World Health Organization
The World Health Organization (WHO) is one of the most important bodies of the United Nations (UN). Its constitution entered into force on 7 April 1948.
WHO’s mandate is that of coordination authority for health within the UN system, taking responsibility for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulation evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
The member states (194 states as of 2012) appoint delegations to the World Health Assembly, which is WHO’s legislative and supreme body which meets yearly in May. The Assembly appoints the Director-General every five years, and votes on matters of policy and finance as well as electing the Executive Board members every three years.
Regional Structure of WHO
According to the 44 articles of the WHO’s constitution a regional structure may be established. As for 2012, six regional offices are established:
- AFRO: Africa (HQ in Brazzaville, Congo - http://www.afro.who.int/ )
- AMRO: Americas (also known as “Pan American Health Organization”, PAHO) (HQ in Washington DC, USA - http://new.paho.org/hq/index.php?lang=en )
- EURO: Europe (HC in Copenhagen, Denmark - http://www.euro.who.int/en/home )
- EMRO: Eastern Mediterranean (HC in Cairo, Egypt - http://www.emro.who.int/ )
- SEARO: South East Asia (HQ in New Delhi, India - http://www.searo.who.int/ )
- WPRO: Western Pacific (HQ in Manila, Philippines - http://www.wpro.who.int/en/ )
The WHO operates 147 country offices in the regions, and have several liaison offices with a number of international organisations.
Many NGOs have formal relationships with the WHO, and even more have informal relationships.
WHO Collaborating Centres
Networks of WHO Collaborating centres are organized around the world. Over 800 institutions in over 80 countries works together in such networks. They are research institutes, parts of universities or academies, which are designated by the Director-General to carry out activities in support of the Organization’s programmes. There is also one network of WHO CCs on Seafarers’ Health, of which there currently are two members, the centres in Hamburg and Esbjerg.
WHO operates using a six-point agenda to address the health objectives and strategic and operational needs. The agenda points are about
Fostering health security
Strengthening health systems
Harnessing research, information and evidence
- Improving performance
Although shipping and seafaring are not mentioned specifically in the mandate of the organization, WHO has undertaken activities on the field of maritime medicine and related topics, like travel medicine, vaccination requirements, occupational medicine, infectious diseases, hygiene etc.
International Medical Guide for Ships
From the Department of Protection of the Human Environment, the International Medical Guide for Ships (IMGS) was first published in 1967 by WHO in cooperation with International Labour Organization and International Maritime Organization. Since then this book has been the standard of guidance for seafarers falling ill or being injured.
The second edition was written in 1988, and was translated into more than 30 languages.
The third edition was approved in 2007 by the three organizations. The text was also endorsed by International Transport Worker’s Federation, International Shipping Federation and International Maritime Health Association.
In addition to being a textbook for seafarers in cases of illness or injury, the book also includes the The List of Recommended Medicines and Equipment based on WHO Model List of Essential Medicines. It also includes the International Health Regulations (see below).
The book is designed like a textbook, well suited for teaching and training purposes, but not to the same extent suitable for practical purposes as a manual on board.
WHO - International Health Regulations (IHR)
The Department of International Travel and Health publishes the International Health Regulations (IHR), which are based on consensus and agreement between 194 countries, including the member states of WHO. Key milestones are the development of plans of action, to ensure that surveillance and response capacities are functioning. The aim of the IHR is to help international communities to prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.
Although travelling by air has taken over as the most rapid and most voluminous way of transporting infectious diseases to other parts of the world, travelling by sea has always had the potential of carrying infectious diseases between different world regions.
Being a seafarer carries the risk of acquiring infectious diseases. Hence vaccination requirements and prophylactic measures have always been important to the seafarer, and will so be in the future. WHO is responsible for the International Certificate of Vaccination or Prophylaxis, based on the IHR, widely used and well known to travellers.
Travel medicine and maritime medicine are medical fields which overlap each other to a great extent. WHO is on of the most important organizations in this field.
WHO - Occupational Health
WHO Collaborating Centres on Occupational Health are key institutions distributed all over the world. A few of these centres are specialized in seafarer’s health, and form their own network, cooperating on research and development.
