical aspects, as well as pragmatic, economic, political and other considerations. Standards of ethics and international health law are relevant in Health EDRM, driven by principles such as respect for persons, justice, solidarity and cul- tural sensitivity (21). These principles enable ethical action with respect to Health EDRM policy, practice, communications, evaluation and research, and promote trust in interactions with affected communities.

1The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without dis- tinction of race, religion, political belief, economic or social condition. Constitution of the World Health Organization (20). HEALTH EDRM FRAMEWORK HEALTH 9

5 COMPONENTS AND FUNCTIONS OF HEALTH EDRM

Health EDRM encompasses a wide range of functions of action by all sectors. Since health issues and components in health and other sectors that en- are not often well represented in intersectoral able countries to manage the health risks of emer- policies and strategies, strong advocacy may gencies and disasters. These functions form sys- be required to ensure a more central place tems to manage risks collectively at all levels, which for health in these important multisectoral underscores the need for effective coordination for policies, strategies and initiatives. successful Health EDRM. 5.2 PLANNING AND COORDINATION The Health EDRM functions are grouped into the fol- A range of plans are required to implement lowing components, derived from a number of sourc- Health EDRM, including those developed to es including adaptation of the health system building support national implementation of the IHR blocks, multisectoral emergency and disaster man- (2005) and the Sendai Framework. They should agement, and the IHR (2005) including epidemic pre- be informed by the findings of risk and capacity paredness and response. Further details on the sug- assessments, exercises and reviews, especially gested list of components and functions can be found those conducted for national multisectoral all- in Annex 2. hazards disaster risk management and under the IHR Monitoring and Evaluation Framework. 5.1 POLICIES, STRATEGIES AND Relevant health considerations should also be LEGISLATION fully integrated into health and multisectoral Health EDRM considerations should be plans, such as national action plans for health integrated into relevant policies and strategies, security, national disaster risk reduction plans, supported by appropriate legislation. plans for preparedness, response and recovery, They should be included in national health and incident management systems. There policies, strategies and plans, be aligned should be coherence and continuity between with national planning and budget cycles, the plans of different levels and jurisdictions and be mainstreamed in the broad range of – local, subnational and national. Plans for national and subnational health programmes. emergency preparedness and response need A national policy or strategy on Health EDRM to be regularly tested and reviewed. Business should outline the roles and responsibilities of continuity plans will also be required by public all public, private and civil society stakeholders, and private institutions to ensure that vital across the components of all-hazards functions and services continue throughout Health EDRM, and include those responsible an emergency (22, 23). for planning and coordination, IHR (2005), surveillance and early warning, emergency Health EDRM coordination mechanisms and/ preparedness and response, recovery, safe or dedicated units should be established to hospitals, and health and related services. ensure appropriate coordination across the Similarly, multisectoral EDRM policies and health sector and with other sectors at each legislation should refer to the protection of level. They should also have procedures to is- people’s health and the minimization of health sue requests for, receive and coordinate inter- consequences as specific aims and outcomes national health partners in case of large-scale HEALTH EDRM FRAMEWORK HEALTH 10

emergencies that exceed national capacities. 5.5 INFORMATION AND This includes having systems in place to re- KNOWLEDGE MANAGEMENT ceive, screen, register and task these partners, Information and knowledge management ca- as well as anticipating, requesting and receiv- pacities will need to be strengthened to sup- ing donations of medicines and equipment. port risk/needs assessments, disease surveillance and other early warning systems, and 5.3 HUMAN RESOURCES public communications. It is important that Dedicated personnel to manage Health EDRM information collection, analysis and dissemi- strategies and related programmes and to im- nation be harmonized across relevant sectors, plement activities are required at national, sub- and mechanisms put in place to ensure that national and local levels. Key human resource “the right information gets to the right people management considerations include planning at the right time”. Research supports the evo- for staffing requirements (including surge ca- lution of evidence, knowledge and practice and pacity for emergency response), education the development of new drugs, vaccines and and training for competency development, and innovative risk management measures. Evi- occupational health and safety. Skilled human dence-based technical guidance is required to resources are central to the effectiveness of build capacity through training programmes Health EDRM strategies and related pro- and health systems improvements. grammes; they require specific and long-term investment in education and training across 5.6 RISK COMMUNICATIONS the spectrum of Health EDRM capacities in Communicating effectively, including risk technical areas such as emergency planning, communication, is a critical function of Health incident management, epidemiology, laborato- EDRM, especially when relating to other sec- ry diagnostics, information management, risk tors, government authorities, the media, and and needs assessments, logistics, risk com- the public. Real-time access and exchange of munication, and health service delivery. information, advice and opinions are vital so that everyone at risk is able to make informed 5.4 FINANCIAL RESOURCES decisions and take action to prevent, mitigate Adequate financial allocations are required and respond to potential emergencies. Public from governments, including the Ministry of information activities should be coordinated Health, and other sources to develop capac- among stakeholders in order to avoid conflict- ities and implement programmes and activ- ing information being disseminated, and be ities. Health EDRM, including prevention and tailored to the risks and needs of diverse at- preparedness measures, has a recurrent cost risk populations, including those with higher which should be fully considered and funded levels of vulnerability. as it is in other sectors related to the safety and security of populations. Financial mechanisms 5.7 HEALTH INFRASTRUCTURE AND should also include contingency funding for LOGISTICS response and recovery. National budgetary Making hospitals, health facilities and related systems need to be sufficiently flexible to pro- infrastructure safe and secure, prepared for vide financing expeditiously in the aftermath emergencies, and energy efficient will protect of an emergency. For advocacy and planning the lives of their occupants, enable effective purposes, it is important to document the eco- health response and recovery, protect public nomic impacts of past disasters on health and and private investments, support sustainability the health system, as well as to estimate the and reduce the impact of health care on cli- costs for future potential emergencies and di- mate and the environment. Many basic ser- sasters. vices, such as water, sanitation and energy, HEALTH EDRM FRAMEWORK HEALTH 11

