Resource Centre Newsletter - Health in Emergencies
Issue 2 April 1998 • •
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Editorial • Health and UN Reform In the News • WHO turns 50 • Acute Humanitarian Crisis in the Federal Republic of Yugoslavia Current Projects • Ireland supports project to strengthen communicable disease control in emergency situation • HINAP project moves forward • Groundwork laid on 'Health as a Bridge for Peace' project • International initiative: Road injury prevention for Sub-Saharan Africa • WHO calls for concerted public health response to anti-personnel mines Meetings and Conferences • April conference of collaborating centres to focus on streamlining services • Global conference looks at health crisis and the internet • World conference on injury prevention and control Publications • The Public Health Consequences of Health Disasters, edited by Eric K. Noji, M.D. • Guidelines for Cholera Control • Earthquakes and People's Health: Vulnerability Reduction, Preparedness, Rehabilitation Training Events • H.E.L.P.98 to be held in Geneva Contacts Health in Emergencies is a quarterly newsletter of The Division of Emergency and Humanitarian Action of the World Health Organization (WHO). This newsletter is not a formal publication of WHO and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated in part or whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in this newsletter do not necessarily reflect those of WHO. Correspondence and inquiries should be addressed to: The Editor The Division of Emergency and Humanitarian Action World Health Organization 1211 Geneva Switzerland Phone: (41 22) 791 4676 Fax: (41 22) 791 4844 E-mail:
[email protected] Chief Editor: Dr Jean-Paul Menu Editor: Therese Desorbay
Editor's Note As many of you told us after reading its first issue, this newsletter fulfils a need for improved communication. It is very encouraging as well as challenging. We need to continue this dialogue and to receive your suggestions for improving contents of the newsletter. Please feel free to provide your comments and material to the editors.
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Editorial Health and UN Reform One year into his first term as Secretary-General, it seems as Kofi Annan has accepted a deceleration of the UN reform process. The first "track" of reform was announced in March of last year with a second "track" announced in July. Since then, there have been extensive discussions in the General Assembly. "Track" one created, among others, four executive committees. One of these committees is the Executive Committee for Humanitarian Affairs (ECHA) which was established for better coordination of humanitarian action. " Track" two was announced at the culmination of the Economic and Social Affairs Committee (ECOSOC) "Process". This "Process" considered ways to improve performance of the entire field of emergency and humanitarian assistance. "Track" two involved UN Subsidiary bodies and one result was the dissolution of the Department of Humanitarian Affairs (DHA). There is now the office for the Coordination of Humanitarian Affairs (OCHA), which is home to the Emergency Relief Coordinator, the Under-Secretary General Mr Sergio Vieira de Mello, who also chairs the Inter-Agency Standing Committee (IASC). At the present time, the IASC and its Working Group are still the main bodies for interagency consultations and strategic decisions. Represented in this committee are all major UN agencies and consortia of NGOs involved in humanitarian action, as well as the International Red Cross and Red Crescent Movements. At the field level, improved coherence and operational coordination are foreseen through a united framework built on the UNDP (United Nations Development Programme) Resident Coordinator, who when needed, will be strengthened by an ad hoc established Humanitarian Coordinator. Specialized agencies like WHO remain. Although UN bodies, they are independent in many ways; the Director-General of WHO reports to the World Health Assembly. A Ministerial Commission is to be established to review, over the next two years, the constitutions of specialized agencies and examine how they can be brought further under the UN umbrella. Two issues to follow in further development: It will be interesting to see to what extent the formal reporting of the Resident Humanitarian Coordinator, both to the OCHA and the UNDP will be functional. The important issue, in the interest of effective emergency response, is to support the authority of OCHA and the Emergency Relief Coordinator over interagency operations. The second issue relates to health in emergency response. Health is at the core of most, if not all, of the efforts to support victims of emergencies and disasters. Shelter, water, food and protection from infectious diseases, vaccinations and curative care, reproductive health and concerns for the disabled: it is the health problems in the end that guide programmes of assistance. With WHO not being a part of ECHA, where a number of strategic and operational
Editor's Note As many of you told us after reading its first issue, this newsletter fulfils a need for improved communication. It is very encouraging as well as challenging. We need to continue this dialogue and to receive your suggestions for improving contents of the newsletter. Please feel free to provide your comments and material to the editors.
