Complex Humanitarian Emergencies

1. Complex Humanitarian Emergencies Clydette Powell, MD, MPH USAID

2. 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

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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.

9. Question #1 • What are your priorities, given the situation?

10. 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”

11. Question # 2 • Now that you have your team, what needs for this population must you consider – and in what sequence?

12. 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)

13. 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

14. 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

15. Question # 3 • How do you handle the “new arrivals”?

16. 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”

17. Communication (cont’d) • 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

18. 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.

19. 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 ?

20. 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

21. 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

22. Thank you!