The other Grade 3 emergencies apart from Ebola

By Jenny Lei Ravelo 21 May 2015

Men walk past damaged buildings after a 7.8-magnitude earthquake hit Nepal on April 25. The disaster is just one of six Grade 3 emergencies that require a massive response from the World Health Organization. Photo by: Laxmi Prasad Ngakhusi / UNDP Nepal

There is no doubt that Ebola was 2014’s biggest health emergency, which required — and continues to command — a massive response from the World Health Organization and the wider international community.

But it was not the only emergency that demanded WHO’s attention and resources over the course of the past year.

During the special session of the executive board on Ebola in January, member states requested the health agency submit a report containing information on all Grade 3 emergencies the organization responded to as from May 2014. This included all Level 3 emergencies under the U.N. Inter-Agency Standing Committee. The request stemmed in part from the public perception and media reports that WHO’s initial limited response and reduced capacity to orchestrate a response to the Ebola outbreak was also partly due to the organization responding to multiple simultaneous crises.

The expert panel tasked to assess the organization’s response to Ebola acknowledged the severity of the situation.

“The panel is cognizant of the many other public health and humanitarian crises that were competing for the attention of WHO and the broader United Nations system during this period. For WHO, these included outbreaks of Middle East respiratory syndrome, poliomyelitis, and [bird flu] H5N1 and H7N9 virus infection,” it noted in its interim report.

However, these are just a few of the 40 emergencies WHO responded to over the past year. And they don’t fall under the Grade 3 or Level 3 categories requiring “substantial WHO response.”

So which ones did? Devex took a closer look.

Central African Republic

The current conflict in CAR dates back to 2012, when Seleka rebels began seizing major towns in a bid to replace the government headed by former President Francois Bozize. Their advances led to the eventual removal of Bozize, but that did not help stabilize the country, and in fact led to further fighting involving his predominantly Christian supporters, the anti-balaka fighters.

The continued violence led to displacements across the country and sparked a humanitarian crisis that impacted the country’s already struggling health care system. A number of health facilities were destroyed, and the insecurity forced personnel to abandon many health centers. WHO notes the crisis in CAR has now displaced more than 1 million people.

Today, the agency has 68 staff members on the ground helping coordinate the provision of emergency health services by partner health organizations. A disease early warning surveillance and response system has been put in place, and a number of health facilities have resumed operations, although most still need corresponding support from health groups.

But the agency notes that challenges remain: continued insecurity, limited number of operational partners and lack of resources — the health cluster has so far received only 12 percent of its $63.2 million appeal as of the time of writing.


There has been widespread insurgency in Iraq for a decade, but it was the advancement and involvement of the Islamic State group in early 2014 in the northern part of the country — which led to the mass displacement of Iraqis, including Yazidi minorities — that had the U.N. and humanitarian partners sounding the emergency alarm.

As of March 2015, there were more than 2 million internally displaced persons in the country, according to U.N. data.

WHO established hubs — or focal points — in 10 governorates in Iraq, coordinating the work of 45 health groups and extending its technical expertise to relevant health ministries. However, the agency and its health partners are facing similar problems as in CAR: insecurity, which has an impact on the number of operational groups on the ground, and limited resources. The health cluster in the country has so far only secured $1.14 million or 0.6 percent of the $189.2 million it needs for health interventions this year alone.

This, however, is just one part of the ongoing humanitarian crisis in the country. Iraq is also hosting some 250,000 Syrian refugees who are being attended to by health organizations.


The recent 7.8-magnitude earthquake in Nepal is currently attracting the biggest attention from the international community. Preliminary assessments point to more than 8 million people having been affected by the temblor, with deaths exceeding 4,000.

Some major hospitals, due to retrofitting that WHO helped initiate prior to the disaster, are currently functional, only sustaining minimal damage. But the agency notes that up to 90 percent of health facilities, particularly in the districts of Ramechhap, Nuwakot, Sindhupalchowk and Gorkha, have been “severely damaged.”

The Nepal disaster benefitted from WHO’s registration system for foreign medical response teams, which was activated in April. This helped lead to the swift deployment of foreign medical teams on the ground. WHO, as a result of lessons learned from the Ebola outbreak in West Africa, was quick to deploy staff — currently totaling 15 — from headquarters and its regional and country offices to support the response.

At present, the agency is involved in performing assessments, setting up disease surveillance systems, as well as coordinating and providing technical guidance in areas such as the management of dead bodies.

South Sudan

The crisis in South Sudan broke out at almost the same time as the one in CAR, triggered by an alleged coup attempt against embattled President Salva Kiir in December 2013.

The conflict has spurred a huge humanitarian crisis across South Sudan, with bouts of violence reported in several parts of the country, which also impacted the provision of health services. A number of hospitals have been attacked, leading to health service suspensions, with health workers fleeing and patients in fear of seeking medical attention.

Most recently, in Unity State, the U.N. noted that all aid agencies had evacuated their staff and put operations on hold. They are now facing an anticipated stockout of essential drugs across the country’s more than 1,000 medical facilities.


The crisis in Syria, now in its fifth year, remains the biggest humanitarian emergency in terms of its breadth and scale. The crisis has spread to neighboring countries of Egypt, Iraq, Jordan, Lebanon and Turkey, which are collectively now hosting nearly 4 million refugees.

The unrest has led to the “near collapse” of Syria’s own health system and to outbreaks of diseases like polio, which had previously been eradicated from the country. WHO says health groups are also now increasingly dealing with mental health problems and complications related to communicable diseases.

WHO has a network of medical focal points across all governorates, including in opposition-controlled areas, and has “active partnerships” with 56 local nongovernmental organizations that are helping deliver much-needed health services.

Yet gaps remain, according to WHO. The health sector would need more than $600 million in 2015 to continue providing lifesaving medicines and supplies, expand immunization services and provide support to neighboring countries’ health systems, which are also burdened by the refugee crisis.

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About the author

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Jenny Lei Ravelo@JennyLeiRavelo

Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.

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