Cooperation is established between this network and International Maritime Health Association.
Occupational medicine is an important part of the field of maritime medicine. Hence, this is an important topic for workers within maritime medicine. With its close link to public health and health systems development, the Occupational Health Programme addresses many determinants of seafarer’s health, such as risks for disease and injury from the working environment, social and individual factors and access to health services.
WHO - Guidelines for Conducting Pre-sea and Periodic Medical Examinations for Seafarers
In May 1993 the Joint ILO/WHO Committee on the Health of Seafarers concluded that an international standard should be developed for pre-sea and periodic examinations.
In 1995, the Conference of Parties to the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW Conference) adopted resolution No. 9, Development of international standards of medical fitness for seafarers and invited the International Maritime Organization in cooperation with the International Labour Organization and the World Health Organization, to develop international standards of medical fitness for seafarers.
Although published by the ILO, these guidelines are the result of a close cooperation between WHO, IMO and ILO. Currently the existing guidelines are being revised (2009), and IMHA is commissioned to produce draft guidelines to replace the 1997 WHO/ILO version.
The establishment of the MLC 2006 and the revision of the STCW Convention prompted the revision of the guidelines. The tripartite workgroup between WHO, ILO and IMO were supposed to do this work, However, due to a change in WHO policy regarding the development of guidelines, WHO withdrew from the discussions, and the new revises guidelines will be published as a joint ILO/IMO document strongly linked to the two conventions.
International Labour Organization
The International Labour Organization was founded in 1919 to pursue a vision based on the premise that universal, lasting peace can be established only if it is based upon decent treatment of working people. The ILO became the first specialized agency of the UN in 1946.
The ILO’s vision of decent work is essential to all activities of the organization. The ILO calls itself “the only ‘tripartite’ United Nations agency”, bringing together representatives for governments, employers and workers to jointly shape policies and programmes. These groups form the constituents of ILO and determine its policies and priorities.
ILO is a very important stakeholder in maritime medicine. The conventions from this UN agency have lead to improved living and working conditions and improved health for seafarers all over the world. The organization
The organization is responsible for a number of international standards and conventions, dealing with working and living conditions for seafarers, most of them replaced by or summed up in the new Maritime Labour Convention (MLC) of 2006. The MLC is looked upon as one of the fourth pillars of maritime conventions, together with the SOLAS, the MARPOL and the STCW Conventions.
ILO’s conventions constitute a long list. The number cannot be given exactly, as it will vary, depending of whether or not one will include fishermen, maritime pilots and dock workers in the maritime setting. The conventions revised by the Maritime Labour Convention 2006, numbers 37 in total. See chapter 5.
In addition to all the conventions, the ILO list of recommendations is even longer. Nearly 200 recommendations have been given up to this day (2009) on different fields, many of them concerning seafaring.
The guidelines issued by ILO includes Guidelines for port state control officers carrying out inspections under the Maritime Labour Convention (MLC), Guidelines for flag State Inspections under the MLC, Compendium of Maritime Labour Instruments, Uniform Identity Documents for Seaferers, Safety and Health in Ports, the ILO code of practice, among others.
The revised Guidelines for medical examinations of seafarers from ILO and IMO replaces the “Guidelines for Conducting Pre-sea and Periodic Medical Examinations of Seafarers” from 1997. See under WHO for more information regarding the change in the way these guidelins are published.
The ILO online Library contains important information, accessible through the CISDOC portal, which is a specialized search engine for getting information about occupational health and safety issues, not only in the maritime sector. It also contains the Encyclopedia of Occupational Health and Safety – a comprehensive online textbook free of use to everybody, as well as the International Chemical Safety Cards (ICSCs), the updated list of all conventions, and the updated list of all ILO Codes of Practice. This is an important source for information for all health professionals working in the field of maritime medicine. The Encyclopedia is also possible to buy in hardcopy, and is widely distributed and used, in several languages.
International Maritime Organization (IMO)
The IMO (originally IMCO – the International Maritime Consultative Organization) is a specialized United Nations agency with 168 Member States and three Associate Members, established by the Convention of the International Maritime Organization. This convention was adopted in 1948 and entered into force in 1958. Thus, IMO could have the first meeting in 1959.
