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Investing in the health of women and girls has been shown to produce good returns not only for women and girls, but also for the society as a whole. It yields high returns on investment through improved productivity, reduced absenteeism, and reduced health care costs.Over the past decades the terms women's health and reproductive health were used interchangeably to refer to conditions related to pre-conception, pregnancy, childbirth, and postnatal care only. However, with the improvement in life expectancy, reduction in maternal mortality ratios and the constant reduction in fertility rates, women now enjoy more years and are exposed to risk factors and diseases that are not always related to the reproductive function. Women in the post-menopausal period undergo physiological and psychological changes that may cause discomfort or change their response to several risk factors, and some diseases may present differently in women than in men. With this in mind, and in an attempt to better understand and respond to women's comprehensive health needs, the WHO Office for the Eastern Mediterranean Region (WHO/EMRO) launched a programme on women's health to generate and analyze evidence related to women's overall health beyond the reproductive component and propose relevant solutions. We need to act now to ensure that health services for women are available, acceptable, and accessible, to ensure that women's health needs are well-covered in the hope of achieving Universal Health Coverage by 2030.

Monkeypox (MPX) is a viral zoonotic disease that is endemic in some countries of Central and Western Africa. Since 1 January 2022, cases of MPX have been reported to WHO by 74 Member States across all 6 WHO regions. As of 21 July 2022, a total of 15 328 laboratory confirmed cases and 72 probable cases, including 5 deaths, have been reported to WHO. Most (11 638/15 328, 76%) of the laboratory-confirmed cases were reported by countries of the WHO European Region, 22% (3316/15 328) by the Region of the Americas, 2% (301/15 328) by the African Region, less than 1% (53/15 328) by the Western Pacific Region, less than 1% (18/15 328) by the Eastern Mediterranean Region (EMR) and less than 1% (2/15 328) by the Region of South-East Asia. All five deaths were reported by the African Region.

UNSTRUCTURED Multiple factors affected COVID-19 transmission in the Eastern Mediterranean Region (EMR), including conflict, demographics, timeliness of travel and social restrictions, migrant workers, weak health systems, and mass gatherings. Countries that responded well to COVID-19 had high-level of political commitment, with multi-sectoral coordination, enabling existing infrastructures to quickly mobilize. In some EMR countries, political instability and fragile health systems hampered the effectiveness of response strategies. The pandemic also highlighted the region’s weak health systems and preparedness, the fragmented surveillance systems, and the lack of trust in the shared information in the region. The disruption of access to and delivery of essential health services was one of the major health system fragilities exposed by the COVID-19 pandemic. In 2020, WHO conducted a Global Pulse Survey which demonstrated that the EMR had the highest disruption in health services compared to other WHO Regions. Thanks to prioritization of this issue by WHO and Member States, as significant improvement in this area was observed regionally one year later, in 2021, in the second round of WHO’s National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement and trust, the return on investment in health security, and that no one is safe until everyone safe. Increasing vaccine coverage is a priority in the EMR in addition to building regional capacities, strengthening health systems, and working towards Universal Health Coverage (UHC) and health security. Additionally, emergency public health is key in preparing and responding to pandemics and biological threats. Integrating public health into the primary care and investing in public health workforce capacity building are essential to reshape public health and health emergency preparedness.

The Universal Health Coverage (UHC) Day has been commemorated on 12 December every year since 2017. In 2019, the theme of the day was "Keep the Promise", referring to the Political Declaration on UHC endorsed by Heads of States at the United Nations General Assembly High-Level Meeting on 23 September 2019. In 2020, the theme is "Protect Everyone", emphasizing global and individual health security in the context of the COVID-19 pandemic, attributed to SARS-CoV 2 - a virus that infected more than 4 million people in the Eastern Mediterranean Region (EMR) and left over 100 000 dead in less than 12 months (6.6% and 7.1% of the global toll, respectively). Keeping the promise of UHC, while ensuring health security, is becoming a priority agenda of policy-makers and practitioners in the EMR in order to save lives, advance health and protect livelihoods.

The World Health Organization has noted the important synergies between health and peace since its very inception, both in its foundational document and in its work globally. The WHO Constitution remarks that the "health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States". In addition, peace is noted as being one of the fundamental conditions to promote health in the Ottawa Charter for Health Promotion in 1986. The Eastern Mediterranean Region (EMR) has been contending with the challenges borne of conflict and insecurity for decades. Currently, nine out of the 22 countries and territories in the Eastern Mediterranean Region are represented in the World Bank's List of Fragile and Conflict Affected States ranging from acute conflict to high institutional fragility.