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decisions are taken, the UN reform, to date, leaves us with structures which do not allow for the best technical guidance. It is hoped that this can be corrected through an effective exchange of information and a process of consultation between IASC and ECHA.
In the News WHO Turns 50 On April 7, 1948 the constitution requested WHO, inter alia, to provide necessary aid in emergencies upon the request or acceptance of Governments. Implementation of this mandate has considerably evolved over those 50 years. Early on, norms and guidelines applicable to emergencies and disasters started being issued under technical programmes. The Organization also responded to a limited number of emergency situations considered of high priority. A specific Emergency Preparedness Programme was created in the 1970s and a full division was established in 1989 at WHO Headquarters. Progress at Regional and country levels was diverse. An effective programme of national capacity building in disaster management was developed in the Region of the Americas to improve preparedness and response and to limit its vulnerability to natural hazards. In 1993 a World Health Assembly resolution produced a major breakthrough. It introduced the concept of humanitarian action and underscored the need for WHO to assume a more pro-active role in emergencies and disasters, based on the three pillars of preparedness, response and advocacy. WHO has accordingly expanded its country and regional emergency preparedness programmes. Simultaneously, it has made every effort to improve its response capability to cope with increase of disasters and complex emergencies. Collaboration with all relevant organizations, particularly within the UN donors resulted in a significant increase of extrabudgetary funding. The future will bring new challenges. WHO will continue to consult with others to ensure that its future role at Headquarters, Regional and country levels matches both its mandate and new expectations of its Member States. At the same time, full attention will be given to ensuring complementarily with other international agencies, inter-governmental and non-governmental agencies. The areas in which needs have been identified and to which WHO plans to contribute are the following: • • • • • •
national and institutional capacity building for emergency preparedness and disaster mitigation and management with priority given to training of nationals in countries most at risk defining and disseminating best practices in humanitarian interventions and providing a health intelligence network for advance contingency planning assessing needs and providing technical support in health emergencies and disasters advocating the use of health as a platform for peace promoting a concerted public health response to the effects of landmines and to violence prevention
Check Out Our Exhibit During the 50th anniversary of the World Health Assembly in May of 1998, EHA in collaboration with the Museum of the International Red Cross and Red Crescent Museum, will present a video exhibit entitled "Health, Humanity and Humanitarian Action." The exhibit will be located in the Palais of the United Nations building and is sponsored by the Swiss Government.
There will undoubtedly be new challenges that will lead to a reconsideration of these priorities. The essential element is to be constantly aware of the needs of communities at risk.