The mission statement of IMO is “Safe secure and efficient shipping on clean oceans”.
The main task is to develop and maintain a comprehensive regulatory framework for shipping including safety, environmental concerns, legal matters, technical co-operation, maritime security and the efficiency of shipping.
Up to 1970s the main task for IMO was to establish a range of conventions. From this time, maintenance and updating of conventions has been the main task. One important example of this is the ongoing (2009) revision process of the STCW Convention (see below, and see Ch. 5).
IMO working concept
The main ruling body is the IMO Assembly, which consists of all Member States. The assembly meets every two years and is responsible for approving the Organization’s work programme, voting the budget and determining the financial arrangements of the Organization.
The Council, which is made up of 40 Member States elected by the Assembly oversees the work of the organization between Assembly sessions. Hence the constituents who determine policies and priorities are the maritime states, usually represented by their maritime authorities or transport ministries.
The technical work of the Organization is carried out by a series of Committees, to which the Member States send their experts as appropriate. The titles of the Committees clearly reflect their area of expertise and responsibility. The committees are listed in Table 1. The committees consider proposals from member states, and if found appropriate, refer them to subcommittees for more detailed development.
Reporting to the Committees are several sub-committees, which are listed in table 2. This is where the detailed work is done.
The meetings in the committees and subcommittees usually lasts for one week, and about 25 such meetings are held each year.
There are some 50 nationalities represented on the staff, in six divisions: Maritime Safety, Marine Environment, Legal and External Relations, Technical Co-operation, Administrative and Conference.
Table 1: The committees of IMO Table 2: The subcommittees of IMO
Acknowledging the international character of shipping and the need of international regulation standards which can be adopted and accepted by all, the first maritime treaties dated back to the 19th century. After the Titanic disaster of 1912, the first international safety of life at sea – SOLAS – convention was agreed, still the most important treaty addressing maritime safety.
IMO is the mother organization for three of the most important maritime conventions, namely the International Convention for the Safety of Life at Sea (SOLAS) of 1974 as amended year by year, the International Convention for the Prevention of Pollution from Ships (MARPOL) of 1973, modified by a protocol of 1978, and the International Convention on Standards of Training. Certification and Watchkeeping for Seafarers (STCW) of 1978, entered into force in 1984, as revised by the 1995 amendments.
But there are a lot of other Conventions from IMO, regulation different parts of the shipping industry, including 12 conventions relating to maritime safety, 7 to maritime pollution, 7 to liability and compensation and four to other topics, i.e. maritime traffic, tonnage measurement, salvage and safety of maritime navigation. See International Conventions, Chapter 5.
IMOs work on the Human Element
It has long been recognised that human performance and the interaction between people are crucial to the safe operation of ships. IMO has focused on fatigue, and a working group was established in 1991.
One example of the combined work is the anchoring of Guidelines of Seafarer’s Hours of Work or Rest in both the IMO’s STCW Convention and the ILO Convention Seafarers' Hours of Work and the Manning of Ships.
Another example is the tripartite cooperation between IMO, ILO and WHO in the Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers (1997). These guidelines meet the obligations in a series of conventions, regulations, recommendations and resolutions, as listed in Table 3.
Table 3: Instruments concerning medical examination of seafarers
Table 3 also illustrates the complexity of the processes of reaching international consensus in maritime health, especially when it involves different UN bodies, each with its very different constituencies to respond to, and the need to be aligned with a number of different international treaties.
International Organization for Migration (IOM)
The IOM was established in 1951, and is the leading inter-governmental organization in the field of migration. The organization works closely with governmental, intergovernmental and non-governmental partners. The Council on which each member state has one representative and one vote, is the highest authority and determines IOM Policies.
The executive committee, at present (2012) comprising 33 members states elected for two-years periods, examines and reviews the policies, operations and administration of the Organization.
The organisation also have a “Standing Committee on Programmes and Finance” (SCPF), which is open to the entire membership and which meets twice a year to examine and review policies, programmes and activities as well as to discuss budgetary and financial matters.
