Council of Arab Ministers of Health

Introduction to the council: A general overview of the council The Council of Arab Ministers of Health aims to improve health service in the Arab world by raising the level of scientific and practical in various disciplines.The Arab Health Ministers' belief in unifiying their efforts to provide better health services for all Arab citizens, and in their desire to achieve this goal, they created the so-called Council (the Council of Arab Ministers of Health). The Arab Health Ministers Council is a technical specialist council under the umbrella of the Arab League. It is composed of the Arab League member states health ministers, has all the powers and competencies necessary to achieve the objectives set out in the Statute of the Council compling with the Charter of the League of Arab States. The Arab Health Ministers Council is the first ministerial specialist council created within the Arab League's scope , under the League's Council resolution.

Background Information on the Topic: General Background Infectious diseases pay no heed to national borders. Mankind has always been threatened by zoonoses, such as influenza, Ebola hemorrhagic fever, SARS, tuberculosis and prion diseases. As seen with the emergence and pandemic of the swine-originating H1N1 flu virus in 2009 and the enterohemorrhagic E. coli (O104) crisis of 2011, it is not possible to predict outbreaks of emerging or re-emerging infectious diseases. The 2010 outbreak of a foot-and-mouth disease highlighted the tremendous effects that trans-border infectious diseases in animals have on society and the threat they pose to the supply of animal protein. Human/animal health and ecosystems are threatened not only by biohazards (such as infectious disease-causing pathogens and microbial toxins) but also by hazards from chemicals discharged into the environment as a result of man's production activities. These hazards include poisonous metals such as mercury, cadmium and lead, pollutants such as DDT, PCB and dioxins, and emerging pollutants contained in flame-retardants and surfactants known to have caused global-scale contamination. People living today's modern lifestyles of convenience have a duty to pass safe living environments on to future generations. Infectious diseases and health hazards from chemicals are often activated at the interface between humans and animals, only manifesting themselves after they have gradually spread. To protect our

environment from hazards and realize the One World - One Health ideal, it is imperative to detect minute changes and abnormalities at this interface so that appropriate preventive measures can be taken. In light of this, contributions from veterinary medicine and veterinarians, who carry a responsibility to ensure the health of animals and people alike, are now needed on a global scale to support the soundness of ecosystems and health. As the trans-border movement of humans, animals, and food increases throughout the world, so does the risk of spreading dangerous pathogens and infectious disease. While new economic markets and technological advances have created unprecedented economic and social opportunities for the League as a whole, the risks – especially health risks – of our increasingly interconnected world continue to proliferate. For any member state, the health and well-being of its population has broad social, political, and economic implications. Rapid urbanization, population growth, and changing lifestyles in the Middle East have strained the public health systems of many Member states. In addition, political instability, and economic uncertainty have the potential to undermine public health systems.

A statement of the issue Displacement is a hallmark of modern humanitarian emergencies. Displacement itself is a traumatic event that can result in illness or death. Survivors face challenges including lack of adequate shelter, decreased access to health services, food insecurity, and loss of livelihoods, social marginalization as well as economic and sexual exploitation. Displacement takes many forms in the Middle East and the Arab World. Historical conflicts have resulted in long-term displacement of Palestinians. Internal conflicts have driven millions of Somalis and Sudanese from their homes. Iraqis have been displaced throughout the region by invasion and civil strife. In addition, large numbers of migrants transit Middle Eastern countries or live there illegally and suffer similar conditions as forcibly displaced people. Displacement in the Middle East is an urban phenomenon. Many displaced people live hidden among host country populations in poor urban neighborhoods – often without legal status. This represents a challenge for groups attempting to access displaced populations. Furthermore, health information systems in host countries often do not collect data on displaced people, making it difficult to gather data needed to target interventions towards these vulnerable populations. The following is a discussion of the health impacts of conflict and displacement in the Middle East. A review was conducted of published literature on migration and displacement in the region. Different cases are discussed with an emphasis on the recent, large-scale and urban displacement of Iraqis to illustrate aspects of displacement in this region.

The most appalling example of public protest evolving into bitter civil conflict is Syria. The consequences for the region continue to be deeply disturbing. First, the human cost—hundreds of thousands of families displaced and living as refugees in Jordan, Lebanon, Turkey, and Iraq. With over 2 million refugees and over 4 million internally displaced Syrians, the UN last month launched the largest humanitarian appeal in its history. Second, the geopolitical threat—as tensions between nations rise as a result of the Syrian conflict, and as conflicts between different groups within the Arab world escalate, the potential for further confrontations elsewhere remains high. And third, the economic burden—political instability will create adverse economic conditions for sustainable growth in the region, with important impacts on prospects for poverty reduction and increased investments into the health sector. In Syria, the health system is already effectively destroyed. The risk of damage to neighboring health systems is real. These political events make it all the more important to examine the conditions for advancing health and wellbeing in the region. This Series describes the state of health of Arab and non-Arab peoples living in the Arab world by estimating the burden of diseases, injuries, and risk factors they face. But then the Series departs from the usual format of our country studies. When the authors met to plan their work, they did not want to use the conventional approach of a health systems analysis, a report of the challenges either from infectious diseases or to maternal and child health, and a call to action. Instead, they wished to describe the region by emphasizing, in particular, the major political determinants of health. A previous comprehensive analysis of health in the Arab world had already been published, so there was considerable scope to, and advantage from, this different approach. With that objective in mind the Series begins with governance. It is followed by studies of non-communicable diseases, universal health coverage, the changing geographies of war, and finally the issue of survival—ecological sustainability in the Arab world. These papers are complemented by a Viewpoint on recent political changes across the Arab world and their meaning for health, two essays on research networks and state formation, and four Comments looking at issues ranging from health equity to tobacco control.

