Eastern Mediterranean Region

Requirements (US$): 818.6 million

Context

Over the past year, the Eastern Mediterranean Region has seen a substantial increase in the number of emergencies due to multiple hazards. Across the Region, WHO responded to 55 disease outbreaks in 2022, compared to 31 in 2021 and 14 in 2020, and the number of people requiring humanitarian assistance has increased from 102.3 million to 127.3 million. Worsening insecurity, major natural disasters (floods in Pakistan, food security crisis in Somalia and Greater Horn of Africa), disruptions due to the COVID-19 pandemic and severe economic decline (e.g., Lebanon, the Syrian Arab Republic) have contributed to an unprecedented level of humanitarian need and vulnerability across the Region. There is also a convergence of crises in many countries with protracted humanitarian needs, e.g., Afghanistan, Somalia and Sudan have all experienced multiple outbreaks, natural disasters, insecurity and displacement throughout 2022. Political tensions and instability conspire to constrain the response to health emergencies.

Attacks on health care facilities are also still widely reported across the Region. According to WHO’s Surveillance System for Attacks on Health Care, as of 6 December 2022, 245 attacks on health care were recorded in seven countries or territories (Afghanistan, Libya, Palestine, Somalia, Sudan, the Syrian Arab Republic and Yemen), resulting in a combined 80 fatalities and 150 injuries of health care workers and patients. Around 37% of deaths and 35% of injuries due to such attacks worldwide occurred in the Region.

The WHO Regional Office for the Eastern Mediterranean will continue to support WHO country offices in their efforts to strengthen countries’ health systems and resilience, and better prevent, prepare for, detect, respond to and recover from health emergencies. Countries in the Eastern Mediterranean Region will continue to work in close collaboration with health partners, including UN agencies, to support ministries of health within the framework of national legislations and international frameworks such as the humanitarian response plans. WHO will also continue to lead health clusters across the Region and align its actions with health clusters’ priorities.

WHO adopts a comprehensive approach to managing health emergencies across the Eastern Mediterranean Region, including prevention, preparedness, detection, response and recovery. WHO’s regional priorities in humanitarian settings for 2023 include:

• Progressively expanding the coverage and quality of an essential package of health services
• Supporting and strengthening the essential elements of the health system, especially the health workforce, health information systems and supply chain management
• Strengthening capacities to prevent, detect and respond to disease outbreaks and other health emergencies
• Facilitating a coordinated approach among partners through leadership of the Health Cluster
• Continuing to support the response to COVID-19, including through increasing vaccination coverage
• Strengthening predictability of end-to-end medical supply chain management, including with the support of the Dubai Logistics Hub
• Improving the monitoring of the effectiveness of humanitarian health response through our Regional Response Monitoring Framework (in collaboration with Johns Hopkins University)
• Tackling the expanding burden of violent injury in conflict through the expansion of our Regional Trauma Initiative (currently implemented in 5 countries)
• Addressing the public health dimensions of food insecurity crises
• Expanding health for peace initiatives
• Integrating the prevention of sexual exploitation and abuse in all elements of work
• COVID-19 priorities at the regional level include:
• Maintaining the engagement of senior government leadership
• Continuing the scale-up of COVID-19 vaccinations, especially in humanitarian settings, e.g., Afghanistan, Somalia, Sudan, Syria, Yemen
• Further strengthening surveillance and other data-management measures, including through roll-out of the new regional integrated disease surveillance strategy and response monitoring framework
• Consolidating the demonstrated gains in laboratory capacities, including those for PCR testing (100-fold increase across the region) and genomic sequencing; expanding support for resource poor settings through expansion of 3 reference laboratories
• Building on the progress in infection prevention and control and risk communications within ministries of health and national health systems
• Empowering communities, expanding social listening and promoting behaviour change
• Promoting and refining evidence-based public health and social measures
• Improving the coverage and quality of clinical care, including through the twinning programme, and expanding access to medical oxygen through the innovative regional oxygen platform
• Further strengthening capacities at points of entry
• Retaining a consistent state of readiness for scaled response, informed by the planning scenarios outlined in the WHO Strategic Preparedness and Response Plan 2022
• Finalizing the formal external evaluation of the regional COVID-19 response (to be finalized in Q1 2023)

Focus Countries

Afghanistan

• People in need: 28.3 million
• People targeted: 23.7 million
• Requirements (US$): 188.4 million

Afghanistan remains one of the most complex humanitarian emergencies in the world, with 28.6 million people currently in need of humanitarian assistance. In 2023, WHO’s activities will focus on supporting the roll-out of the new Health Sector Transitional Strategy, including reaching the most vulnerable populations across the country with a package of essential health services and supporting the foundational elements of the health system. There will be a special focus on scaling activities in the so-called “white areas” that are currently not adequately covered by other partners. WHO will continue to strengthen coordination among partners through its leadership of both the Health Cluster and Health Sector Technical Working Group.