The administration comprises a Director General, a Deputy Director General and a staff. They are independently elected by the Council for a period of five years.
IOM is dedicated to promoting humane and orderly migration for the benefit of all. It does so by providing services and advice to governments and migrants, promoting international cooperation, assisting in search for practical solutions and providing humanitarian assistance to migrants in need. The four major working fields of specific interest are migration and development, facilitation of migration, regulation of migration and forced migration.
Seafaring constitutes a special and unusual form of migration, and is regarded as an important field of interest for the IOM, therefore together with IMHA, ILO, ITF, UNAIDS, ICSW and ISF, IOM embarked on major global project on HIV/AIDS prevention: Global Partnership on HIV and Mobile Workers in the Maritime Sector.
European Maritime Safety Agency (EMSA)
Although not a true international organization, the European Maritime Safety Agency deserves to be mentioned in this context. It is a supranational organization within the European Union. As such its activity has an impact on shipping based within the EU and for other flag states where their ports of call are within the EU.
EMSA Mandate and Organization
EMSA is set up under the Regulation (EC) No 1406/2002 of 27 June 2002, as amended by Regulations (EC) 1644/2003, 724/2004 and 2038/2006.
EU activities on this field started, however, some times before the establishment of EMSA, starting with the Directive 79/115/EEC as early as in 1978.
According to EMSAs own description
“the Agency's main objective is to provide technical and scientific assistance to the European Commission and Member States in the proper development and implementation of EU legislation on maritime safety, pollution by ships and security on board ships. To do this, one of EMSA's most important supporting tasks is to improve cooperation with, and between, Member States in all key areas. In addition, the Agency has operational tasks in oil pollution preparedness, detection and response. As a body of the European Union, the Agency sits at the heart of the EU maritime safety network and collaborates with many industry stakeholders and public bodies, in close cooperation with the European Commission.”
EMSA is focusing on strengthening of the Port State Control regime; auditing of the Community-recognised classification societies; development of a common methodology for the investigation of maritime accidents and; the establishment of a Community vessel traffic monitoring and information system.
The headquarters are in Lisboa, Portugal, and by 2009 it has over 200 staff members. After being internally reorganized in June 2008, EMSA now has three different departments: A: Corporate Services; B: Implementation and; C: Operations.
EMSA has a lot of activities that has an impact on different aspects of maritime health, like regulations and recommendations for the training of seafarers, maritime security, port reception facilities, ship safety and marine equipment and others.
By June 2009 there were about 75 Directives, Regulations and Decisions from the EU within the area of maritime safety.
The Council Directive 92/29/EEC of 31 March 1992 on the minimum safety and health requirements for improved medical treatment on board vessels is an important document for professionals working in the field of maritime medicine.
Other Directives of importance to maritime safety and health concerns
- the implementation of minimum safety and health requirements at temporary or mobile constructions sites,
- on the minimum requirements for the provision of safety and/or health signs at work,
- on the introduction of measures to encourage improvements in the safety and health at work of pregnant workers who have recently given birth or are breastfeeding,
- concerning the minimum safety and health requirements for work on board fishing vessels
- and on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (electromagnetic fields).
It is beyond the scope of this chapter to deal in detail with these documents, but they will be discussed in more detail in Chapter 5, dealing with the international conventions and other regulations.
The European Centre for Disease Prevention and Control - ECDC
Being an EU agency, the European Centre of Disease Prevention and Control is a regional intergovernmental organization. Its impact, however, reaches beyond the European Union. The organization was established in 2005, and its headquarter is in Stockholm, Sweden.
The organization may be regarded as a counterpart to the American CDC, and will apply similar Vessel Sanitation Program to EU ports as the CDC does in the United States of America.
International Mobile Satellite Organization (IMSO)
The International Mobile Satellite Organization (IMSO) is the intergovernmental organization that oversees certain public satellite safety and security communication services provided via the Inmarsat satellites, established under the provisions of the Convention on the International Mobile Satellite Organization.
