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iii
TABLE OF CONTENTS
FOREWORD v
ACKNOWLEDGEMENTS vi
ABBREVIATIONS viii
EXECUTIVE SUMMARY ix
01. INTRODUCTION 1
08. CONCLUSION 18
REFERENCES 19
ANNEXES 21
FOREWORD
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
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
HEALTH EDRM FRAMEWORK
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.
viii
ABBREVIATIONS
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 emer-
gencies 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 have strengthened capacities to re- sectors who are working to reduce health risks and
duce 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 dif-
HEALTH EDRM FRAMEWORK
ferent 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
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 {{ P O L I C I E S , S T R AT E G I E S A N D
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. {{ PL ANNING AND COORDIN ATION:
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: {{ INFORM ATION 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; {{ H E A LT H I N F R A S T R U CT U R E A N D
{{ 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.
HEALTH EDRM FRAMEWORK
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.
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
1
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 sourc-
es 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
HEALTH EDRM FRAMEWORK
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.
1
The 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.
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
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
HEALTH EDRM FRAMEWORK
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, technologi-
cal and societal hazards: a range of risk man-
agement measures are employed (e.g. primary
prevention and recovery in addition to emer-
4
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
HEALTH EDRM:
VISION, EXPECTED OUTCOME AND
GUIDING PRINCIPLES
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
8
1
The 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).
5
9
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,
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, telecommunica-
tion 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 re-
spond 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,
HEALTH EDRM FRAMEWORK
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 de-
velopment 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
HEALTH EDRM FRAMEWORK
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,
1
National 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.
2
The 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/).
3
For 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
Monitor; Capacity for Disaster Reduction Initiative (CADRI Partnership); and the Inter-Agency Standing Committee (IASC) Pre-
paredness for Response.
13
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.
HEALTH EDRM FRAMEWORK
1
For 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 in-
telligence (epidemic intelligence from open sources (EIOS), Global Public Health Intelligence Network (GPHIN)); disease-specific
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. p l a n n i n g , a n d re s o u rc e a l l o c a t i o n
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
HEALTH EDRM FRAMEWORK
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
HEALTH EDRM FRAMEWORK
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 EDRM FRAMEWORK
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,
17
1
IASC 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.
8
18
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 strat-
egies and specific actions to manage the wide
range of risks of emergencies, general strengthen-
ing of a country’s health system, rooted in primary
health care, is also crucial.
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the economic case for action. Washington (DC): accessed 22 May 2019).
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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 EDRM FRAMEWORK
GENERIC 1. 2. 3.
GROUPS1 NATURAL HUMAN-INDUCED2,3 ENVIRONMENTAL
3.1
1.1 1.2 1.3 1.4 2.1 2.2
GROUPS ENVIRONMENTAL
GEOPHYSICAL4 HYDRO-METEOROLOGICAL BIOLOGICAL5 EXTRATERRESTRIAL4 TECHNOLOGICAL SOCIETAL
DEGRADATION17
Earthquake: 1.2.1 1.2.2 1.2.3 Airborne Impact: Industrial hazards:8 Acts of Erosion
SUBGROUPS - ground-shak- diseases - airburst - chemical spill violence
HYDROLOGICAL4 METEOROLOGICAL4 CLIMATOLOGICAL4
ing - meteorite - gas leak Deforestation
Waterborne - radiation [radiologi- Armed con-
MAIN TYPES Tsunami diseases Space weather: cal, nuclear] flicts:14 Salinization
Flood: Storm: Drought
Main types - energetic - interna-
- riverine flood - extratropical Structural collapse:
Mass movement Vector-borne particles tional Sea level rise
-SUBTYPES - flash flood storm Wild fire: - building collapse8,9
(geophysical diseases - geomagnetic - non-inter-
- coastal flood - tropical cy- - land fire [e.g. - dam/bridge failures
trigger): storms national Desertification
- subtypes - ice jam flood clone [cyclonic brush, bush,
[SUB-SUBTYPES] - landslide Foodborne - shockwave Occupational hazards
wind, cyclonic pasture]
- rock fall outbreaks7 - mining Civil unrest Wetland loss/
Mass movement rain, cyclone - forest fire
- subsidence degradation
[sub-subtypes] (hydro-meteoro- (storm) surge] Transportation:8,11
Glacial lake out- Insect infesta- Stampede
logical trigger): - convective - air, road, rail, water,
Liquefaction tion:4 Glacier retreat/
- landslide storm [torna- burst (flood) space
- grasshopper Terrorism: melting
- avalanche do, wind, rain,
Volcanic activity: - locust Explosions - chemical,
(snow) winter storm,
- ash fall biological, Sand encroach-
- mudflow blizzard, dere- Fire8
- lahar Animal diseases radiological, ment
- debris flow cho, lightning,
- pyroclastic nuclear, and
thunderstorm, Air pollution:9
flow Plant diseases explo-
Wave action: hail, sand/dust - haze10
- lava flow sives15,16
- rogue wave storm]
Aeroallergens Infrastructure disrup-
- seiche
tion: Financial
Extreme tem-
Antimicrobial - power outage11 crises:
perature:
resistant micro- - water supply - hyper-infla-
- heatwave
organisms - solid waste, waste tion
- coldwave
water - currency
- severe winter
Animal-human - telecommunication crisis
condition [e.g.
contact
snow/ice, frost/ Cybersecurity
- venomous
freeze, dzud]6
Hazardous materials
Fog in air, soil, water:12,13
- biological, chemical,
radiological
Food contamination7
22
23
SOURCES
1
Multisectoral functions are usually performed by national, subnational and local emergency and disaster management bodies
(e.g. national disaster management agencies).
25
{{
••
EARLY WARNING AND SURVEILLANCE
Indicator-based surveillance 7 HEALTH INFRASTRUCTURE AND
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 •• S t o c k p i l i n g , w a re h o u s i n g , p re -
•• 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
6 RISK COMMUNICATIONS1
•• Public communications
•• Surge capacity planning (e.g. staff,
supplies, equipment, lifelines)
HEALTH EDRM FRAMEWORK
1
Key functions linked to community Health EDRM including community engagement.
28
10 MONITORING
EVALUATION
AND
¬¬
reporting
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
30