Djibouti

• People in need: 400 000
• People targeted: 250 000
• Requirements (US$): 2.9 million

Djibouti has been facing a persistent drought which has left 400,000 people in need of humanitarian assistance and has had major consequences on health, nutrition and food security. WHO’s response in 2023 will focus on enhancing disease surveillance, strengthening outbreak prevention and control and improving access to and quality of essential health and nutrition services for 250,000 persons.

Iran (Islamic Republic of):

• People in need of health assistance: 3.7 million (excluding undocumented Afghan refugees)
• People targeted for health assistance: 1.9 million
• Requirements (US$): 1.1 million

The Islamic Republic of Iran is prone to natural disasters and has over the years seen influxes of refugees due to its geographical location at the border of Afghanistan and Iraq. Over eight million Afghan refugees currently reside in the country, with the most recent wave dating from 2021, stretching the capabilities of Iran’s otherwise well-developed health systems. Given this continuous migration, the country is at risk of cross-border transmission of cholera, dengue, malaria, measles, rubella, polio and tuberculosis. Iran’s readiness to rapidly respond to outbreaks, including through disease detection, diagnosis and treatment among incoming refugees, is critical.

With health care utilization by Afghan refugees costing the Iranian government $32 million per year, the Ministry of Health has asked for support to ensure it can continue to extend essential health services to refugees. In addition, the COVID-19 pandemic revealed health inequities and exposed vulnerabilities in emergency preparedness and response, which have become even more pronounced with the application of international sanctions. This has disrupted the procurement and delivery of medical and laboratory equipment and supplies as well as life-saving medicines because of restricted financial transactions and the unwillingness of suppliers to sell or deliver goods to Iranian entities even for humanitarian purposes.

Iraq

• People in need: 2.5 million
• People targeted: 1 million
• Requirements (US$): 46.5 million

Although there is no Humanitarian Response Plan for Iraq in 2023, there are persistent areas of humanitarian need and recurrent risks due to disease outbreaks, natural disasters and escalations of conflict. WHO will work with local authorities and partners to ensure access to health services for internally displaced persons and returning refugees, as well as to strengthen capacities. WHO will also support the government to revise and implement the National Action Plan for Health Security, thereby strengthening capacities for the detection and response to disease outbreaks and other health emergencies.

Lebanon

• People in need: 2.3 million
• People targeted: 1.3 million
• Requirements (US$): 59.2 million

Lebanon has experienced a series of compounded crises over the past two years, including the Beirut port explosion, the COVID-19 pandemic, financial and economic collapse and the recent cholera outbreak. The large refugee burden adds further strains on an over-stretched health system, while the continuing political and economic crises also severely impact the delivery of health care. WHO will work to ensure continuity and timely access to quality health care (including procurement of medications), support the ongoing response to cholera, COVID-19 and mpox, strengthen all-hazard disaster risk management and further enhance the coordination of the health response.

Libya

• People in need: 2.5 million
• People targeted: 800 000
• Requirements (US$): 25.3 million

Libya’s fragile and severely damaged health system and health care is unable to meet the needs of many people, particularly non-Libyans, migrants and refugees. In 2023, WHO will improve access to quality essential health services for the most vulnerable, scale up integrated disease surveillance and response systems, strengthen trauma management and undertake all-hazard risk profiling and contingency planning. WHO will continue to have a special focus on the vulnerable and under-served populations in the southern and middle areas of the country, including through expansion of services through emergency medical teams and support for primary health care centers.

Occupied Palestinian Territory (oPt)

• People in need: 2.1 million
• People targeted: 1.6 million
• Requirements (US$): 24.6 million

The oPt remains a protracted protection crisis, characterized by nearly 55 years of Israeli military occupation, internal Palestinian political divisions and recurrent escalations of hostilities, placing enormous strains on the health system. In 2023, WHO will further improve trauma and emergency care services, strengthen preparedness and response capacities for potential escalations of conflict, improve access to essential services, strengthen the health system and vulnerable communities’ readiness to respond to potential outbreaks and strengthen protection against attacks on health care.

Pakistan

• People in need: 20.6 million
• People targeted: 9.5 million
• Requirements (US$): 70.8 million

Following the massive impact of flooding in 2022, 6.4 million people are being targeted for humanitarian health assistance. Various disease outbreaks (cholera, measles, malaria) and increased rates of acute malnutrition have been recorded in the country. In 2023, WHO will work to ensure access to an integrated package of essential health services for the flood-affected population in Pakistan and refugees from Afghanistan, address severe acute malnutrition, strengthen disease surveillance, scale up technical and operational support for the response to outbreaks and further enhance coordination of the health sector and will also invest in emergency management capacities of Ministry of Health staff.