upon which health and health services depend, contribute to community-level surveillance, should be available and continue to function household preparedness, local stockpiling, first before, during and after an event occurs. Sup- aid training, and emergency response. Minis- porting logistics will include stockpiling and tries and the private sector may be responsible prepositioning of medicines and supplies, ef- for managing critical infrastructure (e.g. water fective supply chains, and reliable transporta- supply, electricity, transport, telecommunication and telecommunications systems (24, 25). tions) and contribute to civic activities. Their active engagement in activities related to all 5.8 HEALTH AND RELATED aspects of EDRM is therefore vital. SERVICES Public health, pre-hospital and facility-based clinical services must be well prepared to respond effectively in the event of an emergency with health consequences. They should have A healthy population is a resilient the capacity to scale up service delivery to population; a resilient population is a meet increased health needs (e.g. through in- healthy population. creasing bed capacity, establishing temporary facilities or mobile clinics, vaccination cam- paigns) and to take specific measures related to certain hazards (e.g. isolation of infectious cases). A range of health-care disciplines con- 5.10 MONITORING AND EVALUATION tribute to Health EDRM and to building resil- Processes to monitor progress towards meet- ience of communities and countries, including ing health EDRM objectives and core capacities preventing and mitigating risk, preparedness, should be integrated into existing health sector response and recovery. As far as possible, monitoring systems. Standardized indicators representatives from the various disciplines to monitor risks, capacities, and programme should contribute to risk and capacity assess- implementation are all necessary. Sources of ments, planning, implementation, and monitor- relevant indicators include the Sendai Frame- ing and evaluation. work Monitor for targets and indicators, IHR Monitoring and Evaluation Framework, WHO 5.9 COMMUNITY CAPACITIES FOR global survey on country capacities for Health HEALTH EDRM EDRM and WHO regional monitoring and eval- Participation of communities in risk assess- uation mechanisms. Ongoing monitoring can ments to identify local hazards and vulnera- be complemented by intermittent evaluations, bilities can identify actions to reduce health especially of preparedness (e.g. simulations), risks prior to an emergency occurring. Many response and recovery activities. lives can be saved in the first hours after an emergency through effective local response, before external help arrives. The local population will also play the lead role in recovery and reconstruction efforts. Community capacities and activities – including primary health care – and the roles of local health workers, civil society and the private sector are therefore central to effective Health EDRM. Civil society can HEALTH EDRM FRAMEWORK HEALTH 12

6 WORKING TOGETHER TO IMPLEMENT HEALTH EDRM

Effective implementation of Health EDRM strategies local hazards, vulnerabilities and capacities and related programmes and activities is not limited are fundamental for effective Health EDRM, to the health sector. Collaboration with all sectors is including planning for prevention, emergency essential to collectively reduce the health risks and preparedness, response and recovery. consequences of emergencies and disasters (26). Assessments should follow standardized The components and functions, described in section 5, formats and be conducted at national, will also enable a country to implement the Sendai subnational and local levels, with all relevant Framework, the SDGs, IHR (2005),1 the Paris Agree- sectors, and updated at agreed intervals. In ment, and other relevant national, regional and global particular, efforts should be made to use the frameworks. most recent data on, for example, water and sanitation services.2 National and subnational priorities for capacity development and operational planning for Health EDRM {{ Assess the current capacities for managing will depend on the respective country and communi- health risks associated with emergencies ty contexts with respect to the risks and events they and disasters. These assessments may face, the current levels of capacity and the available address a wide spectrum of Health EDRM resources to implement and sustain Health EDRM. components or specific components Therefore, a strategic and systemic approach calls at all levels. Existing plans and capacity for a country – or subnational or local levels – to take assessments should be reviewed and some key steps to analyse the context, the risks and updated on a regular basis. A number of the capacities in place, and develop and implement global, regional and national system-wide priorities for Health EDRM with the active participa- and capacity-specific tools are available tion of major stakeholders. for this purpose. Capacity assessments will identify strengths and areas for 6.1 KEY STEPS IN DEVELOPING development, including priority actions, at HEALTH EDRM STRATEGIES community, subnational and country levels AND IMPLEMENTING PRIORITY to manage the assessed risks.3 ACTIONS {{ Conduct a strategic health emergency {{ Develop and implement multisectoral risk assessment to identify and analyse and health sector capacity development the risks of hazardous events at local, strategies, national action plans for health subnational and national levels. Existing risk security, plans for specific components assessments should be used when available (e.g. health workforce, mental health, and updated on a regular basis. Strategic disease surveillance) and plans to address risk assessments that analyse national and prevention, emergency preparedness,

1National action plans to develop capacities to implement the IHR (2005) will further contribute to broader Health EDRM as well as to local and national multisectoral and all-hazards EDRM plans as described in the Sendai Framework. 2The WHO/UNICEF Joint Monitoring Programme (JMP) regularly reports on water and sanitation in households, schools and health-care facilities and all country data are available on the JMP website (https://washdata.org/). 3For example, IHR (2005) State Party Self-Assessment Annual Reporting tool (SPAR), and voluntary Joint External Evaluation (JEE); WHO Survey of Country Capacities for Health EDRM, and regional assessment and reporting tools; Sendai Framework HEALTH EDRM FRAMEWORK HEALTH Monitor; Capacity for Disaster Reduction Initiative (CADRI Partnership); and the Inter-Agency Standing Committee (IASC) Pre- paredness for Response. 13 health security, plans for specific components reported (e.g. suspected outbreak, chemical (e.g. health workforce, mental health, spill), an initial risk assessment will usually be disease surveillance) and plans to address required to verify its occurrence, to determine prevention, emergency preparedness, its risk to health and to identify requirements response and recovery. These strategies for control measures. Following events and plans should be based on a review of where there is an obvious health impact existing plans, capacity assessments, risk from the outset (e.g. earthquakes, cyclones, assessments, costing of activities, mapping outbreaks) a rapid needs assessment will of resources and other forms of analysis be necessary to determine major health in consultation with stakeholders. Based priorities, to identify ongoing hazards and on available resources, priority actions threats, to assess effectiveness of the local should be integrated into the relevant plans. response, and to determine the requirements Implementation of the strategies and plans for external assistance. should be monitored, evaluated and regularly reported; they should also be updated in line Surveillance, early warning and alert systems, with policy, planning and budget cycles, and linked to early action any change in level and type of risk. Early warning of evolving or potential hazards (e.g. disease outbreaks, cyclones, droughts) is 6.2 AREAS FOR MULTISECTORAL necessary for early action, including mitigation ACTION AS A FOUNDATION FOR measures, operational readiness and timely HEALTH EDRM response. Information from disease surveillance A comprehensive strategy should comprise systems, meteorological forecasting and other all components of Health EDRM as indicated early warning mechanisms plays a critical role above. This requires strengthening of the health in reducing the health and other consequences workforce to manage and implement Health of emergencies. There are several established EDRM at all levels, making financial resources international early warning mechanisms to available for Health EDRM, and investing in which national systems may link in order to take information management and research to action to prevent, detect, prepare and respond to provide the evidence base for the efficient use emergencies and disasters.1 of resources. In addition to efforts to strengthen health systems, especially at the primary care Emergency preparedness for response across level, ministries of health and partners should all hazards consider the following areas for action as a Evidence-based emergency preparedness foundation upon which to build a comprehensive (including operational readiness) measures, Health EDRM strategy. such as multi-hazard emergency response planning and contingency planning for specific Risk assessments and capacity assessments risks, are the foundation of timely and effective Strategic or baseline assessments. The response. These plans should address issues design of Health EDRM strategies, related such as initial risk/needs assessments, programmes and activities should be based incident/event management, communications, on the findings of risk assessments and emergency public health measures, pre-hospital more detailed capacity assessments. care, clinical management, and respective roles and responsibilities across sectors and Event risk and needs assessments. When an agencies. event with potential health consequences is

