WHO/HSE/EPR/DCE/2009.1
Disease risk assessment and interventions
Gaza Strip
January 2009
Communicable Diseases Working Group on Emergencies, WHO headquarters
Communicable Disease Surveillance and Response, WHO Regional Office for the Eastern
Mediterranean, WHO Office for West Bank and Gaza
© World Health Organization 2009
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CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza
Contents
Acknowledgements …………………………………………………………
2
1. Context ……………………………………………….……………………
3
2. Priority health concerns …………………..……………………………
3
3. Priority communicable diseases ………………………………..……
4
4. Priority interventions .…………………………..………………………
6
5. Information sources …………………………………….………………
7
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
─1─
Acknowledgements
This communicable disease risk assessment was produced and edited by the unit on Disease Control in
Humanitarian Emergencies (DCE), part of the Epidemic and Pandemic Alert and Response Department
(EPR) in the Health Security and Environment Cluster (HSE) of the World Health Organization (WHO),
and supported by the WHO Regional Office for the Eastern Mediterranean and the WHO Office for West
Bank and Gaza.
The communicable disease risk assessment was contributed to and reviewed by the Communicable
Diseases Working Group on Emergencies (CD-WGE) at WHO headquarters. The CD-WGE provides
technical and operational support on communicable disease issues to WHO regional and country offices,
ministries of health, other United Nations agencies, and nongovernmental and international organizations.
The Working Group includes the departments of Epidemic and Pandemic Alert and Response (EPR), the
Special Programme for Research and Training in Tropical Diseases (TDR), Food Safety, Zoonoses and
Foodborne Diseases (FOS), Public Health and Environment (PHE) in the Health Security and
Environment (HSE) cluster; the Global Malaria Programme (GMP), Stop TB (STB), HIV/AIDS and
Control of Neglected Tropical Diseases in the HTM cluster; the departments of Child and Adolescent
Health and Development (CAH), Immunizations, Vaccines and Biologicals (IVB) in the Family and
Community Health (FCH) cluster; Injuries and Violence Prevention (VIP) and Nutrition for Health and
Development (NHD) in the Noncommunicable Diseases and Mental Health (NMH) cluster; Security and
Staff Services (SES) in the General Management (GMG) cluster; and the cluster of Health Action in
Crises (HAC) and the Polio Eradication Initiative (POL).
The following people were involved in the development and review of this document and their
contribution is gratefully acknowledged:
Giuseppe Annunziata (HAC/ERO); Maurizio Barbeschi (HSE/EPR); James Bartram (PHE/WSH); Eric
Bertherat (EPR/ERI); Sylvie Briand (EPR/GIP); Amina Chaieb (EPR/ARO); Yves Chartier (PHE/WSH);
Claire Chauvin (DGR/POL); Meena Cherian (EHT/CPR); Alya Dabbagh (FCH/IVB); Mahmoud Daher
(WHO West Bank and Gaza); Ousmane Diouf (HTM/HIV); Pierre Formenty (EPR/BDP); Albis Gabrielli
(HTM/NTD); Celine Gossner (HSE/FOS); Alexandra Hill (PHE/WSH); Stephane Hugonnet (EPR/ERI);
Anthony Laurance (Acting WR, WHO West Bank and Gaza); David Meddings (NMH/VIP); Shanthi
Mendis (CHP/CPM); Marc Van Ommeren (NMH/MSD); Fernando Otaiza (EPR/BDP); Salah Ottmani
(HTM/STB); Jules Pieters (HAC/ERO); Aafje Rietveld (HTM/GMP); Cathy Roth (EPR/BDP); Irshad
Shaikh (EHA/EMRO); Katja Schemionek (WHO/EMRO); Nadia Soleman (EPR/ARO); Peter Strebel
(FCH/IVB); Jos Vandelaer (FCH/IVB); Steven Wiersma (FCH/IVB); Zita Weise-Prinzo (NMH/NHD)
Editing support was provided by Penelope Andrea and Ana Estrela (HSE/EPR).
