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COMPLEX EMERGENCIES: What do we measure and why?. Frederick M. Burkle, Jr., MD, MPH Deputy Assistant Administrator Bureau for Global Health/USAID Senior Scholar, Scientist & Visiting Professor The Center for International Emergency, Disaster & Refugee Studies

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complex emergencies what do we measure and why

COMPLEX EMERGENCIES: What do we measure and why?

Frederick M. Burkle, Jr., MD, MPH

Deputy Assistant Administrator

Bureau for Global Health/USAID

Senior Scholar, Scientist & Visiting Professor

The Center for International Emergency, Disaster & Refugee Studies

Schools of Public Health & Medicine

The Johns Hopkins University Medical Institutions

natural and technological disasters
Natural and Technological Disasters:
  • Defines the public health
  • Exposes its vulnerabilities
  • Direct effects dominate
  • Easy to define
complex emergencies
Complex Emergencies:
  • “…situations in which the capacity to sustain livelihood and life is threatened primarily by political factors, and, in particular, by high levels of violence.”

A. ZWI: London Sch of HTM

complex emergencies lethal mix of
Inequities

Poverty

Injustice

Cultural incompatibilities

Ignorance

Racism

Oppression

Religious fundamentalism

Complex Emergencies: Lethal Mix of ………...
complex emergencies1
DIRECT EFFECTS

Injuries/Illness

Deaths

Human rights abuses

International Humanitarian Law abuses

Psychological stress

Disabilities

INDIRECT EFFECTS

Population displacement

Disruption of food

Destroyed health facilities

Destroyed public health infrastructure

Complex Emergencies: …....
in complex emergencies
In Complex Emergencies:

a similar requirement to:

  • developevidence based indicators…..
  • that characterize and define the public health consequences ofconflict……
  • on populationsaffected…..
  • and to ensure theeffectiveness and accountability of humanitarian response……..
measuring process in complex emergencies
Measuring process in complex emergencies:
  • Many layers of data (both quantitative and qualitative) building on one another…...
  • Constantly characterizing and clarifying what complex emergencies seem to represent……...
  • From this emerge dominate indicators (criteria) that both define and measure……...
evolution
Evolution…...
  • Hostile environment “dirtied” the data
  • Significant inconsistencies in data gathering and reporting; frequently self-serving *

* JAMA: 1994;272:371-376

evolution1
Evolution…...
  • Crude mortality rate (CMR) emerged as a unifying indicator
  • CMR , cause specific mortality rates, and nutritional indicators in under age 5 (U5MR) emerged to ‘characterize’ complex emergencies in developing countries
evolution2
Evolution…...
  • New and more sensitive indicators required in developed country emergencies (advanced weaponry, elderly, raped, mental health)*….and….
  • In each phase of a disaster…..prevention, preparedness, emergency response, recovery, rehabilitation, transition, sustainable development…..

Spiegel PB, Salama P: War & mortality in Kosovo, Lancet, 2000

evolution3
Evolution…...
  • Indicators used to drive delivery of aid led to decreases in mortality and morbidity
  • Led to numerous sources of indicators…NGOs, IOs, Donors, Military, etc…….
evolution4
Evolution…...
  • Attempts to collaborate to provide standards in water/sanitation, nutrition, food aid, shelter/site planning,health services….
  • And controversies in their implementation…..proved to be insensitive to the phases and politics of relief…...
future
Future......
  • By measuring complex emergencies we chose to intervene…bring order to chaos….reduce suffering….and become more effective and efficient….
  • Standards and professionalism of response to complex emergencies will continue to evolve……
future1
Future......

Research: Evidence based *

  • across all phases of disasters ……
  • direct and indirect, quantitative and qualitative, health and non-health, political , economic, social indicators
  • to ensure measurable outcomes, appropriate decision-making, leading to sustainable development………

* Spiegel P: PDM 2002;16 (4):281-285