1For example, Global Disaster Alert and Coordination System (GDACS) for earthquakes, tsunamis, floods, volcanoes, and tropical cyclones; international and regional tsunami warning systems; Famine Early Warning System (FEWS NET), global epidemic intelligence (epidemic intelligence from open sources (EIOS), Global Public Health Intelligence Network (GPHIN)); disease-specific HEALTH EDRM FRAMEWORK HEALTH surveillance systems (e.g. polio, measles, influenza, antimicrobial resistance) and subregional disease surveillance networks (e.g. Mekong River Basin Disease Surveillance, Middle East Consortium on Infectious Disease Surveillance). 14 A resourced emergency operations centre a manner that makes them resistant to (EOC) to manage and coordinate the response local hazards and takes account of climate to emergencies from all hazards should be change scenarios, while existing facilities established within the Ministry of Health or other should be assessed for their safety and appropriate health authority, with clear standard security, and actions taken to make them operating procedures (SOPs). Trained and safe, secure, and better prepared for equipped teams at each level of the health system emergencies. The WHO and Pan American (local, regional, national) should be available for Health Organization Hospital Safety Index rapid and scalable responses. A range of health is an effective tool to assess facilities and disciplines should contribute to emergency to guide improvements in their safety, preparedness and response, including public preparedness and emergency response health, pre-hospital care, nursing, primary care, capacities. medical and surgical specialties, infectious disease management, surveillance, laboratory Health facilities should also provide a services, and risk communication. safe environment for staff and patients and should include structural and non- Emergency preparedness and response structural measures and procedures to mechanisms, such as for outbreak alert and protect them from acts of violence and response and mass casualty management, need cybersecurity attacks. Combining safety to be regularly tested through exercises at each with increased ecological sustainability of level of the health system, and evaluated after health facilities will improve the reliability each emergency. Countries and communities of power and water supplies and reduce should take advantage of the opportunities in waste of health facilities, thus reducing the post-event recovery to strengthen capacities overall impact of health care on climate and reduce risks of future emergencies through and the environment (25). effective planning and sustained implementation of rehabilitation and reconstruction Health sector representation within the measures. NDMA and other platforms Strong representation and advocacy Resilient hospitals and health facilities for health in the main national and A resilient health facility is safe, secure and international forums is necessary to sustainable, and will continue to function position health effectively within policy, in emergency or disaster situations. planning, and resource allocation Measures to strengthen the structural, dialogues, and in operational coordination non-structural and functional integrity of at local, subnational and national levels. health facilities are key to effective Health Without such representation health EDRM. As components of a community’s priorities risk being overlooked by disaster critical infrastructure, hospitals and other managers from other sectors, especially health facilities must operate throughout during planning for natural, technological, emergencies and disasters. They must and societal hazards, and in ensuring a also be capable of managing the additional whole-of-government approach to the patient burden during the response. management of biological hazards. New facilities should ideally be built in HEALTH EDRM FRAMEWORK HEALTH 15

7 ROLES AND RESPONSIBILITIES FOR HEALTH EDRM

The development and implementation of Health the media, and emergency services. Effective EDRM requires the active participation of a wide coordination among these sectors is critical to range of sectors and stakeholders at all levels of so- effective Health EDRM. ciety (Annex 3). The roles of some key stakeholders are outlined below. 7.2 MINISTRY OF HEALTH The Ministry of Health at national and/or 7.1 WHOLE OF GOVERNMENT, subnational level will generally have a leading role in WHOLE OF SOCIETY EDRM measures related to outbreaks. The Ministry Concerted efforts from many ministries and sectors of Health also has the primary responsibility to at all levels are required to reduce the health risks advocate with the NDMA or equivalent authority and consequences of emergencies and disasters. and other sectors on the centrality of Health EDRM In accordance with the Sendai Framework, national across all hazards – natural, technological, societal and local multisectoral and sectoral plans related to and biological. A department, unit or focal point disaster risk management should recognize that within the Ministry of Health should be tasked improved health and well-being are key objectives with the responsibility of managing the national and outcomes of collective action. People’s health Health EDRM strategies and related programmes, is both a source of vulnerability and a foundation including coordination with the NDMA, other of human resilience. Health is also a sector, while ministries, civil society, and the private sector. This biological hazards, along with natural, technological unit/focal point will generally have the responsibility and societal hazards, are critical sources of to convene other departments/ programmes within risk to communities and countries. All these the Ministry (e.g. health services, communicable aspects of Health EDRM should be central to the diseases, environmental health) and to ensure mechanisms for risk and capacity assessments their appropriate contributions to Health EDRM, and the development, planning, implementation, including the development of essential capacities. monitoring and reporting of multisectoral risk Based on local contexts and resources, this role management measures. could be combined with the responsibilities of the IHR National Focal Point, which would provide a The health sector is also dependent on other good opportunity to build broader, all-hazard Health sectors to enable the health system to function EDRM capacities. If there are separate units or focal effectively, and needs to build strong relationships points for the IHR and all-hazards Health EDRM, with actors who play a role in managing health risks close coordination and collaboration will clearly be of emergencies at local, national and international required. levels. These include urban planners, civil engineers, operators of hazardous facilities, climate 7.3 NATIONAL DISASTER information providers, animal health professionals, MANAGEMENT AGENCY critical infrastructure managers including energy, Many countries have an established NDMA or water and sanitation, telecommunications and equivalent that oversees the management and transport providers, pharmaceutical companies, coordination of EDRM activities for large-scale HEALTH EDRM FRAMEWORK HEALTH 16

emergencies and disasters due to most hazards. In many countries, in addition to a broad, whole-of- Other lead agencies may be assigned specific types government approach, national and international of hazardous events, such as outbreaks, chemical civil society and community-based organizations and radiological nuclear events. The NDMA should will have a key role in meeting the basic needs ensure that health is fully integrated into all relevant of vulnerable populations. It is therefore critical policies and plans, that health outcomes are that these organizations have capacities in place prioritized, and that health authorities participate to manage the health risks of emergencies, actively in all related activities. They should also including plans regarding how they will continue include health indicators in the overall monitoring their essential services during a disaster. Local of national and subnational strategies (e.g. for governments should involve civil society and implementing the Sendai Framework and SDGs), local communities in risk assessments, planning, related programmes and plans. capacity development, and providing services and assistance to meet the basic needs of populations 7.4 COMMUNITIES AND with high levels of vulnerability (such as food, health, COMMUNITY-BASED shelter, water and sanitation). ORGANIZATIONS Local communities, including community 7.5 WHO members, civil society and the private sector, must WHO, through its governing bodies and senior be engaged as full partners in all Health EDRM- leadership, has made better protection of people related strategies, programmes and activities. This from emergencies one of the three priorities in its will help to ensure that such strategies and activities Thirteenth General Programme of Work (GPW) are context-specific, culturally appropriate, efficient, 2019–2023. Health EDRM also depends on, and cost-effective. Local communities are well and contributes to, ensuring healthy lives and placed to play a central role in the identification promoting well-being for all at all ages by achieving of hazards, development of preparedness plans, UHC; and promoting healthier populations with detection and response to emergencies, and the more people enjoying better health and well- implementation of recovery efforts. Community being through the implementation of the SDGs. leaders and the local health workforce (e.g. family doctors, nurses, midwives, pharmacists, WHO supports the development and community health workers) can build public implementation of the full range of Health EDRM confidence, disseminate information, and identify actions through the WHO Health Emergencies people at risk. These groups can also provide Programme (WHE) and the involvement of all community-based services to meet the needs of WHO offices and technical programmes that the vulnerable. support strengthening of national health systems and building the resilience of countries and It is important that Health EDRM extends communities. WHE’s mission is to help countries, to a local level, including local government, and coordinate international action, to prevent, and is supported by central and subnational prepare for, detect, rapidly respond to, and recover health authorities. Multisectoral coordination from outbreaks and emergencies. WHO assists mechanisms that bring together all local countries to build their capacity for all-hazards agencies and organizations can provide a central Health EDRM through provision of policy options, focus for cross-agency cooperation to reduce technical support, and establishment of technical health risks and consequences of emergencies guidance, norms and standards. Implementation and disasters. of the SDGs, Sendai Framework, Paris Agreement, HEALTH EDRM FRAMEWORK HEALTH 17

