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

ABSTRACT

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.