Somalia

• People in need: 7.8 million
• People targeted: 7.6 million
• Requirements (US$): 98.6 million

Somalia is currently experiencing an escalating drought that has affected 7.8 million people, displaced 1.1 million in search of food, water and humanitarian assistance and led to rising malnutrition and disease outbreaks. Worsening insecurity has left hundreds dead in recent months and constrained elements of WHO’s operations. In response, WHO will work with health authorities and partners to scale up access to a refined package of essential health and nutrition services. This will include a focus on providing primary health care services – including expanded community health services - to drought-affected communities, treatment of severe acute malnutrition, timely detection and response to acute public health events/ emergencies and strengthening of the health sector’s coordination. We will further expand trauma management capacities, including at pre-hospital and health facility levels.

Sudan

• People in need: 15.8 million
• People targeted: 12.5 million
• Requirements (US$): 43 million

32% of Sudan’s population needs humanitarian assistance, due to the combined effects of conflict, displacement, the rise in criminality and insecurity in parts of Darfur and other conflict-affected areas, unprecedented spikes in acute food insecurity, floods, multiple disease outbreaks and a heavy refugee burden. In 2023, WHO will support essential public health services, particularly at the primary care level, strengthen emergency preparedness, detection and response, address malnutrition and enhance the health sector’s coordination. We will continue our support for emergency management capacities and the Emergency Operations Centre within the Ministry of Health and the strengthening of emergency care services.

Syrian Arab Republic

• People in need: 15.3 million
• People targeted: 12.7 million
• Requirements (US$): 88.3 million

In 2022, health needs have increased due to the combined effects of COVID-19, the recent cholera outbreak and water scarcity, the economic downturn and resulting decreases in humanitarian support as well as the effects of international sanctions, leaving an estimated 15+ million people in need of lifesaving and life-sustaining health services. The already heavily disrupted health system in Syria is unable to respond to these conditions. In 2023, WHO will strengthen access to essential and lifesaving health services, bolster the health system’s resilience and strengthen its capacity to prepare for, prevent, detect and deliver timely responses to health emergencies. WHO will have a special focus on ending the cholera outbreak to ensure that it does not become an endemic disease. Within the context of the whole of Syria, we will employ all modalities to ensure the coverage of essential health services, including a combination of cross-border (northwest) and cross-line (northwest, northeast, RAATA) activities.

Yemen

• People in need: 21.6 million
• People targeted: 19 million
• Requirements (US$): 141.5 million 

Conflict, mass displacement and an economic crisis, made worse by rising malnutrition, COVID-19 and various disease outbreaks have left over 24 million people in need of humanitarian assistance and 19 million people food insecure. WHO’s response is centered around strengthening the health system’s capacity to prevent, prepare for, detect and offer a timely response to disease outbreaks and other health emergencies, offering health services for the most vulnerable, addressing severe acute malnutrition, tackling violent trauma and pre-hospital care, and stopping the transmission of circulating vaccine-derived poliovirus. We will work with authorities in both the north and the south to agree on a tailored approach that optimizes the coverage and quality of both clinical and public health services.

Success stories

When the EMRO region was first struck by the COVID-19 pandemic, lack of baseline oxygen data per country prevented the delivery of oxygen and biomedical supplies to fragile, conflict-affected and vulnerable (FCV) countries and territories such as Afghanistan, Iraq, the occupied Palestinian territory, Pakistan, Somalia, Sudan, Syria and Yemen. Baseline oxygen and biomedical inventory information displayed in an easy-to-read format was needed to understand the actual situation of the oxygen ecosystem and any barriers associated with lack of access.

In response, WHO created an innovative Regional Live Oxygen Platform – a first-ever data platform showing oxygen production capacity and requirements in real time to identify gaps and ways to procure the needed medical oxygen in a timely manner. 17 countries in the Region are now participating in this unique initiative, which will help them make better use of medical oxygen and biomedical resources which are vital for the management of emergencies regardless of the cause - e.g., respiratory infections, trauma, obstetric and pediatric emergencies. WHO also created the Regional Oxygen Network. While the data server will remain in EMRO, WHO plans to hand it over to countries for co-ownership between WHO Country Offices and local ministries of health.

Financial requirements

Overall regional funding requirements for ongoing emergency response operations (US$’000)

Overall regional funding requirements for COVID-19 and other emergencies (US$’000)

Overall funding requirements by pillar for COVID-19 (US$’000)

For more information

Richard Brennan | Regional Emergency Director | WHO EMRO | brennanr@who.int