IHR (2005) and the GPW will continue to guide 7.6 INTERNATIONAL COMMUNITY WHO’s actions to strengthen country capacities in The UN and its organizations, other international managing the risks of emergencies and disasters. agencies, intergovernmental organizations, the International Red Cross and Red Crescent In addition, WHO supports national responses to Movement, NGOs and the private sector can emergencies from all types of hazards, including all contribute to building essential capacities for through its role as Lead Agency of the IASC Health EDRM at country level. They are essential 1 Global Health Cluster, as custodian of the IHR partners of WHO. For example, the UN’s CADRI (2005), and as the secretariat for the Global Partnership supports governments to assess, Outbreak Alert and Response Network (GOARN), plan and develop national capacities for disaster the Emergency Medical Teams Initiative and risk reduction, including preparedness for UHC2030 Partnership, among others. To help emergency response. International and regional inform rehabilitation and reconstruction efforts, partnership initiatives for health security, disaster WHO can support the health component of risk management, chemical and radiation safety nationally led post-disaster needs assessments and incident management, and food safety, and recovery planning, supported by the United can also assist countries to leverage resources, Nations (UN), World Bank and European Union. to build capacity and to link to international WHO also plays an important convening role emergency response mechanisms. Examples of for Health EDRM at regional level with Member such international and regional mechanisms are States and partners, and at global level through UNDRR, the IASC’s cluster system, Emergency facilitation of the WHO Thematic Platform on Medical Teams Initiative, GOARN, and the Health EDRM and its associated Research UHC2030 Partnership. Network, and the Strategic Partnership for Health Security.

1IASC is the primary mechanism at international level for coordination of disaster/humanitarian response. Its members are the main UN and non-UN humanitarian agencies. As Health Cluster Lead Agency, WHO works at country level with ministries of health and humanitarian organizations to ensure that the health sector response to disasters is well led, well coordinated and effective in meeting the needs of the affected population. HEALTH EDRM FRAMEWORK HEALTH 18

8 CONCLUSION

No country – regardless of its economic and so- WHO is fully committed to collaborating with min- cial development level – is immune from the in- istries and partners to support the development of creasing frequency and severity of emergencies. each Member State’s capacities for Health EDRM. All countries require clear policies, strategies and Working together will lead to achieving the highest related programmes to minimize health risks and possible standard of health and well-being of all their associated health and other consequences. communities at risk of emergencies and disasters, These policies and strategies should be multidis- stronger community and country resilience, health ciplinary, intersectoral, and apply comprehensive, security, UHC and sustainable development. all-hazards and risk management approaches. While Health EDRM requires multifaceted strategies and specific actions to manage the wide range of risks of emergencies, general strengthening of a country’s health system, rooted in primary health care, is also crucial.

Capacity development for Health EDRM at country and local levels should take full advantage of, build on, and contribute to, existing programmes and frameworks, including the IHR (2005), the Sendai Framework, the SDGs and the Paris Agreement. HEALTH EDRM FRAMEWORK HEALTH 19

REFERENCES

1. Plan of action for disaster risk reduction 7. Resolution 70/1. Transforming our world: the 2030 2016–2021. Washington (DC): Pan Amer- agenda for sustainable development. Resolution ican Health Organization; 2016 (http://iris. adopted by the General Assembly on 25 Septem- paho.org/xmlui/handle/123456789/33772, ber 2015. New York (NY): United Nations; 2015 accessed 31 March 2019). (A/RES/70/1; (http://www.un.org/ga/search/ view_doc.asp?symbol=A/RES/70/1&Lang=E, 2. Asia Pacific strategy for emerging diseases and accessed 31 March 2019). public health emergencies (APSED III): advancing implementation of the International Health Reg- 8. Sendai framework for disaster risk reduction ulations (2005). Manila: WHO Regional Office for 2015–2030. Geneva: United Nations Office for Di- the Western Pacific; 2017 http://iris.wpro.who.( saster Risk Reduction; 2015 (https://www.unisdr. int/handle/10665.1/13654, accessed 31 March org/files/43291_sendaiframeworkfordrren.pdf, 2019). accessed 31 March 2019).

3. Western Pacific regional framework for disas- 9. International Health Regulations (2005), third ter risk management for health. Manila: WHO edition. Geneva: World Health Organization; Regional Office for the Western Pacific; 2016 2016 (https://apps.who.int/iris/bitstream/han (http://iris.wpro.who.int/handle/10665.1/10927, dle/10665/246107/9789241580496-eng.pdf, accessed 31 March 2019). accessed 31 March 2019).

4. WHO Regional Committee for Africa resolution 10. Paris Agreement. Bonn: United Nations Frame- AFR/RC62/6 on disaster risk management: a work Convention on Climate Change; 2015 (FCCC/ health sector strategy for the African Region‎. CP/2015/10/Add. 1, accessed 31 March 2019). Brazzaville: WHO Regional Office for Africa; 2012 (http://www.who.int/iris/handle/10665/80074, 11. World disasters report 2016: Resilience: saving accessed 31 March 2019). lives today, investing for tomorrow. Geneva: In- ternational Federation of Red Cross and Red 5. WHO Regional Committee for South-East Asia Crescent Societies; 2016 (https://www.ifrc.org/ resolution SEA/RC68/R2 on response to emer- Global/Documents/Secretariat/201610/WDR%20 gencies and disasters. New Delhi: WHO Re- 2016-FINAL_web.pdf, accessed 31 March 2019). gional Office for South-East Asia; 2015 (http:// www.searo.who.int/about/governing_bodies/ 12. People affected by conflict – humanitarian needs regional_committee/rc68-r2.pdf?ua=1, accessed in numbers, 2013. Brussels: Centre for Research 31 March 2019). on the Epidemiology of Disasters; 2013 (https:// reliefweb.int/report/world/people-affected- 6. Action plan to improve public health prepared- conflict-humanitarian-needs-numbers-2013, ness and response in the WHO European Re- accessed 31 March 2019). gion 2018–2023. Copenhagen: World Health Organization Regional Office for Europe; 13. Disease outbreaks by year. Geneva: World Health 2018 (http://www.euro.who.int/_data/assets/ Organization (http://www.who.int/csr/don/ pdf_file/0009/393705/Action-Plan_EN_WHO_ archive/year/en/, accessed 31 March 2019).

