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World
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Background Guide
I.
II.
Combating the growing health concerns among refugees
and within refugee settlements
Developing rapid response mechanisms to infectious
disease outbreaks.
Evan Cotreau, Head Chair
[email protected]
Mai Nagabayashi
[email protected]
17
World Health Organization (WHO)
What is the WHO, and what do they do
The World Health Organization’s underlying goal is to build a healthier future for people
all over the world. WHO works in offices in over 150 countries, working side by side with
governments and other partners to ensure the ability to provide healthy living conditions for
people throughout the world. In conjunction WHO strives to combat diseases and infectious
diseases. We help mothers and children survive in conflict areas. We ensure the air people
breathe is safe, the water they drink is clean, and the food they eat isn’t rotten. WHO is also
committed in providing medicines and vaccines to areas that need them.
Where WHO Works
WHO supports countries to attain their health goals, by working within the established
national policies and strategies at combating health problems. WHO assists countries by
establishing collaborative efforts amongst multiple sectors of government and partners including,
bi- and multilaterals and funds and foundations. WHO also encourages civil society
organizations and bodies within the private sector to help in achieving these goals.
Committee Information
The ultimate agenda of the WHO is for “the attainment by all people of the highest possible level
of health,” with responsibilities ranging from providing leadership in global health epidemics
and research to monitoring trends and offering support within countries. As such, the:
WHO fulfills its objectives through its six core functions:
● Providing leadership on matters critical to health and engaging in partnerships where
joint action is needed;
● Shaping the research agenda and stimulating the generation, translation and
dissemination of valuable knowledge;
● Setting norms and standards and promoting and monitoring their implementation;
Articulating ethical and evidence-based policy options;
● Providing technical support, catalyzing change, and building sustainable institutional
capacity; and
● Monitoring the health situation and assessing health trends
The governing forum of WHO is the World Health Assembly (WHA). The WHA is
composed of the health ministers of all 194 member states of WHO, and is the world’s highest
health policy setting body.
Resources
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World Health Organization: http://www.who.int/en/
CIA World Factbook: https://www.cia.gov/library/publications/the-world-factbook/
World Health Organization http://www.who.int/about/en/
Constitution of the World Health Organization
http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
Topic 1: Combating the growing health concerns among refugees and within
refugee settlements
Refugees are a tragic reminder of the wars, oppression and famine that continue to taint
our rapidly changing world, forcing millions of uprooted people into exile and focusing
international attention onto forgotten conflicts and isolated, little-known countries. The United
Nations High Commissioner for Refugees (UNHCR) has reported that in 2015, there are a total
of 65.3 million who are forcibly displaced, 21 million of whom are refugees and 10 million are
stateless people.1
The conflict in Syria transitioned from an insurgency to a civil war during the summer of
2012. For the first year of the conflict, Bashar al-Assad relied on his father’s counterinsurgency
approach; however, his campaign failed to put down the 2011 revolution and accelerated the
descent into civil war. As the Assad regime lost its counterinsurgency campaign, Syria falls into
a civil war killing 450,000 civilians2 From the fall of the Assad regime to the ongoing threat of
ISIS, Syria remains the center of attention in the media. As such, the highest number of refugees
are in Syria with a total of 4.8 million refugees, almost 1.4 million Syrians fled the country in
2015, UNHCR says.3 As many of them are settled in neighboring countries, including Turkey
(2.7 million), Lebanon (1.05 million), Jordan (655,000), and Iraq (247,000). The vast majority of
Syrian refugees remain in the Middle East with little or no medical nor health care. The
seriousness of this issue is intensified by the increase in diseases, injuries, mental and
psychological wellness concerns as a result from the traumatic outcomes of war that added to the
underlying decrease in the accessibility of health social insurance. Amongst other issues include
the need for cooperation and funding from developed nations, intergovernmental organizations
(IGOs) and non-governmental organizations (NGOs).
