WHO-EM/CBI/065/E

A preliminary framework to safeguard

Health security in cities of the Eastern Mediterranean Region

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................................................................................................................... violence and crime...........................1 Shelter and safety of buildings and housing...INTRODUCTION...............................................................................3 Slum areas..........................................................................................2 Prevention of chronic and acute environmental health hazards..........CONTENTS 1..........................................................4 Emergency preparedness....................6 .........1 PRACTICAL HEALTH SECURITY THEMES IN CITIES OF THE REGION...........5 Road traffic accidents......................1 Safety and accessibility of hospitals and health facilities............................................................................................ injuries.... assessment and response.

Physical safety further requires timely access to emergency services and health facilities and safeguards against environmental hazards. The health security theme(s) selected by each city should be simple. health services and health related factors are addressed in the WHO healthy city programme. In contrast. preventing violence and maintaining law and order. Urban planning. PRACTICAL HEALTH SECURITY THEMES IN CITIES OF THE REGION Shelter and safety of buildings and housing The healthy cities programme may promote “safe shelter” as a human right and a health prerequisite. services and facilities and master plans for longterm urban development. practical and feasible for advancement by WHO. However. A homeless person or a person who lives in a makeshift shelter with plastic sheets as walls and dry leaves as a roof has no protection to safeguard his/her health. Chronic urban problems related to environment. institutions departments. Cities of lowincome and middle-income countries are highly vulnerable to emergency situations. health security concerns are particularly relevant in cities and large towns in middle-income and low-income countries. epidemics and pandemics. preventive measures against prevent fire and electrical accidents). the best approach would be to select a group of priority health security themes that can be advanced by a healthy city programme and as a part of World Health Day’s promotional and awareness raising efforts. cities in middle-income and low-income countries face enormous health security challenges. structural safety. They have sizeable slums and low-income areas and many shortcomings in health and other related services. In some areas where the price of urban land has sky rocketed and housing shortages are severe. and downright deficient in others. there is an urgent need to address acute health threats and conditions within the “health security in cities” concept. Given the wide scope and involvement of many agencies. nutrition. urban planning and management is very good and most cities have safe buildings. preventing road traffic crashes. 1 . The primary concern is the physical safety of city dwellers: ensuring safe housing (shelter. In the WHO Eastern Mediterranean Region. which can result in building collapse. In the highincome countries of the Gulf Cooperation Council (GCC). floods and conflict. The occasion of World Health Day 2010 provides a good opportunity to launch the concept. INTRODUCTION Health security in cities encompasses a wide range of concerns. management and safety standards are below average in some of these countries. particularly through the healthy city programme. extra floors are sometimes added to buildings. poverty.1. as well as natural and man-made disasters such as earthquakes. civil society and other stakeholders.

making timely emergency access to them at times impossible. resulting in heightened health risks during summer heat. Promoting and providing technical support for strengthening and improving the structural safety of all major hospitals to resist earthquake. laboratories and examination rooms can expose people to communicable diseases. and enforcement of hospital building and functional codes and standards. Healthy city programme interventions • • Promoting the long-term goal of eliminating homelessness and unsafe shelters on the city political and development agenda. poor structural and building conditions are barriers to maintaining good hygiene standards. private hospitals are often allowed to function in 2–3 apartments of a building located in a narrow alley or highly congested street. 2 • • • . The earthquakes in the Islamic Republic of Iran (2003) and Pakistan (2005) showed that for cities in many parts of the Region. Safety and accessibility of hospitals and health facilities In many cities. ease of access for ambulances and emergency services. In these hospitals. adequacy of elevators and outpatient waiting areas. buildings are extremely vulnerable to seismic tremors and earthquakes. Promotion and strong advocacy for inclusion of strict codes and standards for location and facilities of hospitals in urban planning and urban development. Conducting a strong promotion and advocacy campaign for structural safety of buildings. Assist for development of private hospital licensing and the required codes and standards and criteria. especially in low-income areas. A formidable challenge facing all cities is to make their hospitals and health facilities safe. Post-operative recovery rooms sometimes lack air-conditioning.Many countries are also earthquake-prone and in almost all cities. Healthy city programme interventions • Promotion and support for the assessment of: structural and functional safety of hospitals and major health facilities. They lack space for parking and for people who bring patients to hospital. calamity can be just around the corner. especially for new public and private hospitals. facilities for movement and transportation of patients. reinforcement of building codes and promotion of seismic protection for new multistory buildings. Such hospitals also expose neighbours to unwanted health risks. Many of the large public hospitals in cities of the Region are old and in need of repair. The structural safety of health facilities in the event of natural disasters is unknown in most cities and in most countries. The waiting areas for outpatient clinics.

