Complex Humanitarian Emergencies

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Complex Humanitarian Emergencies

• Clydette Powell, MD, MPH
• USAID

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Objectives

• Define and discuss the causes and phases of CHEs
• Understand the magnitude and measures of CHEs
• Use a case scenario to illustrate the reality and
  optimum approaches to addressing CHEs

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Definition of CHE

• CHE Human disaster that occurs during and
  follows war and civil strife
• Inciting event natural or man-made
• Characterized by displacement
• Loss of existing societal infrastructure
• Concerns for personal security
• 90 of war related mortality among civilian
  non-combatants

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Refugees and IDPs

• Flight across border (R) or within border (IDP)
• 14 million refugees
• 15 20 million IDPs
• UN and international protections vary
• Degree of difficulty in assistance

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Phases of CHEs

• Acute (early) emergency 0 1 month
• Late or recovery 1 -6 months
• Rehabilitation and development 6 or more months
• Measure of severity depends on magnitude and
  vulnerability of population
• CMR number of deaths per 10,000 per day

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Scenario

• Recent political changes with ongoing instability
• Drought and early famine
• Aggressive land reform with massive displacement
  of people (IDPs)
• Excellent health care system on sharp decline,
  with drop in trust by public
• Public health services characterized by patchy
  coverage (eg., EPI)

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• Rapid inflation, increasing unemployment
• Out-migration of health care professionals
• Disease outbreaks
• HIV on rise (1 in 3 persons) and TB incidence
  increasing
• Poor recognition of disease or means of
  treatment poor coping skills
• Increasing urban migration

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YOU in the scenario

• You are a public health director of a rural
  health clinic with limited facilities
• Over the following two days, 10,000 exhausted
  IDPs arrive in your area
• Included in these are women and children and
  people of different ethnic groups (known to be at
  odds with one another)
• District authorities have come asking for your
  help.

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Question 1

• What are your priorities, given the situation?

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Lesson 1 - Coordination

• Before jumping to health solutions or any needs,
  build a team
• Have clear authority structure for delegation and
  coordination
• Communicate clearly and succinctly
• Have a camp manager
• Designate a reporter

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Question 2

• Now that you have your team, what needs for this
  population must you consider and in what
  sequence?

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Priority needs

• Food
• Water and sanitation
• Shelter
• Identification of vulnerable populations
• Appropriate health interventions for these
  populations for example
• Immunizations
• Nutritional assessment (e.g., MUAC)

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Lesson 2

• Keep first things first
• Keep the big picture in mind (30,000 foot view)
• Collect only the data you need
• Be watchful for disease outbreaks for rapid
  response
• Maintain nutritional surveillance
• Monitor security and safety conditions

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Day 3

• Government officials and politicians, along with
  UN agencies, World Food Program, arrive on the
  scene
• CNN as well as local news media are setting up
  cameras, and reporters are swarming the camp
  perimeter

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Question 3

• How do you handle the new arrivals?

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Lesson 3 - Communication

• One designated camp reporter
• Daily updates and sound bites
• Data driven, not sensationalistic or speculative
• No opinions offered
• Do not get drawn into criticisms
• If answer not known, offer to get back to person
  with question
• Remember journalists are never off duty

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Communication (contd)

• Be aware of UN politics
• Respect national politicians and the process
• Be aware of hidden agendas, confusing or
  overlapping mandates
• Keep in mind historical context
• Anticipate your comparative advantage and whether
  you will stay engaged in the process or withdraw
  at some point

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Two Weeks Later.

• The army arrives to contain both the situation
  and the IDPs, who are regarded as a threat to
  local and national security. You are told that
  the army is there for your safety and security,
  but their presence limits your access to the camp
  and curfew is put in place.

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Question 4

• How do you respond to this new development in the
  second week, especially in light of large and
  expanding health needs and ongoing health
  services?
• Does the composition of your health staff modify,
  or mitigate, your approach ?

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Lesson 4

• Use low tech interventions
• Recruit among the camp population
• Anticipate from the start your exit plan,
  contingencies, potential scenarios different from
  the one at the beginning.
• Attempt to promote ongoing dialogue between the
  camp and local population

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Resources

• www.reliefweb.org
• UN High Commissioner for Refugees for Human
  Rights
• International Committee of the Red Cross
• Medecins sans Frontieres
• Office for Coordination of Humanitarian Affairs
• FEWSNET
• Universal Declaration of Human Rights
• International Law of Human Rights
• USAID - Office of Foreign Disaster Assistance
  and Office of Transition Initiatives
• DOS - Population Refugees and Migration

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Thank you!