Acute Humanitarian Crisis in the Federal Republic of Yugoslavia The Federal Republic of Yugoslavia (Serbia and Montenegro) continues in a situation of humanitarian crisis with further deterioration. New deaths injuries and displaced persons have added to the chronic humanitarian crisis that previously existed. The situation has also affected the neighbouring countries of Albania and the former Yugoslav Republic of Macedonia. The WHO Liaison Offices and the WHO Humanitarian Assistance Office in Albania are also on alert. WHO continues to take action in the region along with other organizations and NGOs, particularly the Mother Teresa Organization. WHO immediately took action from the beginning of the crisis. Their activities included evaluating and monitoring the rapidly changing situation and reporting to WHO offices, UN agencies in the Republic and to diplomatic missions. Rapid field assessment missions were performed and emergency medical material was delivered to both Serbian and Albanian health centres. WHO intends to continue providing health kits to all parties involved. Appeals have been made to the Italian Government to release new emergency medical health kits and cholera kits from the Pisa warehouse. Meanwhile, the Norwegian Government have supplied WHO with a donation of surgical kits in the region. Beyond the response to this acute situation, WHO's efforts in the region will focus on prevention and control of communicable diseases, mental health care, national drug policy reform, health care policies, coordination of humanitarian assistance in the health sector and public health advocacy. A joint mission with WHO and the Italian authorities to the Federal Republic of Yugoslavia took place in February of this year to develop and plan a strategy regarding further cooperation in the field of humanitarian assistance. The Italian Government has given funds for emergency health and social assistance of vulnerable groups in the area. For more information please contact Dr Jan Theunissen. e-mail:
[email protected]
Current projects Ireland Supports Project to Strengthen Communicable Disease Control in Emergency Situations Communicable diseases pose a serious threat to the health of refugees and displaced persons. Their vulnerability to diseases is increased as a result of massive population displacement leading to temporary settlement in camps. Diseases are mainly due to overcrowded conditions, poor water supply and inadequate health facilities. In this setting, measles, diarrhoeal diseases and acute respiratory infections are the major killers. Health workers in these camps must have up-to-date and clear information on how to prevent and treat communicable diseases so that refugees and displaced persons do not die unnecessarily from them. WHO has produced many disease-specific guidelines on communicable disease control (examples: measles, cholera, shigella and meningitis). However, many of these guidelines do not deal with emergency situations and they are often difficult to obtain. The importance of WHO's role in standard setting in emergency situations was confirmed in March 1997, at a meeting on WHO's role in complex emergencies with UN agencies, donors, NGOs and academic institutions. In response to this, WHO initiated a project entitled "Communicable Disease Control in Emergency Situations." The project is funded by the Government of Ireland and started in June 1997 with a three-year project perspective.
One of the major outcomes of the project will be the development of a WHO manual on Control Of Communicable Diseases in Emergency Situations which will be the result of collaboration between eight WHO Divisions. The manual will contain the most up-to-date information on communicable disease control in refugee and displaced populations and will be used by health workers at the field level. It will deal with issues of surveillance, prevention, epidemic control, diagnosis and case management. Other UN agencies, major NGO's and academic institutions are providing input into the development of the manual to ensure that the manual is useful to field staff. Dissemination of this manual is equally important and electronic copies will be placed on the EHA website to ensure widespread access to the document. Another outcome of the project will be the development of a health information system to standardize collection of disease data between national governments, UN agencies and non-governmental agencies. This health information is essential to provide data on disease burden, identify disease priorities and to provide early warning systems for epidemics. Refugees and displaced persons are entitled to good quality health care. The use of standard guidelines will help to ensure that best practices are used in emergency situations. Standardized guidelines will also facilitate coordination of health care activities between the various operational agencies which is particularly important in the area of epidemic control. Without proper disease control in emergency situations, thousands of refugees and displaced persons are at risk of dying from preventable diseases. It is hoped that this project will reduce the disease burden and deaths among this vulnerable population by ensuring effective control of communicable diseases via agencies working in emergency situations. For more information please contact Dr Maire Connolly. email:
[email protected]
HINAP Project Moves Forward As reported in the first issue of this Newsletter, HINAP (Health Intelligence Network for Advanced Contingency Planning) was launched in November of 1997 as a joint initiative of the WHO/EHA and the CDC's International Emergency and Refugee Health Program of the National Center of Environmental Health. It is conceived as a partnership between all organizations involved in health relief in complex humanitarian emergencies involving sudden population displacements. The project's major objective is to consolidate, edit, organize and redistribute existing baseline data and background information, to the right people at the right time in an easy-to-use format. Existing data on displaced and potentially displaced populations is often scattered among many different agencies in formats that are difficult to utilize and access. HINAP would serve as a centralized source where limited information on items such as population demographics, health infrastructure, medical and health data would be quickly and easily available to planners and managers. HINAP will focus on country situations where latent or low-level tensions have not yet attracted significant attention but could escalate. It will assist decision making in order to spur preventative measures where possible and contingency planning where necessary. HINAP will depend almost exclusively on information provided by other Divisions within WHO and from outside organizations (government, UN, NGOs and international organizations). Some of this information may already be on the Internet. Examples of information that could be collected for countries of origin and countries of asylum include:
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basic ethnographic data on populations at risk of displacement health data such as epidemic risks, incidence and prevalence of communicable diseases and vaccination coverage, nutritional status and country health profiles list and capabilities of in-country NGOs and UN Agencies description of the country's disaster plan, if any
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level of health professional training in the country of origin which may help in recruiting and training of refugee health workers logistics information such as warehouse capacity, availability and price of fuel, air and road access and telecommunications capacity local and regional laboratory capabilities in-country production of and/or availability of drugs, jerry cans, cooking kits and other needed items.