There are a number of health concerns amongst refugees and refugee settlements. While
many suffer from physical illness, some also suffer face mental concerns due to post traumatic
stress disorder (PTSD) from recent experiences as many they may have lost relatives and friends,
and they have certainly been forced to abandon homes and possessions, and a way of life. While
mental health is a main concern for many refugees, the physical health concerns and needs of
refugees and IDPs is of the utmost importance, as diseases are plagued around war-torn
countries4
Food Concerns
Chronic malnutrition makes refugees fragile and more susceptible to a variety of diseases
and illnesses. Most refugee camps do not have sufficient food to provide to their populations,
and refugees are frequently dependent entirely on humanitarian aid.5 The United Nations High
Commissioner for Refugees (UNHCR) recommends that each refugee receive more than 2,100
calories per day, but often camps fall short of this standard. As 170,000 refugees flee their home
country in Sudan to escape conflict, many are faced with food insecurity in two refugee camps in
1
UNHCR, Figures at a Glance: http://www.unhcr.org/en-us/figures-at-a-glance.html
I AM SYRIA, Death Toll: http://www.iamsyria.org/death-tolls.html
3
http://www.unhcr.org/en-us/news/press/2015/7/559d67d46/unhcr-total-number-syrian-refugees-exceeds-fourmillion-first-time.html
4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231133/
5
http://www.unhcr.org/45fe62642.pdf
2
South Sudan. New epidemiological data shows that refugees are suffering from malnutrition and
also mortality.6 Moreover, it is not only the quantity of food that is insufficient. The lack of food
variety, fruits and vegetables causes many refugees to suffer from deficiencies in essential
vitamins and minerals, which can lead to a variety of diseases. For example, chronic deficiencies
of vitamin A can lead to xerophthalmia and blindness in childhood, while iron deficiency can
lead to anemia, vitamin C deficiency leads to scurvy, niacin deficiency causes pellagra, and
thiamin deficiency results in beriberi7
The Dzaleka refugee camp is located in the central region of Malawi and hosts refugees
mostly from the Great Lakes and Horn of Africa regions. Due to the lack of funding, the World
Food Programme (WFP) has been forced to reduce rations. Ration cuts mean that refugees are
only receiving 40 percent of the recommended minimum daily kilocalories, compromising longstanding efforts to achieve food security in Dzaleka camp. Currently, the refugees are only
receiving three of the five planned foods – and even then a lot of their food are served in half the
initial amount. The WFP would require a sum of US$2 million to continue the provision of full
rations for the next months.
In order for refugees to be well-nourished, it is recommended that each refugee must
obtain 2100 calories a day to be fit and healthy. As such, there needs to be a permanent
settlement, and therefore refugees are encouraged to grow their own food in small gardens,
cutting down on malnutrition and ensuring the consumption of a more balanced diet.
Water Concerns
According to the UNHCR, more than half of the refugee camps in the world are unable to
provide the recommended daily water minimum of 20 liters of water per person per day. The
lack of clean water is correlated with the presence of diseases such as diarrhea and cholera,
therefore, it is an important public health issue to ensure that refugees receive an adequate
quantity of water. Though it is important to provide adequate quantities of water, the water
quality and hygiene is also of the utmost importance. Even if the water that is provided is not
contaminated, the transfer of water between vessels, the storage of water in the home, and
touching the inside of water vessels with the hands are risk factors for contamination.8
In 2005, there were 11 cholera cases amongst the households who has access to 110L per
day in the Kakuma refugee camp in Kenya. Meanwhile, Cholera has affected 163 people
amongst households with access to only 37L of water per day. Similar trends were found
regarding diarrhea. A study carried out between 2005 and 2006 in Kenyan and Ghanaian refugee
camps found that the households who reported a case of diarrhea within the previous 24 hours
collected 26% less water on average than those households who did not report any cases.
It is also vital for water to be readily accessible, and the taps should be centrally located.
If the water taps are far away, children might have to interrupt their schooling to collect water for
their families. In addition, if the water taps are very far away, the physical burden of water
collection grows immensely. In order for refugees to be able to get access to clean water, it is
6
Doctors Without Borders, Catastrophic Malnutrition in Refugee Camps: http://www.msf.ca/en/article/catastrophicmalnutrition-refugee-camps
7
https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/nutrition-growth.html
8
Refugee Camp Water: https://www.alws.org.au/media/wysiwyg/discovermore/schools/awareness_week_2015/Refugee_Camp_Water_1.pdf
important that there are readily available water nearby camps so refugees do not have to travel
afar. The UNHCR therefore recommends that all households have access to a water tap that is
less than 200 meters away. In addition, the use of water purification tablets that self-dissolve in
water, often chlorine-based can also help to decrease diarrhoeal diseases and can be used for
large quantities of water depending on the size of the tablet. It is essential for refugees to receive
an adequate quantity of good quality water because water has an impact on so many vital sectors
of society, including nutrition, health, education and sanitation.