These public services include:
- services for maritime safety within the Global Maritime Distress and Safety System (GMDSS) established by the International Maritime Organization (IMO)
- distress alerting
- search and rescue co-ordinating communications
- maritime safety information (MSI) broadcasts
- general communications
- aeronautical safety AMS(R)S services through compliance with the Standards and Recommended Practices (SARPs) established by the International Civil Aviation Organization (ICAO)
IMSO also acts as the International LRIT Coordinator, appointed by IMO to coordinate the establishment and operation of the international system for the Long Range Identification and Tracking of Ships (LRIT) worldwide.
IMSO Working concept
IMSO works closely with IMO, ICAO, ITU and other interested international organizations, as well as Inmarsat Ltd itself, in developing recommendations, standards and operational practices that support and may improve the public services. The Organization’s special relationship with IMO is fostered and maintained by regular reports to the IMO Maritime Safety Committee on the provision and quality of satellite services for the GMDSS, and continuing detailed work on the establishment of the International LRIT System.
The Organization operates through:
- the Assembly of Parties, integrated by its 93 member States, which generally meets every two years;
- the Directorate, headed by the Director General, Capt. Esteban Pacha-Vicente of Spain, who is the Chief Executive Officer and legal representative of IMSO; and
- an Advisory Committee, comprising a number of Member States, appointed by the Assembly, which meets regularly.
The United Nations Environmental Program, UNEP, is the mother organization for three different important conventions, namely the Stockholm Convention, the Rotterdam Convention and the Basel Convention, each of them with its own secretariat.
The three related secretariats work closely together and stand behind numerous decisions for complementing each others mandate in the field of environment protection.
Preparation of guidelines is an important obligation for the secretariats, as is the sharing common facilities for regional centres. Recent development of finding synergy in joint implementation between three Conventions (Basel, PIC and SC) is underway, through the establishment of a joint working group.
The Basel Convention
The Basel Convention is especially important, with its guidelines for ship scrapping, and with its participation in a joint working group with ILO and IMO as the other partners.
ILO, IMO and Basel Convention have three different approaches to ship scrapping, the Basel Convention looking into the environmental risks, the ILO looking into the people in the industry that dismantle the ships, and the IMO looking into the design, construction, operation and preparation for sound recycling.
The Rotterdam Convention
The Rotterdam Convention was established to promote shared responsibility and cooperative efforts among Parties in the international trade of certain hazardous chemicals in order to protect human health and the environment from potential harm;
to contribute to the environmentally sound use of those hazardous chemicals, by facilitating information exchange about their characteristics, by providing for a national decision-making process on their import and export and by disseminating these decisions to Parties.
The Convention creates legally binding obligations for the implementation of the Prior Informed Consent (PIC) procedure. It built on the voluntary PIC procedure, initiated by UNEP and FAO in 1989 and ceased on 24 February 2006.
The Stockholm Convention
The Stockholm Convention on Persistent Organic Pollutants is a global treaty to protect human health and the environment from chemicals that remain intact in the environment for long periods, become widely distributed geographically, accumulate in the fatty tissue of humans and wildlife, and have adverse effects to human health or to the environment. Exposure to Persistent Organic Pollutants (POPs) can lead serious health effects including certain cancers, birth defects, dysfunctional immune and reproductive systems, greater susceptibility to disease and even diminished intelligence. Given their long range transport, no one government acting alone can protect is citizens or its environment from POPs. In response to this global problem, the Stockholm Convention, which was adopted in 2001 and entered into force in 2004, requires Parties to take measures to eliminate or reduce the release of POPs into the environment. The Convention is administered by the United Nations Environment Programme and is based in Geneva, Switzerland.
 The Constitution of WHO: http://www.who.int/governance/eb/who_constitution_en.pdf
 International Medical Guide for Ships: World Health Organization 2007, ISBN 978 92 4 154720 8
 Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers: http://www.ilo.org/public/english/dialogue/sector/techmeet/ilowho97/meden2.htm#Heading4
 Council Directive 92/57/EEC of 24 June 1992
 Council Directive 92/58/EEC of 24 June 1992
 Council Directive 92/85/EEC of 19 October 1992
 Council Directive 93/103/EC of 23 November 1993
 DIRECTIVE 2004/40/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL
of 29 April 2004
 LRIT = Long Range Identification and Tracking of Ships