Different pieces of information exist at different levels of the information pipeline at WHO and other organizations but not in a form that is easily accessible for emergency personnel. HINAP's goal is to consolidate and deliver refugee relevant information to practitioners in a state-of-the-art manner (example: World Wide Web) and a variety of other formats (example: regular hard copy bulletins, CD-ROM, e-mail, faxback, etc.). It will improve targeting of international response in humanitarian emergencies involving sudden population displacements and improve cost effectiveness of health interventions. This project is funded by the US State Department's Bureau of Population, Refugees and Migration (BPRM), the United Kingdom's Department for International Development (DfID) and the Government of Japan. For more information please contact Dr Eric Noji. e-mail:
[email protected]
Groundwork laid on 'Health as a Bridge for Peace' project The goal of the Health as a Bridge for Peace project is to develop practical guidance on peace-building for health professionals. From January to April of this year the German government has provided a qualified legal trainee, specialized in international law and human rights, to work on the project. The intern, Friederike Tschampa, began to select and compile relevant international humanitarian and human rights laws and to apply them to the guidelines on best practices for health workers in emergency and conflict situations. EHA has also become more involved in areas of human rights and humanitarian law, both within WHO and with other agencies. In addition, a technical working group, represented by all of EHA's units, was set up to carry out the conceptual background work and to clarify the process for drafting guidelines for the project. For more information please contact Dr Louisa Chan. e-mail:
[email protected]
International Initiative: Road Injury Prevention for SubSaharan Africa The WHO/World Bank's report "The Global Burden of Disease" estimates that deaths from noncommunicable diseases will climb from 28.1 million a year to 49.7 million by the year 2020. Road traffic injuries are believed to take third place in the rank order of disease burden by the year 2020. Ethiopia has the highest rate of fatalities per number of vehicles in the world with Uganda ranking second. There are few injury prevention programmes in these countries and emergency medical systems are often inadequate. There is an urgent need to determine the magnitude of road traffic injuries and to face the issue as a public health priority. WHO has responded by launching an International Initiative for Road Injury Prevention for Sub-Saharan Africa. In October of 1997, a planning meeting took place with UNECA (United Nations Economic Commission for Africa), OAU (Organization of African Unity) and the WHO/EHA Pan African Training Centre in Addis Ababa, Ethiopia. The meeting focused on what type of road injury prevention is already in place and included a briefing on WHO's forthcoming initiative. In December 1997, the initiative was officially launched in Entebbe, Uganda,
with the Ministry of Health of Uganda, the Injury Control Centre-Uganda, the Canadian Network for International Surgery and representatives of participating countries: Ethiopia, Kenya, Egypt, Uganda, Zimbabwe and South Africa. The short-term goal of the initiative is to measure the extent and severity of the traffic injury problem in Sub-Saharan Africa through surveillance, providing the basis for policy formulation. The long-term goal will be to strengthen the countries' capacities to prevent and manage the burden of road traffic injuries. Initial actions will be to provide a country situation analysis in the coming months through the pilot testing of the "Trauma Registry Form" developed by the Injury Control Centre-Uganda. In addition, a course will be organized on injury and violence prevention for African health care professionals. A follow-up meeting is scheduled to take place in June or July of this year in Johannesburg. Traumatic brain injury is the most severe outcome of road injuries. The established committee on the prevention of road injuries in Sub-Saharan Africa involves among others, experts belonging to the network of WHO Collaborating Centres on Neurotrauma Prevention and Management. For more information please contact Monica Goracci. e-mail:
[email protected]
