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. PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION. United Nations: Civil-Military Coordination and the Cluster System. Dr. Ciro R. Ugarte Emergency Preparedness and Disaster Relief. Outline:.

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Pan american health organization pan american sanitary bureau regional office of the

.

  • PAN AMERICAN HEALTH ORGANIZATION

  • Pan American Sanitary Bureau, Regional Office of the

  • WORLD HEALTH ORGANIZATION

United Nations:

Civil-Military Coordination and the Cluster System

Dr. Ciro R. Ugarte

Emergency Preparedness and

Disaster Relief


Outline

Outline:

  • UN Humanitarian Civil-Military Coordination

  • UN Cluster System.

  • Challenges & opportunities of DOD / International Organizations Coordination.


Un civil military coordination

UN Civil-Military Coordination

  • The focal point for UN civil-military coordination is the Civil-Military Coordination Section (CMCS) of OCHA.

  • CMCS often deploys a Coordination Officer to support field-effective mechanisms.

  • The most common interface mechanisms are:

    • Civil-Military Operations Centre (CMOC)

    • Civil-Military Cooperation House (CIMIC House)

    • Humanitarian Operation Centre (HOC)


Pan american health organization pan american sanitary bureau regional office of the

UN Civil – Military Coordination

  • Humanitarian organizations and military forces have different mandates

  • Humanitarian organizations endeavour to provide assistance to affected populations based on assessed needs and on the humanitarian principles.

  • Civil defense units are deployed in a humanitarian crisis based on the agenda of their government.

  • Militaries are deployed with a specific security and political agenda or in support of a security and political agenda.


Range of civil military relationship

Range of civil-military relationship

PEACE

TIME

COMBAT

Low opportunities of CM cooperation / high risks for humanitarians of being drawn into conflict dynamics

High opportunities of CM cooperation / low risks for humanitarians of being drawn into conflict dynamics


Principles on military civilian relations

Principles on military-civilian relations

  • Humanitarian criteria to use/accept military assets.

  • Military assets unique and only as a last resort.

  • A humanitarian operation retains its civilian nature.

  • Follows principles of humanitarian assistance.

  • Avoid direct delivery of humanitarian assistance.

  • Retains its international and multilateral character.


Un civil military coordination in the health sector

UN Civil-Military coordination in the health sector

  • The mission of the Global Health Cluster (GHC) is to build consensus on humanitarian health priorities and related best practices, and strengthen system-wide capacities to ensure an effective and predictable response.

  • The GHC looks at how civil-military coordination might affect humanitarian agencies’ ability to access affected populations and provide health assistance.

    Global Health Cluster - Position Paper

    Civil-military coordination during humanitarian health action


Pan american health organization pan american sanitary bureau regional office of the

Building a Stronger, More Predictable Humanitarian Response System


Changing environment

Changing Environment

  • Proliferation of humanitarian actors

  • Demands for more structured international responses

  • Changing role of the UN(less direct implementation, more standard-setting and facilitation, more capacity-building)

  • Competitive fundingenvironment

  • Increased public scrutinyofhumanitarian action


Pan american health organization pan american sanitary bureau regional office of the

Whose reform?

Inter-Agency Standing Committee (IASC)

Composed of NGO consortia, Red Cross and Red Crescent Movement, IOM, World bank and UN agencies


Pan american health organization pan american sanitary bureau regional office of the

FOUR PILLARS OF REFORM

CLUSTER APPROACH

Adequate capacity and predictable leadership in all sectors

HUMANITARIAN COORDINATORS

Effective leadership and coordination in humanitarian emergencies

PARTNERSHIP

Strong partnerships between UN and non-UN actors

HUMANITARIAN FINANCING

Adequate, timely and flexible financing


Cluster mechanism

Cluster mechanism

General Assembly Resolution 46/182 on humanitarian assistance: IASC (Inter Agency Standing Committee)

  • Cluster lead agencies identified, PAHO/WHO for health cluster,

  • UNICEF for WASH cluster and nutrition cluster

  • WFP for food

  • Others…


Links with government and national authorities

Links with Government and national authorities

“Each State has the responsibility first and foremost to take care of the victims of natural disasters and other emergencies occurring on its territory. Hence, the affected State has the primary role in the initiation, organization, coordination, and implementation of humanitarian assistance within its territory.”

UN General Assembly Resolution 46/182


Pan american health organization pan american sanitary bureau regional office of the

AIM

  • High standards of predictability, accountability and partnership in all sectors or areas of activity

  • More strategic responses

  • Better prioritization of available resources


United nations cluster approach

United Nations Cluster Approach


New global cluster leads

New global cluster leads

Technical areas

Nutrition UNICEF

Water/Sanitation UNICEF

Health WHO

Emergency Shelter:Conflict IDPsUNHCR

DisastersIFRC ‘Convenor’

Cross-cutting areas

Camp Coord/Mgmt:Conflict IDPsUNHCR

DisastersIOM

Protection: Conflict IDPsUNHCR

Disasters & civilians

in conflict (non-IDPs)HCR/OHCHR/UNICEF

Early Recovery UNDP

Common service areas

Logistics WFP

Telecommunications OCHA/UNICEF/WFP


Responsibilities of global cluster leads

Responsibilities of global cluster leads

  • Standard setting

  • Standard setting and consolidation of ‘best practice’

  • Building response capacity

  • Training and system development at local, regional and international levels

  • Surge capacity and standby rosters

  • Material stockpiles

  • Providing operational support

  • Emergency preparedness

  • Advocacy and resource mobilization


Designating sector cluster leads at the country level

Designating sector/cluster leads at the country level

The UN consults the host government and national/international humanitarian actors to determine priority sectors.

