Humanitarian Crisis in Southern Africa
Briefing: 10 July 2002, Palais des Nations
by David Nabarro, Jóhanna Lárusdóttir, Rayana Bu-Haka, Claire Chaignat and Fadela
Chaib of the World Health Organization, joined by Nils Kastberg of UNICEF
Issues:
What is the problem?
Why is it happening?
What does WHO plan to do?
Can WHO succeed in helping to reduce the extent of this crisis?
What is the problem?
At least 60 million people in Southern Africa – mainly Malawi, Zambia, Lesotho,
Zimbabwe, Swaziland, and Mozambique - are facing a large scale humanitarian crisis. Currently
12 million people are severely affected and at risk: 2-3 million of them are under 5 years of age.
Why is it happening?
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Dry weather and erratic rainfall over the past two years have led to severe food shortages in
the region.
This is compounded by instability and population displacement in some countries.
The governments of the region try to provide crucial services on very small budgets – for
example, health care for less than $20 per person per year in at least two countries: there are
severe shortages of essential medicines in health centres.
Low salaries and difficult conditions for health workers have resulted in a “skills drain”.
The underlying high prevalence of HIV infection, and AIDS, has resulted in reduced
production in household units and affected communities, and reduced numbers of health
workers, teachers, etc. . In Lesotho it is estimated that the prevalence of HIV/AIDS is 24%, in
Mozambique 13%, in Swaziland 26%, in Zambia 20%, in Zimbabwe 25%(UNAIDS 2000)
and in Malawi it is 30%.
So, there are millions of people at risk of extreme poverty and suffering due to lack of
food, lack of opportunities to earn cash through agriculture and food production, and insecurity.
In addition, they are eating seed grain which is resulting in increasing their long-term prospects of
sustained poverty.
The conditions are resulting in increased malnutrition levels particularly among children
(one Malawi survey showed child malnutrition levels increasing from 6% to 19% in three
months). This is associated with increased susceptibility to illness which is already resulting in
higher mortality rates in all groups, with a crude mortality in some areas exceeding one per
10,000 people per day. This indicates that there is now a severe humanitarian crisis.
We are particularly concerned about the doubling of life-time risk of maternal mortality in
some areas, the continuing rise in tuberculosis and acute respiratory infections and the risk of
severe measles. The crisis could be reflected in at least 300,000 “excess” deaths during the next
six months.
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If death rates in a setting exceed one per ten thousand per day, it is recognised as an
emergency situation. A recent community survey in Malawi reported a crude mortality of
1.9 per 10,000 per day. Many people had died in their homes, unable to reach health
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facilities. The number of women who delivered in health facilities decreased by 7%. But
those mothers who made it to the health facilities were faced with a 71% increase in
mortality rates. This means that the lifetime risk for a mother to die in childbirth
increased from 1 in 21 in 1995 to 1 in 12.3 over a few months.
Mortality rates in Zimbabwe for tuberculosis and acute respiratory infections rose
markedly over the last three years - for TB from 25.47 per 10,000 in 1998 to 41.87 in
2001 and for respiratory infections from 19.35 in 1998 to 36.15 in 2001.
The importance of clear water being available to those who need it cannot be overstressed. Most of the population living in the rural areas of the countries affected have
limited access to water. This problem is exacerbated in Lesotho and Swaziland. The
national coverage for safe water in Lesotho is 77.1% and 53.6% for sanitation: as a result
nearly half of the population is at high risk of outbreaks of feaco-oral disease.
In summary, this humanitarian crisis represents a continuation of acute problems due to
rainfall failure, long-term deterioration in health services, exacerbated by AIDS, and underlying
political and economic issues faced in the region. We anticipate that a substantial effort is needed
to maximise the survival of people at risk, reduce suffering and re-establish human and economic
development in the affected communities.
What does WHO plan to do?
The strategy is planned as follows: First, provide food which is a critical need, but – on
its own – is not sufficient to ensure survival. So, second, we need to address health needs.
1. We must focus on enabling people to survive this crisis through
- health care targeted to priority problems
- food rations designed for those at risk (eg for children)
- increased access to water, with the promotion of hygiene and sanitation
2. We must ensure that all concerned know how communities are being affected by the crisis to
ensure an accurate, effective and efficient response
- assessment of people's health status (with a focus on the status of poor people, and
especially women and children)
- surveillance of changes in health over time
- a response tailored to need – e.g. on infectious diseases and safer pregnancy
3. We must work hard to strengthen the basic elements of existing health services
- access to essential medicines
- vaccines and cold chains
- encouragement to critical staff to stay in post and provide services
We nee to working with donors and Governments to help ensure that health staff are paid
promptly, receive the allowances they are entitled to, and are adequately supported as they
respond to the crises)
4. We must help coordinate and support effective responses
- working closely with national Governments and NGOs able to respond to people's needs
- ensuring effective information systems (again, working with governments, NGOs and other
agencies)
- responding promptly to disease outbreaks, such as cholera
- focusing on safer pregnancy, child health, people affected by HIV/AIDS
- helping ensure that water is of adequate quality and quantity
- building up the capacity of WHO country teams
Can WHO succeed?
By working in a way which offers careful analysis of issues, support for Governments, NGOs
and others who are implementing responses, monitoring of the health situation – particularly of
mothers and children - and coordinating effectively with other key participants in the response
(UNICEF, WFP, bilateral donors and international NGOs), WHO will make a significant
contribution to a successful response.
The World Food Programme is seeking $500m for food for the region. This is vital. The
regional appeal will also include $40m for health and nutrition activities of which $19m is requested
by WHO. This financial support is essential if WHO is to coordinate efforts to ensure the survival of
affected people in this serious humanitarian crisis.
Further information:
Rayana Bu-Hakah, EHA, tel. +41 22 7913748, e-mail: buhakahr@who.int