Sanitation Concerns
The provision of adequate sanitation services is crucial to prevent communicable diseases
and epidemics while ensuring good health and dignity. Though the importance of having
adequate latrines is well documented, still 30% of refugee camps do not have adequate waste
disposal services or latrines. A study conducted in refugee camps in Bangladesh found that
camps that provided sanitation facilities had cholera rates of 1.6 cases per 1,000 people, while
camps that had no such facilities had cholera rates that were four times greater (4.0-4.3 cases per
1,000 people)9 In addition to providing latrines and sanitation services, it is also important to
provide the population with sufficient resources to curb diseases and epidemics.
As the number of refugee constantly increases day by day, this creates a more pressing
issue on infrastructural housing and sanitation. In 2013, at a camp for Syrian refugees in Iraq, aid
agencies say overcrowded living conditions in Domiz (Duhok Province) - built for 25,000
refugees but now accommodating almost twice that number - have put refugees’ health at risk.10
At the same time, this is putting a strain on water contamination that could lead to various of
other diseases as well. Diarrheal disease, the second leading cause of death in children under the
age of 5, is preventable if appropriate water, sanitation and hygiene infrastructure and practices
are in place.
A study in a Kenyan refugee camp found that sharing a latrine with 3 or more households
was found to be a significant risk factor for cholera due to an increase in the fecal-oral
transmission of the disease.11 The key to a good hygiene and sanitation program is creating
positive behavior change so that infrastructure that is developed is used and maintained. By
promoting the importance of cleanliness in communal bathing and latrine areas, refugees can be
made aware of the dangers associated with dirty and contaminated water.
Mental Concerns
9
UNHCR, A review of water and sanitation provision in refugee camps in association with selected health and
nutrition indicators – the need for integrated service provision: http://www.unhcr.org/enus/protection/environment/4add71179/review-water-sanitation-provision-refugee-camps-association-selectedhealth.html
10
IRIN News, Containing disease in a Syrian refugee camp in Iraq:
http://www.irinnews.org/report/98349/containing-disease-syrian-refugee-camp-iraq
11
NCBI, Cholera outbreak in Kenyan refugee camp: risk factors for illness and importance of sanitation:
https://www.ncbi.nlm.nih.gov/pubmed/19346392
While living in their home country, refugees often experience traumatic events and
adverse situations such as sexual violence, genocide, torture, political persecution, the loss of
loved ones, and forced child soldiering, which frequently prompt them to escape from their
country of origin.
Similarly, violence often characterizes the would-be safe haven of the UNHCR refugee
camps in the immediate aftermath of the refugees’ flight. Following the Rwandan genocide of
1994, much of the Hutu tribe escaped into neighboring Democratic Republic of Congo and other
bordering countries, as the Tutsi tribe took over power and enacted revenge on those Hutus they
believed were responsible for the 1994 genocide. However, amongst the fleeing ‘refugees’ were
war criminals, who used the refugee camps in the Democratic Republic of Congo as a base and
cover to launch attacks against those now in power in Kigali, Rwanda’s capital. These Hutu
militiamen used fear tactics and propaganda to keep the refugees complicit in order to recruit
allies and fighters. These tactics furthered violence in the area and severely affected the
psychological health of refugees who were already recovering from a ghastly genocide.
However, it is not only traumatic events or experiences that affect the mental health of
refugees. Recent work has shown that the daily hassles of living in refugee camps, such as
waiting in line at the water tap, also negatively impact mental health. refugees have witnessed
and experienced many traumatic events, as well as multiple and chronic adversities, they have a
high risk of developing mental health problems and have a higher prevalence of psychological
disorders, in particular depression and post-traumatic stress disorder (PTSD). PTSD is an anxiety
disorder which often occurs after witnessing or experiencing an event that is personally
threatening.
It is important to address the mental health of refugees because mental illness severely
impacts the functioning of a person in many different ways and can also contribute to poor
physical health. For example, mental illness often negatively impacts the ability of an individual
to engage in economically productive activities, to benefit from educational opportunities, and
also makes one more prone to experiencing addictive substance abuse and a dysfunctional family
life. Thus, in order to ensure the refugees’ successful adaptation and functioning after
resettlement, it is critical to identify and treat mental health illness.
Questions to Consider in Your Research
● Myanmar’s Rakhine State: What is the current health concern within the Rohingya
refugee settlement?
● Where is the funding coming from?
● What are the concerns within host countries? I.E. spread of diseases
● What is your country doing specifically regarding this issue?
