1. 9 th Dealing with Disasters Conference: A New Agenda for a New Era Introduction/Setting the scene Jonathan Abrahams Emergency Risk Management and Humanitarian Response Department WHO abrahamsj@who.int Phone: +41 22 791 4366

2. Basic outline 1.Health imperative for DRR 2.Successes and barriers to health 3.Strategy for strengthening health in the Sendai Framework 4.Emergency and Disaster Risk Management for Health 5.WHO Commitments/Actions 6.Future collective actions 7.How can we help health?

3. Health Imperative for Emergency and Disaster Risk Management (EDRM) Disasters from natural and technological hazards >100,000 killed/year Approximately 200 million affected/year – (including sick, injured) 172 million affected by conflict Plus epidemics and other biological hazards Other health issues Mental health Disability Damage to health facilities; disrupted services Health and vulnerability Poor health affects education, livelihoods, development

4. Health Imperative for EDRM (2) Health: in top 3 priorities for communities Health indicators measure losses & effectiveness of actions by all sectors Health as a bridge for effective DRR Core of social justice, right to health, worker’s health Health is a pre-requisite for DRR towards sustainable development

5. Key Success Factors for EDRM-H Sustained investment in long-term programmes with committed champions ▫stable EDRM-H unit in MoH – all hazards ▫full-time professional staff and defined budget. Health well-coordinated and respected by multisectoral actors Window of opportunity after major emergencies and disasters Leveraging resources for one hazard to build all-hazards systems WHO support to countries for stronger preparedness - (Latin America & Caribbean, Bangladesh, Iran, Nepal, Philippines, Viet Nam, Morocco)

6. Barriers to promoting health in DRR/DRM People’s health not explicit primary purpose of DRM Reference to “social” outcomes and saving lives - BUT injury, illness, disability, continuity of services missing Health as a sector - not an outcome and human right, BUT all other sectors contribute to health. Epidemics/pandemics cause emergencies/disasters, not usually in DRR. Response & recovery role in DRR and better outcomes missed Health voices absent from multisectoral forums on EDRM Only 3 references to health in the Hyogo Framework!

7. Key lessons/challenges for health for the implementation of the HFA and practice 1.Increase exposure & number of people affected = increase health risks & demands on health system 2.Health effects = “mortality”plus injury, disease, disability, mental health, and effect on social function 3.Global/national progress on safe hospitals; variable national progress on policy, risk assessment, education, preparedness 4.WHO – AFRO: African Regional Strategy for DRM; WHO Eastern Mediterranean Region support for Member States 5.Limited resources to support development of DRM-H capacity 6.Need for a holistic framework – emergency and disaster risk management that links: 1.All-hazards approach – natural/biol, tech, societal 2.Linking prevention, preparedness, response and recovery 3.Linking DRM H – to health systems, IHR 4.Recognises that all sectors/disciplines contribute to health outcomes

8. Integrating EDRM and Health - countries National emergency preparedness (or DRM) plans: 130 WHO Member States Safer Hospital Programmes 80 MS taking action on Safer Hospitals 4,000 hospitals assessed Structural, non-structural, hospital preparedness International Health Regulations (2005) > 60 have established the necessary core capacities Active in global and regional platforms – thematic platform for EDRMH (2009)

9. 5 key messages to strengthen health in the 2015 framework for DRR (Sendai) ISSUE RESULT Make people’s health and well-being an explicit outcome +++ Targets and indicators for DRR focus on health +++ An all-hazards approach including biological hazards ++ Strengthen action and investment in health/other sectors ++ Safe Hospitals Initiative as a global priority for action +++

10. Key messages for health at the centre of the post-2015 Framework for DRR 1.Health, not just saving lives, as an explicit outcome of DRR 2.An all-hazards approach (including epidemics and pandemics) 3.Safe Hospitals Initiative as a priority action 4.Greater investment in health & related sectors 5.Targets and indicators focus on health

11. Other key messages to strengthen (health in) DRR ISSUE RESULT Principles – multisectoral, multidisciplinary, people-centred, based on ethical norms etc ++ Attention to emerging/neglected issues for DRR (and groups) ++ Local events, small scale emergencies & large-scale disasters ++ Promoting Science and Research +++ Risk management preferable to DRR ++ Focus on Community Priorities – education, health, responsive government ++

