"As soon as the arms are laid down, reconstruction of the health system and other infrastructure must begin. And we must move quickly if we are to deal with malnutrition and prevent an upsurge in diarrhoeal diseases, measles, acute respiratory infections and other conditions typically seen when there are mass displacements of people," Dr Gro Harlem Brundtland, Director-General of the World Health Organization (WHO), the lead international agency in health matters, said today.

"From WHO's experience in emergencies ranging from the Great Lakes of Africa to the Balkans, to natural disasters such as the Turkish earthquake and Hurricane Mitch, we have seen that all of the above activities, and the arrival of medicines, material and medical personnel, need to be well choreographed to give the maximum benefit to the people affected," added Dr Brundtland.

Before the recent crisis, the vaccination status of children was reportedly (in 1996) quite high (85-90%) in East Timor. However, in 1995, over 500 cases of diphtheria were reported and some outbreaks of measles and neonatal tetanus were reported. Other health indicators (1995) also showed that East Timor's health was not as good as that of the rest of Indonesia:

• Infant Mortality Rate was 60/1000 live births;
• under age five mortality was 100 per 1000;
• malaria parasite prevalence rate 12.25%;
• dengue reported on the increase;
• high incidence of diarrhoeal diseases.

The main determinant of the health situation in both East and West Timor is now the population movement. With an estimated 500,000 people displaced in all of Timor, and with the migration of doctors and other health providers outside East Timor and the evacuation of nongovernmental organization staff, health assistance to both the displaced people and the population remaining in place has come almost to a standstill. Moreover, because of a lack of security, certain population groups cannot access still-functioning health services.

Immediate health priorities in the wake of the international peacekeeping force's arrival in East Timor will include: ensuring that the population of the province (800,000) has enough food and drinkable water; recommencing immunization and treatment programmes for life-threatening infectious diseases, in particular among children; providing obstetric services; and the re-establishment of surveillance systems to detect any increase in disease occurrence. In the medium-term, additional priorities will include dealing with the consequences of violence and ensuring that everyone has access to both full health facilities, including reproductive services, and safe water and sanitation. With the support of WHO headquarters and the WHO Southeast Asia Regional Office, staff are already in West Timor, working for the displaced population there.

WHO has teams standing by in Jakarta and Darwin, ready to go in with the peacekeeping troops. The first tasks performed in Dili will be the setting up of a health management coordination mechanism so that other organizations involved in the provision of health services will have a technical reference point, and a needs assessment to determine which health actions are the most pressing.

In conjunction with the United Nations Office for the Coordination of Humanitarian Affairs and other UN agencies, WHO is deploying its SUMA (supply management) system for the coordinated management of relief items and supplies. SUMA was first developed by the Regional Office for the Americas of WHO (PAHO/AMRO) and used to great effect during Hurricane Mitch.