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NOTE ON MISSION TO MALDIVES: 5 -
6 January 2005
Dr Mukesh Kapila,
Senior Adviser- Crises, WHO/HAC, Geneva
1. The
purpose of my one-day mission to the Maldives,
accompanied by Dr Waheed Abdullah, was to assist
the WHO Country Office in establishing their disaster management operational
arrangements to deal with the unprecedented crisis in south East
Asia due to the tsunami of 26 December 2004.
2. We
are grateful for the co-operation and support of all colleagues in WHO Maldives.
For such a small country office with limited resources, they are to be
commended for their initial response led by the Acting WR, and the current
determined continuation of their work.
3. Following
briefings from the Acting WR and WHO staff, we met with the Acting UN
Resident and Humanitarian Coordinator, and UN Country Team (including UNDP,
UNICEF, WFP, UNFPA, OCHA), and the visiting UN Disaster Assessment and
Coordination (UNDAC) Team. At the request of the UNRC ai,I was asked to conduct a discussion session with the UN Country Team on
lessons learnt from elsewhere on processes for post crisis recovery. I also
had brief contact with a visiting DFID/UK aid and military delegation, (there
are hardly any donor missions or embassies resident in the Maldives). We
called on the Director General Health Services (who is also a member of the
WHO Executive Board) to discuss what he wants us to do; he also expressed his
views on wider perceptions of WHO policy and effectiveness in crisis
situations.
4. The
conclusions of the mission are captured in the separately- distributed
strategy paper on Strengthening WHO for Emergency Health Action in the
Maldives. Our strategic situation overview is that the
impact of the disaster on this archipelago nation of 300,000 people scattered
among approx. 200 inhabited islands is disproportionately greater than that
reflected by the relatively small number of 100 dead and missing, and over
1300 injured. This is because of the vulnerability of its tourism dominated
economy and the fragility of its natural environment. Despite its relatively
high GDP per capita of US$2500, it is also challenged by human resource
limitations typical of small island states. The devastation has directly
affected a third of the population, and a quarter of the productivity related
land mass.
5. Within
this context, the physical damage to health infrastructure is relatively
moderate (37 of 206 facilities) but potential negative health impact is
accentuated by pre-existing policy and practical limitations, for example, in
relation to health sector financing and the costly logistical necessities of
the referral chain (dependent on sea and air) to meet basic curative needs.
Potable water supplies are a severe problem on several islands (but hopefully
this is temporary as desalination and other solutions are found, funded by
several donors, and if rains come in time to cleanse the aquifers).
Meanwhile, the importance of communicable disease surveillance
(including food safety and vector control on dengue prone islands) is of
particular importance - not least because of the political and economic
sensitivities associated with any preventable disease outbreaks that may set
back tourism recovery.
6. As
immediate humanitarian assistance efforts get better organised
and gather pace, discussion has started on the recovery and reconstruction
process. An emerging issue is the Government's preference to relocate
many of the 12,000 displaced people and others to main islands (where basic
services can be provided more efficiently), and discourage re-settlement of
severely damaged and economically marginal smaller islands. This will
obviously have a bearing on how the health infrastructure is
reconstructed. A donor conference is
expected in March, and discussion has started on a possible joint assessment
process (with the World Bank) of reconstruction needs. WHO will be expected
to play a full and timely role in this, directly and in support of the
Ministry of Health.
7. Consistent
with WHO's regional strategy the WHO Maldives strategy
for emergency health action prioritises five
action areas: surveillance and response, strengthening medical supplies
management, water quality monitoring, planning for recovery and
reconstruction, and health sector coordination.
8. The
necessary strengthening of the Country Office proposes four additional
international staff for an initial period of six months: an emergency
coordinator, a public health specialist, a logistician, and a finance and
administrative officer, supported by additional national staff, and short
missions in specialised areas. The Office has
established an Emergency Task Force which has effectively mobilised the whole office. The additional staff will
need additional accommodation close to the current WHO office. In view of the
compact nature of the office and the proposed forward programmer, we do not
think that there is need for a formally constituted Operations Room, such as
in SEARO and Sri Lanka. Neither are sub-offices on other islands necessary.
However, OR- type protocols should be instituted such as daily review
meetings, situation reporting, etc. The Operations Room of the UN (next to
the Office of the Resident Coordinator where all UN agencies except WHO are
located) should be sufficient as a resource that can also be used by WHO as
required.
9. In
conclusion, SEARO and HQ are advised to move quickly to establish the
additional complement of proposed staff. The Office will then have to give
early attention to devising specific financing proposals for funding, under the
framework of the agreed emergency health action strategy.
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