WHO Calls for Concerted Public Health Response to AntiPersonnel Mines At the 101st Session of the Executive Board, its members approved a Resolution declaring that the damage caused by anti-personnel mines is a public health problem. The Board requested that the Director-General submit to the 51st World Health Assembly a plan of action for a concerted public health response to anti-personnel mines. This request comes after the signing of the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction, in Ottawa, in December 1997. This led to the Ottawa Process II, which has recognized the coordinating role of the UN System in monitoring the implementation of the Treaty. This process will concentrate on demining and providing humanitarian assistance to landmine victims. The WHO plan of action was finalized after consultations with some of the Member States, NGO's and the ICRC. Activities included in the plan will focus on five priority areas endorsed by the Executive Board:
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surveillance and information prevention and awareness emergency and post-emergency care rehabilitation coordination within the United Nations
Within WHO, the Unit of Violence and Injury Prevention (PVI) of the EHA will be responsible for the finalization and subsequent implementation of the plan of action. PVI will ensure integration of the plan within the Division's ongoing activities, particularly regarding surveillance and information, in order to efficiently use existing resources. Coordination within the UN System will be ensured through the UN Mine Action Service set up by the Department of Peacekeeping Operations. As the lead agency for coordination of international work in public health, WHO will provide guidance for all public health related matters. Moreover, in order to maximize efforts and to provide a concerted and coherent response in assisting anti-personnel mine victims, collaboration with
UNICEF, ICRC and NGOs, at both headquarters and country levels, will be a priority in project implementation. To date, the country of Ireland has provided funding and an epidemiologist has been seconded by the country of Belgium. For more information please contact Monica Goracci. e-mail:
[email protected]
Meetings and Conferences April Conference of Collaborating Centres to Focus on Streamlining Services WHO/EHA has organized a meeting of Collaborating Centres in St. Petersburg, Russia April 7-8, 1998. The meeting will be hosted by the Centre for Emergencies and Disaster Medicine Management, "Zaschita." The general objective of the meeting is to increase the value of services that the Collaborating Centres can provide to the Member States. Priority areas of collaboration to be discussed for 1998-1999 are the production of manuals and support of training, development and networking of information systems and coordination of research and production of guidelines. Focus will also be placed on streamlining mechanisms for coordination and collaboration between the Centres and WHO and between the Collaborating Centres themselves. For more information please contact Dr Edouard Kossenko. e-mail:
[email protected]
Global Conference Looks at Health Crisis and the Internet Health Crisis and the Internet was the subject of a conference held in Bogota, Colombia, November 18-20, 1997. It was organized by WHO, PAHO and the Ministry of Colombia and was attended by those involved in health crisis management, NGOs universities and the public and private sectors involved in telecommunications and information exchange. In the months prior to the conference, a questionnaire was sent to all WHO country offices. Questions explored the actual or planned use of Internet, requirements envisioned, and its perceived usefulness in emergency situations. Respondents all agreed that Internet was important and about one-half found the system feasible. For those who found the system feasible and useful, it was obvious that Internet is a powerful means of communication across borders with potential usefulness in the field of health crisis. However, according n place would require good and reliable telephone lines, complete computer hardware and software, training for professionals in the health field as well in other fields (maintenance, repairs and computer specialists), language skills and lastly, financial resources to cover investment and recurring costs. At present, the distribution of this type of equipment in WHO Regions varies from high to near absence. Internet is one of the most sophisticated and recent technologies whose usefulness should be assessed in relation to other means of rapid communication in disasters: telephone, fax, telex, etc. An analysis of the strengths and situations, of the various patterns of communication is a prerequisite. Programme design is also seen as an essential element if the Internet is used in disaster situations. A protocol including specifics about disaster will need to be developed to provide the accurate and essential information required.
