This document discusses emergency response challenges and opportunities in the Eastern Mediterranean region. It notes that the number of people in need of humanitarian assistance has increased 117-110% since 2015 and outlines the top countries burdened by fragility, conflict, and refugee crises. While COVID-19 response increased some capacities, preparedness remains a challenge. The document highlights some response successes but also areas needing improvement like operational readiness and fragmentation. It concludes by emphasizing opportunities to sustain COVID gains through resilience-building, and priorities around preparedness, high-threat pathogens, protracted crises, and supply chain management.

1. Emergencies and the IHR (2005)
in the Eastern Mediterranean
Region
Dr Richard Brennan
Regional Emergency Director
WHO Health Emergencies Programme

2. Worsening emergency burden and increasing risks
• People in need of assistance
‒ 140 million; 19% of Region’s
population
People in need (in millions)
0
50
100
150
200
250
300
350
400
2015 2016 2017 2018 2019 2020 2021 2022 2023
Global
Region
+117%
+110%
• Natural disasters
‒ 7/20 largest globally 20212022
• Outbreaks (non-COVID-19)
‒ 63 outbreaks in 2023; 21 Member
States
Sources: CRED, OCHA, UNHCR, WHO

3. Distribution of humanitarian burden in Region
COUNTRY/TERRITORY FRAGILE AND
CONFLICT-AFFECTED
SITUATIONS
(n = 9; 41%)
CONFLICT
(n = 10; 45%)
REFUGEE BURDEN > 250 000
(n = 7; 32%)
INTERNATIONAL EMERGENCY APPEALS
(n = 13; 59%)
Afghanistan + + Humanitarian Response Plan (HRP)
Egypt + 652 000 Syrian Arab Republic, Sudan
Refugee Response Plans (RRPs)
Iran (Islamic Republic of) + 3 425 091 Afghanistan RRP
Iraq + + 273 716 Syrian Arab Republic RRP
Jordan 697 761 Syrian Arab Republic RRP
Lebanon + 818 861 Flash, Syrian Arab Republic RRP
Libya + Flash, Sudan RRP
Pakistan + 1 743 785 Flash, Afghanistan RRP
Palestine + + HRP
Somalia + + HRP
Sudan + + 1 097 128 HRP
Syrian Arab Republic + + HRP
Yemen + + HRP
Sources: OCHA, Peace Research Institute Oslo (PRIO), UNHCR, World Bank

4. COVID-19 response = Increased capacities
Clinical capacity
• Oxygen-generating capacities in 16
Member States
• 50 000+ trained on critical care
Disease surveillance
• Average sentinel sites: 51 to 81 (59%)
• Integrated Disease Surveillance and Response (IDSR)
in 8 Member States
• Event-based surveillance in 12 Member States
Laboratory capacity
• Average laboratories: 25 to 110 (340%)
• 21 Member States with genomic sequencing
capacity
Emergency operations centres
• 1221 Member States
Other
• IPC units in Ministry of Health
• RCCE units in Ministry of Health
• Community health

5. Averting cholera deaths
• CFR < 1.0% in 7 of 8 cholera outbreaks
• Median CFR = 0.19% (range 0.01–1.67%).
Preventing excess mortality and famine
• Somalia – famine averted
• Syrian Arab Republic (Al Hol)
Improving outcomes from severe acute
malnutrition (SAM)
• Cure rates in Pakistan, Somalia, Sudan
and Yemen > 85%, (standard > 75%)
Meeting international standards

6. What are external reviews saying about our work?
COVID-19 (2020–2022)
 80% of external observers
stated WHO’s response
exceeded or met expectations
Whole of Syria response
(2016–2022)
 “A” rating  UK Government
Programme Completion
Review
Yemen (2017–2022)
 “Highly satisfactory”
project rating by World Bank
for the Emergency Health
and Nutrition Project
(highest on a 6-point scale)

7. Where are we not doing so well?
Preparedness
• IHR core capacities flatlined
• 3 of 90+ national action plans for health
security (NAPHS) funded globally
Operational readiness
• Need to be faster, more effective
• SOPs, stockpiles, rapid response caps
Fragmentation & duplication
• Disease surveillance
• Emergency management arrangements
0
20
40
60
80
100
2018 2019 2020 2021 2022
Average State Party Self-
Assessment Annual Reporting
(SPAR) scores
Eastern Mediterranean Region
20182022
SPAR scores

8. Increasing needs, but funding has flatlined
• 29% emergency appeals
funded in 2023
• 23% health sector
funded in 2023
Sources: OCHA/Financial Tracking Service

9. Opportunities: sustaining COVID gains = Resilience
Identify options to integrate & institutionalize
• Surveillance, laboratories
• IPC, RCCE, public health emergency operations centres
Rationalize and “right-size”
• Laboratories, ICU beds, emergency operations centres
Undertake costing exercise
Prioritize in plans, budgets & proposals
• NAPHS
• Domestic financing
• Pandemic Fund and other proposals

10. Looking forward: our priorities
Strengthening preparedness & readiness
• Updating and resourcing NAPHS & all-hazard plans
• Engaging in Working Groups on IHR & INB
Detecting and responding to high-threat pathogens
• Expanding IDSR and integrated surveillance for
respiratory viruses
• Scaling up One Health
Improving outcomes in protracted crises
• Applying health systems approach/Humanitarian-
Development-Peace Nexus
• Institutionalizing response monitoring framework
• Improving trauma care
Improving supply chain management
• Upgrading Dubai logistics hub
• Strengthening country-level capacities

11. 11
Amendments to the IHR (2005)
• Proposed amendments > 300 proposed by 16 Member States
• Working Group on Amendments to the IHR (WGIHR) Five meetings
to consider the amendments
• Intersessional meetings to refine the package of proposed
amendments
• Regional engagement Good but limited to a few countries
Saudi Arabia leading negotiations on a couple of Articles/annexes
• Common areas with WHO CA+ equity, surveillance, access to medical
countermeasures & benefit-sharing, financing, capacity-building,
preparedness/health system resilience
Progress
Next steps: WGIHR 6 in December, followed by a proposed package of
amendments for consideration by WHA77

12. 12
INB and CA+ development
▪ Six meetings of Intergovernmental Negotiating Body (INB)
– including intersessional meetings
▪ Zero draft of WHO CA+ submitted for consideration of fourth meeting of INB
– revised text prepared by INB Bureau; reviewed by drafting group
▪ High-level political declaration approved during 78th session of the UN
General Assembly (UNGA78) emphasizes conclusion of negotiations on CA+ and
completion of amendments to IHR
▪ Joint plenary session of the INB and WGIHR for coherence and
complementarity
▪ CA+ proposal for negotiating text to be circulated by 16 October 2023
▪ Regional engagement very limited – Pakistan and Saudi Arabia leading on a
couple of Articles
Progress
Next steps: Three additional sessions (including four “two-week
marathon” sessions) in Q1 2024 – to submit outcome to WHA77

13.  Seize the opportunity of COVID-19 – sustain
the gains
 Redouble efforts on preparedness and
readiness – invest and monitor
 Improve service delivery in fragile and conflict-
affected situations – apply health
systems/Humanitarian-Development-Peace
Nexus approach
 Increase engagement in WGIHR and INB
processes
Requests to Member States