2.3.1 Introduction
10. WHO undertakes a range of assessments in its emergency work. The most important for guiding initial emergency response are the risk assessment conducted for public health events[1] and the situation analysis conducted for sudden onset emergencies.[2] The outcomes of these assessments will determine if an operational response[3] is required by WHO, and if it is, the event or emergency will be referred for grading. Figure 1 illustrates the relationship between risk assessment, situation analysis and WHO grading and operational response.
Figure 1: Linking risk assessment and situation analysis to WHO grading and operational response*
*For sudden-onset emergencies, grading occurs within 24 hours of risk assessment/situation analysis
2.3.2 Risk Assessment Conducted for Public Health Events
20. Early detection and risk assessment are critical to WHO's work. Early detection is required for early action to prevent public health events from becoming emergencies, and risk assessment improves decision-making for effective response.
30. Event verification is undertaken when the occurrence, nature, cause and extent of a potential public health event are unknown or where the sources of the report require substantiation.[4] Verification may take several hours to several days, depending on the context. If necessary, a team will deploy to the event location for verification, in-depth investigation and, as required, risk assessment.
40. Once an acute event is verified, it may undergo a structured rapid risk assessment. The decision to conduct a full and rigorous risk assessment is context-specific. It signals the need to document the public health risks of an event, its likely impact and actions recommended by WHO.
2.3.3. Situation Analysis Conducted for Sudden Onset Emergencies
50. In natural disasters, acute conflicts and other acute emergencies with obvious health impact or risks from the outset, WHO and partners support governments in undertaking a rapid situation analysis to determine the nature and scale of the emergency, its health consequences and risks, the gaps in available response and coordination capacities, and the need for an operational response by the Organization. This initial situation analysis is usually based on a review of secondary data and conducted within 24–72 hours of onset, as per the IASC's Humanitarian Programme Cycle, together with partners.
60. If an operational response is required, WHO immediately repurposes the country office, activates the business contingency plan, initiates response activities and proceeds to grading within a maximum of 24 hours of the situation analysis. For slow-onset emergencies, e.g. due to drought or conflict, there may be a longer, context–specific interval before grading.
70. An interagency Multi-sector Initial Rapid Assessment (MIRA)[5] is then completed, usually within 14 days for sudden onset emergencies, although this may take longer for slower onset emergencies. WHO leads the health component of the MIRA. More detailed health sector needs assessments are also usually conducted thereafter.
2.3.4. Recommendations for Risk Assessment and Situation Analysis
80. The risk assessment or situation analysis leads to recommendations depending on the level and type of risk, which may include advice to:
- Discard the event since it does not present a public health risk.
- Implement monitoring, mitigation, preparedness and readiness measures. Such events or emergencies can be considered as ungraded or pre-grading. The Regional Emergency Director (RED) ensures such events are documented in the Event Management System (EMS).
- Refer to the event or emergency for grading, which is required for all events:
- Requiring an operational response by WHO;
- Assessed as high or very high risk. Moderate risks may also be referred for grading at the discretion of the assessment team.
- Classify it as an event reportable under the International Health Regulations (IHR) by the IHR Annex 2 decision instrument to assess and notify events that may constitute a public health emergency of international concern (PHEIC).
- Refer to the event for consideration as a PHEIC. The Director General determines a PHEIC following a review of recommendations from the IHR Emergency Committee convened for the event by WHO.
2.3.5 WHO Grading of Public Health Events and Emergencies
90. Grading is an internal activation procedure and is not directly dependent on either consultation with Member States or official requests for international assistance. Grading may be initiated by any level of the organization (i.e. country, regional, headquarters). However, the primary responsibility lies with the RED. The Director of Emergency Operations (EMO) will oversee the grading process for large-scale emergencies with the potential for substantial multi-regional impact. While the relevant WCOs participate in the grading exercise, the HWO/WR never single-handedly determines the grade of an emergency.
100. Grading is conducted to:
- Activate WHO's Incident Management System (IMS) and Emergency SOPs;
- Inform the Organization of the level of WHO's operational response to an emergency and the need for the mobilization of internal and external resources;
- Determine the need for a surge of additional human and material resources.