12. Recommendations to strengthen the reference(s) to health in the pre-zero draft framework for disaster risk reduction Also: Construct/review framework through “health lens”, environmental, economic and cultural lenses Use peoples health more often in the text Disaster risk management framework that integrates response and recovery. All hazards framework that integrates biological hazards. Preamble messages. Disasters measured in terms of health and human consequences Health as a pre-requisite for DRM and sustainable development Health as a bridge for effective DRM Health at the core of social justice, including people’s right to health, health of workers at risk of emergencies

13. 3 rd World Conference on Disaster Risk Reduction 6500 delegates, 100+ Ministers, 900 media, 150,000 participants in Public Forum Sendai Framework, Declaration, Commitments 2 Health Working Sessions ▫DRM for healthy societies ▫Reducing risks of pandemics and epidemics Public Forum ▫Protecting people’s health from disaster risks

14. Sendai Framework for Disaster Risk Reduction I. Preamble II. Expected outcome, goal, 7 targets III. Guiding principles IV. Priorities for action V. Role of stakeholders VI. International cooperation and global partnership

15. Sendai Framework for DRR Preamble to Outcome and Goal 16. … a substantial reduction of disaster risk requires perseverance and persistence, with a more explicit focus on people and their health and livelihoods, and regular follow-up. Sendai Outcome The substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries Sendai Goal Prevent new and reduce existing disaster risk through the implementation of integrated and inclusive economic, structural, legal, social, health, cultural, educational, environmental, technological, political and institutional measures that prevent and reduce h azard exposure and vulnerability to disaster, increase preparedness for response and recovery, and thus strengthen resilience

16. Sendai Framework for DRR – 7 Targets (a)Substantially reduce global disaster mortality by 2030, (b)Substantially reduce the number of affected people globally by 2030, (c)Re duce direct disaster economic loss in relation to GDP by 2030. (d)Substantially reduce disaster damage to critical infrastructure and disruption of basic services, among them health and educational facilities, including through developing their resilience by 2030. (e)Substantially increase the number of countries with national and local DRR strategies by 2020. (f)Substantially enhance international cooperation to developing countries through adequate and sustainable support to complement their national actions for implementation of this framework by 2030. (g)Substantially increase the availability of and access to multi-hazard early warning systems and disaster risk information and assessments to the people by 2030.

17. Sendai Framework for DRR – 4 Priority Areas 1.Understanding disaster risk 2.Strengthening disaster risk governance to manage disaster risk 3.Investing in DRR for resilience 4.Enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation and reconstruction

18. 30++ references to health in Sendai Framework 28 (d) Promote transboundary cooperation …. reduce disaster risk, including epidemic risk; 30 (i) Enhance the resilience of national health systems, -integrating DRM into primary, secondary and tertiary health care; -developing the capacity of health workers in understanding disaster risk and applying and implementing DRR approaches in health work; -…. enhancing training capacities in the field of disaster medicine; -supporting … community health groups in DRR … with other sectors, -implementation of the International Health Regulations (2005) 31(e) Enhance cooperation between health authorities and stakeholders -to strengthen country capacity for DRM for health, -implementation of IHR and building of resilient health systems

19. References to health in Sendai Framework 3o(i) Strengthen … access to basic health care services, incl maternal, newborn & child health, sexual & reproductive health, food security & nutrition 30(k) People with life threatening and chronic disease … should be included in the design of policies and plans to manage their risks before, during and after disasters, including having access to life-saving services 33(c) Promote the resilience of new and existing critical infrastructure, … hospitals and other health facilities, to ensure that they remain safe, effective and operational during and after disasters … provide live-saving and essential services 33(n) Establish a mechanism of case registry and a database of mortality caused by disaster …to improve the prevention of morbidity and mortality; 33(o) Enhance recovery schemes to provide psychosocial support and mental health services for all people in need

20. Integrating EDRM and Health - countries National emergency preparedness (or DRM) plans: 130 WHO Member States Safer Hospital Programmes 80 MS taking action on Safer Hospitals 4,000 hospitals assessed Structural, non-structural, hospital preparedness International Health Regulations (2005) > 60 have established the necessary core capacities Active in global and regional platforms – thematic platform for EDRMH (est 2009); WCDRR

