WASHINGTON, DC — A senior World Health Organization (WHO) official on Wednesday called 2013 an “unprecedented period” in terms of humanitarian disasters, with crises in South Sudan, the Central African Republic, and Syria overwhelming the system.
“I’ve been in this field for over twenty years and I’ve never had a twelve month period like we’ve had the last year,” Dr. Richard J. Brennan, Director of Emergency Risk Management and Humanitarian Response at the WHO, told a press briefing in Washington on Wednesday. Under the WHO’s grading system, Brennan said, one or two “Level 3″ emergencies — events that completely overwhelm local capacity to provide health services, an “all-hands on deck” for aid workers — can be expected every three to four years. The last 13 months have seen four, including the typhoon in the Philippines, leaving the humanitarian agencies stretched to capacity.
And despite the staggering number of crises happening simultaneously, funding has been hard to come by — the U.N.’s unprecedented $13 billion request for crises around the world is still vastly underfunded. The problem becomes even worse when it comes to the situations that receive less attention in the media: of the $8 million the WHO has requested to provide critical care in South Sudan, the organization has only received 23 percent; the Central African Republic has only seen 11 percent of the $16 million funding request come in. These “forgotten crises,” Brennan continued, drop further in coverage due to attention being diverted to the current crisis in Ukraine. “Geopolitically, there’s not a lot of interest there, but from a humanitarian perspective there are enormous needs,” he said.
Michelle Gayer, the WHO’s coordinator for Surge and Crisis Support, added that complexities of the health care sector make it more difficult to deliver than other forms of assistance — particularly when a country’s system has been decimated. “Food can be airlifted and dropped, and the average person knows what to do with food,” she said. “You can’t just drop medicines. You need to be diagnosed, you need to be treated, you need to be followed up.” In places like Syria, where the medical community was on par with those seen in the West, Gayer said, local NGOs and practitioners can be supported enough to fill those gaps.
In the CAR, a different take is needed. Seventy camps in the capital city in Bangui house thousands of people who had to flee their homes in the midst of continuing communal violence. The state has effectively collapsed, leaving the World Health Organization doing more to fill the gaps in health service than would normally be expected of the organization, which leaves operational missions to NGOs and other arms of the United Nations system. The violence has also meant that most of the health workers who would normally work in more rural communities have withdrawn from the field into Central African cities, leaving the population outside city limits without adequate care.
And interim CAR president Catherine Samba-Panza’s government has no money with which to pay health workers, some of whom have gone six months without collecting a salary. That leaves the WHO, in the words of Gayer, as the provider of last resort, leveraging what money it has to prevent outbreaks of infectious diseases, treat chronic ails, and provide maternity care to pregnant women in Internally Displaced Person camps. As part of the strategy in CAR, the WHO is coordinating with NGOs on the ground to pay the salaries — or “incentives” in the parlance of the community — of health workers who remain at their posts. A large part of that process was standardizing the amount of pay across the field, “so the guy at the Save the Children clinic doesn’t hear that the guy MSF is getting paid more,” Brennan said, referring to Médecins Sans Frontières, or Doctors Without Borders. The full process itself is still being worked out, given the logistical constraints on the ground, with the WHO itself paying the salaries of senior health workers at the district level as well as several health facilities there, Brennan said.
On top of the more recent flashpoints in South Sudan and CAR, there’s the more protracted crisis that Syria has become as it enters its third year — which has the potential to last for another 10 years. Brennan pointed to the work of the WHO in the region, coordinating health services for the 2.5 million refugees in neighboring countries and 4 million Syrians displaced within the country. Brennan also praised Syria’s neighbors for moving quickly to prevent the spread of polio, which reemerged in the war-torn last year. Since then, six rounds of vaccinations have been planned within Syria itself, another four rounds in the surrounding countries, and two in Egypt.
But access to patients has been a concern in all three situations, Brennan said. In particular, the United Nations Security Council recently demanded that the Syrian government allow full humanitarian access to areas it has currently has under siege. “I think its small steps,” he said, when asked whether President Bashar al-Assad has been seen adhering to the Council’s demands, pointing to the recent Syrian decision to allow aid to cross into rebel held territory. “So one of the requirements of the resolution is tracking the implementation, so there’s a lot more advocacy and work to be done. It’s a first step.”
Both Brennan and Gayer also noted that in their experience, the past year has shown an decrease in the ability of workers to operate in conflict zones free from danger. “The idea of the sanctity of health care, the neutrality of health care is being lost in many of these crises,” Brennan said, pointing to instances in the CAR, South Sudan, and Syria alike in which hospitals have been destroyed, health workers targeted, and patients dragged from their beds. While these sorts of instances have occurred in past conflict, he later clarified, “what we’re concerned about is the scale of it and the nature of it. … All of us feel there’s been a step change.”
Brennan concluded the briefing by telling the assembled reporters that the years he thought of as the most stressful to the humanitarian system — 1999 with conflicts in Kosovo, East Timor, and the Democratic Republic of the Congo; 2005 with the aftermath of the Christmas Day tsunami, earthquakes in Pakistan, and Hurricane Katrina; and 2010 with the Haiti earthquake and floods in Pakistan — were nothing on the scale of 2013. “I always think of those years as the years where we were absolutely hammered as humanitarian agencies,” he said. “This year, the last twelve months, have been another order of — another scale up.”
So what happens if there’s another Level 3 emergency, one reporter asked? Brennan’s simple answer, while meant jokingly, highlighted just how much of strain this last year has been on the system: “Pray.”