The Eastern Mediterranean Region (EMR) is the origin and host to an increasing number of forcibly displaced people, mainly due to conflicts and economic disparities. Overall, 66% of the world's refugees originate from EMR. The numbers of internally displaced persons (IDPs) have been growing steadily in the region during the past decades, rising to 19.5 million in 2020, 45% of the world's total. Some 11.7 million of these (including 5.7 million Palestinians) remain in the region while the rest have taken the risk of difficult journeys to countries outside of the region in search of asylum and better life. These populations are often at higher risk of poor health due to the conditions they live in and limited access to quality health care.

The Eastern Mediterranean Region (EMR) faces massive challenges that threaten people's livelihood and health due to multiple factors, including socioeconomic disparities, conflicts and emergencies in many countries of the Region. The COVID-19 pandemic has further exacerbated these challenges and significantly disrupted access to essential health services. As highlighted in recent flagship reports, the region is unlikely to achieve health-related Sustainable Development Goals, unless crucial changes are made in the way the goals are pursued. Effective implementation of digital health technologies could provide opportunities to enhance the response to the pandemic, as well as improve the access to health services and develop stronger and more resilient health systems.

Evidence has shown that some of the major causes of health inequities arise from the conditions in which people are born, grow, live, work and age, in addition to a wider set of forces and systems shaping individuals' and societies' health and well-being. Such conditions are known as the 'social determinants of health'. However, efforts to address these determinants have remained challenging and unsatisfactory in many parts of the world, including in the Eastern Mediterranean Region. Policies to contain the ongoing COVID-19 pandemic have further exposed and amplified the existing and even created new dimensions in social and health inequities, as we elaborate further below. Meanwhile, the pandemic offers a unique opportunity to tackle inequities and build back fairer.

The Eastern Mediterranean Region (EMR) confronts unprecedented health challenges, exacerbated by demographic and epidemiologic changes, triple burden of disease, increasing healthcare costs, as well as the effects of contracted emergencies, social conflicts and massive population movements. Such challenges have repercussions on health care delivery and health research systems. Research for health is essential for developing solutions that contribute to health improvements. Investment in research for health contributes to health, economic growth and equity.

The WHO Eastern Mediterranean Region (EMR) is characterised by a large range in routine immunisation coverage. We reviewed progress in access, deployment efforts, and use of COVID-19 vaccines in the EMR to identify bottlenecks and propose recommendations. We compiled and analysed data reported to WHO regarding the number of vaccines provided emergency use authorisation (EUA) in each country, the number of vaccine doses allocated and delivered by COVAX, the number of vaccine doses received bilaterally, the date of initiation of vaccination, vaccine usage rate and overall vaccination coverage. In June–July and October–November 2021, we conducted two rounds of a regional survey to assess vaccine acceptance and calculated the weighted proportion of individuals who would get vaccinated once a vaccine is available and recommended. We stratified the analysis according to four groups based on their participation status in COVAX, from the highest to lowest income, that is, (1) fully self-financing high-income countries (group 1), (2) fully self-financing upper middle-income countries (group 2), (3) Advance Market Commitment (AMC) countries not eligible to receive Gavi support (group 3) and (4) AMC countries eligible for Gavi support (group 4). As of 31 December 2021, the median number of vaccines provided with EUA was 6 for group 1, 11 for group 2, 8 for group 3 and 9 for group 4. On the same date, COVAX had delivered 179 793 310 doses to EMR countries. Vaccination started on 10 December 2020 in group 1, on 13 December 2020 in group 2, on 30 December 2020 in group 3 and on 20 January 2021 in group 4. The regional acceptance survey (first round) pointed to higher vaccine acceptance in group 1 (96%), than in others, including group 2 (73.9%), group 3 (78.8%) and group 4 (79.3%), with identical patterns in the second round (98%, 78%, 84% and 76%), respectively. Usage of vaccine allocated by COVAX to participating countries was 89% in group 1, 75% in group 2, 78% in group 3 and 42% in group 4. The full dose and partial dose coverage decreased with the income groups of countries, from 70% and 6% in group 1, to 43% and 8% in group 2, to 33% and 11% in group 3, and 20% and 8% in group 4. All 22 EMR countries introduced COVID-19 vaccines by 21 April 2021, but with major inequities in coverage. Additional efforts are needed to address the determinants of unequal vaccine coverage at all stages of the result chain to improve vaccine equity.