21. The future: Emergency & Disaster Risk Management for Health – a policy framework  Better health outcomes for people at risk of emergencies and disasters.  Countries and communities with strongercapacities for EDRM  Builds on health systems, disaster management, International Health Regulations  Based on risk management approach, 5 guiding principles, 6 concrete programme priorities, and 9 essential capacities  Assists countries to implement the health aspects of the Sendai Framework for Disaster Risk Reduction (2015-2030)

22. Emergency & Disaster Risk Management for Health – changing the paradigm? FromTo Event-basedRisk-based ReactiveProactive Single-hazardAll-hazard Hazard-focus Vulnerability and capacity - focus Single agency Whole-of- society/multisectoral Separate responsibility Shared responsibility of health systems Response-focusRisk management Planning for communitiesPlanning with communities World Congress for Disaster & Emergency Medicine

23. Emergency Risk Management for Health (EDRM-H) Vision Improved health outcomes for people at risk of emergencies and disasters. Expected Outcome Countries and communities with better capacities to manage the health risks associated with emergencies and disasters. A new paradigm Adopting a risk management approach Bridge health and multisectoral ERM Draws on multisectoral EM, DRR, IHR, health systems World Congress for Disaster & Emergency Medicine

24. Risk Management Policy Framework 5 guiding principles:  Comprehensive approach across the emergency management cycle.  All-hazards approach  Inter-sectoral collaboration  Community participation and resilience  Integration of EDRM-H within health system strengthening

25. 9 Essential Capacities of EDRM-H 1.Policies, legislation and strategies 2.Planning and coordination 3.Human resources 4.Financing 5.Information and communications 6.Monitoring and evaluation 7.Health infrastructure and logistics 8.Health and related services 9.Community capacities for EDRM-H

26. WHO commitments/actions for EDRM-H  Communicate Sendai Framework; global implementation plan for health  EDRM-H Policy to be signed off with guidance developed  Technical assistance to Member States: risk and capacity assessments strengthening capacities for the International Health Regulations (2005) & surveillance emergency preparedness  Safe Hospitals Initiative / Smart Hospitals  WHO-WMO Climate and Health Office  Strengthening capacities in recovery World Congress for Disaster & Emergency Medicine

27. WHO commitments to support Member States 1. Risk & Capacity Assessments 2. Surveillance, Early Warning & Alert 3. International Health Regulations (2005) 4. Preparedness for Response 5. Safe Hospitals 6. Strengthening health relationship with NDMA

28. Sendai Framework: Going forward for health? Health in all multisectoral DRM policies, plans, programmes monitoring and reporting of Sendai FDRR Health sector Awareness and communication on the Sendai Framework Apply Sendai FDRR & scale up capacity development for EDRMH Health policies and programmes include EDRMH Mobilise resources at local, national, regional, global levels Strengthen the thematic platform on EDRM-H

29. “Proposals to strengthen references to health in the pre-zero draft for the post-2015 framework for DRR Scope All hazards: Natural hazards, such as hydro-meteorological, geological and biological hazards, technological (including industrial) hazards, and to the risks from climate change. Epidemics and pandemics (due to biological hazards) have the potential to overwhelm local and national resources and cause widespread health, social, economic and environmental outcomes. Appropriate ways to address societal hazards, such as conflict, social unrest and financial crises, linked with other hazards, commonalities with managing other risks. Comprehensive risk management: all measures to manage risks, including prevention, preparedness, response and recovery: All measures that reduce risks and lead to the desired outcomes and targets - before, during and after events. Combination of risk prevention, preparedness, response and recovery Multi-hazard or “all hazards” approaches required

30. Sendai Framework: Going forward for health? How will the Sendai Framework and EDRM-H protect people’s health? How can you contribute to better health outcomes through emergency and disaster risk management for health? What would you like to see from WHO? And the UN system? How can we help each other?

