Strengthening hospital resilience in the Eastern Mediterranean Region.

"Adaptation is surviving but resilience is for thriving."In recent years, the multiple threats of COVID-19 and other disease outbreaks, intensified climate change and severe weather events, and increasing conflicts and humanitarian emergencies have highlighted the need to strengthen resilience in the different sectors, including social, economic, environment, and health. Resilience is the ability of a system, community or society exposed to hazards to resist, absorb, accommodate, adapt to, transform, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions through risk management.

Genomic sequencing for epidemic and pandemic preparedness and response: EMRO's vision and strategic interventions.

Whole-genome sequencing (WGS) is an approach for studying and analysing the entire genomic sequence of pathogens. It provides the most comprehensive characterization of an organism's genetic make-up. In January 2020, scientists used next-generation sequencing (NGS) as one of several sequencing technologies to study severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to reveal the first genetic makeup of this new virus only 11 days after the first cluster of cases due to the COVID-19 pandemic was reported. This crucial information was vital to the subsequent rapid development of test kits, vaccines and treatment regimens to respond to the pandemic. The sequencing information, later as the pandemic evolved, became essential for informing public health policies through monitoring and characterization of SARS-CoV-2 variants.

Solidarity in response to COVID-19 outbreak in the Eastern Mediterranean Region.

The coronavirus disease 2019 (COVID-19) outbreak that began in Wuhan, Hubei Province, China in late 2019 has spread globally within a few months. The Director General of the World Health Organization (WHO) declared the COVID-19 outbreak to be a public health emergency of international concern (PHEIC) after the second meeting of the IHR (2005) Emergency Committee on 30 January 2020. On 12 March 2020, the outbreak of COVID-19 was characterized as a pandemic.

Public health emergency operation centres: status, gaps and areas for improvement in the Eastern Mediterranean Region.

The functionality of Public Health Emergency Operations Centres (PHEOCs) in countries is vital to their response capacity. The article assesses the status of National PHEOCs in the 22 countries of the Eastern Mediterranean Region. We designed and administered an online survey between May and June 2021. Meetings and Key Informant Interviews were also conducted with the emergency focal points in the WHO country offices and with other select partners. We also collected data on PHEOCs from the Joint External Evaluations conducted in the Region between 2016 and 2018 in 18 countries, and intra-action review mission reports conducted in 11 countries to review the response to COVID-19 during May 2020-June 2021 - and other relevant mission reports. Only 12 countries reported having PHEOC with varying levels of functionality and 10 of them reported using PHEOC for their response operations. This review formed the baseline of capacity requirements of National PHEOC in each country and will facilitate identifying benchmarks of areas of improvement for future national, WHO and partners support.

'Health for All by All' during a pandemic: 'Protect Everyone' and 'Keep the Promise' of Universal Health Coverage in the Eastern Mediterranean Region.

The Universal Health Coverage (UHC) Day has been commemorated on 12 December every year since 2017. In 2019, the theme of the day was "Keep the Promise", referring to the Political Declaration on UHC endorsed by Heads of States at the United Nations General Assembly High-Level Meeting on 23 September 2019. In 2020, the theme is "Protect Everyone", emphasizing global and individual health security in the context of the COVID-19 pandemic, attributed to SARS-CoV 2 - a virus that infected more than 4 million people in the Eastern Mediterranean Region (EMR) and left over 100 000 dead in less than 12 months (6.6% and 7.1% of the global toll, respectively). Keeping the promise of UHC, while ensuring health security, is becoming a priority agenda of policy-makers and practitioners in the EMR in order to save lives, advance health and protect livelihoods.

From health emergency preparedness to response action: a long journey in Lebanon.

Emergency preparedness is a critical pillar of the International Health Regulations (IHR), a legally binding instrument underlying the global health security regime that came into effect in 2005. Lebanon, a small country of 10 452 km2 bordering the eastern Mediterranean, ratified the IHR in 2007 after the devasting effects of a sudden military conflict in 2006 that severely impacted the recovering health system. Moreover, the Lebanese health system infrastructure was only just recovering from 15 years of civil war that ended in 1990. Since 2005, the country has also faced a complex refugee crisis potentiating the risk of disease outbreaks since 2011, in addition to a severe financial crisis that has degenerated into social unrest since October 2019, and more recently the COVID-19 pandemic since February 2020.

"Social Distancing" Amid a Crisis in Social Isolation and Loneliness Solidarity in response to COVID-19 outbreak in the Eastern Mediterranean Region

The coronavirus disease 2019 (COVID-19) outbreak that began in Wuhan, Hubei Province, China in late 2019 has spread globally within a few months. The Director General of the World Health Organization (WHO) declared the COVID-19 outbreak to be a public health emergency of international concern (PHEIC) after the second meeting of the IHR (2005) Emergency Committee on 30 January 2020. On 12 March 2020, the outbreak of COVID-19 was characterized as a pandemic.

Coronavirus Disease 2019 outbreak: preparedness and readiness of countries in the Eastern Mediterranean Region.

On 31 December 2019, a cluster of acute respiratory illness was reported from China and later confirmed as novel coronavirus on 7 January 2020. This virus is the same member of the coronavirus family that caused the severe acute respiratory syndrome (SARS-CoV) reported in China 2003, and Middle East respiratory syndrome (MERS-CoV) reported in Saudi Arabia in 2012. The initial cases have been linked to a live seafood market in Wuhan, China, and the specific animal source is yet to be determined. The detection of this new virus in humans without knowing the source of the infection has raised greatly heightened concerns not only in China, but also internationally. To date, the outbreak has spread to most provinces in China and 25 other countries within a relatively short period. Consequent to its spread, Dr Tedros Ghebreyesus, Director General of the World Health Organization (WHO), declared the outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020.

Responding to health emergencies in the Eastern Mediterranean region in times of conflict

WHO's Eastern Mediterranean region (EMR) is facing emergencies on a scale that is perhaps unprecedented in its history. There is armed conflict in 12 of the region's 22 countries.1 , 2 The region's 680 million people3 represent 9% of the global population, yet the EMR is home to 43% of those who need humanitarian assistance4 and is the source of 64% of the world's refugees.5 The health effects of these crises are immense. Direct health consequences include trauma-related deaths and disability, gender-based violence, and mental disorders. Disruption of health systems contributes to increased morbidity and mortality from infectious diseases, malnutrition, obstetric complications, and non-communicable diseases (NCDs). Health indicators in the EMR are among the worst in the world.6 State fragility and conflict are among the biggest challenges to attainment of Sustainable Development Goal 3.7 Conflict is a global health security threat because affected countries are less able to prevent, detect, and respond to disease outbreaks. More than 70% of disease outbreaks worldwide occur in fragile and conflict-affected settings.8 Yemen has experienced the largest cholera outbreak in history.9 During the second half of 2019, there were six concurrent disease outbreaks in Sudan.10 Wild polio virus returned to Syria due to conflict,11 while Afghanistan and Pakistan are two of three countries where the virus remains endemic.12 The average International Health Regulations (IHR) core capacity score is much lower for the 12 conflict-affected countries than for the other countries in the region,6 placing them at greater risk of spread and public health consequences of the ongoing outbreak of coronavirus disease 2019 (COVID-19) and other epidemic-prone diseases. WHO's global COVID-19 strategic preparedness and response plan13 therefore prioritises countries with weak health systems for technical and operational support from international partners. COVID-19 has already affected ten countries in the region, as of Feb 28, 2020, including Afghanistan, Iraq, and Pakistan.