On 25 September 2015, the United Nations (UN) General Assembly adopted and committed to a new development agenda "Transforming our world: the 2030 Agenda for Sustainable Development", which translated into 17 Sustainable Development Goals (SDGs). Global commitment to SDGs ushered in renewed calls to improve availability and accessibility of timely and quality information to monitor the progress towards achieving the health-related SDGs globally and in the Eastern Mediterranean Region (EMR). Health-related targets - under SDG 3 and also within other goals - require careful measurement and monitoring in order to track progress and success in policy implementation. SDG targets requires accurate and timely reporting of diseases, risk factors, mortality and causes of deaths (ranging from maternal mortality to death from road traffic accidents) and health care and social determinants of health.

Early on in the COVID-19 pandemic, the WHO Eastern Mediterranean Regional Office (WHO EMRO) recognised the importance of epidemiological modelling to forecast the progression of the COVID-19 pandemic to support decisions guiding the implementation of response measures. We established a modelling support team to facilitate the application of epidemiological modelling analyses in the Eastern Mediterranean Region (EMR) countries. Here we present an innovative, stepwise approach to participatory modelling of the COVID-19 pandemic that engaged decision-makers and public health professionals from countries throughout all stages of the modelling process. Our approach consisted of first identifying the relevant policy questions, collecting country-specific data, and interpreting model findings from a decision-maker’s perspective, as well as communicating model uncertainty. We used a simple modelling methodology that was adaptable to the shortage of epidemiological data, and the limited modelling capacity, in our region. We discuss the benefits of using models to produce rapid decision-making guidance for COVID-19 control in the WHO Eastern Mediterranean Region (EMR), as well as challenges that we have experienced regarding conveying uncertainty associated with model results, synthesizing and comparing results across multiple modelling approaches, and modelling fragile and conflict-affected states.