HEALTH EDRM FRAMEWORK HEALTH web_2.pdf?ua=1, accessed 31 March 2019). 20

14. Results briefs. Climate insurance. Washington 21. Global health ethics: key issues. Ge- (DC): The World Bank; 1 December 2017 (https:// neva: World Health Organization; 2015 www.worldbank.org/en/results/2017/12/01/ (https://apps.who.int/iris/bitstream/hand climate-insurance, accessed 31 March 2019). le/10665/164576/9789240694033_eng.pdf, accessed 31 March 2019) 15. Fan VY, Jamison DT, Summers LH. Pandem- ic risk: how large are the expected losses? Bull 22. International Health Regulations (2005) mon- World Health Organ. 2018;96(2):129–34. itoring and evaluation framework. Geneva: World Health Organization; 2018 (https://apps. 16. World Bank; Institute for Health Metrics and Eval- who.int/iris/bitstream/handle/10665/276651/ uation. The cost of air pollution: strengthening WHO-WHE-CPI-2018.51-eng.pdf?sequence=1, the economic case for action. Washington (DC): accessed 22 May 2019). The World Bank; 2016 (https://openknowledge. worldbank.org/handle/10986/25013, 23. Bangkok Principles for the implementation of the accessed 31 March 2019). health aspects of the Sendai Framework for Di- saster Risk Reduction 2015–2030. Geneva: United 17. Global assessment of national health sector Nations Office for Disaster Risk Reduction; 2016 emergency preparedness and response. Gene- (http://www.who.int/hac/events/2016/Bangkok_ va: World Health Organization; 2008 (http://www. Principles.pdf, accessed 31 March 2019). who.int/hac/about/Global_survey_inside.pdf, accessed 31 March 2019). 24. Safe hospitals and health facilities [website]. Ge- neva: World Health Organization (https://www. 18. 2009 UNISDR terminology on disaster risk re- who.int/hac/techguidance/safehospitals/en/, duction. Geneva: United Nations Office for Di- accessed 31 March 2019). saster Risk Reduction; 2009 (https://www.unisdr. org/files/7817_UNISDRTerminologyEnglish.pdf, 25. Smart hospitals [website]. Washing- accessed 31 March 2019). ton (DC): Pan American Health Organiza- tion (https://www.paho.org/disasters/index. 19. Report of the open-ended intergovernmental ex- php?option=com_content&view=article&id=366 pert working group on indicators and terminology 0:hospitales-inteligentes&Itemid=911&lang=en, relating to disaster risk reduction. New York (NY): accessed 31 March 2019). United Nations Note by the Secretary-General; 2016 (A/71644; https://www.unisdr.org/we/inform/ 26. Joint external evaluation tool: Internation- publications/51748, accessed 31 March 2019). al Health Regulations (2005), second edition. Geneva: World Health Organization; 2018 20. Constitution of the World Health Organiza- (https://apps.who.int/iris/bitstream/hand tion. In: Basic documents, 48th edition. Ge- le/10665/259961/9789241550222-eng.pdf, neva: World Health Organization; 2016:1-9 accessed 31 March 2019). (http://apps.who.int/gb/bd/PDF/bd48/ basic-documents-48th-edition-en.pdf, accessed 31 March 2019). HEALTH EDRM FRAMEWORK HEALTH 21

ANNEXES

ANNEX 1. 22 WHO CLASSIFICATION OF HAZARDS

ANNEX 2. 24 COMPONENTS AND FUNCTIONS OF HEALTH EMERGENCY AND DISASTER RISK MANAGEMENT

ANNEX 3. 30 LIST OF STAKEHOLDER GROUPS FOR HEALTH EMERGENCY AND DISASTER RISK MANAGEMENT HEALTH EDRM FRAMEWORK HEALTH 22 17

3. 3.1 DEGRADATION Erosion Deforestation Salinization rise level Sea Desertification loss/ Wetland degradation retreat/ Glacier melting - encroach Sand ment ENVIRONMENTAL ENVIRONMENTAL ENVIRONMENTAL - - 14 15,16 2,3 2.2 chemical, Acts ofActs violence Armed con - flicts: interna - tional - non-inter - national unrest Civil Stampede Terrorism: - biological, radiological, and nuclear, - explo sives Financial crises: hyper-infla - tion currency - crisis SOCIETAL - 7 8 8,9 2. 12,13 8,11 11 9

2.1 HUMAN-INDUCED 10 8 TECHNOLOGICAL Industrial hazards: Industrial - chemical spill chemical - leak gas - [radiologi radiation - nuclear] cal, collapse:Structural collapse building - failures dam/bridge - hazards Occupational mining - Transportation: water, rail, road, air, - space Explosions Fire pollution: Air haze - - disrup Infrastructure tion: outage power - supply water - waste waste, solid - water telecommunication - Cybersecurity materials Hazardous water: soil, air, in chemical, biological, - radiological contamination Food 4

1.4 Impact: airburst - meteorite - weather: Space energetic - particles geomagnetic- storms shockwave - EXTRATERRESTRIAL 5 - 7 [snakes, [snakes, 1.3 4 BIOLOGICAL venomous Airborne diseases Waterborne diseases Vector-borne diseases Foodborne outbreaks Insect infesta Insect tion: grasshopper - locust - diseases Animal diseases Plant Aeroallergens Antimicrobial - micro resistant organisms Animal-human contact - animals spiders] 4 -

1. 2.3 Drought fire: Wild [e.g. fire land - brush, bush, pasture] fire forest - out lake Glacial (flood) burst CLIMATOLOGICAL 1. 1.2 4 NATURAL 6 - - - [e.g. [torna 1.2.2 HYDRO-METEOROLOGICAL Fog Storm: extratropical - storm cy tropical - [cyclonic clone cyclonic wind, cyclone rain, surge] (storm) convective - storm rain,do, wind, storm,winter - dere blizzard, cho, lightning, thunderstorm, sand/dusthail, storm] tem Extreme perature: heatwave - coldwave - winter severe - condition frost/ snow/ice, dzud] freeze, MTEOROLOGICAL 4

1.2.1 Flood: flood riverine - flood flash - flood coastal - flood jam ice - movement Mass - (hydro-meteoro trigger): logical landslide - avalanche - (snow) mudflow - flow debris - action: Wave wave rogue - seiche - HYDROLOGICAL 4 - 1.1 GEOPHYSICAL Earthquake: ground-shak - ing Tsunami movement Mass (geophysical trigger): landslide - fall rock - subsidence - Liquefaction activity: Volcanic fall ash - lahar - pyroclastic - flow flow lava - WHO CLASSIFICATION OF HAZARDS CLASSIFICATION WHO

1 GROUPS GENERIC GROUPS -SUBTYPES -SUBTYPES MAIN TYPES MAIN TYPES SUBGROUPS [SUB-SUBTYPES] [SUB-SUBTYPES] HEALTH EDRM FRAMEWORK HEALTH 1. ANNEX 23

