August 2002
Southern Africa Humanitarian Crisis
WHO and the Humanitarian Crisis in Southern Africa
Currently between 12 and 14 million people in Southern Africa are at risk as a result of
the current humanitarian crisis. The conditions are resulting in increased malnutrition
levels particularly among children. 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 approaching two per 10,000 people per day. Some surveys
reveal that the life-time risk of maternal mortality has doubled in recent months, that the
incidence of tuberculosis, malaria and acute respiratory infections is on the rise, and that
there is a high risk of measles, at least in Angola. Without effective action to enable the
most vulnerable to survive, at least 300,000 people will die as a result of this crisis in the
next six months. The crisis affects mainly Malawi, Zambia, Lesotho, Zimbabwe,
Swaziland and part of Mozambique. However one should not lose sight of the structural
vulnerability of Namibia, too, nor of the humanitarian predicament of nearby Angola,
different in its causes but equally daunting.
It is common knowledge that dry weather and erratic rainfall over the past two years have
led to a severe decline in production. In some countries, this is compounded by economic
crisis, instability and population displacement, resulting in widespread food shortages.
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
31%, in Mozambique 13%, in Swaziland 33.4%, in Zambia 21.5%, in Zimbabwe 33.7%
and in Malawi it is 15% (UNAIDS 2002).
Of special concern to WHO, is the fact that the governments of the region have to
provide crucial services on very small budgets (for example, in Mozambique and Malawi
the health expenditure is respectively US$ 8 and 10 per person per year 1); as a result
severe shortages of essential medicines and other supplies in health centres are frequent.
On a more specific note, low salaries and difficult conditions for health workers have
resulted in a “skills drain”, that the current hardships risk to accelerate.
This is not the first crisis of this sort in Southern Africa. In 1992-93, drought and
complex emergencies in Mozambique and Angola combined together to call for a major
humanitarian efforts. In that occasion, WHO learnt at least three major lessons:
i.
drought and food shortages are public health affairs, at least as much as
matters of production and distribution of food. In a severe and protracted crisis,
the entire society and its structures are hit, including the health systems. Just to
give few examples, in that same period hospital admissions doubled,
governments had to curtail the import of essential drugs, health workers left their
jobs and the sub-region suffered severe cholera and dysentery epidemics;
1
World Bank, most recent data referring to the period 1990-98
August 2002
Southern Africa Humanitarian Crisis
ii.
in order to survive, people rely on very fragile coping systems - they sell
vital assets, migrate, etc; once the crisis is over, their vulnerability will be more
severe than it was before, and recovery will have to start from "less than Zero";
iii.
Non-food aid is slow at the beginning of a food crisis, but increases as the
emergency unfolds and its effects on health -i.e. starvation and growing
mortality- are documented. External support targets life-saving interventions, but
funds can also help the sector recovery. It is important, therefore, that aid is used
for redressing the sector flaws and not for recreating past vulnerabilities. Thus,
while providing life-saving services and preparing for rehabilitation, the health
sector also needs to start rethinking itself: the sooner, the better;
WHO’s strategic view and approach :
1
Countries must be enabled to mount appropriate responses to the nutritional and
health crisis, at all levels: this goes from tackling prevailing causes of morbidity among
children and women, to stemming the skill drain and handling public concerns, e.g. about
the health consequences of consuming GM crops
2
Up to date information must circulate regularly and widely: on health (mortality,
morbidity -in particular communicable diseases- and malnutrition) and access to essential
health services among different communities.
3
The responses to the health and nutritional aspects of the crisis must be
effectively coordinated, and this implies optimising the comparative advantages of all
partners, using evidence-based strategies and seeking maximum service coverage within
available resources
4
Health systems must reach those in need as close as possible to their actual
residence with adequate supplies of medicines and appropriate foods for nutritional
rehabilitation, so to minimise the risks associated to people's displacement and
concentration. The capacity to respond to specific health problems - including disease
outbreaks - must be put in place as close as possible to where it is actually needed.
Thus, WHO is
 reprogramming national plans of action so as to enable national authorities to respond
to immediate needs
 increasing its in-country support to national efforts on epidemiology, surveillance,
disease control, nutritional capacity, health systems performance
 strengthening its presence at sub-regional level , so to increase the regional support
to country and local responses
 contributing to wider UN system co-ordination ( e.g. through Johannesburg Office)
 working for stronger and effective alliances with NGOs
So far, WHO's response is being supported through reprogramming regular country
cooperation activities, through special grants (initially $300,000) from the Director
General's and Regional Director's development fund, through resources from DFID-
August 2002
Southern Africa Humanitarian Crisis
backed revolving fund, and through contributions from the Government of Italy rapid
response arrangement. In addition, the Canadian government has expressed interest in
providing a grant that will allow us to scale up the health response in Malawi, that in
many ways seems to be the most severely affected country at the moment.