Contributions to previous risk assessments from the following focal points have also been incorporated:
Bernadette Abela-Ridder (HSE/FOS); Andrea Bosman (HTM/GMP); Claire-Lise Chaignat (PHE/WSH);
Pascale Gilbert-Miguet (GMG/SES); Lulu Muhe (FCH/CAH).
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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1.
Context
The Gaza Strip, on the eastern Mediterranean coast between Israel and Egypt has been the setting for a
protracted humanitarian crisis. It has a population of 1.5 million with the sixth highest population density
in the world, and a very young demographic with 18% of the population under 5 years of age (274 000
children). Recent events have resulted in a severe exacerbation of the chronic humanitarian crisis.
As of 18 January, over 50 896 people had been newly displaced and were residing in 50 shelters organised
by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). It is
estimated that there may be an additional tens of thousands of displaced people, mainly sheltering with
host families. As of 18 January, the Ministry of Health of the Palestinian Authority (MoH) reported that
1 300 people had been killed since 27 December, of whom at least 410 were children and 104 women.
Over 5 300 were reported injured, including 1 855 children and 797 women.
Vital infrastructure has been severely compromised or destroyed, resulting in lack of shelter and energy
sources, sudden deterioration of water and sanitation services, food insecurity, overcrowding and severely
curtailed access to health services. Since 27 December 2008, at least 16 health facilities and 16
ambulances have been reported damaged and as of 14 January, 21 out of 57 MoH health facilities and 3
out of 18 UNRWA health facilities were closed (OCHA).
Those facilities that remain operational face a number of challenges, including (i) low staffing levels due
to insecurity, especially in Gaza City; (ii) electricity for only a few hours per day from emergency
generators; (iii) uncertain supply lines; and (iv) inaccessible health care services for most of the catchment
area population, with attendance rates reported to have fallen by more than 50%.
2.
Priority health issues
The risk of excess morbidity and mortality is primarily from traumatic injury or from the discontinuation
of treatment for chronic conditions due to poor access to health care services. Diarrhoeal diseases
currently represent the most important risk of excess morbidity and mortality from communicable diseases.
The priorities below may change should the crisis continue for an extended period.
•
Immediate treatment of traumatic injury, burns and acute surgical conditions
The current overwhelming health concern is timely access to appropriate care for those who are
injured. The nature of presenting injuries includes open wounds, blunt trauma and burns. Delays in
provision of trauma and emergency surgical care and rehabilitation for the injured can increase the
likelihood of complications including disability, or of death.
An adequately functioning pre-hospital emergency medical service (EMS), such as an ambulance
service, and emergency rooms that are adequately staffed and equipped can significantly improve
survival rates among those with life-threatening injuries and surgical conditions.
Given the context (reduced staffing, treatment delays, interruptions to electricity and limited water
supplies), the risk of wound infection is high (for guidelines on surgery, and wounds and injuries, see
section 5). Tetanus is of particular concern as vaccination coverage among adults is low (see Table 1).
Health care workers should ensure they are suitably protected including with all appropriate
vaccinations.
•
Mental disorders and psychosocial problems
The stress and losses that occur during emergencies are a risk factor for a wide range of mental
disorders, including mood and anxiety disorders (such as post-traumatic stress disorder). WHO
projects that the long-term effects of emergencies can increase the number of people with severe
mental disorders by an average of 1% above baseline and those with mild and moderate mental
disorders by an estimated 5-10% above baseline. Much of the affected population is also likely to be
burdened by a wide range of symptoms of distress and other psychosocial problems caused by severe
trauma, loss and social and living conditions.
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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•
Continued treatment and care for chronic conditions
Prior to recent events, non-communicable disease was the leading cause of death in the Gaza Strip.