Availability and safety of blood transfusion is a major concern in countries affected by humanitarian emergencies. These emergencies increase demand for blood transfusion and make its delivery challenging and complex. Nevertheless, there is a lack of information on emergency preparedness and response capacity of blood transfusion services and on the challenges in meeting patients' needs.To assess availability and safety of blood transfusion during humanitarian emergencies.We searched PubMed and Index Medicus for the World Health Organization Eastern Mediterranean Region for data on availability and safety of blood transfusion during humanitarian emergencies. We also gathered information through a survey and during a regional consultation in Tunisia.We found 24 publications on disaster from 5 countries in the Region and 16 publications on disaster preparedness and blood transfusion in casualties and severe trauma outside the Region. However, none dealt with availability and safety of blood transfusion during humanitarian emergencies. Armed conflicts and terrorism, flooding and earthquakes are the most frequent emergencies with 10-85% of the injured requiring blood transfusion. There are gaps in emergency preparedness and response, including human resources, transport and cold chain, supply of consumables and maintenance of equipment, power supply, and finances.There is a need to integrate blood transfusion services in the overall national emergency preparedness and response, and provide assistance to affected countries to address identified gaps. Recommendations for individual countries need to be tailor made, along the lines of the regional strategic framework for blood safety and availability.مدى توافر وسلامة نقل الدم أثناء الطوارئ الإنسانية.إيتمجيتا عبدالله، رنا حاجة، سيس سيبينجا.إن توافر وسلامة نقل الدم مصدر اهتمام كبير في البلدان المتضررة من حالات الطوارئ الإنسانية. إذ تزيد هذه الحالات الطارئة من الطلب على نقل الدم وتجعل تقديمه صعباً ومعقداً. ومع ذلك، هناك نقص في المعلومات حول التأهب لحالات الطوارئ والقدرة على الاستجابة لخدمات نقل الدم والتحديات التي تواجه تلبية احتياجات المرضى.تقييم مدى توافر وسلامة نقل الدم أثناء الطوارئ الإنسانية.بحثنا في برنامج PubMed وبرنامج Index Medicus لإقليم منظمة الصحة العالمية لشرق المتوسط للحصول على بيانات حول مدى توفر وسلامة نقل الدم أثناء الطوارئ الإنسانية. كما جمعنا المعلومات من خلال استبيان ومن خلال المشاورات الإقليمية في تونس.وﺟد ﺎﻧ 24 وثيقة ﻧﻣشورة ﺣول الكوارث من 5 ﻟﺑدان ﻓﻲ الإقليم و 16 وثيقة ﻧﻣشورة ﺣول التأهب للكوارث و ﻘﻧل اﻟدم ﻓﻲ الإصابات وفي الرضوح الشديدة ﺎﺧرج اﻹقليم. ومع ذلك، لم يتطرق أي منها إلى توافر وسلامة نقل الدم أثناء حالات الطوارئ الإنسانية. تعتبر النزاعات المسلحة والإرهاب والفيضانات والزلازل من أكثر حالات الطوارئ شيوعاً والتي يتطلب 10 - 85 % من المصابين فيها نقل الدم. وهناك ثغرات في التأهب للطوارئ والاستجابة لها، بما في ذلك الموارد البشرية والنقل وسلسلة التبريد وتوفير المواد المستهلكة وصيانة المعدات وإمدادات الطاقة والشؤون المالية.هناك حاجة ماسة إلى دمج خدمات نقل الدم في التأهب والاستجابة الوطنية الشاملة لحالات الطوارئ، وتقديم المساعدة إلى البلدان المتضررة لملء الثغرات المحددة. يجب أن تكون التوصيات الخاصة بكل بلد على حدة، بما يتماشَى مع الإطار الاستراتيجي الإقليمي لسلامة الدم وتوافره.Approvisionnement en sang et sécurité transfusionnelle dans les situations d’urgence humanitaire.L’approvisionnement en sang et la sécurité transfusionnelle sont des préoccupations majeures dans les pays affectés par les situations d’urgence humanitaire. Ces situations d’urgence sont à l’origine d’une augmentation de la demande en transfusions sanguines et rendent la réalisation de cette procédure difficile et complexe. Néanmoins, il existe un manque d’informations sur les capacités de préparation et de riposte des services de transfusion sanguine aux situations d’urgence, ainsi que sur les difficultés à répondre aux besoins des patients.Évaluer l’approvisionnement en sang et la sécurité transfusionnelle dans les situations d’urgence humanitaire.Nous avons effectué des recherches dans PubMed et l’Index Medicus pour la Région OMS de la Méditerranée orientale afin de trouver des données sur l’approvisionnement en sang et la sécurité transfusionnelle dans les situations d’urgence humanitaire. Nous avons également recueilli des informations au moyen d’une enquête et au cours d’une consultation régionale en Tunisie.Nous avons trouvé 24 publications sur les catastrophes naturelles dans cinq pays de la Région, et 16 publications sur la préparation aux catastrophes naturelles et la transfusion sanguine pour les blessés et les cas traumatologiques graves en dehors de la Région. Cependant, aucune ne traitait de l’approvisionnement en sang et de la sécurité transfusionnelle dans les situations d’urgence humanitaire. Les conflits armés et le terrorisme, les inondations et les séismes sont les situations d’urgence les plus fréquentes, avec 10 à 85 % de blessés nécessitant des transfusions sanguines. Des lacunes existent en matière de préparation et de riposte aux situations d’urgence, notamment en ce qui concerne les ressources humaines, le transport et la chaîne du froid, l’approvisionnement en consommables et l’entretien des équipements, l’approvisionnement en électricité et les finances.Il est nécessaire d’intégrer les services de transfusion sanguine au processus global de préparation et de riposte aux situations d’urgence au niveau national, ainsi que d’apporter une assistance aux pays affectés pour leur permettre de combler les lacunes identifiées. Les recommandations pour chaque pays doivent être faites sur mesure, conformément au cadre stratégique régional pour la sécurité transfusionnelle et la disponibilité des produits sanguins.

The World Health Organization (WHO) has declared 2020 as the Year of the Nurse and the Midwife. World Health Day on 7 April is dedicated to supporting nurses and midwives and highlights the central role of these professions in advancing universal health coverage, achieving health-related sustainable development goals, and the Eastern Mediterranean Region Vision 2023: Health for All by All.This year, we sadly mark World Health Day in the face of the devastating COVID-19 pandemic, which has brought to attention more than ever the crucial and invaluable role of health workers, who are working tirelessly day and night to care for patients and save lives. In fighting COVID-19, not only might they become infected and put their own lives at risk, but they also face distress and burnout because of long working hours. In addition, many health workers have to be away from their homes for prolonged periods, for fear of putting their own families at risk of acquiring the infection. Even before the pandemic, the safety and security of health workers in the Eastern Mediterranean Region has been a significant concern, as more than half of the countries of the Region face acute and protracted crises, and 70- 80% of total recorded attacks on health facilities globally occur in the Eastern Mediterranean Region.