History of the Topic in the Arab World

According to the World Health Organization, non-communicable diseases (NCDs) are the leading global cause of death and strike hardest at the world’s low and middle income populations. NCDs include cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, with risk factors including “tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol”. These risk factors pose a growing threat to public health and safety for all members of the League. In addition, communicable diseases pose a large and dangerous threat to the health and stability of the League, as they are spread from one person to another or from an animal to a person. The spread often happens “via airborne viruses or bacteria, but also through blood or other bodily fluid.” Infectious diseases “are estimated to account for about a quarter of deaths worldwide, more than 13 million deaths each year. The top causes of death from infectious disease include lower respiratory tract infections and diarrheal diseases.” The emergence of new pathogens such as human immunodeficiency virus (HIV), severe acute respiratory syndrome (SARS), tuberculosis, and malaria, as well as previously unknown animal diseases, such as bovine spongiform encephalopathy (mad-cow disease), are of particular concern to governments around the world as they have the potential to severely disrupt public health systems. Furthermore, the Council of Arab Ministers of Health might consider public health during times of crisis. For example, hospitals, ambulances and clinics throughout Syria are currently are prominent targets for regime air strikes. According to a first-hand account, “remains of ambulance vehicles, bombed or destroyed by gunfire, mar the streets of Aleppo and surrounding villages. Every medical facility in town bares some damage from explosions. The doctors here [unidentified hospital in Aleppo] say they have all been arrested at least once for their role in treating the wounded. Most were tortured.” Health status indicator reporting throughout the region rarely reflects the dramatic variations in public health services and infrastructure accessible to urban and rural communities, to religious or ethnic minorities, and to the large expatriate labor populations in the Gulf States. Most of the Gulf States partially or completely exclude these migrants from government-supported health services. HIV/AIDS prevalence remains low in the Middle East, especially when compared to the noncommunicable disease burden related to tobacco use, chronic diseases such as cardiovascular conditions and diabetes, and

accidents. However, trading patterns and uneven disease control measures at ports and borders render the region extremely vulnerable to imported animal diseases, including those that cross into the human population directly or via insect vectors. Saudi Arabia and Egypt have experienced outbreaks of H5N1 avian influenza in poultry, with dozens of human cases in Egypt. Despite growing awareness of the problem, few states in the region have devoted significant resources to preparing for public health crises and neither transparent sharing of health data nor pandemic planning have occurred beyond the subregional level. To date, regional cooperation on disease control has depended substantially on the expectation that wealthy nations will subsidize outbreak containment efforts to protect their own interests. For example, Saudi Arabia dedicates significant resources to preventing disease outbreaks during the annual Hajj. When the first epidemic of Rift Valley fever (a livestock disease transmissible to humans directly or via mosquitoes) outside Africa occurred on the Arabian Peninsula in 2000, the Saudi government conducted a cross-border vector control campaign in affected parts of neighboring Yemen. In 2007, the Saudi government pledged significant funds to Yemen’s malaria eradication efforts and set about galvanizing the other Gulf states to contribute similarly. In contrast to Southeast and South Asia, the contiguous states of the Middle East (with the exception of Israel) fall into one WHO administrative region, allowing viable external regional health coordination.

International Actions: In 2007, revised International Health Regulations entered into force, expanding WHO’s authority to detect, report, and respond to transnational health threats. This framework dramatically expands global data sharing and cooperation, requiring nations to strengthen core capacities for detecting health threats such as disease outbreaks at the local level, determine whether the incidents constitute potential “public health emergencies of international concern,” and, if so, report them to WHO in a timely way. If experts judge that these crises pose authentic threats, WHO will notify all necessary stakeholders and coordinate any international assistance. Compliance currently depends on “shaming” nations that fail to disclose health catastrophes. No funding has been made available to assist nations with capacity building; the cost of full implementation is unclear. These regulations reflect a renewed commitment by developed nations to international public health cooperation as a tool for protecting national interests, fueled by concerns that China’s lack of transparency during the 2003 SARS epidemic prevented interventions that might have limited the epidemic.