The usefulness of Internet cannot be seen in isolation and should be analysed with its organizational and managerial implications in the various regions. Case studies in various settings and countries would provide a complete picture reflecting the diversity of situations in a given region. For more information please contact Dr Reynaldo Flores. e-mail:
[email protected]
World Conference on Injury Prevention and Control The 4th World Conference on Injury Prevention and Control will be held May 17-20, 1998 in Amsterdam, Netherlands. The conference is organized by WHO and its network of collaborating Centres and has been ongoing since its creation in Stockholm, Sweden in 1989. The Collaborating Centres meet yearly to plan and evaluate the biyearly conference which brings together those involved with the latest research, technology, and strategies for injury prevention and control. For more information please contact Dr Claude Romer. e-mail:
[email protected]
Publications The Public Health Consequences of Health Disasters, edited by Eric K. Noji, M.D.
"Illustrated with examples from recent research in the field, this book summarizes the most pertinent and useful information about the public health impact of natural and man-made disasters. It is divided into four sections, dealing with general concerns, geophysical events, weatherrelated problems and human-generated disasters. The author starts with a comprehensive discussion of the concepts and role of surveillance and epidemiology, highlighting general environmental health concerns, such as sanitation, water, shelter and sewage. The other chapters, based on a variety of experiences and literature drawn from both developing and industrialized countries, cover discrete types of natural and technological hazards, addressing their history, origin, nature, observation and control. Throughout the book, the focus is on the level of epidemiologic knowledge on each aspect of natural and man-made disasters. Exposure, disease and health-event surveillance are stressed because of the importance of objective data to disaster epidemiology. In addition, Noji pays particular attention to prevention and control measures and provides practical recommendations in areas in which the public health practitioner needs more useful information. He advocates stronger epidemiologic awareness as the basis for better understanding and control of disasters. A comprehensive theoretical and practical treatment of the subject, The Public Health Consequences of Disasters is an invaluable tool for epidemiologists, disaster relief specialists and physicians who treat disaster victims." •
Review extracted from The Oxford University Press book announcement.
Report on Applied Health Research Now Available The Consultation on Applied Health Research Priorities in Complex Emergencies is a document summarizing the results of the October 1997 conference which focused on how to improve response to emergencies. Participants concentrated discussions on questions of applied health research in relation to the early phase of complex humanitarian emergencies. Topics included nutrition, reproductive health and women's health, control of communicable diseases, information management, mental health, health services management and ethical issues. Research priorities in
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announcement. To order in the US: Oxford University Press Order Dept. 2001 Evans Road Cary, NC 27513 Other countries, fax: (212) 726 6453 or e-mail:
[email protected]