Resources
 Healthcare Access and Conditions in Refugee Camps:
https://www.cdc.gov/immigrantrefugeehealth/profiles/congolese/healthcareaccess/index.html
 Migration and Health: Key Issues:
http://www.euro.who.int/en/health-topics/health-determinants/migration-andhealth/migrant-health-in-the-european-region/migration-and-health-key-issues#292936
 Doctors Without Borders:
http://www.doctorswithoutborders.org/country-region/syria
 Health Care in Refugee Camps and Settlements:
http://www.uniteforsight.org/refugee-health/module1#_ftn5
 Current Research on Mental Health of Syrian Refugees:
https://www.apa.org/international/pi/2015/09/noor-baker.pdf
 The Ongoing Humanitarian Emergency in Myanmar’s Rakhine State:
http://www.doctorswithoutborders.org/news-stories/field-news/ongoing-humanitarianemergency-myanmars-rakhine-state
 Rohingya Face Health Care Bias in Parts of Asia, Study Finds:
https://www.nytimes.com/2016/12/05/world/asia/rohingya-myanmar-health-care.html
Topic 2: Developing rapid response mechanisms to infectious disease
outbreaks.
We live in a world today, rapidly increasing in globalization and industrialization. With
the increased mobility of individuals, international trade, deforestation, and the impacts of
urbanization not only rapidly changing the world we live in, but linking us together more and
more. Add to this the rapid adaptation of microorganisms, which has brought forth the return of
many old communicable diseases and the emergence of new ones. Antimicrobial resistance has
caused many curative treatments to be less effective in a wide range of diseases. This has lead to
many scenarios where a communicable disease in one country can be a concern for other
countries.
In industrialized countries, communicable disease mortality has decreased greatly in
recent years. The concern now lies in preventing the resurgence of past disease epidemics and
preventing the outbreak of new ones. In developing countries, the biggest concern is detecting
communicable disease outbreaks, and preventing them from spreading. This has to be done by
responding to outbreaks early and stopping the spread of the disease before it has a major impact
on public health, trade, and tourism. Both developing and industrialized countries share one
major means of addressing these health concerns, and it is by developing a strong surveillance
system to measure risk. In order for this to be fully effective, it would be in the best interest of
nations developing national surveillance systems to develop global partnerships.12
What are Infectious Diseases
Infectious diseases are caused by pathogenic microorganisms, including bacteria,
parasites, fungi, and viruses. These diseases can be spread both, directly or indirectly, from
person to person. Zoonotic diseases are infectious diseases of animals that can cause disease
when transmitted to a human.13 Some examples of infectious diseases are Tuberculosis,
Influenza, Measles, Malaria, Meningitis, Yellow Fever, HIV/AIDS, Ebola virus disease, Cholera,
and Sever acute respiratory syndrome. ca
Communicable Diseases
A communicable disease is an infectious disease transmissible by direct contact with an
affected individual or the individual's discharge or by indirect means. Factors that increase the
spread of communicable diseases can derive from environmental, socioeconomic, and behavioral
sources, and can spread by international travel and migration. Vaccine-preventable, foodborne,
12
World Health Organization Global Infectious Diseases Surveillance:
http://www.who.int/mediacentre/factsheets/fs200/en/
13
World Health Organization Infectious Diseases: http://www.who.int/topics/infectious_diseases/en/
zoonotic, health care-related and communicable diseases pose significant threats to human health
and may sometimes threaten international health security. WHO has developed standards and
guidelines, with cooperation of governments, to help countries implement effective disease
prevention and control programs and to address risk factors.14 It is important to note that many
communicable diseases can also be considered as an infectious disease. The distinguishing factor
that determines if a disease is communicable is if it can be spread by direct contact with an
infected individual or bodily fluids. Some communicable disease to consider are Ebola virus
disease, Flu, Hepatitis B, HIV/AIDS, Measles, MRSA, Rabies, West Nile Virus, Zika,
Tuberculosis, and Sexually Transmitted Diseases.
Emerging Diseases
As defined by the WHO, “an emerging disease is one that has appeared in a population
for the first time, or that may have existed previously but is rapidly increasing in incidence or
geographic region.”15 In December of 2015, public health experts and scientist were brought
together by WHO to meet in Geneva to discuss emerging pathogens that are most likely to cause
an outbreak in the foreseeable future, and to assess what current medical countermeasures exist
in treating these diseases. They developed a list of diseases that are of the most concern, that will
become the focus on WHO’s future research and development projects to help control the
possibility of future outbreaks.
