Despite significant improvements in health outcomes over the past decade, the Middle East and North Africa (MENA) region faces many challenges in meeting the growing health needs of the population, due to changing demographic and epidemiological profiles.

Climate change, population growth and ageing, urbanisation, migration, and food and water shortages add to the impact of civil unrest in some parts of the region. Poverty levels are high, and infectious and emergent diseases place a dual burden on the region, especially with increasing rates of non-communicable diseases (NCDs).

Limited access to basic health services and to clean water and sanitation conditions affect the lives of millions of people. Meanwhile, each year, natural disasters and other crises claim thousands of lives and impact many more. Mortality rates from road-traffic injuries, in MENA, are among the highest in the world.

The International Federation of Red Cross and Red Crescent Societies' (IFRC) Strategy 2020 aims to "enable healthy and safe living", by supporting the resilience of communities to cope with current challenges, socio-economic changes, and recurrent disasters. Achieving better health and a healthy and safe future, involves expanding access to primary and public health services, enhancing emergency health, improving care, and tackling underlying social and behavioural factors.

Current Civil Unrest:

Some parts of the Middle East and North Africa have been experiencing civil unrest since the beginning of 2011. In many ways, these events are unprecedented and the levels of uncertainty, violence, and volatility have been dramatic.

Since the beginning of the crisis, Red Cross and Red Crescent National Societies in Tunisia, Egypt, Libya, Yemen, Syria and, recently, Lebanon and Jordan have played an important role in providing first aid and medical assistance, as well as clean water, sanitation facilities and hygiene promotion to affected populations.

They have been assisted by the broader Red Cross Red Crescent Movement which utilises a range of disaster management tools, developed over years of experience, to respond quickly to sudden needs, especially, where the local Red Cross or Red Crescent needs support. These include Emergency Response Units (ERUs) which are standardised teams of trained personnel and modules of equipment that are ready to be deployed at short notice as part of the global Red Cross Red Crescent Disaster Response system. In addition, ERUs are used in large emergency response operations to provide emergency and basic health care, clean water production, and mass sanitation.

In addition, IFRC and local Red Cross Red Crescent teams respond in community-oriented ways to meet personal needs. For example, some of these methods include relief distributions, hygiene promotion activities and by offering psycho-social support.

Each situation and each country has its own challenges. One of the great strengths of the Red Cross Red Crescent Movement is its network of local community based volunteers who know best how to respond in ways that work for their communities.

Simple acts of humanity

For the people of Libya, 2011 was a dramatic and traumatic year which made the deployment of psychosocial support one of the most pressing needs for the Libyan Red Crescent. This included some simple but effective actions. For one group of children in Libya, support began with sheep, a song, and a dance. With the important festival of Eid El Kebir taking place at the end of November, populations still sheltering in camps had no means of acquiring sheep for the festive meal. Without such a meal, Eid is not Eid, therefore, the IFRC and other donors bought 45 sheep, enough for the entire camp as well as six neighbouring camps in Benghazi. During the three preceding days and on the festive day itself, social activities were organised for 350 children by Libyan Red Crescent volunteers who gathered to sing and dance together while the feast was being prepared.

Unity

In Tataouine, the Tunisian Red Crescent established a clinic, in April 2011, to provide medical care to the thousands of Libyans fleeing across the nearby border. The development of this clinic provided an average of 2,000 consultations per month. This clinic was a testament to local initiative, combined with the best of what the Red Cross Red Crescent stands for. An entire network of Libyan doctors worked alongside their Tunisian colleagues, with a modest room acting as the 'coordination centre' for the Libyan medical diaspora. Every couple of weeks, Libyan doctors from around the world, and from Libya itself, flew in with their portable equipment to provide much-needed specialist services including gynaecology, cardiology, and paediatric services. A neatly printed schedule, taped to the entrance of the clinic every Monday morning, informed patients of the coming week's rota.

Voluntary service adapts to challenging circumstances

In Syria, a first aid ambulance team member says softly: "It is a very difficult situation. I can't think about it. If people don't get help…" his voice trails off as he looks into the distance. But there is little time for reflection.

Where there used to be three Red Crescent ambulances, there are now more than thirty across the country and more are needed. Where they used to respond mainly to traffic accidents, they now put their own lives at risk to assist people injured in the fighting.

The Syrian Arab Red Crescent is the only humanitarian organization that regularly manages to reach people affected by the unrest, but some areas are very difficult to reach. As a result, the Syrian Arab Red Crescent has had to 're-think' and adapt its emergency and basic health operations, and has done so in practical and innovative ways.

Ambulance teams have been enhanced, not only in terms of numbers but in terms of capacity, to provide more than basic first aid. Each ambulance is accompanied by a team of four Red Crescent volunteers, including a doctor. They are able to treat the wounded and even perform basic surgical procedures when necessary. Ambulance No. 304 in Homs has carried out 395 calls over the past four months. In Damascus alone, thirty teams of young men and women, all volunteers, many of them medical students, work in shifts to ensure that emergency medical needs are met around the clock. A hotline has been set up to respond to calls from the public.

"I have not told my mother where we work", says a young woman volunteer. "She would be too worried". Her smile is courageous, but her eyes are tired. The pace is unrelenting.

Syrian Arab Red Crescent has also recognized that basic health care needs are going unmet because people are unable to travel freely in and out of certain areas. They, therefore, came up with the idea of establishing 'medical health points' which are small, one-room clinics set up within communities where access is difficult. Two are now operational in Rural Damascus. Plans are underway to set up an additional thirteen in high-need areas across the country. These clinics focus on providing first aid , treating chronic diseases, and offer basic health care where it does not exist.

Finally, Red Crescent mobile health units, which had been established in 2007 to provide free health care to displaced Iraqis, have been re-routed to assist Syrians displaced into rural areas, where access to social support is difficult, and meeting basic needs is a challenge. Providing basic needs is made especially difficult with many distanced from family-support mechanisms and lacking sufficient financial resources to pay for their own health care. In one day, the mobile clinic in Baba Amer (Homs) saw 152 cases which included 90 gynaecological and 62 paediatric consultations.

The situation in Syria has, and will continue to demand, innovative solutions using limited resources in shifting context. There is a general recognition of the compounded cost of violence, health-care staff leaving their posts, hospitals running out of supplies and vaccination campaigns coming to a halt. These knock-on effects dramatically limit access to health care for entire communities, many of whose members may be suffering from chronic or conflict-related health problems.

These knock-on effects dramatically limit access to health care for entire communities, many of whose members may be suffering from chronic or conflict-related health problems.

"During seven years as a Syrian Arab Red Crescent volunteer, I have never experienced anything like this before", says a soft-spoken young first aider from Homs.

Upholding the Red Cross Red Crescent's Fundamental Principles has been at the core of The Syrian Arab Red Crescent ,and the broader Red Cross Red Crescent's , continuing attempts to provide a minimum of emergency and basic health care in what continues to be a dangerous and difficult context.

The way forward

In this new context, the health and humanitarian challenges facing MENA are huge. It is of the upmost importance to underline that under international humanitarian law, armed parties must distinguish between civilians and those involved in crisis, and take all feasible precautions to spare civilian lives. Medical staff, facilities, and humanitarian relief personnel must be respected and protected. The IFRC continues to call on all those involved in crises to respect the humanitarian mission of National Societies and ensure the safety and security of all Red Cross Red Crescent volunteers and staff as they deliver their services. This shown of respect is required so that they can continue to provide much-needed assistance to vulnerable people. GHD