The UN ensures lead agencies are designated for all the key sectors. Where possible, lead agencies at the country level should mirror those at the global level.

Sector/cluster leads are the provider of last resort, subject to access, security and funding.


United nations cluster system

United Nations Cluster System


Cluster approach in haiti

Cluster Approach in Haiti:

Specific Challenges in Haiti:

  • Too many people

  • Civil-military cooperation

  • Over coordination (10 meetings a day)

  • Weakness of national authorities

  • No legal or formal authority of the cluster coordinator to triage….


External actors in haiti an unregulated industry

External actors in Haiti,an unregulated industry

  • Urban SAR teams: from 30 countries (1,800 rescuers)

  • UN agencies

  • Red Cross societies

  • International NGOs

  • Bilateral non state institutions (universities)

  • Religious associations

  • Ad-hoc initiatives

  • Total of 43,000 Internationals


Health cluster in haiti

Health Cluster in Haiti


Coordination the health cluster in haiti

Coordination: the Health Cluster in Haiti

  • The Cluster began operating 3 days after the earthquake and a full time HC Coordinator.

  • By February 16, 390 agencies registered with the HC.

  • Sub-working :

    • primary care,

    • hospital care

    • referral system

    • medical supplies

    • rehabilitation.


Health cluster in haiti1

Health Cluster in Haiti


Hospitals

Hospitals

  • Day 10: 8 foreign field hospitals/40 health facilities

  • Day 13: 12 foreign field hospitals( 2 ships)/ 48 health facilities

  • Day 15: first military hospital leaving, others schedule their departure

  • Day 21: two more hospital ships arrived

  • Day 24: 21 foreign field hospitals/91 health facilities

Russian Field Hospital


Land based foreign field hospitals 21

Land based Foreign Field Hospitals: 21

  • MSF (Doctors without borders): 5 field hospitals,

    16 Operating theatres and 1,237 bed capacity, 800 internationals and over 3,000 nationals, 5,707 surgical interventions (first month 2,386; second 1,902 and third 1,419). No patients were rejected.

  • Israel military Hospital: arrived on day 4

    1,100 treated patients. 242 surgical procedures under anesthesia were performed on 205 patients. Patients with brain injuries; paraplegia, low Glasgow coma score not accepted.


Other disasters

Other disasters

  • Bam: 11 FFH 550 beds /Ukrainian first

  • Banda Aceh: 9 FFH /Singapore first/beds?

  • Pakistan: 10 FFH/Turkish first/ 38 Cuban FFH???

  • Costs/bed/day: +/- 2,000 USD

  • No FFH arrives early enough for trauma care

    Source: Karolinska/Sweden PDM vol 23.no 2, 2008


Challenges

Challenges:

  • Field hospitals concentrate on what they do best.

  • Rapid turnover of patients to achieve efficient use of theatres.

  • No post op care. the least sophisticated facilities were the most overworked.

  • No referral system between facilities.

  • No internationally accepted standards but professional groups (military, Red Cross, MSF) developed their own guidelines.


The problems

The problems

  • Unacceptable practices.

  • Questions about clinical competencies.

  • Accountability and coordination.

  • Complementarity of deployed medical teams (trauma, plastic surgery, crush syndrome, post op, rehab.)

  • Better match btw supply and demand (time of arrival).


Opportunities establishing an international registry of fmt foreign medical teams

Opportunities: establishing an international registry of FMT (Foreign Medical Teams)

  • Faster deployment (if governments can rapidly identify and approve FMT).

  • Better complementarities.

  • Reduction of duplications or overlap.

  • Better transparency and coordination with national authorities/cluster

  • Donors encouraged to support a registered FMT.


Thinking big

Thinking big…


Other initiatives

Other initiatives

  • Registration: database of foreign medical teams, no validation required.

  • Certification: technical evaluation, implies liability for the certifying agency (INSARAG classification).

  • Accreditation: formal compliance with predetermined standards: is usually voluntary.

  • Licensure: Government permission( UK, Spain).

  • Emergency surgery coalition( ESC).


The three wishes of the humanitarian organizations

The three wishes of the humanitarian organizations

“We know what to do”,

the military should provide:

  • Security … without inconvenience

  • Transport …at no cost

  • Communications... without controls


In normal times

In normal times . . .

¡ I NEED A DOCTOR !


In disaster situations

In disaster situations. . .

DISASTER

ZONE

I NEED

ONE DOCTOR!


Lessons learned from tsunami recovery

Lessons Learned from Tsunami Recovery

Key Propositions for Building Back Better

Beneficiaries deserve the kind of agency partnerships that move beyond rivalry and unhealthy competition.

A Report by the UN Secretary-General’s

Special Envoy for Tsunami Recovery,

William J. Clinton. December 2006


The real challenge coordination

The real challenge: Coordination

Hospitals

INTERPOL

CDC

Donor countries

USAID

CIDA

HHS

DOD

Private health centers

ECHO

MSF

OAS

CAPRADE

Universities

National Emergency Agency

UK

Ministry of health

ACNUR

SCR

France

CARE

Japan

PAHO WHO

MC

South Com

FNUAP

Netherlands

WFP

OXFAM

ICRC

Red Cross

CEPREDENAC

UNDAC

ORAS CONHU

Local NGO

PRESS

Health Canada

CARITAS

Security

Church

UNICEF

IFRC

CDERA

Lessson…learned?


Pan american health organization pan american sanitary bureau regional office of the

.

  • PAN AMERICAN HEALTH ORGANIZATION

  • Pan American Sanitary Bureau, Regional Office of the

  • WORLD HEALTH ORGANIZATION

United Nations:

Civil-Military Coordination and the Cluster System

Dr. Ciro R. Ugarte

Emergency Preparedness and

Disaster Relief


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