Surveys indicate a 9% prevalence of diabetes mellitus among the adult population. In 2007, UNRWA
treated approximately 34 000 hypertensive and 23 000 diabetic patients in the territory (a total of 45
000 patients taking into consideration an overlap of the conditions), with a prevalence in the adult
population of 17% and 12% respectively. Among these patients, about 7 000 were receiving insulin
therapy and 22 000 were taking hypertension drugs; 23% of patients with hypertension and/or those
with diabetes (10 000) were considered to be at high risk of complications and death. Among these
patients, the two groups considered to be at highest risk are the young insulin dependent diabetic
patients with severe hypertension, and those on renal dialysis. These patients are only able to tolerate
an interruption of therapy for 4-5 days in the first case and a maximum of one week in the second.
•
Communicable diseases
Risk of diarrhoeal disease outbreaks may increase with protracted disruption to water and sanitation
services. Risk of outbreaks of vaccine-preventable diseases is currently low, given high reported
vaccine coverage, with the exception of tetanus vaccination among adults. However this may change
if vaccination programmes are disrupted for protracted periods.
3.
•
Priority communicable diseases
Waterborne and foodborne diseases
The risk of outbreaks of waterborne and foodborne diseases is currently high and will increase if water,
sanitation and food control services are not restored, or are allowed to deteriorate further. The main
pathogens of concern are Campylobacter, Salmonella, Shigella, Leptospira, rotavirus, as well as other
enteropathogens such as Entamoeba histolytica and hepatitis A and E1. Typhoid fever, reports of
which increased in the Gaza Strip in 20072, is also a concern. Cholera has not been reported in the
territory since 1992.
Currently, 55 out of 145 wells in the Gaza Strip are not functioning and 80% of the water supply in the
territory is estimated to be unsafe for drinking (OCHA). Sewage treatment has been disrupted and
sewage has been reported in the streets of Beit Hanoun and Beit Lahiya. Monitoring of water quality
has stopped since 4 January 2009, following the closure of the Public Health Laboratory.
•
Vaccine-preventable diseases
Vaccination programmes have ceased as of 27 December 2008. However, given the high reported
routine vaccination coverage prior to that date (Table 1), with the notable exception of tetanus
coverage in adults, the risk of measles, polio, diphtheria, and pertussis outbreaks is currently low.
The main risk is from tetanus resulting from trauma (inadequately treated wounds and burns) and from
maternal and neonatal tetanus (MNT) following unsafe deliveries. Tetanus vaccination coverage in
adults is low and protection is known to wane with age. The incubation period is usually 3–21 days,
and the case-fatality ratio (CFR) is 70–100%. (For prevention and management of tetanus, see Section
5).
Currently there are about 1 200 births per week in the Gaza Strip (UNFPA - OCHA Field Update
16/01/09). Many of the newborns are not receiving routine vaccinations in line with Expanded
Programme on Immunization (EPI) schedules. Un-immunized children will require catch-up
vaccination doses once the EPI activities are able to resume. If disruption to EPI services is of short
duration (i.e. a few weeks), it is unlikely that vaccination coverage will dip below the herd immunity
thresholds. However, the Gaza Strip is a very densely populated area which requires greater levels of
1
2
Exclusive breastfeeding should be encouraged. The most appropriate alternative for infants dependent on a breast milk substitute
(BMS) is ready-to-use infant formula is most appropriate as it does not require mixing with water.
UNRWA Health Report 2007. http://www.un.org/unrwa/publications/pdf/ar_health2007.pdf
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
─4─
herd immunity, and therefore higher vaccination coverage, than less densely populated areas. If
vaccination programmes are suspended for a protracted period, accumulating birth cohorts of unimmunized children will result in lowered vaccination coverage levels, placing the entire community
at risk of outbreaks of vaccine-preventable diseases.