Increasingly, the language employed by WHO and its partner organizations mirrors the securitization of health issues by the United States and the G8 nations, driven by fears of bioterrorism before the more recent focus on pandemic planning. In all three regions, this shift has affected local perceptions of disease and disaster, allowing avian influenza and other outbreaks to be framed as security concerns instead of humanitarian concerns. Based on levels of supranational engagement, the concept has gained the most traction in Southeast Asia, where the 1997 economic crisis and environmental concerns fostered a more general spirit of cooperation on nontraditional security issues and receptiveness to a human security framework. Public health experts in the region have characterized the securitization of disease as an opportunity to normalize the concept that security and development are “two sides of the same coin,” and that nations are not secure if their citizens are not healthy. The security focus allows mobilization of resources and political will at levels necessary to effect real change but carries the possibility of backlash from stakeholders in the security and public health communities. Although the new international health security framework describes the need for all states to build public health infrastructure in the name of mutual protection, the scope of the demands may also be perceived as an enormous obligation for developing nations assumed primarily for the benefit of wealthy states. While the international community shows little hesitation in mobilizing massive amounts of humanitarian aid in the wake of health catastrophes, assistance in preparedness remains limited primarily to transient bilateral agreements. Integration of global health security into the broader paradigm of reciprocal responsibility could conceivably include the following concepts:

• All nations have an obligation to share health information and specimens with the international community, and no nation can fairly withhold either for reasons of national sovereignty or economic security.

• The international community must ensure that all available cost-effective and feasible interventions are supplied to states that share information and specimens, and provide support to build necessary public health infrastructure for those nations that lack sufficient internal resources.

• The International Health Regulations alone are not sufficient to provide global health security, even if implemented exactly as currently written. Further assessments will be required to determine what infrastructure will be realistically needed to monitor, detect, and respond to threats effectively on a global basis, and to establish the right balance of incentives and sanctions for reporting.

The emerging infectious diseases now discovered almost annually can no longer be relied upon to remain safely in remote forests and farmlands. Health crises constitute a real threat to national security in an era of globalization; effective preemption relies upon institutional strength and international cooperation. The intertwining of information, economic, and security systems across the world creates an interdependence of vulnerability among nations, within and between regions. In view of the profound inequalities in resources and capacities among nations, a commitment by resource-rich states to strengthening public health institutions in developing nations represents not just a humanitarian dream, but an investment in mutual defense.

The Council of Arab Ministers of Health endorses strategy to halt the HIV epidemic in Arab countries: March 14, 2014 represents a historical landmark of the regional HIV response in MENA . The Council of the Arab Ministers of Health has officially endorsed the Arab AIDS Strategy (2014-2020). A resolution on the strategy endorsement was presented by the League of Arab States, seconded by H.E the Minster of Health of Bahrain , H.E the Minister of Health of Mauritania and Sudan delegation and was unanimously endorsed by all 22 Arab Countries. The Arab AIDS Strategy aims at reducing to more than 50% by 2020 the rate of new HIV infections transmitted through sexual relations and among injecting drug users as well as new infections among children; the mortality rate of mothers living with HIV and the mortality rate among people living with HIV.

Recommendations: In response to the increase in international travel and trade, and emergence and re-emergence of international disease threats and other health risks, 194 countries across the globe have implemented the World Health Organization International Health Regulations since 2005. The stated purpose and scope of the IHR are “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.” The IHR also require member states to “strengthen core surveillance and response capacities at the primary, intermediate and national level, as well as at designated international ports, airports and ground crossings.”

Some solutions to this issue will improve the identification, surveillance, the availability of drugs and vaccines, reporting, containment, education, research and treatment of disease in member states. As new global treats emerge, each of these factors will change from country to country. The Council of Arab Ministers of Health must develop a way to promote League-wide cooperation in regard to disease outbreaks and control efforts. In addition, the Council must consider the role of doctors and health professionals during times of civil war or crisis. The Trans-border infectious diseases topic that examines common public health issues affecting member states with special regard for population growth and the threat of trans-border infectious diseases with the refugee crisis is of vital importance to region as a whole, and to the states that host refugees in specific. The Syrian refuges that are seeking shelter in neighboring states have brought about a large number of diseases due to the low living standards. This committee shall further assess this tragic epidemic in depth. Building upon international, regional, and national actions of member states will be the key challenge of the delegates. The constructive debates should desirably find the solution to the topic at hand. Taking into consideration the rather cloudy (unclear) destiny of the current refugee increase, the concern shall be minimizing the effects of trans-border infectious diseases. The solutions should be reasonable, bearing in mind economic capacities of the host Arab states (Lebanon, Egypt, Jordan, and Iraq) and the UN funding limitations. Awareness, vaccines, educational enlightenment, and subsidies, are not to be undermined.

Questions to Consider: 1. What effects have increasingly integrated trade, economic

development, human movement, and cultural exchange had on patterns of disease in your country?

2. What is your country’s policy in regards to the reporting of infectious disease outbreaks to the international community?

3. What public health issues and infectious disease outbreaks has your country faced in the past? The present?

4. What kind of public health initiatives and educational measures has your country implemented in the past? The present?

5. Which member states have adopted successful education initiatives? Which have not, and why?

6. What is your country’s greatest public health concern in the next year? The next 10 – 15 years?

7. What has been the effect of refugees in your country? 8. What are the diseases encountered as a result of drastic inflow in

refugees to your country? 9. What are the solutions that your governments have taken to limit the

effects? 10. Priority of this issue to your countries foreign policy?

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