The International Federation assists victims of disasters through its worldwide network of National Societies. Almost every country in the world has a Red Cross or Red Crescent society, each with branches and trained volunteers at community level. Cooperation among these societies provides additional capacity, solidarity, financial and human resources. Our mission is to improve the lives of vulnerable people by mobilizing the power of humanity.
These National Societies are responding to natural disasters, conflicts, and are increasingly involved in the everyday silent disasters caused by infectious diseases.
The response system to major emergencies is based on the right of National Societies to request support in a crisis, and of the International Federation's Secretariat to offer support. The Secretariat's role is that of coordinator; it launches international appeals to raise funds for relief operations, and then mobilises personnel and relief goods. The 2002-2003 efforts amounted to 270 million Swiss francs to fund 72 humanitarian assistance programmes.
Not surprisingly, with increasing needs and decreasing resources in many disaster prone countries, the International Federation finds its National Societies engaged well beyond the initial emergency responses and into long periods of rehabilitation and reconstruction work. The International Federation is therefore launching appeals not just for disasters but for the long term problems of maternal and child health, water and sanitation, polio, measles, malaria, tuberculosis, and HIV/AIDS.
These are indeed the humanitarian "crises" of our times.
Redefining these "Humanitarian Crises"?
The complex emergencies which we have witnessed in the last two decades of the 20th century have increasingly drawn our attention to an unprecedented number of natural disasters such as devastating floods, hurricanes, droughts, and earthquakes to mention but a few. We have also witnessed the man-made disasters of devastating population movements as a result of genocides and conflicts. It has almost become normal to equate "humanitarian crises" with these events.
But as the 21th century dawns upon us, we are very much part of an HIV epidemic that has lingered too long as a "silent crisis". Not only HIV/AIDS but malaria and tuberculosis are also seriously threatening our populations. These crises require the same energetic and resourceful response that natural and man-made disasters have evoked. The catastrophic and uninterrupted growth of our worldwide HIV/AIDS epidemic is forcing us to rethink our priorities and to redirect more attention to the world's "silent public health emergencies".
Public Health ----has it fallen off the map?
In its effort to draw the world's attention to these "silent killers", the Federation, in its World Disaster Report 2000, focused on public health. It stated "Diseases such as HIV/AIDS and malaria have become ongoing disasters -less headline friendly than sudden natural catastrophes or refugee crises, but far more deadly".
In 1999, approximately 100,000 people were killed by natural disasters, but an estimated 13 million died of infectious diseases. UNICEF reports that more than 2 million annual deaths in children <5 years are a result of poor water and sanitation conditions, and WHO reports that nearly 3 million people are dying of HIV/AIDS each year, that tuberculosis is claiming more than 1.7 million lives, and that measles and malaria claim the lives of more than 1 million children annually.
These are disturbing numbers in light of the fact that all of these deaths can be averted through simple public health interventions. These responses need to be massive, quick, and effective.
Responding to these Humanitarian Crises
There are no choices here. Humanitarian actors must respond to the "traditional" emergencies and to these "silent public health emergencies". This is not an either/or decision. Governments, development agencies, institutions, and nongovernmental organizations, must respond with the same urgency that we devote to natural and man-made disasters. In times of emergency, we provide quick and effective health relief to fill temporary gaps in basic health care services.
Some of these gaps are not temporary. HIV/AIDS, malaria, measles, and tuberculosis, all "silent killers" will need long term attention and responses. There is progress. The Sphere project launched in 1997 by a group of humanitarian NGOs and the International Federation provides a set of minimum universal standards for emergency responses. This handbook addresses infectious disease control and prevention with a special focus on HIV/AIDS, measles, malaria, and tuberculosis during emergencies and conflicts.
The way forward - putting it together
In recent years and outside of disaster settings, the Federation has been increasing its appeals to address the "silent killer" diseases. A recent example includes the successful Africa Measles Initiative.
The Measles Initiative is a global partnership launched in 2001. It is a long-term commitment to control measles deaths in Africa by vaccinating 200 million children and preventing 1.2 million deaths over five years. Leading this effort are the American Red Cross, United Nations Foundation, the Centers for Disease Control and Prevention, with the World Health Organization, International Federation of Red Cross and Red Crescent Societies, UNICEF and other corporate and NGO partners. The Measles Initiative is having a profound impact on the health of all children in Africa.
In January 2004, WHO reported on the progress made in reducing global measles deaths for the period 1999-2002. Globally, there has been an estimated 29% reduction in measles deaths over the 3 year period, with an estimated 35% reduction in Africa. Moreover, 67% of the total global reduction was due to the 170,000 annual measles deaths that have been averted in Africa.