Table 1. Routine vaccination coverage at one year of age, 2006, West bank and Gaza*
Antigen
% coverage*
(BCG) bacille Calmette–Guérin
99
Diphtheria–pertussis–tetanus, 3rd dose
96
Hepatitis B, 3rd dose
97
MCV (measles-containing vaccine)
99
Polio, 3rd dose
96
Tetanus (women of childbearing age)
42
*Official estimates reported to WHO/UNICEF, as of 14 January 2009.
•
Acute Respiratory Infections (ARI) including pneumonia
Children and newborns are particularly at risk from ARI and have an increased risk of death from
pneumonia. The main risk factors include crowding, poor ventilation, indoor smoke, malnutrition and
lack of breast-feeding. The disruption of EPI services also means fewer babies receive supplements of
vitamin A, a highly effective preventive intervention against ARI. Acute malnutrition is a major
contributing factor to morbidity and mortality from communicable diseases such as ARI, particularly
in children. Micronutrient deficiencies, especially iron deficiency anaemia and vitamin-A deficiency,
remain public health problems in the Gaza Strip3.
•
Tuberculosis (TB)
Between 20 and 25 new TB cases are reported annually from the Gaza Strip. Untreated active
pulmonary TB carries a case fatality ratio (CFR) of 65% within 5 years. In the acute phase of this
emergency, the main concern for TB programmes is the continuation of treatment which is likely to be
hampered by drug supply problems and loss of contact with patients.
•
Avian influenza A(H5N1)
Highly pathogenic A(H5N1) was reported in poultry in the Gaza Strip in 2006. No human cases have
been reported to date.
•
HIV/AIDS
The prevalence of HIV in the Gaza Strip is low. No new AIDS cases were reported in 20074.
•
Malaria
There is no risk of malaria in the Gaza Strip.
A functioning communicable disease surveillance system was in operation prior to June 2006. This has
since deteriorated and ceased functioning as of 27 December 2008.
3
4
UNRWA Health Report 2007. http://www.un.org/unrwa/publications/pdf/ar_health2007.pdf
UNRWA Health Report 2007. http://www.un.org/unrwa/publications/pdf/ar_health2007.pdf
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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4.
Priority interventions
Interventions to reduce morbidity and mortality in the Gaza Strip are fundamentally
dependent on patients' ability to access health care, which is at present severely
compromised.
•
Provide emergency medical and surgical care for traumatic injury, burns and life
threatening surgical conditions. Ensure appropriate wound management including tetanus
prophylaxis.
•
Ensure the continuation of treatment of chronic conditions for those on medications
including TB, hypertension, diabetes and kidney disease. Where feasible, decentralization
of care will increase treatment coverage given the restrictions on movement.
•
Provide support for mental health and psychosocial disorders.
o Include specific psychological and social considerations in provision of general
health care;
o provide psychological first aid to people with severe, acute anxiety;
o ensure continued access to care for people with severe mental disorders.
•
Provide sufficient safe water, sanitation and reinforced hygiene measures for infection
control.
•
Establish and maintain an effective mechanism for communicable disease
surveillance and response to detect and respond to outbreaks, with particular focus on
diarrhoeal diseases.
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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5.
Information Sources
WHO headquarters and WHO Regional Office for the Eastern Mediterranean/EMRO
Communicable Disease Surveillance and Response, WHO/EMRO
http://www.emro.who.int/csr/
Disease control in humanitarian emergencies (DCE), WHO/HQ
http://www.who.int/diseasecontrol_emergencies/en/
Health Action in Crises (HAC), WHO/HQ
http://www.who.int/hac/en/
Avian and Pandemic Influenza
Avian influenza
http://www.who.int/topics/avian_influenza/en/
Pandemic influenza preparedness and mitigation in refugee and displaced populations. Second edition
May 2008.(pdf -550 kb)
http://www.who.int/diseasecontrol_emergencies/WHO_HSE_EPR_DCE_2008_3web.pdf
Child health in emergencies
Emergencies documents
http://www.who.int/child_adolescent_health/documents/emergencies/en/index.html
Pocket book of hospital care for children
http://www.who.int/child_adolescent_health/documents/9241546700/en/index.html
Acute respiratory tract infections in children
http://www.who.int/fch/depts/cah/resp_infections/en/
IMCI Chart Booklet (WHO; UNICEF, 2006)
http://www.who.int/child_adolescent_health/documents/IMCI_chartbooklet/en/index.html
Diarrhoeal diseases
Acute diarrhoeal diseases in complex emergencies: critical steps.