In 2019, upon reviewing countries' reports, the regional verification commission for measles and rubella elimination declared elimination of measles and rubella in Bahrain, Islamic Republic of Iran and Oman. This achievement in the Eastern Mediterranean Region (EMR) constitutes a major success, since it occurs at a time when there remain highly challenging situations in several countries of the Region. In addition, there are unprecedented high transmission rates of measles throughout the world, with other World Health Organization (WHO) regions either not progressing (status quo) or regressing. Indeed, the WHO Region of the Americas and several other countries have in fact lost the status of measles elimination.

Twenty-five years ago, tuberculosis (TB) was declared a global health emergency by the World Health Organization (WHO). However, TB still remained one of the top 10 causes of death worldwide in 2015. In 2014, the World Health Assembly (WHA) had approved a new global strategy to end TB that builds on successes achieved by the DOTS and the Stop TB Strategy. The End TB Strategy 2016-2035 envisions a world free of TB by pursuing policies that promote prevention and care, and encourage research and innovation, which is in line with the Sustainable Development Goals (SDGs) calling for the TB epidemic to end by 2030. In 2002, the Global Fund to fight AIDS, Tuberculosis and Malaria - a partnership between governments, civil society, private sector and patients - was launched to raise significant funds to support programmes in countries and communities most in need.

Case-control studies are commonly used to evaluate effectiveness of licensed vaccines after deployment in public health programs. Such studies can provide policy-relevant data on vaccine performance under ‘real world’ conditions, contributing to the evidence base to support and sustain introduction of new vaccines. However, case-control studies do not measure the impact of vaccine introduction on disease at a population level, and are subject to bias and confounding, which may lead to inaccurate results that can misinform policy decisions. In 2012, a group of experts met to review recent experience with case-control studies evaluating the effectiveness of several vaccines; here we summarize the recommendations of that group regarding best practices for planning, design and enrollment of cases and controls. Rigorous planning and preparation should focus on understanding the study context including healthcare-seeking and vaccination practices. Case-control vaccine effectiveness studies are best carried out soon after vaccine introduction because high coverage creates strong potential for confounding. Endpoints specific to the vaccine target are preferable to non-specific clinical syndromes since the proportion of non-specific outcomes preventable through vaccination may vary over time and place, leading to potentially confusing results. Controls should be representative of the source population from which cases arise, and are generally recruited from the community or health facilities where cases are enrolled. Matching of controls to cases for potential confounding factors is commonly used, although should be reserved for a limited number of key variables believed to be linked to both vaccination and disease. Case-control vaccine effectiveness studies can provide information useful to guide policy decisions and vaccine development, however rigorous preparation and design is essential. publishedVersion

The case-control methodology is frequently used to evaluate vaccine effectiveness post-licensure. The results of such studies provide important insight into the level of protection afforded by vaccines in a ‘real world’ context, and are commonly used to guide vaccine policy decisions. However, the potential for bias and confounding are important limitations to this method, and the results of a poorly conducted or incorrectly interpreted case-control study can mislead policies. In 2012, a group of experts met to review recent experience with case-control studies evaluating vaccine effectiveness; we summarize the recommendations of that group regarding best practices for data collection, analysis, and presentation of the results of case-control vaccine effectiveness studies. Vaccination status is the primary exposure of interest, but can be challenging to assess accurately and with minimal bias. Investigators should understand factors associated with vaccination as well as the availability of documented vaccination status in the study context; case-control studies may not be a valid method for evaluating vaccine effectiveness in settings where many children lack a documented immunization history. To avoid bias, it is essential to use the same methods and effort gathering vaccination data from cases and controls. Variables that may confound the association between illness and vaccination are also important to capture as completely as possible, and where relevant, adjust for in the analysis according to the analytic plan. In presenting results from case-control vaccine effectiveness studies, investigators should describe enrollment among eligible cases and controls as well as the proportion with no documented vaccine history. Emphasis should be placed on confidence intervals, rather than point estimates, of vaccine effectiveness. Case-control studies are a useful approach for evaluating vaccine effectiveness; however careful attention must be paid to the collection, analysis and presentation of the data in order to best inform evidence-based vaccine policies. publishedVersion