SOURCES

1. Report of the open-ended intergovernmental expert work- accessed 18 February 2019). ing group on indicators and terminology relating to disas- 10. International cloud atlas [website]. Geneva: World Meteo- ter risk reduction. Note by the Secretary-General. New rological Organization (https://cloudatlas.wmo.int/haze. York (NY): United Nations ; 2016 (A/71/644; https://www. html, accessed 18 February 2019). unisdr.org/we/inform/terminology, accessed 18 February 11. Coppola D, editor. Introduction to international disaster 2019). management, 3rd edition. Oxford: Butterworth-Heine- 2. OCHA Annual Report, 2017. Geneva: United Nations Of- mann; 2015. fice for the Coordination of Humanitarian Affairs; 2017 12. Recommendations for the transport of dangerous (https://www.unocha.org/sites/unocha/files/2017%20 goods, 19th edition. New York and Geneva: United Na- annual%20report.pdf, accessed 18 February 2019). tions; 2015 (https://www.unece.org/fileadmin/DAM/ 3. Types of disasters: definition of hazard [website]. Ge- trans/danger/publi/unrec/rev19/Rev19e_Vol_I.pdf, neva: International Federation of Red Cross and Red accessed 18 February 2019). Crescent Societies; 2019 (http://www.ifrc.org/en/what- 13. IHR core capacity and monitoring framework. Geneva: we-do/disaster-management/about-disasters/definition- World Health Organization; 2013 (http://apps.who.int/iris/ of-hazard/, accessed 18 February 2019). bitstream/10665/84933/1/WHO_HSE_GCR_2013.2_eng. 4. EM-DAT: International Disaster Database [web- pdf, accessed 18 February 2019). site]. Brussels: Centre for Research on the Epi- 14. The protocol additional to the Geneva conventions for demiology of Disasters; (https://www.emdat.be/, 12 August 1949, and relating to the protection of vic- accessed 18 February 2019). tims of international armed conflicts (Protocol I) of 8 5. International Health Regulations, third edition. Geneva: June 1977. Geneva: International Committee of the World Health Organization; 2005 (https://apps.who.int/ Red Cross; 1977 (https://www.icrc.org/ihl/INTRO/470, iris/bitstream/handle/10665/246107/9789241580496- accessed 18 February 2019). eng.pdf, accessed 31 March 2019). 15. National strategy for chemical, biological, radiological, nu- 6. Dzud national report 2009–2010. Ulaanbaatar: United clear, and explosives (CBRNE) standards [website]. Wash- Nations Development Programme and Swiss Agen- ington (DC): United States. Department of Homeland cy for Development and Cooperation; 2010 (https:// Security; 2010 (http://www.dhs.gov/national-strategy- www.academia.edu/2426652/How_Mongolian_herders_ chemical-biological-radiological-nuclear-and-explosives- affected_by_Dzud_natural_phenomena_2009-2010_ cbrne-standards, accessed 18 February 2019). government_and_pastoralists_disaster_management, 16. Treaty on the non-proliferation of nuclear weapons [web- accessed 18 February 2019). site]. New York (NY): United Nations Office for Disarma- 7. Jaykus L, Woolridge M, Frank J, Miraglia M, McQuat- ment Affairs; 2012 (http://www.un.org/disarmament/ ters-Gollop A, Tirado C. Climate change: implications for WMD/Nuclear/NPT.shtml, accessed 18 February 2019). food safety. Rome: Food and Agriculture Organization of 17. Technical guidance for monitoring and reporting on the United Nations; 2008 (http://www.fao.org/3/i0195e/ progress in achieving the global targets of the Sendai i0195e00.pdf, accessed 18 February 2019). Framework for Disaster Risk Reduction. Geneva: Unit- 8. EM-DAT: General classification [website]. Brus- ed Nations Office for Disaster Risk Reduction; 2017 sels: Centre for Research on the Epidemiology of (https://www.unisdr.org/we/inform/publications/54970, Disasters (https://www.emdat.be/classification, accessed 18 February 2019). accessed 18 February 2019). 9. Global environmental outlook 3: past, present and future perspectives [website]. Nairobi and London: United Nations Environment Programme; 2002 (https://wedocs.unep. org/bitstream/handle/20.500.11822/8609/GEO-3%20 REPORT_English.pdf?sequence=7&isAllowed=y, HEALTH EDRM FRAMEWORK HEALTH 24

ANNEX 2. COMPONENTS AND FUNCTIONS OF HEALTH EMERGENCY AND DISASTER RISK MANAGEMENT

Health EDRM encompasses a wide range of functions •• Integration of Health EDRM in policies in health and other sectors that collectively reduce the and legislation for specific components health risk and consequences of all types of hazardous (e.g. addressing Health EDRM in events including emergencies and disasters. These national and subnational policies for the functions form systems for managing risks at all health workforce, noncommunicable levels, which underscores the need for effective diseases, mental health, disability, coordination of these functions for successful Health hospitals, antimicrobial resistance, EDRM. The breadth of functions recognizes that many immunization). stakeholders contribute to, and need to be engaged in developing and implementing capacities for Health {{ CAPACITY DEVELOPMENT STRATEGIES EDRM. The focus here is mainly on the roles played by •• Capacity assessments (with reference the health sector and those that have direct effects on to the components and functions of this the performance of the health sector (e.g. multisectoral Health EDRM Framework) coordination, logistics). •• Strategies for capacity development for: ¬¬ Comprehensive Health EDRM Although not exhaustive, this Annex provides a (across and including the suggested list of functions; it is acknowledged that components and functions many other functions in health and other sectors according to national and contribute to improving health outcomes for people subnational priorities at risk of emergencies and disasters (e.g. land-use ¬¬ Specific components and functions planning, food production). Functions are grouped of Health EDRM as outlined in this into components that are derived from a number of annex sources including the health system building blocks, ¬¬ Specific hazards (e.g. cholera, multisectoral emergency and disaster management, radiation, air pollution, extreme and the IHR (2005) including epidemic preparedness temperatures, terrorism) and response. ¬¬ Implementation of global and regional frameworks (e.g. national POLICIES, STRATEGIES AND action plans for implementing 1LEGISLATION the IHR (2005), national and local disaster risk reduction strategies, {{ POLICIES, STRATEGIES, LEGISLATION national action plans for climate •• Legal frameworks for Health EDRM and change) multisectoral EDRM •• Integration of Health EDRM into: •• Health sector EDRM policies ¬¬ health systems development •• Multisectoral EDRM policies1 strategies •• Health and multisectoral policies for ¬¬ multisectoral emergency and specific hazards (e.g. cholera, chemical disaster risk management hazards, floods, road safety) development strategies •• Integration of Health EDRM in national/ ¬¬ climate change adaptation subnational health policies, strategies strategies. and plans and in national multisectoral development plans and policies

1Multisectoral functions are usually performed by national, subnational and local emergency and disaster management bodies