http://www.who.int/cholera/publications/critical_steps/
Cholera outbreak: assessing the outbreak response and improving preparedness
http://www.who.int/cholera/publications/cholera_outbreak/
First steps for managing an outbreak of acute diarrhoea.
http://www.who.int/cholera/publications/first_steps/
Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1
http://www.who.int/topics/cholera/publications/shigellosis/
Oral cholera vaccine use in complex emergencies: What next? Report of a WHO meeting. Cairo, Egypt,
14–16 December 2005. [pdf-3200kb]
http://www.who.int/topics/cholera/publications/cholera_vaccines_emergencies_2005.pdf
Background document: the diagnosis, treatment, and prevention of typhoid fever (WHO, 2003) [pdf230kb]
http://whqlibdoc.who.int/hq/2003/WHO_V&B_03.07.pdf
Drug donations
Guidelines for Drug Donations (WHO, revised 1999) [pdf-270kb]
http://whqlibdoc.who.int/hq/1999/WHO_EDM_PAR_99.4.pdf
Environmental health in emergencies
Guidelines for drinking-water quality, third edition, incorporating first addendum
http://www.who.int/water_sanitation_health/dwq/gdwq3rev/en/index.html
Environmental health in emergencies and disasters: a practical guide
http://www.who.int/water_sanitation_health/emergencies/emergencies2002/en/index.html
WHO Technical notes for emergencies
http://www.who.int/water_sanitation_health/hygiene/envsan/technotes/en/index.html
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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Frequently asked questions in case of emergencies
http://www.who.int/water_sanitation_health/emergencies/qa/en/index.html
Four steps for the sound management of health-care waste in emergencies
http://www.healthcarewaste.org/en/documents.html?id=184&suivant=25
Food safety
Ensuring food safety in the aftermath of natural disasters
http://www.who.int/foodsafety/foodborne_disease/emergency/en/
Prevention of foodborne disease: Five keys to safer food
http://www.who.int/foodsafety/consumer/5keys/en/index.html
Guideline for the safe preparation, storage and handling of powdered infant formula (WHO, 2007)
http://www.who.int/foodsafety/publications/micro/pif2007/en/index.html
Gender & gender-based violence
IASC Guidelines for Gender-based Violence Interventions in Humanitarian Settings (2005) [pdf-1900kb]
http://www.humanitarianinfo.org/iascweb2/downloaddoc.aspx?docID=4435&type=pdf
IASC Gender Handbook in Humanitarian Action Women, Girls, Boys and Men Different Needs – Equal
Opportunities (2006) [pdf-3200kb]
http://www.humanitarianinfo.org/iascweb2/downloaddoc.aspx?docID=4496&type=pdf
Clinical management of rape survivors: Developing protocols for use with refugees and internally
displaced persons. 2004 - Revised edition (WHO/UNHCR)
http://www.who.int/reproductive-health/publications/clinical_mngt_rapesurvivors/
Hepatitis
Hepatitis A
http://www.who.int/csr/disease/hepatitis/whocdscsredc2007/en/
http://www.who.int/immunization/documents/positionpapers/en/index.html
Hepatitis E
http://www.who.int/csr/disease/hepatitis/whocdscsredc200112/en/
http://www.who.int/mediacentre/factsheets/fs280/en/
HIV/AIDS
Guidelines for HIV/AIDS interventions in emergency settings: Interagency Standing Committee
guidelines
www.who.int/3by5/publications/documents/iasc/en/
Laboratory specimen collection
Guidelines for the collection of clinical specimens during field investigation of outbreaks (WHO, 2000)
http://www.who.int/csr/resources/publications/surveillance/WHO_CDS_CSR_EDC_2000_4/en/
Leishmaniasis
http://www.who.int/leishmaniasis/en/
Leptospirosis
http://www.who.int/water_sanitation_health/diseases/leptospirosis/en/
Malnutrition
Nutrition in emergencies publications
http://www.who.int/nutrition/publications/nut_emergencies/en/
Communicable diseases and severe food shortage situations (WHO, 2005) [pdf-250kb]
http://www.who.int/diseasecontrol_emergencies/guidelines/Severe_food_shortages.pdf
The management of nutrition in major emergencies.(WHO, 2000) [pdf-12 800kb]
http://whqlibdoc.who.int/publications/2000/9241545208.pdf
