A/HRC/37/33 standard of health, and should strive to ensure that no child is deprived of his or her right of access to health-care services. In humanitarian situations, children are exposed to additional health risks, while existing risks are also heightened; at the same time, the ability to respond to these risks is undermined, as primary health care and infrastructure are compromised, and health systems are eroded. The main causes of child morbidity and mortality in emergencies include injury, diarrheal disease, acute respiratory tract infection, pneumonia, measles, malaria, bacterial infection, and malnutrition. 25 The denial of access to humanitarian assistance can have a significant impact on not only children’s right to health but also their right to survival and development. 44. In humanitarian situations, children are particularly vulnerable to undernutrition and micronutrient deficiencies, particularly when they are dependent on others to provide for their needs. They may also suffer from discriminatory access to food, both within the household and in the community. In countries where child malnutrition is already a significant risk factor, even small-scale natural disasters can greatly worsen the health of affected children.26 Moreover, where families are at risk of, or already suffer from, malnutrition, the children are more like to leave the household either to seek paid work (including hazardous labour) or to secure access to food (for example, by entering alternative care).27 45. Following an emergency situation, States should ensure that preventative and curative health services are established as a matter of priority, particularly with regard to illnesses to which children under-5 are most vulnerable, such as pneumonia, diarrhoea, malaria and malnutrition. In this respect, WHO has developed the Manual for the health care of children in humanitarian emergencies, a set of guidelines designed to assist in the assessment and management of children in emergency situations, and that can also be used in the training of health-care workers. Furthermore, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) recognizes the need to protect the right to health, including in humanitarian and fragile settings. 46. In addition to providing an efficient and effective response to an emergency situation, it is also important to build capacity before a crisis arises through risk assessments and the development of preparedness and response plans. The health impact of humanitarian situations on children can be substantially reduced if authorities and communities are well prepared and able to reduce their vulnerabilities. 28 47. Safe, age-appropriate water, sanitation and hygiene facilities are vital to ensure children’s well-being in humanitarian situations. For example, children who do not feel safe using toilets may resort to risk or harmful behaviours, such as travelling outside of populated areas to defecate or attempting to eat or drink less so as not to need to go to the toilet as often.29 It is also important that girls have suitable materials for dealing with periods, including at schools so that their access to education is not inhibited. 30 48. Children require not only physical support, such as food and clean water, but also psychosocial care to prevent and address fear and trauma arising from the emergency or humanitarian situations. They are at risk of mental health problems particularly in humanitarian situations, leading to changes in their behaviour, social relations, emotions and physical reactions. Changes of these types can be the result of primary stressors (such as injuries or exposure to violence) or secondary stressors (for example, disruption of the social fabric of community life, lack of financial support, loss of physical possessions, or 25 26 27 28 29 30 10 World Health Organization (WHO), Manual for the health care of children in humanitarian emergencies, 2008. Humanitarian Coalition, “Children and Disaster Relief”. Child Protection Working Group, Minimum Standards for Child Protection (see footnote 6), p. 190. WHO, Risk reduction and emergency preparedness: WHO six-year strategy for the health sector and community capacity development, 2007, p. 9. Child Protection Working Group, Minimum Standards for Child Protection, p. 196. Ibid.