HEALTH EDRM FRAMEWORK HEALTH (e.g. national disaster management agencies). 25

PLANNING AND COORDINATION ¬¬ with other countries, regional and 2 (AT ALL LEVELS – NATIONAL, international actors SUBNATIONAL, LOCAL) •• IHR (2005) national focal points •• Budget for Health EDRM unit staff, {{ COORDINATION MECHANISMS coordinating bodies and related •• For developing and implementing programmes functions: policies, assessments, •• Coordination centres /Emergency planning, capacity development; operations centres. prevention, emergency preparedness, response and recovery operations; {{ PREVENTION AND MITIGATION PLANNING implementation; monitoring and AND COORDINATION reporting •• Plans for prevention and mitigation of •• Multisectoral coordination mechanisms risks at different administrative levels/ ¬¬ Health sector and multisectoral jurisdictions (e.g. national, subnational, Health EDRM local, community) ¬¬ All-hazards and hazard-specific •• Health sector at different jurisdictions •• Coordination of programme and project (e.g. national, subnational, district, local, management community) •• Programme/project monitoring, ¬¬ Inclusion of various health evaluation and reporting. programmes and disciplines ¬¬ Inclusion of other sectors {{ PLANNING AND COORDINATION FOR •• Cross-border, subregional, regional EMERGENCY PREPAREDNESS, READINESS and international mechanisms (e.g. for AND RESPONSE joint assessments, planning, capacity •• Pre-event response planning at all levels development (e.g. training), information (health sector and multisectoral) sharing (e.g. surveillance), operations, ¬¬ all-hazards response planning logistics) ¬¬ contingency planning for specific •• Regulations and protocols for events international assistance/rules of ¬¬ planning for specific situations engagement for external agencies. (conflict, mass gatherings) •• Coordination of preparedness/readiness {{ HEALTH EDRM UNITS IN MINISTRIES OF for response measures HEALTH •• Incident management systems, including •• Dedicated staff/unit to coordinate Health command, control, coordination and EDRM development and operational communications roles at different administrative levels •• Emergency operations centres and (community, local, subnational and networks national) •• Mass casualty management ¬¬ within health sector (across •• Needs assessments disciplines and jurisdictions) •• Surge capacity planning ¬¬ with other sectors •• Specific procedures – standing operating procedures (SOPs). HEALTH EDRM FRAMEWORK HEALTH 26

{{ RECOVERY PLANNING AND COORDINATION •• Licensing and accreditation of staff/ •• Pre-event recovery planning at all levels volunteers (health sector/multisectoral) •• Surge capacity planning for personnel •• Post-event recovery planning at all levels •• Safety and security of all personnel (health sector/multisectoral) (health and other sectors – in the •• Assessments workplace, in emergencies). •• Recovery coordination and management •• Transition planning FINANCIAL RESOURCES •• Post-event health system strengthening 4 •• Budget for Health EDRM programmes strategies (staff, activities/services, health supplies, •• Specific procedures and protocols hospitals and infrastructure, etc.) (SOPs). ¬¬ Specific programmes/services to fulfil Health EDRM roles {{ BUSINESS CONTINUITY MANAGEMENT •• Contingency funds for emergency •• Organizational risk assessments response and recovery •• Organizational response and recovery •• Financial arrangements for emergency plans care (e.g. cost waiver policies, treatment •• Staff health and welfare. of non-residents, medical repatriation) •• Social/health safety nets (access to {{ EXERCISES, SIMULATIONS health care, reducing financial barriers – •• Exercise management programme UHC, food assistance) •• Design, development and conduct of •• Compensation systems (e.g. long-term ¬¬ drills care for people affected by emergencies ¬¬ discussion exercises and disasters, insurance) ¬¬ field exercises •• Cash transfer mechanisms (e.g. •• Exercise evaluation vouchers) •• Update of plans, procedures and •• Resource mobilization. protocols •• Update of capacity development plans. INFORMATION AND 5 KNOWLEDGE MANAGEMENT HUMAN RESOURCES 3 •• Multidisciplinary workforce capacity in {{ RISK ASSESSMENTS place by occupational group •• Strategic emergency risk assessments •• Essential Health EDRM positions at (health and multisectoral) national and subnational level are filled •• Event risk assessments •• Workforce development strategies •• Hazard analysis (integration of Health EDRM functions •• Exposure analysis and competencies): •• Vulnerability analysis at national and ¬¬ general health workforce by level, by community levels profession, by occupational group •• Capacity assessments •• Training needs analyses •• Needs assessments before, during and •• Competency frameworks after emergencies •• Curriculum development •• Dissemination of risk assessments for •• Learning, training course delivery: use by policy-makers and practitioners. ¬¬ pre-service, in-service, university, community level HEALTH EDRM FRAMEWORK HEALTH 27

{{ EARLY WARNING AND SURVEILLANCE HEALTH INFRASTRUCTURE AND •• Indicator-based surveillance 7 LOGISTICS •• Event-based surveillance •• Multi-hazard early warning systems {{ LOGISTICS, SUPPLIES •• Early warning for different hazards •• Logistics systems (including cold chain •• Public health laboratories, diagnostics, for vaccines, specimen transport) characterization •• Essential supplies/medicines •• Epidemiological investigations. •• Health emergency kits •• Temporary health facilities {{ RESEARCH FOR HEALTH EDRM •• Stockpiling, warehousing, pre- •• Health EDRM research agenda positioning of supplies •• Case studies •• Transportation •• Operational research •• Telecommunications •• Research community for Health EDRM •• Security of operations •• Pharmaceutical development (e.g. drugs, •• Donation guidelines/emergency vaccines), equipment importation of medicines. •• Research ethics. {{ RESILIENT HEALTH FACILITIES (SAFE, {{ KNOWLEDGE MANAGEMENT – SUSTAINABLE, SECURE, SMART) TECHNICAL GUIDANCE AND SUPPORT •• Health facility standards and codes for •• Technical guidance existing and new health facilities •• Development of good practice/ •• Universal design (e.g. access for people guidelines/protocols with disabilities) •• Reviews and lessons learned •• Safe siting and construction •• Institutionalization of lessons •• Equipment, devices (safety, security, ¬¬ in training programmes maintenance) ¬¬ health systems improvement •• Emergency management (e.g. •• Local and indigenous knowledge. emergency preparedness and response: planning, training, exercises) {{ INFORMATION MANAGEMENT •• Infection prevention and control (in health •• Fundamental datasets facilities and other health-care settings) •• Operational information •• Patient isolation capacity •• Loss databases •• Decontamination •• Emergency reporting •• Energy efficiency, reduced carbon •• Standards. footprint •• Security of health facilities 1 RISK COMMUNICATIONS •• Surge capacity planning (e.g. staff, 6 •• Public communications supplies, equipment, lifelines) •• Media (e.g. engagement, training) •• Ensuring lifelines/support services •• Coordinated communication strategies (including water, staff welfare). •• Risk communication (e.g. public, health workforce, other sectors).

