WHO steps up its role in health emergencies.

Abstract

The World Health Organization is on the brink of a major transformation into an agency that is fully mandated and equipped to respond to outbreaks and humanitarian emergencies. David Nabarro talks to Fiona Fleck. Q: How did you first become interested in working in emergencies? A: When I started out as a physician during the early 1970s, I wanted to work with communities, rather than in hospitals, particularly in places where people were unable to access health services. I worked in Kurdistan in northern Iraq in 1974, in rural Nepal, eastern India and then Bangladesh. But my interest in community health was there before I studied medicine. I wanted to understand what was needed for people to be less distressed, and not to suffer when ill --wherever they lived, and whether they were poor or wealthy. When I worked in areas affected by conflict I realized that the challenges are the same as anywhere else but that it's more difficult to ensure that people can access the health care they need. Q: Can you tell us about your appointment as the UN Secretary-General's special envoy for Ebola in 2014 and how the outbreak triggered soul-searching and reconsideration of the way health emergencies are addressed? A: The outbreak was bigger than anything we'd seen before and moving so fast that organizations had to develop and revise their action plans while they were being implemented. The presidents of the most affected countries were asking the UN to play a leading role in ensuring they were properly supported. They felt abandoned. Flights to their countries had been cut. They weren't receiving the help they needed. I was working with [WHO Director-General] Margaret Chan, the Secretary-General [Ban Ki-moon] and senior advisers as they sought a massive scale-up in support of the affected countries. The Secretary-General proposed a totally new mechanism, based on what is used for UN peacekeeping operations, to give extra muscle and coordination to the international response. It became known as the UN Mission for Ebola Emergency Response or UNMEER for short. UNMEER was approved by the UN General Assembly and endorsed by the UN Security Council in the middle of September 2014: it was implemented in record time. It was developed at a time when we did not know how big the outbreak would become, with some projections that more than a million people would become infected. Q: The Report of the Ebola Interim Assessment Panel released this year found that coordination was weak between WHO and its UN and nongovernmental partners on many levels--financial, logistical etc.--during the outbreak and that WHO lacked staff capacity to respond adequately. How can the response to such emergencies be more effective in future? A: There were concerns about whether WHO sounded the alarm soon enough in the early months of 2014 and others are examining this. Since August 2014 WHO has consistently provided the technical guidance, analytical expertise and capacity to lead and this has been valued by all involved in the response. At the same time, the UN helped to bring together different UN agencies and partners, each with their sets of skills and can do this in future. As a new entity offering additional capacity for overall leadership, liaison with governments, donor engagement and logistical support, UNMEER was unprecedented and unlike any other UN operation in which I have been involved. Q: In what sense? A: If you get it right, a leadership and coordination body such as UNMEER can bring the players together like the conductor of an orchestra. Individual musicians may play beautiful melodies, but the power of harmony emerges through the skills of the conductor. We need to do more of this at the UN. There are thousands of nongovernmental groups--and some businesses as well--that yearn for effective coordination and clear direction. It is never one organization alone that responds to an emergency, partnerships are essential. …