The Measles Partnership has played a major role in supporting African countries in sustainably reducing measles deaths. Given all of the activities that have occurred during 2003 in conducting supplemental immunization activities (SIAs), combined with ongoing efforts to strengthen routine immunization services in priority countries, it is estimated that the 2003 mortality estimate will bring us much closer to achieving the 2005 goal of reducing global measles deaths by 50% compared to 1999 levels. Through 2003, the Measles Partnership had vaccinated more than 129 million children in 29 African countries.
New Approaches: Achieving synergies and impact through integration
This partnership with major Red Cross and government donors has piloted an innovative approach of integrating multiple interventions using mass vaccination campaigns as a delivery platform to effectively deliver other life saving interventions of Vitamin A, mebendazole, and insecticide treated bednets (ITNs) to reach high coverage at lower costs. We have now completed two efforts at integration, one in Ghana and another in Zambia.
The Ghana Red Cross example
Measles and malaria are two major causes of deaths in Africa. While measles campaigns rapidly achieve high coverage at low cost resulting in near elimination of measles deaths, no similarly effective approach for ITN distribution has been demonstrated. In order to achieve rapid, high, and equitable ITN coverage at low cost, 14,200 ITNs were distributed during a 7 day measles vaccination campaign in Ghana, in December 2002. One ITN was distributed free of charge to every caretaker that accompanied one or more children less than five years of age to a vaccination/distribution post in a district of 145,000 people.
High coverage rates for both measles vaccination and ITNs were achieved at low cost. Pre-distribution, 20.1% of families had a bednet and only 6.0% of children slept under them. Post-distribution, 80.1% of children slept under an ITN. The cost of ITN distribution was $0.32 because it was combined with the transport and delivery of measles vaccine and other supplies. This delivery cost was lower than that of any reported social marketing scheme. Distribution of ITNs during measles campaigns has great potential for rapidly achieving high coverage at low cost to both consumers and providers.
The Zambia Red Cross example
In a June 2003 effort to reduce morbidity and mortality from measles, malaria, vitamin A deficiency, and intestinal worms, the Zambia Red Cross joined with the Ministry of Health and multiple partners to plan and implement a massive effort which included Vitamin A, mebendazole, and vaccinating all children 9 months to 15 years of age against measles. In an attempt to scale-up the Ghana integrated ITN experience, more than 90,000 ITNs were procured for distribution in 5 remote districts during this campaign. This 7 day integrated effort involved intense community education and information by Red Cross community volunteers prior to and after ITN distribution.
Very high coverage was achieved quickly, effectively, and at low cost for all interventions.
These coverage figures are unprecedented. The following represents national coverage for children under 15 years of age. ITN distribution data is for children under 5 years in the 5 target districts.
Results, Zambia Integrated Campaign, June 2003 Intervention Targeted Reached Coverage*
Measles Vaccine 1,600,916 1,955,647 107% Vitamin A 1,713,923 1,864,818 109%
Mebendazole 1,421,056 1,537,583 108%
ITNs 65,745 77,579 118%
*coverages greater than 100% result from a combination of low census estimates, newcomers, and children not in target group who received services
Thus the Ghana pilot effort in one remote district demonstrated the safety and feasibility of integrating ITN distribution during a measles campaign. With Ghana's success in achieving high coverage in a cost-effective way, a large scale effort in Zambia validated the viability of scaling-up to achieve high coverage in large population groups.
These lessons are now providing the base for a nation-wide measles and ITN integrated effort in Togo in December 2004. Successfully achieving high coverage in Togo will result in that country's achievement of a critical Abuja target for ITN coverage in children and pregnant women.
Conclusion
By pooling financial resources, technical expertise, and operational capacities, partnerships with civil society enable scaling-up to a level that WHO and UNICEF could not reach alone with Ministries of Health. This approach has also been successfully demonstrated with polio eradication where the unprecedented long term (20 years+) financial support of Rotary International enabled massive scaling-up of WHO, UNICEF, and country programmes to achieve a 99% reduction in polio cases worldwide.
"Making a major difference to the health of vulnerable people throughout the world" is the mission of the International Federation. The lessons of the last decades have demonstrated that making a "major difference" will require new ways of working when responding to disasters and to the world's "silent everyday emergencies".
In summary, these new ways include: integration of infectious disease control and prevention in disaster responses, responding as quickly and as effectively to the everyday "silent killers" as we do to emergencies, and creating global and national partnerships to pool resources and to scale-up massively to achieve impact in these humanitarian crises.