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Key environmental issues linked to health in a humanitarian response

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The goal of the health sector response during a humanitarian crises is to reduce avoidable mortality, morbidity and disability. Additionally, the sector seeks to restore the delivery of, and equitable access to, preventive and curative health care as quickly as possible and in as sustainable a manner as possible. The health and environmental sectors are closely linked, where the state of the environment, such as air and water quality, directly impacts people’s health and where health sector activities may impact the environment. Environmental health is the branch of public health concerned with all aspects of the natural and built environment affecting human health.

Communicable disease is a common cause of death in disasters and crisis, with disaster-affected people often residing in unsanitary conditions and also more vulnerable to disease due to malnutrition, stress and fatigue. In humanitarian response, environmental issues such as water provision and sanitation, waste management (and control of associated pests and vectors), cooking practices (and associated indoor smoke), chemical risks from damaged infrastructure or vector control, are directly linked to health. (Environmental) health officials are therefore a key collaborator for environmental organizations wishing to support the response.

Some key environmental activities linking to the health sector are outlined below:

Improper management of healthcare waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment. Healthcare waste from health posts, clinics and hospitals should be segregated and handled in line with international guidance. Designated personnel should be assigned and trained to deal with healthcare waste. The ash from incinerators should be disposed of properly. Expired, poorly labelled or packaged drugs are frequently donated in emergencies but have little value in the response and represent a major public health problem for local authorities. See SPHERE guidelines and healthcare waste guidance for more information.

During an emergency it is often difficult to properly manage solid waste. In many disasters, large amounts of additional waste is created, presenting additional challenges for civil society, local and national governments, private sector and humanitarian and emergency responders. Disaster waste not only impedes access and rescue operations, it also creates additional health risks and may in many instances contain hazardous waste such as fuel oil and asbestos. See the Disaster Waste Management guidelines for more details on waste disposal site planning.

Proper provision of water and sanitation is key to reducing environmental health risks. Facilities should be designed in accordance with relevant standards. Where possible, greywater should be reused. See Chapter 7 and 8 of WHO Environmental health in emergencies and disasters: a practical guide and the SPHERE guidance for more information

Where the disaster has caused a rise in vectors or pests such as insects or rodents, vector specialists need to be consulted to develop a plan of action on how best to deal with the issue. Pesticides should be used with care and in line with applicable national legislation and international best practice. See Chapter 10 of the WHO Environmental health in emergencies and disasters: a practical guide for advice. 

When constructing and refurbishing healthcare facilities the use of materials should be considered. Environmentally-friendly and local materials should be used where feasible. The handling and disposal of hazardous waste, (generator) fuel and oils must be properly done in order to avoid contamination of water sources or the soil. 

In case of contamination from a release of chemical materials, public health officials must be involved in the assessment of risk. When it comes to technological hazards, such as chemical and radiological/nuclear hazards, it is important to include public health officials in the design of communication materials in order to properly address but not exaggerate risks. See APELL guidance and Chapter 12 of  WHO Environmental health in emergencies and disasters: a practical guide for advice on proper messaging.

Climate change may exacerbate disaster risk, with strong links to public health, for example the increase in certain pests due to warming. Algal blooms may intensify and malaria-carrying mosquitoes may spread to areas previously not affected by malaria.

In preparedness, health development activities, such as improving water-supply systems, should be conducted in close collaboration with environmental actors.

Resources

Key Resource

Overview of technologies for the treatment of infectious and sharp waste from health care facilities

This study, conducted in 2019 by WHO, looks at safe health care waste management, including segregation, collection, transport, treatment and waste disposal and understands that it is fundamental to wider efforts to provide quality and safe health care. The report includes safe health care waste management practices and understands that this supports a number of the UN Sustainable Development Goals (SDGs), including Goal 3 on health, Goal 6 on safely managed water and sanitation, Goal 7 on climate change and Goal 12 on sustainable consumption and production.

This research is based on new global data released by WHO/UNICEF in 2019, where data from the represented 560,000 facilities from 125 countries, indicate that 40% of health care facilities do not segregate waste.

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Safe management of wastes from health-care activities

This document highlights the key aspects of safe health-care waste management to guide policy-makers, practitioners and facility managers to provide services in health-care facilities. It is based on the comprehensive and detailed WHO handbook Safe management of wastes from health-care activities. The report is part of the WHO/UNICEF Joint Monitoring Programme (JMP) and looks at the broader water, sanitation and hygiene (WASH) and infection prevention and control (IPC) efforts, safe management of health-care waste reduce health-care-related infections.

