Peter Salama MD MPH Chief, Child Survival and Immunization, UNICEF Working for UNICEF in Emergencies: The Role of the Health Professional in Emergencies Peter Salama MD MPH Chief, Child Survival and Immunization, UNICEF

Highest <5 MR Ranked Countries 1) Sierra Leone 2) Niger 3) Angola 4) Afghanistan 5) Liberia 6) Mali 7) Somalia 8) Guinea-Bissau 9) DRC 10) Zambia 11) Chad 12) Mozambique 13) Burkina Faso 14) Burundi 15) Malawi 16) Rwanda 17) Nigeria 18) Mauritania 19) CAR 20) Guinea Countries in RED color are the ones considered ‘emergency countries’. Almost half of the countries in the top 20 list are emergency countries and Afghanistan in the only non-African country. *Source: Lancet 2003

Background on Afghanistan 20 years of civil war Human rights abuses Infrastructure devastated Late 2001: fall of Taliban regime Bonn peace process 3 years of successive drought Influx of refugees Influx of aid and organizations

Background: Health Indicators Under five mortality: 257/1000 LBs Infant mortality: 165/1000 LBs Maternal mortality ratio: high Malnutrition prevalence: high Incidence communicable diseases: high Life Expectancy: 45 – 47 years

Causes of Death, Children < 5 yrs, Kohistan District, Afghanistan, April 2001 Source: SCF US / CDC/ UNICEF

Programme Management

Reported Measles Cases by Month, Afghanistan January 2001-March 2003 Number of measles cases per month 2002 2003 Month

Policy Making

Budget Summary

Advocacy

Maternal Mortality Ratios* Province Ratio Kabul 400 (200-600) Laghman 800 (400-1100) Kandahar 2200 (1500-2900) Badakshan 6500 (5000-8000) Combined estimate 1600* * Maternal deaths / 100,000 live births per year, *Source: Bartlett et al. Lancet 2005.

Comparison of International MMRs *Source: UNICEF Maternal Deaths per 100,000 Live Births

Number of Injuries per Month, by Explosive Type, Afghanistan, March 2001 – June 2002 Total = 1,636 Average = 102/mo *Source: CDC MMWR 2003

Age distribution of victims 57% < 20 yrs 42% < 15 yrs

Risk Behavior by Age Group 22% 16% 14% 14% 11% 10% 8% 6%

Assessments

Other Roles Capacity Building Diplomacy Fund-raising Clinician