In a large number of cities. A major chemical disaster could occur at any time. there are no regulations for adequacy of parking facilities. 3 . New housing schemes rarely address the need for adequate road capacity. As cities have grown. Prevention of chronic and acute environmental health hazards Many cities in the Region suffer from acute and chronic air pollution. bridges and other unplanned “quick fixes”. Instead of planning for it. or are already in the middle of congested housing. untreated wastewater is still being used to irrigate vegetables grown in urban peripheries in a substantial number of cities. especially in countries with asignificant number of solid waste scavengers that earn their living by recovering recyclable material in solid waste dumps. inspection and enforcement of chemical safety in toxic chemical producing plants and factories are inadequate in many areas or are not followed with the necessary rigour. The problem of solid waste management still is a serious public health hazard. This is a very serious urban health security issue. Furthermore. with a huge negative impact on health and well-being. There are no strict protocols or guidelines for housing and population density in urban planning and management. Streets in many cities are public car parks. There are severe shortcomings in urban planning and management. This poses considerable threat to public health. resulting in health-threatening congestion in city centres and many parts of the city. many large industrial complexes such as cement plants. money and time are later wasted in building flyovers. and transportation and traffic management do not use strategic planning for congestion prevention. The standards of monitoring. power generation plants and petrochemical plants are now encroaching on urban areas. There are no standards to connect the number of projected cars with road capacity and parking facilities. Similarly. these wastes are mixed and dumped in disposal sites.• Strong advocacy and technical assistance in resource mobilization to ensure water supply adequacy and safety and proper waste management and disposal for all hospitals. A critical deficiency in solid waste management is the lack of ironclad regulations to separate medical and toxic hazardous waste from domestic waste. metal foundries.

Encouraging/assisting in multicity studies on impact of untreated wastewater on the health of urban periphery farmers. moratorium on allowing new cars entering roads. The health. compared to number of cars. etc. scavengers. environmental. Critical deficiencies in infrastructure. economic and social conditions of slum areas are a major health security challenge in cities. as well as crime. • • • • Slum areas Slum areas can threaten the health of the entire city. type of fuel.Healthy city programme interventions • • Organizing educational meetingson air pollution and urban planning and management. Promoting/assisting multicity research studies on city transportation and air pollution (population density and length of roads. network and observatory. illicit drug use and other social ills. Promoting and assisting in creation of an intersectoral “health and slum areas forum”. including resulting morbidity and mortality. cardiovascular diseases and other health matters.). 4 . Promoting and assisting in establishing community based projects to raise the health status of slum dwellers. economic and social factors) in slum areas of the city. Identification of critical health security risks in slums with respect to epidemics and pandemics and setting special action to minimize risks. especially among high-risk groups such as garbage collectors. as well as poor nutrition and poverty often make slum areas breeding grounds for diseases and other health hazards. etc. Encouraging/assisting in multicity studies and evidence generation on air pollution impact on respiratory. with participation of city universities and research institutions. Encouraging/participating in health impact assessment of solid waste management. sanitation and environmental conditions. Healthy city programme interventions • • • • • Encouraging/assisting in national reviews of available material on health in slum areas in each country. assisting and mobilizing assessment studies on health and its determinants (environmental. Promoting. car age. rules and regulations for vehicle licensing. Promoting and advocating in identification of heavy polluter and toxic chemical industries in cities and their removal to suitable areas out of the city.