Infant feeding in emergencies - guidance for relief workers in Myanmar and China
http://www.who.int/child_adolescent_health/news/2008/13_05/en/index.html
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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Guidelines for the inpatient treatment of severely malnourished children (WHO, 2003) [pdf-400kb]
http://www.who.int/nutrition/publications/severemalnutrition/9241546093/en/index.html
Community-based management of severe malnutrition
http://www.who.int/nutrition/publications/severemalnutrition/978-92-806-4147-9/en/index.html
Management of the child with a serious infection or severe malnutrition: guidelines at first referral level
in developing countries (WHO, 2000)
http://www.who.int/child_adolescent_health/documents/fch_cah_00_1/en/index.html
Guiding principles for feeding infants and young children during emergencies (WHO, 2004) [pdf-1800kb]
http://www.who.int/nutrition/publications/guiding_principles_feedchildren_emergencies.pdf
Infant and young child feeding in emergencies. Operational guidance for emergency relief staff and
programme managers (IFE, 2007) [pdf-870kb] (in English and Arabic)
http://www.ennonline.net/pool/files/ife/ops-guidance-2-1-english-010307.pdf
http://www.ennonline.net/pool/files/ife/ops-g-arabic-v2-1.pdf
Gaza Alert - Media Guide on Infant and Young Child Feeding in Emergencies (in English and Arabic)
http://www.ennonline.net/pool/files/ife/ife-media-flyer-final(1).pdf
http://www.ennonline.net/pool/files/ife/media-guide-on-ife-arabic.pdf
Management of dead bodies
Management of dead bodies after disasters: a field manual for first responders (2006) [pdf-1100kb]
http://www.paho.org/english/dd/ped/DeadBodiesFieldManual.pdf
Management of dead bodies in disaster situations (WHO, 2004) [pdf-780kb]
http://www.paho.org/english/DD/PED/DeadBodiesBook.pdf
Measles
WHO/UNICEF Joint Statement on reducing measles mortality in emergencies (WHO/UNICEF, 2004)
http://whqlibdoc.who.int/hq/2004/WHO_V&B_04.03.pdf
WHO measles information
http://www.who.int/immunization/topics/measles/en/index.html
Measles fact sheet
http://www.who.int/mediacentre/factsheets/fs286/en/
Medical waste in emergencies
Medical wastes in emergencies
http://www.who.int/water_sanitation_health/medicalwaste/emergmedwaste/en/
Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies (WHO, 1999)
http://www.healthcarewaste.org/en/documents.html?id=15&suivant=16
Four steps for the sound management of health-care waste in emergencies (WHO, 2005)
http://www.healthcarewaste.org/en/documents.html?id=184&suivant=8
Mental health in emergencies
Mental heath in emergencies
http://www.who.int/mental_health/resources/emergencies/en/index.html
http://www.who.int/mental_health/resources/emergencies/en/index.html
IASC Guidelines on Mental Health and Psychosocial support in Emergency settings (2008)
English [pdf-800kb]
http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_april_20
08.pdf
Arabic [pdf-1.1 Mb]
http://www.who.int/mental_health/emergencies/iasc_guidelines_arabic.pdf
IASC Guidelines on Mental Health and Psychosocial support in Emergency settings: Checklist for field use
(2008) [pdf-4 MB]
http://www.who.int/mental_health/emergencies/IASC_guidelines.pdf
Meningitis
Control of epidemic meningococcal disease. WHO practical guideline, 2nd edition (WHO, 1998)
http://www.who.int/csr/resources/publications/meningitis/WHO_EMC_BAC_98_3_EN/en/
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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Outbreak Communications
WHO Outbreak communication guidelines
http://www.who.int/csr/resources/publications/WHO_CDS_2005_28/en/index.html
Polio
WHO-recommended surveillance standard of poliomyelitis
http://www.who.int/immunization_monitoring/diseases/poliomyelitis_surveillance/en/index.html
Surgery - emergency surgical care
Integrated Management for Emergency and Essential Surgical Care (IMEESC) tool kit
http://www.who.int/surgery/publications/imeesc/en/index.html
Tetanus
Maternal and Neonatal Tetanus. M Roper et al. Lancet 2007; 370: 1947-59.
