Virtual Environmental and Humanitarian Adviser Tool – (VEHA Tool) is a tool
to easily integrate environmental considerations in humanitarian response. Field Implementation guidances are useful for the design and execution of humanitarian activities in the field.

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VEHA - Field Implementation Guidance

Enabling activities - Health service delivery
Providing access to safe and integrated quality healthcare
Providing sufficient and appropriate healthcare at the different levels of health system

Providing sufficient and appropriate healthcare at the different levels of health system


Environmental factors causing/contributing to the needs and affecting the humanitarian activity

Pollution and environmental degradation intensify environmental health risks and create harmful living conditions. Pollution of the water, soil, and the air is a threat to human health and wellbeing and exacerbates poverty and inequality. Additionally, natural and man-made disasters can quickly overwhelm and/or interrupt the healthcare system. Public health can be affected by disruptions of physical, biological, and ecological systems, including disturbances originating here and elsewhere. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.

Gender, age, disability and HIV/AIDS implications
  • Women and girls tend to be affected disproportionately by emergencies. Indeed, gender inequalities tend to be exacerbated, leading to increased dependence and exclusion. This can directly impact their capacity to access external assistance and restrict and/or influence individual coping mechanisms.
  • An inclusive healthcare system can facilitate access of persons with disabilities to health facilities and distribution sites, contribute to overcoming the barriers they may face, and ensure that their specific vulnerabilities and needs have been taken into account. Well-planned health interventions can act positively on the safety and well-being of populations and contribute to addressing some of the risks directly linked with health conditions in emergencies.


Environmental impact categories

Air pollution
Soil pollution
Water pollution
Climate Change
Loss of biodiversity and ecosystems
Natural resource depletion
Soil erosion

Summary of Impacts
Potential environmental impacts
  •  Construction waste
  •  Unsustainable natural resource depletion for the supply of construction materials
  •  Laboratory and hospital waste
  •  Solid waste burning or disposal causes air, water, and soil pollution
  •  Burning fossil fuels for energy generation
  •  Water resource depletion
  •  Greywater and black water pollution
  • Environmental determinants of health
  • Environmental hazards
  • Hazardous substances/chemicals
Impact detail
Detailed potential environmental impact information

Environmental impacts can occur from all health service activities, including construction waste, laboratory and hospital waste; construction materials; solid waste management causing air, water, and soil pollution; burning fossil fuels for energy generation, minimising water waste and effluent polluting soil and water; environmental determinants of health; environmental hazards such as floods, droughts, crop pests, and disease; landslides and desertification. Health services produce waste including solid waste, organic, and medical waste which can all pollute and create disease vectors. Health facilities use hazardous substances/chemicals for cleaning, medicinal use, and anaesthetics which can seriously pollute the environment if released in an uncontrolled manner.


Summary of environmental activities
  • Reduce construction waste
  • Sustainably source construction materials
  • Implement sustainable solid waste
  • Assess and mitigate sources of air, water, soil pollution
  • Sustainable utilities avoiding fossil fuels, minimising water waste and effluent polluting soil and water
  • Assess and plan to mitigate environmental determinants of health
  • Assess and address environmental hazards
  • Sustainable solid, organic, and medical waste handling and disposal
  • Assess and address disease vectors
  • Controlled storage and handling of hazardous chemicals.
Detailed guidance for implementing suggested environmental activities
  • Most examples of change management towards environmental sustainability, are bottom-up, local, and driven by providers. While bottom-up change is crucial, it needs to be complemented by a governance-driven top-down change in order to have a significant effect throughout whole health systems.
  • Assess and mitigate environmental impacts of health facility refurbishment, maintenance, operation, and construction activities including solid waste, construction materials, pollution of air, water, soil, and use of utilities including fossil fuels. Assess and plan to mitigate environmental determinants of health. Assess and address environmental hazards such as landslides, malaria, flooding, and disease spread. Assess and address solid, organic, and medical waste handling and disposal. Assess and address disease vectors including facilities cleaning and storage and handling of hazardous chemicals.
Lessons Learnt
Lessons from past experiences
  • Examples of planned change for environmental sustainability in health systems exist in a few countries: the NHS Sustainable Development Unit is using a “Route Map” to develop a sustainable health system by identifying areas that require progress and describing roles of different stakeholders. The Route Map is structured across a vision, or ultimate goal, and covers three periods: “Getting started”, “Transformation phase” and “Transformation occurs”.
  • Integrating health systems sustainability into national environmental programming.
  • Organizing national stakeholder consultations to agree on a national joint vision and objectives.
  • Using a route-map approach jointly agreed with stakeholders to highlight opportunities and coordinate action plans
  • Identifying relevant entry points facilitated by local circumstances (for example, availability of EU accession funds, or obligations under binding multilateral environmental agreements).
  • Engaging in intensive awareness-raising among the public and within health systems.
  • Identifying champions within the leadership of health systems.
  • Elaborating on low-cost and high-opportunity priorities for the first five years.
  • Engaging in institutional capacity-building through hands-on learning, and communicating results systematically
Activity Measurement
Environmental indicators/monitoring examples

# of locations / communities / facilities that have been included in an overall environmentally sustainable healthcare service provision plan.

Main Focus
Focus of suggested activities
  • Prevention of environmental damage
  • Mitigation of environmental damage
  • Environmental enhancement
Resource implications (physical assets, time, effort)

Significant time for consultation and assessment of existing health services capacities, efficiency, environmental impacts, and opportunities for environmental impact prevention, mitigation, and possible enhancements.

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