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Inside WHO’s early warning system in Cox’s Bazar, Bangladesh

The reporting form is concise and direct – similar to the reason Dr Shahadad Hossain

The reporting form is concise and direct – similar to the reason Dr Shahadad Hossain gives for filling out and filing it each day: “It saves lives.”

The team lead of a mobile medical team at Balukhali settlement, near Cox’s Bazar, Bangladesh is referring to WHO’s Morbidity and Mortality Daily Reporting Surveillance Form, the cornerstone of its Early Warning, Alert and Response System (EWARS). The emergency surveillance system is critical to protecting the health of more than half a million people who have arrived in the area in recent weeks after fleeing Rakhine state, Myanmar.

Here’s how it works: Every evening, Dr Hossain’s team – like other mobile and fixed medical teams – tally the incidence of symptoms consistent with seven epidemic-prone diseases and a series of health events of special interest. That information is then fed to WHO epidemiologists who work into the night, combing the data at the Health Emergencies Operation Center, an information and coordination hub set up jointly by WHO and the Ministry of Health and Family Welfare.

The need for rigorous health data collection and analysis is clear. With the massive influx of people now living in a series of makeshift and temporary settlements, problems of overcrowding and inadequate access to water, sanitation and hygiene provide public health challenges, including from the spread of water-borne and infectious disease. By creating a central node for data collection and analysis, crucial information can be gathered from mobile and fixed medical teams to build a firewall against the spread of disease.

“The systematic collection, analysis and interpretation of health-related data are the foundation of an effective emergency health response,” says Dr Roderico Ofrin, WHO Regional Emergency Director. “Every day we are receiving vital information from public and private health providers that can help us protect the health of this very large and vulnerable group,” he says.

Dr Hammam El Sakka, WHO Health Emergencies Team Lead, explains the system’s design. “The reporting system is based on a common list of syndromes that includes diarrhea, fever, fever and rash, and fever and jaundice among others,” he says. “But it is also calibrated to the epidemiological profile of both Cox’s Bazar and Rakhine state and the specific challenges of this emergency. That’s why we’ve included reporting for severe acute malnutrition, skin conditions and tetanus among other key concerns.”

According to Dr El Sakka, daily reporting of these conditions provides the power to act with decisive efficiency. “We cannot wait for laboratory confirmations. Where there is a spike in cases we can follow-up with a rapid investigation and provide live-saving assistance as and where needed.”

To make that happen, WHO has mobilized essential supplies now being strategically positioned at health facilities at or nearby the settlements. That includes 25 Inter-Agency Basic Health Kits able to provide life-saving care to 25 000 people for three months. It also includes four Inter-Agency Diarrheal Disease kits, 2 000 000 chlorine tablets and 250 000 packets of saline and ORS.

WHO’s response in Cox’s Bazar has been immediate. It will be ongoing. WHO has so far mobilized just over USD one million to prevent and respond to disease outbreaks and support the delivery of health services amid an immensely challenging scenario. It requires an additional USD 5.3 million for the next six months to continue its work.

“The Early Warning, Alert and Response System will provide vital protection to nearly half a million people whose health and wellbeing is deeply vulnerable,” says Dr Ofrin. “Needs on the ground are pressing. We are working closely with the Ministry of Health and Family Welfare and other humanitarian partners to meet them.”

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Inside WHO’s early warning system in Cox’s Bazar, Bangladesh
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