Guidelines for Cholera Control Guidelines for Cholera Control sets out facts and advice needed to guide public health actions in response to an outbreak of cholera. Noting that the introduction of cholera into a country cannot be prevented, the book stresses the many things that can be done to prepare health services, educate the general public, save lives of patients and prevent further the spread of an outbreak. The objective is to help managers of national diarrhoeal disease control programmes and non-governmental agencies to make the most effective decisions concerning selection of medical supplies and emergency response to an epidemic. Throughout, emphasis is placed on the importance of safe water, scrupulous personal hygiene and careful food preparation as the most effective preventative measures. Readers are also alerted to public health interventions, such as vaccination, chemoprophylaxis and cordon sanitaire which are ineffective, wasteful and therefore to be discouraged. Available in English, French and Spanish To order write to: WHO Distribution and Sales, 1211 Geneva 27, Switzerland Fax: (41 22) 791 4857
Earthquakes and People's Health: Vulnerability Reduction, Preparedness, Rehabilitation This 285-page document covers the proceedings of a January 1997 WHO symposium held in Kobe, Japan. The meeting was attended by a multi-disciplinary and multi-cultural group of experts who discussed environmental and health consequences posed by earthquakes. The document also outlines recommendations for improved standards, organization, logistics and vulnerability reduction. Available in English To order write to: WHO Distribution and Sales, 1211 Geneva 27, Switzerland Fax: (41 22) 791 4857 or e-mail:
[email protected]
each area were defined and follow-up mechanisms were proposed. For a copy of the report please contact Dr Danielle Deboutte. e-mail:
[email protected]
Training Events H.E.L.P. 98 to be Held in Geneva Health Emergencies in Large Populations (H.E.L.P.) is a course designed to train experienced health professionals who may deal with disaster situations. An upcoming course is to be held in Geneva on May 11-29, 1998, at the International Committee of the Red Cross. The course is jointly organized by the International Committee of the Red Cross (Health Division), the Faculty of Medicine of the University of Geneva (Unité de Santé Communautaire) and WHO/EHA. H.E.L.P. will cover topics that include Planning, Food and Nutrition, Environmental Health, Communicable Disease, Health Services, Epidemiology, Coordination and International Law. The content will reflect the current knowledge of health emergencies and will be given by experienced people who have worked with international humanitarian organizations or universities. For more information please contact: International Committee of the Red Cross: Tel.: (41 22) 730 22 23 Fax: (41 22) 733 96 74 e-mail:
[email protected]
Contacts Division of Emergency and Humanitarian Action World Health Organization 1211 Geneva 27, Switzerland. Phone: (41 22) 791 2752/2727/2987. Fax: (41 22) 791 48 44 Pan African Emergency Training Centre Emergency Health Training for Africa (EHTP) PO Box 60035, Addis Ababa, Ethiopia. Phone: (25 11) 517 600. Fax: (25 11) 513 264 Regional Office for Africa (AFRO) Emergency and Humanitarian Action (EHA) Temporary Location Medical School, C ward Parirenzatwa Hospital Mazoe Street PO Box BE 773 Belvedere Harare Zimbabwe Phone: (263) 4 70 69 51 or 4 70 74 93. Fax: (263) 4 70 56 19 or 4 70 20 44 Regional Office for the Americas (AMRO)/ Pan American Health Organization (PAHO) Emergency Preparedness and Disaster Relief Coordination Programme (PED) 525, 23rd Street, NW Washington, DC 20037 USA.
Phone: (202) 861 4325 or (202) 861 3399. Fax: (202) 775 4578 Regional Office for the Eastern Mediterranean (EMRO) Coordination, Resource Mobilization and Emergency Relief (CMR) PO Box 1517 Alexandria 21511 Egypt. Phone: (20 3) 48 202 23/24 or 48 300 90. Fax: (20 3) 48 389 16 Regional Office for Europe (EURO) Coordination and Resource Mobilization (COR) 8, Scherfigsvej 2100 Copenhagen O Denmark. Phone: (45) 39 17 17 17. Fax: (45) 31 17 18 18 Regional Office for South East Asia (SEARO) Health Services Development (HSD) World Health House Indraprastha Estate Mahatma Gandhi Road New Delhi 110002 India Phone: (91 11) 331 7804/7823. Fax: (91 11) 331 8607 or 11 332 7972 Regional Office for the Western Pacific (WPRO) Division of Health Infrastructure (DHI) PO Box 2932 1099 Manila Philippines. Phone: (63 2) 528 80 01. Fax: (63 2) 521 10 36 or 536 02 79
