This research examines the impact on health-care provision of advanced state failure and of the violence frequently associated with it, drawing from six country case studies. In all contexts, the coverage and scope of health services change when the state fails. Human resources expand due to unplanned increased production. Injury, threat, death, displacement, migration, insufficient salaries, and degraded skills all impact on performance. Dwindling public domestic funding for health causes increasing household out-of-pocket expenditure. The supply, quality control, distribution, and utilisation of medicines are severely affected. Health information becomes incomplete and unreliable. Leadership and planning are compromised as international agencies pursue their own agendas, frequently disconnected from local dynamics. Yet beyond the state these arenas are crowded with autonomous health actors, who respond to state withdrawal and structural violence in assorted ways, from the harmful to the beneficial. Integrating these existing resources into a cohesive health system calls for a deeper understanding of this pluralism, initiative, adaptation and innovation, and a long-term reorientation of development assistance in order to engage them effectively.

In accordance with the World Health Assembly Resolution 58.1, the World Health Organization (WHO) convened an Expert Consultation in Geneva, Switzerland from 15–17 February 2006 to discuss and provide recommendations for enhancing emergency preparedness and capacity building at the community, country, regional, and global levels. The consultation included experts and representatives of non-governmental and inter-governmental organizations. Recommendations included a set of operational objectives and strategies for achieving them. It was recognized that emergency preparedness is part of development and that crises occur at the community level. The recommendations, therefore, were focused at the community and country levels and outlined processes by which WHO could assist countries in augmenting their abilities to cope with health emergencies. This document provides a detailed discussion of the issues addressed, the conclusions reached, and recommendations based on the conclusions.

This is a summary of the proceedings of the Conference on the Health Aspects of the Tsunami Disaster in Asia that was convened by the sunami World Health Organization in Phuket, Thailand from 04–06 May 2005. It contains reviews of the experiences of the health sector and early recovery fol following the Earthquake and Tsunami with emphasis onwhat was done well and what could have been done better and the lessons learned that can be incorporated into actions that will mitigate the damage created by future events. It outlines the national and international responses and recovery and the actions taken and not taken by the international community in support of the countries affected. Specific issuesaddressed include: (1) needs assessments; (2) coordi- coordination; (3) filling gaps in essential services, and (4) capacity building at the country level. Each of these aspects is analyzed as to its: (1) appropriateness; (2) adequacy; (3) effectiveness; (4) efficiency; and (5) connectedness.

Much of what occurred provided benefits to the stricen population, but there is substantial room for improvement through implementation of the lessons learned. These lessons must be converted into actions in order to mitigate the damagesustained and to enhance our responses to the damage from future

This is a summary of the presentations and discussion of Panel 2.12, The Health Sector Contribution to Disaster Reduction, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related the healt sector's contribution to disaster reduction as pertain to the damage created by the Tsunami. It is presented in the following major sections: (1) issues; (2) lessons learned; and (3) recommendations.

Inter-agency coordination in humanitarian assistance dates as a discipline from the 1960s. The United Nations, Red Cross, governmental, and nongovernmental agencies have evolved different mechanisms to achieve it. Present practices in field-based, inter-agency coordination of the health sector remain variable and non-standardized. International experiences in coordination of humanitarian assistance reveal numerous issues of jurisdiction, authority, capacity, and competency. New tools to help overcome these issues in the health-sector coordination include binding principles of engagement, protocols for the assumption of responsibilities, standardized minimum essential data sets, and health-sector component summaries.