- Permit the use of resources from the CFE above US$ 50,000;
- Convey to partners, donors and other stakeholders WHO's assessment of the scale of unmet needs within the health sector and, by extension, the requirement for additional international resources.
110. WHO's immediate operational response to acute events and emergencies is not dependent on grading. If the risk assessment or situation analysis indicates the need for an operational response, WHO immediately repurposes the country office(s), initiates response activities and then proceeds to grading within a maximum of 24 hours of the analysis.
120. The grading assigned to an acute emergency (i.e., Grade 1, Grade 2 or Grade 3) indicates the level of operational response required by WHO for that emergency.
130. Protracted emergencies (that persist for longer than six months) are assigned protracted grades (i.e., Protracted Grade 1, Protracted Grade 2 or Protracted Grade 3) to indicate the level of operational response to be sustained by WHO over a prolonged, often indefinite period.
140. For Grade 2 and 3 emergencies due to an infectious hazard and any high or very high risk that remains ungraded, the UN Secretary-General and the UN Emergency Relief Coordinator are notified, per the IASC Level 3 Activation Procedures for Infectious Disease Events.
150. The declaration of a Level 3 emergency by the IASC automatically results in a WHO Grade 3 emergency declaration if not already activated.
160. A review of operational requirements and grade is conducted every three months. However, the frequency may vary depending on the evolution of the emergency and the operational context.
170. After six months, emergency grades are removed, except for emergencies for which the IASC decides to maintain a Level 3 (in which case, WHO would maintain Grade 3) or when WHO determines to extend the grade for a prescribed timeframe based on the operational context and response requirements.
180. For an emergency that persists for over six months, WHO will consider whether it meets the definition of a protracted emergency.[6] A protracted grade is applied provided that the following criteria are met:
- Adequate resources have already been deployed to meet the acute emergency needs.
- An agreement has been made among the three levels of the Organization that WHO requires a sustained operational response beyond six months.
- The emergency is no longer an IASC Level 3 emergency or PHEIC.
190. Any situation in which ongoing humanitarian needs in a country are addressed through an IASC Humanitarian Response Plan (HRP), or equivalent will also be graded as a protracted emergency.
200. The details of the WHO grading process may be found in ERF II Chapter 2
[1] Rapid Risk Assessment of Acute Public Health Events. Geneva, World Health Organization; 2012 (http://apps.who.int/iris/bitstream/10665/70810/1/WHO_HSE_GAR_ARO_2012.1_eng.pdf, accessed 27 February 2017).
[2] IASC Reference Module for the Implementation of the Humanitarian Programme Cycle. Geneva: Inter-Agency Standing Committee; 2015 (https://interagencystandingcommittee.org/iasc-transformative-agenda/documents-public/iasc-reference-module-implementation-humanitarian, accessed 27 February 2017).
[3] An "operational response" consists of WHO emergency actions that exceed the usual country-level cooperation that the WHO Country Office has with the Member State. These actions are summarized under the Health Operations and Technical Expertise function of the IMS: disease prevention and control measures; risk communication and community engagement; health service delivery; technical expertise, science and research; and training of health staff.
[4] Early detection, assessment and response to acute public health events: Implementation of Early Warning and Response with a focus on Event-Based Surveillance Interim Version. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/112667/1/WHO_HSE_GCR_LYO_2014.4_eng.pdf, accessed 27 February 2017).
[5] Multi-Cluster/Sector Initial Rapid Assessment Guidance. Geneva: Inter-Agency Standing Committee; 2015 (https://interagencystandingcommittee.org/iasc-needs-assessment-task-force/iasc-multi-clustersector-initial-rapid-assessment-mira-manual-2015), accessed 5 September 2023).
[6] A protracted emergency is "an environment in which a significant proportion of the population is acutely vulnerable to death, disease and disruption of livelihoods over a prolonged period. The governance of these environments is often weak, with the state having a limited capacity to respond to, and mitigate, the threats to the population, or provide adequate levels of protection". Source: A Harmer and J Macrae (eds). 2004. Beyond the continuum: aid policy in protracted crises. HPG report 18. London, Overseas Development Institute