assessment and response Emergencies in relation to the city include natural and man-made disasters (earthquake. especially in schools. fire and conflicts). • • • Epidemics and pandemics • Developing a format and a protocol for epidemic and pandemic monitoring. assessment and response are usually undertaken at the national level. These are a good basis on which to build emergency preparedness capabilities in cities. with focal points identified at the local level. Emergency preparedness policies. 5 • . The vulnerability profile includes assessing the capabilities of the public and private health sectors in the city. clinics. etc. environmental health conditions. covering hospitals. The vulnerability profile also covers capabilities for environmental health monitoring and management and logistic support such as ambulance and fire services. surveillance. Developing prototype demonstration projects in 3–4 cities in emergency-prone countries. including existing and required capabilities for surveillance and public communication and media reporting. disease surveillance systems and media and public information channels. These activities could be further strengthened by developing a health vulnerability profile in each city. etc. fire department and civil defense capabilities to cope with emergency conditions as part of the above protocol. Emergency preparedness. health and environment staff. data and information collection. including health facilities. landslide. related emergency health management. Promotion of the establishment of intersectoral committees for epidemic control and management.Emergency preparedness. Considerable work has been done in risk and hazard analysis in relation to emergency in the Region. epidemics and pandemics. cyclone. The functional structure is still very much highly centralized (with exception of one or two countries). media and public information mechanisms. available expertise of the staff to handle emergency medical needs. control and management (in line with the national and international strategies and regulations). and environmental emergencies (chemical and physical). Assessing ambulance. flood. strategies and organizational approaches have been prepared in 11 countries of the Region. crowded public places and high risk contributing factors. emergency power supply and heavy machinery such as loaders. information collection. bulldozers. Examining the existing and required linkages between different sectors at the city level and national disaster management set-ups. exchange and reporting. Healthy city programme interventions Natural disasters • Developing a format and a protocol for health vulnerability profile preparation.

transportation. establishing poison control facilities in a focal poison control hospital with access to poison and antidote information to advise hospitals and clinics to deal with affected patients. who often enter the trade because of poverty. It will be necessary to connect road traffic crashes as a health security concern at the city level to the national programme. strengthening the capabilities of hospitals and health facilities to cope with potential chemical accidents. Road traffic accidents. Assessing the safety status and routine safety monitoring of such plants. and are often abused. Advocating the relocation of such plants away from densely populated areas. The safety and well-being of all these vulnerable groups is an important urban health security concern. are often subject to abuse. etc. especially identifying the industries and plants producing or using large quantities of toxic chemicals. many cities have “street children” who are used in the drug trade and in petty theft. such as fertilizer. especially countries of the GCC. violence against women is common. Similarly. Environmental emergencies • • • • • • Promoting and facilitating the preparation of a chemical safety profile at the city level. The rate of falls and injuries is particularly high among children and the elderly. Commercial sex workers. violence and crime Countries of the Region have among the highest rates of road traffic crashes in the world. The healthy city programme is an excellent venue to bring together all concerned sectors at the city level. An elaborate WHO collaborative programme is ongoing with countries in the Region. pesticides. 6 . assessing the collection. injuries. especially the handling of medical and industrial radionuclide waste. As part of chemical safety profile or separately. Based on the chemical safety profile. If not existing.• Promoting the education of city health staff and health facility workers to cope with epidemics and pandemics. including unsafe roads and pedestrian walkways. including access to a chemical information bank and poison control centre. Injuries in cities of the Region have many causes. Residents of slum areas are also more exposed to accidental injuries. In some countries of the Region. treatment and disposal of chemical and medical waste at the city level. especially in the case of older plants. petrochemicals.

As part of social mobilization for prevention of and control of HIV/AIDS. Promoting/facilitating the preparation of chemical safety profiles at the city level. petrochemicals. especially identifying the industries producing or using large quantities of toxic chemicals such as fertilizer. In close collaboration with civil society. pesticides. Advocating for the relocation of such plants away from densely populated areas. establishing women’s volunteer groups to help in preventing violence against women. etc. 7 . Promoting the safety of sidewalks and public places in cities and developing projects to improve their safety. creating neighborhood watch groups to protect the safety of children. religious organizations. especially older plants and factories.Healthy city programme interventions • • • • • • • • Promoting the application of national road traffic crash prevention activities at city level. promoting the safety of commercial sex workers. In collaboration with legal and religious authorities. women and children’s groups. Assessing the safety status and routine safety monitoring of such plants.

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