The study includes health-care waste categories and risks, waste storage requirements, wastewater management, among others and is in line with the UN Sustainable Development Goals (SDGs), mainly SDG 3 on health, SDG 6 on safely managed water and sanitation, as well as SDG 12 on sustainable consumption and production.

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The Rapid Environmental Impact Assessment in Disasters (REA) tool

The Rapid Environmental Impact Assessment in Disaster (REA) is a tool to identify, define, and prioritize potential environmental impacts in disaster situations.

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Disaster Waste Management Guidelines (DWMG)

These guidelines were developed with the aim of supporting the full cycle of disaster waste management, from risk reduction and contingency planning through to emergency planning response following a disaster or conflict.

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The Sphere Handbook

The Handbook is one of the most widely known and internationally recognized tools for the delivery of the quality humanitarian response

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Sphere Handbook Health Standards

The Sphere Minimum Standards for Healthcare are a practical expression of the right to healthcare in humanitarian contexts. The standards are grounded in the beliefs, principles, duties and rights declared in the Humanitarian Charter. These include the right to life with dignity, the right to protection and security, and the right to receive humanitarian assistance on the basis of need.

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Environmental health in emergencies and disasters: a practical guide

The guide is targeted to emergency planners and environmental technical staff working in a disaster context. It provides detailed guidance on environmental health activities in the prevention, preparedness, response and recovery stages of an emergency.

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WHO: Health response to technological incidents

This WHO page gathers guidance concerning the public health response to technological incidents, e.g. chemical accidents and accidents related to the transport of hazardous goods.

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USAID sector environmental guidelines: Healthcare waste

The guidelines outline the typical environmental impacts of healthcare waste and provides options on how to mitigate or prevent these.

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Visual Field Guide: Healthcare waste

Quick identification of serious environmental concerns in small-scale sanitation activities.

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Key Resource

Green Recovery & Reconstruction Toolkit: Training Toolkit for Humanitarian Aid (GRRT)

The GRRT is a toolkit and training program designed to increase awareness and knowledge of environmentally responsible disaster response approaches.

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Additional Resource

Asbestos and Humanitarian Response – A Life-Threatening Humanitarian Challenge

This summary summarizes the session from the Humanitarian Networks and Partnerships Week on Asbestos and Humanitarian response, from February 2020. Core questions posed in the session included (1) what the immediate actions, which can be taken to reduce the asbestos risks in post-disaster operations, and (2) What the long-term options are for reducing overall asbestos risks and specific risks following disasters. The summary further includes available information and guidelines on disaster waste handling and cases studies conducted by the Mozambique Shelter Cluster and UNDP on General Strategy for Risk Reduction linked to Asbestos Cement.

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Additional Resource

Glossary of Health Emergency and Disaster Risk Management Terminology

WHO has conducted a Glossary that aims to enable all actors, sectors and communities to work together more efficiently. The glossary is developed to remedy the lack of standardized terminology in the field of Health Emergency and Disaster Risk Management (Health EDRM). It is designed for practitioners, policymakers and other stakeholders who work in the fields that contribute to reducing the health risks and consequences of all types of emergencies and disasters.

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Additional Resource

From containment to recovery: Environmental responses to the COVID-19 pandemic

The OECD has published a brief on the immediate steps that governments can take to ensure that emergency measures implemented to tackle the Novel Coronavirus COVID-19 crisis. The brief highlights that the crisis should not derail governments efforts to address pressing environmental challenges and improve environmental health and resilience of societies.

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Additional Resource

Compendium of Technologies for Treatment/Destruction of Healthcare Waste

The UNEP division of Technology, Industry and Economics International Environmental Technology Centre has written a compendium which outlines the process of technology selection in the health-care sector based on UNEP’s Sustainable Assessment of Technologies (SAT) methodology. The report highlights the importance of waste management concerning healthcare waste generated by facilities, medical laboratories and biomedical research facilitates, as well as waste from minor or scattered sources.

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Additional Resource

Evaluating Climate Vulnerability in Humanitarian Hotspots

This study, conducted in 2019, focuses on the definition of climate vulnerability with operational and political perspectives and delivers guidelines for assessing climate vulnerability in long-term crises, such as in conflict-affected countries and recurrent disaster-prone areas.

The research draws on an extensive academic literature review in the fields of biology, political science, sociology and geography. It derives data from a variety of innovative projects and methods in the field of development and humanitarian aid, induced and encouraged by the Grand Bargain. In addition, the research offers a contribution to the IKI Project carried out by the UNEP/OCHA Joint Environment Unit in the refugee camp of Gitega Province in Burundi.

