Complex Humanitarian Complex Humanitarian EmergenciesEmergencies

Clydette Powell, MD, MPHClydette Powell, MD, MPH

USAIDUSAID

ObjectivesObjectives

Define and discuss the causes and Define and discuss the causes and phases of CHEsphases of CHEs

Understand the magnitude and Understand the magnitude and measures of CHEsmeasures of CHEs

Use a case scenario to illustrate the Use a case scenario to illustrate the reality and optimum approaches to reality and optimum approaches to addressing CHEsaddressing CHEs

Definition of CHEDefinition of CHE

CHE: Human disaster that occurs CHE: Human disaster that occurs during and follows war and civil strifeduring and follows war and civil strife

Inciting event: natural or man-madeInciting event: natural or man-made Characterized by displacementCharacterized by displacement Loss of existing societal infrastructure Loss of existing societal infrastructure Concerns for personal securityConcerns for personal security 90% of war related mortality among 90% of war related mortality among

civilian non-combatantscivilian non-combatants

Refugees and IDPsRefugees and IDPs

Flight across border (R) or within Flight across border (R) or within border (IDP)border (IDP)

14 million refugees14 million refugees 15 – 20 million IDPs15 – 20 million IDPs UN and international protections varyUN and international protections vary Degree of difficulty in assistanceDegree of difficulty in assistance

Phases of CHEsPhases of CHEs

Acute (early) emergency: 0 – 1 monthAcute (early) emergency: 0 – 1 month Late or recovery : 1 -6 monthsLate or recovery : 1 -6 months Rehabilitation and development : 6 or Rehabilitation and development : 6 or

more monthsmore months Measure of severity: depends on Measure of severity: depends on

magnitude and vulnerability of magnitude and vulnerability of populationpopulation

CMR: number of deaths per 10,000 per CMR: number of deaths per 10,000 per day day

ScenarioScenario

Recent political changes with ongoing Recent political changes with ongoing instabilityinstability

Drought and early famine Drought and early famine Aggressive land reform with massive Aggressive land reform with massive

displacement of people (IDPs)displacement of people (IDPs) Excellent health care system on sharp Excellent health care system on sharp

decline, with drop in trust by publicdecline, with drop in trust by public Public health services characterized by Public health services characterized by

patchy coverage (eg., EPI)patchy coverage (eg., EPI)

Rapid inflation, increasing unemploymentRapid inflation, increasing unemployment Out-migration of health care professionalsOut-migration of health care professionals Disease outbreaksDisease outbreaks HIV on rise (1 in 3 persons) and TB incidence HIV on rise (1 in 3 persons) and TB incidence

increasingincreasing Poor recognition of disease or means of Poor recognition of disease or means of

treatment; poor coping skillstreatment; poor coping skills Increasing urban migrationIncreasing urban migration

YOU in the scenario:YOU in the scenario:

You are a public health director of a rural You are a public health director of a rural health clinic with limited facilitieshealth clinic with limited facilities

Over the following two days, 10,000 Over the following two days, 10,000 exhausted IDPs arrive in your areaexhausted IDPs arrive in your area

Included in these are women and children Included in these are women and children and people of different ethnic groups (known and people of different ethnic groups (known to be at odds with one another)to be at odds with one another)

District authorities have come asking for District authorities have come asking for your help. your help.

Question #1Question #1

What are your priorities, given the What are your priorities, given the situation?situation?

Lesson 1 - CoordinationLesson 1 - Coordination

Before jumping to health solutions or Before jumping to health solutions or any needs, build a teamany needs, build a team

Have clear authority structure for Have clear authority structure for delegation and coordinationdelegation and coordination

Communicate clearly and succinctlyCommunicate clearly and succinctly Have a camp managerHave a camp manager Designate a “reporter”Designate a “reporter”

Question # 2Question # 2

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

Priority needsPriority needs

Food Food Water and sanitationWater and sanitation ShelterShelter Identification of vulnerable populationsIdentification of vulnerable populations Appropriate health interventions for Appropriate health interventions for

these populations – for example:these populations – for example: ImmunizationsImmunizations Nutritional assessment (e.g., MUAC)Nutritional assessment (e.g., MUAC)

Lesson # 2Lesson # 2

Keep first things firstKeep first things first Keep the big picture in mind (“30,000 Keep the big picture in mind (“30,000

foot view”)foot view”) Collect only the data you needCollect only the data you need Be watchful for disease outbreaks for Be watchful for disease outbreaks for

rapid responserapid response Maintain nutritional surveillanceMaintain nutritional surveillance Monitor security and safety conditionsMonitor security and safety conditions

Day 3Day 3

Government officials and politicians, Government officials and politicians, along with UN agencies, World Food along with UN agencies, World Food Program, arrive on the sceneProgram, arrive on the scene

CNN as well as local news media are CNN as well as local news media are setting up cameras, and reporters are setting up cameras, and reporters are swarming the camp perimeterswarming the camp perimeter

Question # 3Question # 3

How do you handle the “new arrivals”?How do you handle the “new arrivals”?

Lesson 3 - CommunicationLesson 3 - Communication

One designated “camp reporter”One designated “camp reporter” Daily updates and sound bitesDaily updates and sound bites Data driven, not sensationalistic or Data driven, not sensationalistic or

speculativespeculative No opinions offeredNo opinions offered Do not get drawn into criticismsDo not get drawn into criticisms If answer not known, offer to get back to If answer not known, offer to get back to

person with questionperson with question Remember: journalists are never “off duty”Remember: journalists are never “off duty”

Communication (cont’d)Communication (cont’d)

Be aware of UN politicsBe aware of UN politics Respect national politicians and the Respect national politicians and the

processprocess Be aware of hidden agendas, confusing Be aware of hidden agendas, confusing

or overlapping mandatesor overlapping mandates Keep in mind historical contextKeep in mind historical context Anticipate your comparative advantage Anticipate your comparative advantage

and whether you will stay engaged in and whether you will stay engaged in the process or withdraw at some pointthe process or withdraw at some point

Two Weeks Later….Two Weeks Later….

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

Question # 4Question # 4

How do you respond to this new How do you respond to this new development in the second week, development in the second week, especially in light of large and especially in light of large and expanding health needs and ongoing expanding health needs and ongoing health services?health services?

Does the composition of your health Does the composition of your health staff modify, or mitigate, your staff modify, or mitigate, your approach ?approach ?

Lesson # 4Lesson # 4

Use low tech interventionsUse low tech interventions Recruit among the camp populationRecruit among the camp population Anticipate from the start your exit plan, Anticipate from the start your exit plan,

contingencies, potential scenarios contingencies, potential scenarios different from the one at the beginning.different from the one at the beginning.

Attempt to promote ongoing dialogue Attempt to promote ongoing dialogue between the camp and local populationbetween the camp and local population

ResourcesResources www.reliefweb.orgwww.reliefweb.org UN High Commissioner for Refugees; for Human UN High Commissioner for Refugees; for Human

RightsRights International Committee of the Red CrossInternational Committee of the Red Cross Medecins sans FrontieresMedecins sans Frontieres Office for Coordination of Humanitarian AffairsOffice for Coordination of Humanitarian Affairs FEWSNETFEWSNET Universal Declaration of Human RightsUniversal Declaration of Human Rights International Law of Human RightsInternational Law of Human Rights USAID - Office of Foreign Disaster Assistance and USAID - Office of Foreign Disaster Assistance and

Office of Transition InitiativesOffice of Transition Initiatives DOS - Population Refugees and MigrationDOS - Population Refugees and Migration

Thank you!Thank you!