1. Complex Emergency Response: Are We Prepared? Lebanon Experience Seventh Global Measles Partners Meeting 27 – 28 th February 2007, Washington D.C. Dr. Mirza, Imran Raza, MBBS, MSc UNICEF Lebanon Dr. Edward Hoekstra, MD, MSc, UNICEF HQ Dr. Jeff McFarland, MD, UNICEF HQ Dr. Peter Carrasco, MD, WHO, Geneva

2. 12 July 2006 Man Made Disaster

3. 350,000 bombs were dropped on Lebanon

4. Damage to Infrastructure Yaroun Health Centre, South Lebanon Kafra Dispensary, South Lebanon Courtesy WHO Lebanon Beirut

5. Photo Dina Debbas

6. single most important “ Immunization of children against measles is probably the single most important ( and cost - effective ) preventive measure in emergency - affected populations, especially those living in camps ” M Toole and R Waldman Annu. Rev Public Health 1997;18-283-312

7. EPI Program Lebanon EPI program is led by MoPH, with UNICEF, WHO, MOSA and NGOs active partners since 1987 The national schedule includes vaccinations against Polio, Measles, MMR, DPT – HepB - Hib (penta recently introduced) BCG not given to Lebanese children but to Palestinian ones only Different public and private EPI calendars Private sector cover 60% of the immunization activities –buys vaccines at market price Routine program MCV is between 80% to 90% for 2005 – 2006

8. Reported confirmed Measles cases by Districts 2004 – 2006

9. Measles Cases by Month and Year 2003 - 2006 Cases Crises 20032004200520062007

10. Percentage Year Measles cases by age groups 2003 - 2006

11. Measles cases by vaccination status 2003 - 2006 Percentage

12. Pan Arab Population and Family Survey (PAPFAM) Results 2004 PAPFAM survey conducted in 2004 reported 53% measles coverage Coverage disparities at Governorate level

13. Emergency Response for Measles Vaccination Ongoing measles transmission Children between 9 months and 14 years of age in IDP centers were vaccinated 60,000 children vaccinated

14. Challenges during Response One million population forced to flee their homes - moving from one part of the city to another as the bombing continues. - Around 130,000 in 823 schools and other public locations - 565,000 with relatives and friends Links with outside world blocked Competing priorities – shelter, water, food, etc Immediate return of displaced population after ceasefire

15. Challenges during Response (Cont…) Fragile Health system specially EPI Lack of Human resources Weak Managerial capacity of the Ministry Destroyed health facilities and cold chain equipment Disparity of civic society and lack of coordination

16. No major outbreaks Rapid implementation of life saving interventions UN and partners key in protecting children Conclusion Measles emergency response “.. it is one of the worst places in the world in terms of getting aid to those most in need …” Jan-Egeland

17. “Back to Immunization”

18. Post Crises EPI Activities Cold chain assessments conducted New cold chain equipment supplied Routine EPI activities re-vitalized Considering low vaccination coverage, poor sanitation conditions, population movement, two rounds of Polio NIDs conducted (92% coverage)

19. Next Plans Nationwide MR (measles – rubella) vaccination campaign – Fall 2007 –Target age: 9 mnths – 14 years age –Target population: 1.2 million Development of National EPI Policy and plan of actions Bridging Public-Private partnership Introducing RED approach

20. Thanks for saving my life