1Key functions linked to community Health EDRM including community engagement. HEALTH EDRM FRAMEWORK HEALTH 28

HEALTH AND RELATED SERVICES gatherings) 8 (BEFORE, DURING AND AFTER •• Prevention and control (services) at EMERGENCIES, INCLUDING points of entry ROUTINE, EMERGENCY AND •• Biosafety and biosecurity SURGE) •• Violence prevention (e.g. children, gender-based, older people) 1. HEALTH-CARE SERVICES •• Specialized programmes for •• Pre-hospital services/care subpopulations (e.g. poor, disability, ¬¬ Medivac services gender, age-specific, refugees, migrants). •• Primary care services •• Emergency care (NB. Refer to component on Information and •• Surgical care knowledge management for early warning •• Communicable disease prevention, and surveillance functions). control, care •• HIV/AIDS 3. SPECIALIZED SERVICES AND MEASURES •• Injury prevention and trauma care FOR SPECIFIC HAZARDS •• Mental health and psychosocial support •• Communicable disease outbreaks •• Sexual and reproductive health ¬¬ bioterrorism •• Maternal and neonatal health ¬¬ zoonotic diseases (One Health with •• Child health animal health) •• Adolescent health •• Antimicrobial resistance •• Care for the elderly •• Food safety •• Noncommunicable diseases •• Technological •• Laboratory and diagnostic services ¬¬ Chemical hazards and toxins •• Blood services ¬¬ Radiological hazards •• Rehabilitation services ¬¬ Transportation •• Emergency medical/health teams ¬¬ Cybersecurity •• Assistive products and services •• Conflict, violence, terrorism •• Palliative care. •• Natural hazards (e.g. extreme temperatures, volcano, flood) 2. PUBLIC HEALTH MEASURES •• Air pollution •• Health education and promotion •• Environmental degradation. •• Infection prevention and control •• Immunization programmes COMMUNITY HEALTH EDRM •• Management of the dead and missing 9 CAPACITIES •• Environmental health •• Risk awareness ¬¬ Water, sanitation, hygiene •• People-centred action (e.g. people, ¬¬ Vector control subpopulations with vulnerabilities) ¬¬ General and health care waste •• Health promotion management •• Community risk assessments •• Food security •• Individual and household measures •• Nutrition •• Community risk prevention and •• Societal measures, (e.g. quarantine, mitigation measures for urban, rural and school closures, cancellation of mass other settings HEALTH EDRM FRAMEWORK HEALTH 29

•• Emergency preparedness, operational •• Follow-up and implementation readiness, response and recovery of lessons/recommendation (e.g. planning for urban, rural and other updates of planning, training, capacity settings development) •• Training of local health workforce for •• Programme and project monitoring, Health EDRM (e.g. community health evaluation and reporting workers, nurses, family doctors) •• Statutory reporting at national/ •• Community health services (e.g. primary subnational/local levels health care, community-based clinical •• Reporting for SDGs, IHR (2005), Sendai care) Framework and regional frameworks •• First aid ¬¬ National focal points for IHR •• Community engagement/social ¬¬ Sendai Framework monitoring mobilization national focal points (multisectoral); •• Community support and networks. health focal points for Sendai Framework monitoring and MONITORING AND reporting 10 EVALUATION ¬¬ Focal points for SDG reporting •• Performance frameworks (performance •• Regional and global reports of country standards, indicators, specific targets) Health EDRM capacities (e.g. IHR •• Ethics frameworks State Parties Self-Assessment Annual •• Reviews (e.g. policy, planning, operational, Reporting, global survey of country after-action reviews, health services) capacities for Health EDRM). HEALTH EDRM FRAMEWORK HEALTH 30

ANNEX 3. LIST OF STAKEHOLDER GROUPS FOR HEALTH EMERGENCY AND DISASTER RISK MANAGEMENT

Effective Health EDRM requires the active participation subnational, local) of representatives of stakeholder groups who are •• Emergency services (e.g. fire, interested parties in the management of risks, for police, ambulance), national example, risk owners, groups with vulnerabilities, or hydrometeorological services groups with capacities to manage the risk. Some of the •• Military services, national security key stakeholder groups are listed below. Consideration committee. should be given to the involvement of these stakeholder groups at local, subnational, national, regional and {{ HEALTH (AT ALL LEVELS) international levels for Health EDRM (see also Health •• Ministries of health (departments, EDRM components and functions in Annex 2). programmes), health authorities, National Institutes of Public Health {{ COMMUNITY •• Health EDRM committees, IHR national •• At-risk populations, subpopulations or focal points groups with higher levels of vulnerability •• WHO collaborating centres according to the local context (e.g. the •• WHO Thematic Platform for Health poor, women, men, children, people with EDRM, WHO Platform for Health EDRM disabilities, older people, indigenous Research Network people, migrants, refugees and displaced •• Professional associations (e.g. medical, people) public health, nursing and midwives’ •• Survivors of emergencies and disasters associations, academies/colleges of •• Community groups, civil society medicine, World Association for Disaster organizations and networks (e.g. and Emergency Medicine) volunteer groups, community welfare •• Health-related NGOs and health groups, students, teachers, indigenous networks peoples, ethnic groups, faith groups, •• Health-care providers (public, private, youth, women, older people, disability, nongovernment sectors), local health health networks, community service workforce (e.g. family doctors, nurses, organizations, e.g. Rotary clubs). midwives, pharmacists), community health workers {{ GOVERNMENTS (AT ALL LEVELS) •• Hospitals and other health-care facilities •• Leaders, parliamentarians and •• Private sector health organizations and politicians professionals (health-care facilities, •• Government ministries and agencies health insurance, pharmaceutical). (e.g. health, social services, finance, planning, education, agriculture, foreign {{ OTHER GROUPS (IN HEALTH AND OTHER affairs, environment, infrastructure, SECTORS) public information, communications, •• Academia, universities, education and transport, defence, industry, tourism, training bodies, research institutes international development) •• Nongovernment and volunteer groups; •• National disaster management agency, faith-based groups; labour unions and multisectoral emergency/disaster groups management committees (national, •• Media, social media, new media HEALTH EDRM FRAMEWORK HEALTH 31

•• Community influencers, champions (e.g. African Union, Arab League, Asian for Health EDRM (e.g. musicians, sport Disaster Preparedness Center (ADPC), stars) Association of Southeast Asian Nations •• Private sector (privately owned water, (ASEAN), Caribbean Disaster Emergency food, power, telecommunications, Management Agency (CDEMA), Centro insurance, technology, hazardous facility de Coordinación para la Prevención de los managers, etc.), industry associations, Desastres Naturales en América Central transport y República Dominica (CEPREDENAC), •• Multinational companies (e.g. energy European Union (EU), Pacific Community, (power, fuel), communications, South Asian Association for Regional infrastructure, media) Cooperation (SAARC)) •• Global clusters, including the Global {{ UN, REGIONAL AND INTERNATIONAL Health Cluster ORGANIZATIONS •• Development cooperation partners, •• UN and specialized agencies, notably the donors FAO, UNDP, UNDRR, UNICEF, UN Office •• International NGOs, Red Cross/Red for the Coordination of Humanitarian Crescent Movement (IFRC, International Affairs (OCHA), UN Population Fund Committee of the Red Cross (ICRC)) (UNFPA), WHO, World Meteorological •• Regional and international centres for Organization (WMO), World Organisation health and multisectoral EDRM. for Animal Health (OIE) •• Regional intergovernmental and regional emergency management organizations HEALTH EDRM FRAMEWORK HEALTH

ISBN 978-92-4-151618-1