Introduction to Public Health in Emergencies

1
Introduction to Public Health in Emergencies
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Learning Objectives

• Humanitarian Principles - the code of conduct
• Lessons learned in response to emergencies over
  the last thirty years
  
• New structures in emergency response as a result
  of lessons learned

3

Humanitarian Conventions

• International Humanitarian Law
• International Human Rights Law
• Refugee law
• The Code of Conduct for the International Red
  Cross and Red Crescent Movement and NGOs

4
Humanitarian Principles

• International Humanitarian Law
• Assistance to civilians in time of conflict
• Distinction between combatants and non-combatants
  
  
• Refugee law
• Principle of non-refoulement a principle in
  international law, specifically refugee law, that
  concerns the protection of refugees from being
  returned to places where their lives or freedoms
  could be threatened

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Humanitarian Principles Contd

• The Code of Conduct
• Humanitarian imperative
• - Assistance based on need
• - Aid not used to further other aims
• - Aid not an instrument of foreign policy
• - Respect culture and custom
• - Build on local capacity
• - Involve beneficiaries
• - Reduce future vulnerabilities
• - Recognize dignity of disaster affected
  populations

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Actors in Emergencies

• United Nations WHO, UNICEF, WFP, OCHA, UNHCR
• Donors ECHO, DFID, OFDA, PRM, CIDA, SIDA
• Organizations with special mandate ICRC, IOM,
  IFRC
  
• INGO MSF, SC, ARC, IRC, CARE
• FBO WVI, ADRA
• Government MOH, Military, Disaster Minister
• Local NGO National Red Cross/red crescent, FBO
• Military national, Foreign, UN
• Policy and advocacy Amnesty international, Human
  rights watch, Physicians for Human Rights,
  International Crisis Group, Africa Watch
  
• Conflict resolution Carter center
• Private foundations Gates,
• Academic institutes Columbia, John Hopkins
• Others CDC, Epicenter

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History of Emergencies

• 1977 -1985 Afghan refugees in Pakistan
  Ethiopian refugees in Somalia, and Sudan (measles
  epidemic, scurvy)
  
• 1987-92 Mozambique, Malawi general food
  distribution, lack of minerals/vitamins (Pellagra
  epidemic)
  
• 1991 Iraq role of military, non -
  refoulement
  
• 1992-3 Somalia UN military role
• 1992-95 Bosnia- Herzegovina role of NATO, UN
  military, Sexual violence, ethnic cleansing
  
• 1993 Thailand (Cambodian refugees)
• 1994 Rwanda, DRC- Goma genocide, refugee,
  quality of response, accountability, SPHERE

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History of Emergencies (Contd.)

• 2000 Kosovo developed country, different
  public health perspective
  
• 1998 - 2000 Ethiopia food insecurity, measles,
  quality of nut surveys
  
• 2001 Afghanistan independence, civil-military
• 2004 Tsunami coordination, community
  participation, accountability
  
• 2005 Pakistan gender in humanitarian
  response
  
• 2005 the Humanitarian reform cluster approach,
  financing (CERF ), coordination, partnership
  
• 2006 Lebanon quality of response, role of
  local CBOs
  

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Crude Mortality Rate (CMR) Evolution in Different
Emergencies(Salama Peter et al 2004)
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CMR in Camp Versus Non-camp Situations 2004
lessons learned from complex emergencies over the
past decade
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Natural Disasters Reported 1990 - 2006
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Summary of Lessons Learned

• Emergency response must be based on accurate
  information and use a public health approach
  
• Major causes of mortality in emergencies are
  preventable through well-proven, low-cost public
  health interventions
  
• Protection of affected populations, maintenance
  of humanitarian space and safety of humanitarian
  workers is becoming increasingly difficult
  

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Summary of Lessons Learned (cont.)

• Emergency response has evolved as a specialist
  field with its own indicators, policies,
  procedures, manuals, and reference materials
  
• Agencies that have developed institutional
  expertise in the key technical areas of
  humanitarian aid and invested in staff training
  have proven their effectiveness
• Relief agencies must be accountable to agreed
  standards
  
• Better outcomes with involvement of host
  government staff and use of local skills
  
• Preparedness and coordination between agencies is
  key for effective response.
  

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Steps Taken

• Code of conduct
• Some agreement on use of mortality and
  malnutrition indicators
  
• The SPHERE guidelines
• Cluster approach

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Coordination

• Coordination between international organizations,
  NGOs, host country government, local community,
  displaced population
  
• Common objectives being pursued
• Maximize use of resources and manpower
• Ensure all sectors are covered
• Avoid duplication of efforts
• Sharing of information

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Cluster Leadership Approach

• Objective
• Address identified gaps in response and enhance
  the quality of humanitarian action by
  strengthening partnerships.aimed at improving
  effectiveness of response by ensuring greater
  accountability, predictability and partnership

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Cluster Leads

• Logistics WFP
• Shelter UNHCR
• Health WHO
• Nutrition UNICEF
• WatSan UNICEF
• Protection UNHCR
• Camp Mgmt UNHCR / IOM
• Communications OCHA
• Early Recovery UNDP
• Education UNICEF

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Thank You

• Questions? Comments?