The study is available in French only.

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Additional Resource

Mozambique Shelter Cluster & UNDP – General strategy for risk reduction linked to asbestos cement

This strategy addresses awareness, assessment and management of asbestos cement material present in debris and damaged roofing following Cyclone Idai in Mozambique (2019). Drawing from the case study, the strategy (document) provides a general outline of key steps to raise awareness (presentation) ; design trainings; and plan and implement safe removal, handling and disposal of asbestos in emergency situations (Guidance Note)

 

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Additional Resource

Reducing Environmental Impacts of Vector Control Chemicals in Emergencies

Disasters can create environments in which vectors can increase dramatically and spread diseases. However, the chemicals most commonly used to dispose of these vectors can damage the environment and health. This paper provides guidance on how to create post-disaster sanitary efforts that remove the amount of vectors while simultaneously reducing harm to the environment and human health.

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Additional Resource

The Knowledge Hub on Health and Migration

The Knowledge Hub on Health and Migration is a joint effort committed to building expertise on the public health aspects of migration and making  information in this area widely available. The Hub provides tool kits, training materials, reports and schooling to better prepare for the health needs which arise during large-scale migration events.

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Flood Resilience Portal

The Flood Resilience Portal is a tool which provides open access to resources to build resiliency to floods. It issues reviews of past responses and provides community-specific flood resilience measurements.

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Prepare Center

PrepareCenter.org is an initiative established by the Red Cross which provides reports, case studies and training materials to encourage better preparedness for emergencies. It also provides insights and tools to integrate themes such as climate change, environment and urban resilience in disaster preparedness.

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WHO UNFCCC – Climate and Health Country Profile Project

The WHO UNFCCC Climate and Health Country Profile Project provides country-specific estimates of current and future climate hazards. It also identifies the  effects of climate change on human health and identifies mitigation and policy change actions. The data is collected via biennial surveys and was completed in 2017. The next series will be released in 2019 and will cover approximately 80 countries.

 

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Nepal Environment and Humanitarian Action Country Study

The Nepal Environment and Humanitarian Action (EHA) country-level study is one in a series of studies undertaken by the United Nations Environment Programme (UNEP) / UN Office for the Coordination of Humanitarian Affairs (OCHA) Joint Environment Unit (JEU) in 2015 that assesses the extent to which environmental concerns have been mainstreamed in humanitarian action. It provides guidance to humanitarian actors on how to improve environmental mainstreaming in a rapid onset emergency.

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Additional Resource

Afghanistan Environment and Humanitarian Action country study

The Afghanistan Environment and Humanitarian Action (EHA) country-level study is one in a series of studies undertaken by the Joint UNEP/OCHA Environment Unit (JEU) in 2015 that assesses the extent to which environmental concerns have been
mainstreamed in humanitarian action. This study provides guidance and advice to humanitarian actors on how to improve environmental mainstreaming in a protracted crisis.

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Additional Resource

Climate Change and Health: An Urgent New Frontier for Humanitarianism

A policy briefing provided by the international research collaboration The Lancet Countdown, offering an updated analysis of the intersection of climate change and global health. The briefing integrates the findings of the 2018 Lancet Countdown on Climate Change’s International Report with MSF’s documented on-the-ground experiences.

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Additional Resource

UN Environment ‘Quick guides’ on how humanitarian action can minimize environmental impacts

The ‘Quick guides’ contain key guidance on environmental issues relevant to six sectors of (viz. Food Security and Agriculture Sector, Basic Needs Sector, Health Sector, Education Sector, Protection Sector and Livelihood Sector) of humanitarian response to population displacement. They underscore the opportunities to minimize negative environmental impacts during humanitarian action. These quick guides are developed by UN Environment mostly for humanitarian action in urban setting. Please download the Quick Guides here.

Additional Resource

The Flash Environmental Assessment Tool (FEAT)

The Flash Environmental Assessment Tool (FEAT) helps to identify existing or potential acute environmental impacts that pose risks for humans, human life-support functions and ecosystems, following sudden-onset natural disasters. FEAT focuses primarily on immediate and acute impacts arising from released hazardous chemicals.

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Additional Resource

Health & Environment Tools for Effective Decision-Making: The WHO-UNEP Health and Environment Linkages Initiative (HELI)

The Health and Environment Linkages Initiative (HELI) is a global effort by WHO and UN Environment to promote and facilitate action in developing countries to reduce environmental threats to human health, in support of sustainable development objectives.

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