HEALTH WORKERS: HEROES UNDER THREAT, UNDER PRESSURE

Tell us a little about your own experience in emergencies
In 2003, when I was WHO representative in Iran, there was a devastating earthquake in Bam which destroyed almost the entire community within a few seconds. 100% of the health facilities collapsed to the ground and 70% of the health workforce died within the first few minutes of the disaster. You can imagine the situation we were facing - it was an emergency within an emergency situation where the first kind of assistance necessary is providing care and relief to the injured.

In such situations, there are two requirements – the infrastructure and someone to deliver the services. In the Bam situation, we did not have any of those facilities – you can of course build temporary facilities, but if you don’t have the trained, the right kind of health workers you are simply in deep trouble. There were a lot of lessons learnt from the Bam disaster. First was that health infrastructure needed to be sustained during an emergency. Second was that we had to have proper preparedness plans. Preparedness plans need to be shared with the staff, who need to be trained on them and the plans need to address the needs not only of patients, but also of the health workers. Subsequently, WHO along with other partners took a number of steps to mobilize health workers from surrounding areas. This was not easy. But I can assure you that if you learn the lessons, things can change over a short period.

We had another earthquake in Lauristan, Iran in April 2006 and because the lessons were learnt – there was a proper preparedness plan, and a warning system. The physical damage in terms of the overall structure was much greater, but the number of people who died, including the health personnel were significantly less compared to what we faced in Bam. This clearly emphasized the need to have functional health systems, which are resilient, which has the basic ingredients to stay functional and also making sure that health workers are available.

Do you think health workers can be trained to deal with emergencies?
There are a number of existing programmes, but it is an area which needs much greater attention. WHO is also taking the lead in emphasizing various phases of response and emergencies and one of the fundamental response in preparedness – if you want to have better response and relief mitigation efforts subsequently. Within that it is important to also have the staff trained, with a comprehensive plan with clear roles and responsibilities of various levels, categories, and the linkages between various staff. Coordination mechanisms in time of emergencies need to be clear as is having the right kind of back up mechanisms in place – i.e. medicines and other support which are necessary.

How do health workers cope with emergencies?
Importance must also be given to the psychosocial needs of the health workers- it is not only the populations which suffer. More often it is the health workers who are at the forefront. I have seen cases where health workers may have survived, but they have lost members of their family, friends and loved ones. So they are going through a phase where they have the moral responsibility to be at the forefront and help others and at the same time to overcome their grief and personal challenges faced in such emergencies.

How in your view can health workers be protected in armed conflict?
This is an issue which goes much deeper. We need a response at the political level, leadership level, within sectors and in civil society. Health workers are here to serve everyone and we must recognize that and protect them. We have seen a number of armed conflicts and emergencies which have severely affected the health workforce. We have also seen in countries instances where large populations, including health workers, were forced to migrate for safety reasons, despite their desire to work. We need to make sure they are protected, respected and supported before, during and after emergencies, so that the impact of disasters, natural or otherwise are minimal.

What is your message on this theme of WHD this year calling countries to make hospitals safe in emergencies?
From the perspective of the Alliance, this issue is very critical given the fact that globally we are facing a huge shortage of health workers. Reports in 2006 state that we are short of four million health workers globally, especially in countries which are more prone to disasters and emergencies. We are already in the process of helping countries, with WHO and other partners, to address their health worker shortages by scaling up, by providing training programmes, building the infrastructure, building training institutes, improving retention incentives, etc. despite all these we can find ourselves in a situation where there is an emergency which negates all the positive impact and changes so far. That is why it is more important while we are scaling up as an Alliance, the World Health Day message and policy and approach of making sure health facilities are resilient during emergencies is so important. Training programmes of health workers, pre-service as well as in-service training programmes must be part of the curriculum, must address the issues of how they must react before, during and after an emergency. This is the only way if we want to make sure lives are saved and health facilities are functional during an emergency!

¹ The mission of the Global Health Workforce Alliance (GHWA) is to work through the coordinated actions of its members to ensure a motivated and skilled workforce is trained, supported and retained in sufficient numbers to overcome the crisis in health care provision, to move towards universal access to prevention, treatment and care against major health problems, and to accelerate achieving the health related Millennium Development Goals (MDG)