31. “Proposals to strengthen references to health in the pre-zero draft for the post-2015 framework for DRR Outcomes Strengthening outcomes – Need to include health and wellbeing explicitly among the outcomes Health and wellbeing should be made an explicit outcome, alongside social, economic and environmental outcomes. Saving lives could be maintained, but health should be made an explicit outcome. Deaths, injury, illness, disability, malnutrition and other chronic health conditions that affect school attendance, food and nutrition security, sustainable livelihoods and other social functioning. Emphasise role of all community groups, including women and youth Measurement of indicators, targets and outcomes - disaggregation of data by sex, age and disability wherever possible. Targets Health outcomes Support for reducing mortality due to disasters; and people affected Accompanied by injury, illness, disability, psycho-social consequences, social functioning Safe hospitals Support the target on reducing infrastructure loss by focussing on schools and hospitals. Essential and valuable community and national asset Feasible to measure than other forms of infrastructure

32. “Proposals to strengthen references to health in the pre-zero draft for the post-2015 framework for DRR Principles Comprehensive risk management: Managing risk rather than managing events. Reduce hazards, vulnerabilities and exposures, and strengthening capacities Prevention, preparedness, response and recovery measures to reduce risks to health, social and economic development, and the environment All-hazards: Many action to reduce risks are the same or similar for different types of hazards, risks and events. Strengthen elements, sectors and systems for all types of hazards – natural (hydro- meteorological, geological, biological), technological and societal hazards. Multisectoral integration: Whole of society approach under the leadership of government(s) All sectors of government, private sector, and communities Each sector should integrate disciplines within the sector, collaborate with other sectors. Integration optimises resources available to reduce risks at different and all levels.

33. “Proposals to strengthen references to health in the pre-zero draft for the post-2015 framework for DRR Priority Actions A health lens could be brought to priority actions to emphasize for multi-sectoral collaboration to achieve health outcomes and address health issues. All sectors and stakeholders should address the needs of groups whose vulnerabilities are associated with their health status, including the aged, people with disabilities, pregnant and lactating women, children, people with communicable and non-communicable diseases, migrants and displaced persons. All sectors and stakeholders should work together to reduce risks associated with biological hazards, epidemics and pandemics, ▫makes reference to the International Health Regulations (2005) as an allied global framework for strengthening national capacities for and responding to epidemics and pandemics of international concern.

34. “Proposals to strengthen references to health in the pre-zero draft for the post-2015 framework for DRR Priority Actions Strengthen action and resources to enhance resilience of health systems and develop the capacity of the health sector in disaster prevention, preparedness, response and recovery to: integrate DRR practice in primary health care at local level/health systems develop institutional capacity/scale up good practice across health develop the capacity of the health workforce for DRR support community health groups (e.g. support groups for people with specific diseases, elderly, people with disabilities, children, women, men) ▫vital information on vulnerability and capacities of their communities. improve local/national health emergency, preparedness, response, recovery ▫local disaster health response and international coordination (e.g medical teams) ▫psychosocial support ▫access to basic health services (e.g. reproductive health) ▫compliance with the International Health Regulations (2005) ▫building back safer and more resilient health services, hospitals and other infrastructures in recovery and reconstruction.

35. “Proposals to strengthen references to health in the pre-zero draft for the post-2015 framework for DRR Priority Actions Establish the Safe Hospitals Initiative as a global priority for action to ensuring that new and existing health facilities remain operational in emergencies and disasters. Health facilities, especially hospitals, are critical assets for communities before, during and after emergencies and disasters 77 countries report action to make hospitals safe and operational in emergencies and disasters, Scale up implementation of the Safe Hospitals Initiative, national safe hospital programmes and actions to: ▫protect patients and health workers; ▫protect the physical integrity of hospitals and health facilities, including building and retrofitting new and existing hospitals safely and protecting critical systems and equipment; ▫prepare hospitals to function and provide appropriate levels of healthcare in times of emergencies and disasters.

36. DRM and the SDGs for Health SDG for health focus on: 1.Universal health coverage 2.Millenium Development Goals 3.Non-communicable diseases Proposed Health SDG in Open Working Group Report contains: Early warning, risk reduction and management of national and global health risks

37. More information at: http://www.who.int/hac/techguidance/preparedness/en/ Jonathan Abrahams WHO HQ abrahamsj@who.int Ph: +41 22 7914366 Further information