http://www.who.int/hpvcentre/Maternal_and_neonatal_tetanus_Seminar.pdf
Tetanus Immunization: Maternal and Neonatal Tetanus (MNT) elimination
http://www.who.int/immunization_monitoring/diseases/MNTE_initiative/en/index.html
Surgical Care at the District Hospital (2003)
http://www.who.int/surgery/publications/en/SCDH.pdf
Travel advice
Guide on Safe Food for Travellers
http://www.who.int/foodsafety/publications/consumer/travellers/en/index.html
International Travel and Health (2008)
http://www.who.int/ith/en/
Tuberculosis
Tuberculosis care and control in refugee and displaced populations. An interagency field manual (2007). [pdf960kb]
http://whqlibdoc.who.int/publications/2007/9789241595421_eng.pdf
Vaccines and biologicals
http://www.who.int/immunization/en/
Vector control
Integrated vector management
http://www.who.int/malaria/integratedvectormanagement.html
Pesticides and their application for the control of vectors and pests of public health importance ( WHO,2006)
http://whqlibdoc.who.int/hq/2006/WHO_CDS_NTD_WHOPES_GCDPP_2006.1_eng.pdf
Wounds, injuries and trauma care
Prevention and management of wound infection [pdf-40kb]
http://www.who.int/hac/techguidance/tools/Prevention%20and%20management%20of%20wound%20
infection.pdf
Guidelines for essential trauma care (2004) [pdf-764kb]
http://whqlibdoc.who.int/publications/2004/9241546409.pdf
Prehospital trauma care systems (2005) [pdf-566kb]
http://www.who.int/violence_injury_prevention/publications/services/39162_oms_new.pdf
Integrated Management for Emergency and Essential and Surgical Care (IMEESC) tool kit
http://www.who.int/surgery/publications/imeesc/en/index.html
Best Practice Guidelines on Emergency Surgical Care in Disaster Situations [pdf-2254kb]
http://www.who.int/surgery/publications/BestPracticeGuidelinesonESCinDisasters.pdf
White Phosphorous: Systemic Agent
http://www.cdc.gov/NIOSH/ershdb/EmergencyResponseCard_29750025.html
Surgical Care at the District Hospital (2003)
http://www.who.int/surgery/publications/en/SCDH.pdf
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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WHO generic essential emergency equipment list [pdf-111kb]
http://www.who.int/surgery/publications/EEEGenericListFormatted%2006.pdf
Zoonotic diseases
http://www.who.int/zoonoses/resources/en/
CD risk assessment and interventions, Gaza. January 2009.
Communicable Disease Working Group on Emergencies (CDWGE-WHO/HQ);
WHO Regional Office for the Eastern Mediterranean (EMRO), WHO Office for West Bank and Gaza.
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