The following list reflects the disease priorities needing urgent research and development
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Crimean Congo hemorrhagic fever
Ebola virus disease
Lassa fever
MERS
SARS
Marburg
Rift Valley fever
Nipah
This list provided the foundation for the WHO Blueprint for R&D preparedness, which focuses on
accelerating research and development on emerging dangerous pathogens, which have the most potential
to create an epidemic. The Blueprint also advocates for allocating initial resources to research and
development in order to help generate diagnostics, vaccines and treatments for all the diseases within the
list. This Blueprint demonstrates WHO’s commitment to providing effective and efficient treatment in the
potential case of an epidemic of these emerging diseases.
14
WHO Regional Office for Europe Communicable Diseases: http://www.euro.who.int/en/healthtopics/communicable-diseases
15
WHO Emerging Diseases: http://www.who.int/topics/emerging_diseases/en/
Chikungunya, severe fever with thrombocytopenia syndrome, and Zika were determined to be
serious emerging diseases, that will require action by WHO in order to promote research and
development, but not to the severity of the other diseases within the Blueprint. It was also found that
HIV/AIDS, Malaria, Avian influenza, Dengue, and Tuberculosis all have epidemic potential. The
reasoning behind why they were not included in the Blueprint was due to the vast disease control and
research networks that already exist for these infectious diseases.16
WHO’s Role in the Surveillance of Diseases
From 1992 on, there has been growing concerns over emerging and re-emerging diseases.
This has resulted in several national and international initiatives to improve and restore the
surveillance and control of communicable diseases. In 1995 the World Health Assembly
produced a resolution urging all Member States to strengthen surveillance for infectious diseases
in order to detect the emergence of previous diseases and to identify new infectious diseases. The
Assembly recognized that in order for this resolution to be successful, it would depend on the
ability to obtain information on infectious diseases and the willingness of sovereign nations to
communicate the information nationally and internationally.
Improving the detection and surveillance of re-emerging and new infectious diseases, will
lead to better prioritization of public health efforts both nationally and internationally. WHO has
utilized a global surveillance system which links together existing local, regional, national and
international networks of medical centers and labs to create a super surveillance network. This
network is being constructed with the 191 WHO Member States and other partners, that includes
the European Union-United States Task Force on Emerging Communicable Diseases and the
US-Japan Common Agenda. 17
WHO’s Alert and Response Operations
In order to protect the population from emerging epidemics, WHO continuously
dedicates resources to track evolving infectious diseases. This allows for the spread of
information amongst countries that will allow for appropriate responses when needed to protect
the health of their people. Since June of 2007, the International Health Regulations have been
enforced, with four main areas of focus, protect, prevent, control, and provide a public health
response. All of these areas of focus must work in synergy in order to protect the populations at
risk from the international spread of disease. The IHR provides a framework for WHO alert and
rapid response activities that are already implemented, and strengthens countries abilities to
control international outbreaks, while simultaneously strengthening international public health
16
WHO WHO publishes list of top emerging diseases likely to cause major epidemics:
http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/
17
World Health Organization WHO’s role in disease surveillance:
http://www.who.int/mediacentre/factsheets/fs200/en/
security. It is important to note that the regulations within the IHR must consider international
traffic within affected countries, especially in regards to trade, in order to not hurt the country’s
economy. The context of the IHR provides a cohesive guideline for all the countries involved,
with respect to national sovereignty.
The IHR (2005) introduce new operational concepts including:
 Specific procedures for disease surveillance, notification and reporting of public health
events and risks to WHO by countries
 Requests by WHO for verification of public health events occurring within countries
 Rapid collaborative risk assessment with and assistance to countries
 Determinations as to whether an event constitutes a public health emergency of
international concern
 Coordination of international response18
Questions to Consider in Your Research
● What diseases, both infectious and communicable, are affecting your country?
● Does your country already have systems in place for handling disease outbreaks?
● Where do many of these infectious diseases originate from? What does your country do
to assist in the countries of origin?
● Is your country a party to the International Health Regulations? If so how does your
country implement its guidelines into its government structure?
Resources
18
WHO, Alert and Response Operations: http://www.who.int/csr/alertresponse/en/
 WHO Regional Office for Europe Communicable Diseases
http://www.euro.who.int/en/health-topics/communicable-diseases
 WHO Alert and Response Operations http://www.who.int/csr/alertresponse/en/
 WHO facts and information on Infectious Diseases
http://www.who.int/topics/infectious_diseases/en/
 WHO Global infectious disease surveillance
http://www.who.int/mediacentre/factsheets/fs200/en/
 International Health Regulations
http://apps.who.int/iris/bitstream/10665/246107/1/9789241580496-eng.pdf?ua=1
 State Parties to the International Health Regulations
http://www.who.int/ihr/legal_issues/states_parties/en/