Eastern Mediterranean Office Research Articles

Could Emergency Diseases Surveillance Systems Be Transitioned to Routine Surveillance Systems? A Proposed Transition Strategy for Early Warning, Alert, and Response Network.

In humanitarian emergencies, traditional disease surveillance systems either do not exist to begin with or come under stress due to a huge influx of internal or external migrants. However, cramped camps with an unreliable supply of safe water and weak sanitation systems are the ideal setting for major disease outbreaks of all kinds. The Early Warning, Alert and Response Network (EWARN) has been supported by the WHO since the late 1990s to ensure health system capacity to identify and control risks early before they become major epidemics. These systems have been proven to be an excellent asset in reducing morbidity and mortality in humanitarian crises around the world. However, there is also a global challenge of transitioning them back to a regular or national monitoring system in their respective countries. This article is the result of in-country consultations arranged by the Eastern Mediterranean office of the World Health Organization. In these consultations, the unique local conditions and limitations of different countries were discussed to identify a way forward for transitioning these emergency disease surveillance systems into regular systems. After these discussions, different options were presented which could be further modified according to local needs. As there has not been any documented evidence of a successful transition of any emergency surveillance system, it is difficult to discuss or determine the gold standard for transition. As with any public health program being practiced in the field, local decision-making with some broad guidelines will be the best approach available. This article provides these guidelines and practical steps which could be further modified according to country needs.

Offline: “We can do something and we can succeed”

It is sometimes noted, ruefully, that global health is an affectation of western nations. The flourishing of departments of global health in Anglo-American universities has not been matched by a reciprocal response in countries claimed to be the subject of global health's concerns. The insistent (and awkward) question won't go away. Why should a country care about global health? The seventh meeting of The Lancet Palestinian Health Alliance (LPHA), held in Amman (Jordan), and in Ramallah (State of Palestine), sought to provide an answer. Led in Amman by the Director of Birzeit University's Institute of Community and Public Health, Niveen Abu-Rmeileh, together with Rita Giacaman and Huda Zurayk, the LPHA is a network of regional and international researchers committed to the highest possible scientific standards. One goal of the LPHA is to develop and advance local evidence-based policy and practice. The alliance is broad—multilaterals (WHO and its Eastern Mediterranean Office), universities (Birzeit, American University of Beirut), local humanitarian organisations (United Nations Relief and Works Agency), and charities (Medical Aid for Palestinians). The 100 abstracts presented in Amman covered issues ranging from reasons for medical referrals of Gaza patients in 2015 (led by Mohamed Lafi at the WHO West Bank and Gaza Office) to the experience of Palestinian children facing traumatic events (led by Sabrina Russo from An-Najah National University in the West Bank). Both abstracts won prizes. But, as one member of the audience asked pointedly about the conference, “so what?” After Amman some of us crossed the King Hussein (Allenby) bridge to reconvene in Ramallah. We wanted to translate scientific dialogue at a research conference into policy analysis with Palestinian health decision makers. Health policy isn't wholly rational. And it certainly isn't based (always or alone) on evidence. However, research can make a difference. Tony Laurance (Medical Aid for Palestinians) argued that researchers could (and should) do more to hold decision makers to account. The capacity for policy analysis (not merely research production and publication) needed to be strengthened. The public health research community needed to sharpen its public voice. Research, at its best, can describe the reality of lives lived in threatened communities. It can identify vulnerable groups, highlight emerging threats, evaluate new interventions, and model the future. Most importantly of all, research can promote a culture of critical thinking. Despite exceptionally adverse conditions, Palestinians have much to be proud of—excellent and constantly improving universities, notable public health successes (eg, near elimination of thalassaemia), and the presence of an inspiring new generation of researchers and leaders. Abdul Latif Abu Hijleh (President of Birzeit University) put it well—his goal was “to put science in the service of the community”. But what about the importance of global health for Palestinians? Isn't global health a flattering self-indulgence next to the material difficulties of building a health system under extreme pressures? Not at all. The perspective of global health draws attention to profound transitions in disease and disease risks, massive macro-trends that cannot be avoided (such as urbanisation, ageing and multimorbidity, and ecological degradation), and compelling evidence that there is an undervalued and enormous pay-off from investing in health. The big idea in global health today is sustainable development (embodied in 17 Sustainable Development Goals). But what do the SDGs mean for Palestinians? First, achieving the objective of universal health coverage. Second, health system strengthening (better health financing, human resources for health, and health information). And finally, addressing the social and political determinants of health. Global health matters to the lives of Palestinians because its methods permit the discovery of forces shaping their health in the national context. The social movement that is global health provides opportunities for Palestinians to influence the international conversation about those forces. And global health—its community of publics, scholars, activists, and policy makers—enables Palestinians to tell their story (past, present, and future) through the lens of health. Niveen ended the meeting in Ramallah on an optimistic note—”We can do something and we can succeed in health.” The research community is an indispensable, although too often neglected, partner in doing so.