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(English captions by Trisha Paul, University of Michigan.)

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In this session, we are going to look at complex[br]emergencies, a major form of public health

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disasters in the Eastern Africa region.

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Let us start by looking at this scenario.

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A certain district Y has been affected by[br]a 10 year conflict in which over 200,000 people

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have been internally displaced and they live[br]in camps.

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They cannot return to their homes for fear[br]of the rebels.

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The living conditions and health status of[br]people in these camps is very poor.

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This is an example of a complex emergency.

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What then is a complex emergency?

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A complex emergency is a deep social crisis[br]in which large numbers of people die from

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war, displacement and hunger owing to man[br]made disasters.

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This is a definition by Klugman.

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It is also defined as a humanitarian crisis[br]with a breakdown in authority due to internal

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or external conflicts that requires international[br]response. This definition is by the UN Office

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for Coordination of Humanitarian Affairs,[br]OCHA.

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Characteristics of a complex emergency include[br]violence and massive displacement of people and,

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administrative, economic, and political collapse.

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It is long lasting and widespread.

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That means it affects a large number of people.

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There is usually exploitation and worsening[br]of existing differences in civil society like

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economic differences, social differences,[br]political differences, religious differences,

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and others.

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These often dispute over legitimacy of authority,[br]usually between government and other formal

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or informal groups like rebels, insurgents,[br]etc.

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Vulnerable population is at greatest risk.

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Large scale humanitarian assistance is often[br]needed.

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There is usually hindrance of assistance by[br]political or military forces, meaning that

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some groups that have power may prevent others[br]from receiving assistance.

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Complex emergencies are usually political.

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They often result in catastrophic public health[br]problems.

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Complex emergencies often include wars and[br]civil strife, armed aggression, insurgency

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and other actions resulting in displaced persons[br]and refugees.

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They usually have a political undertone.

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Can you name some in your region?

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Look at these pictures and try to understand[br]some of the effects of complex emergencies.

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Priority interventions in refugee or mass[br]displacement of people situations.

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There is need for Rapid Needs Assessment.

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There is need to provide water and sanitation[br]for affected people.

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There is need to provide food and nutrition[br]for affected people, need to provide shelter

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and site planning, health care, control of[br]communicable diseases, and coordination of

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the humanitarian response.

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What is important in Rapid Needs Assessment?

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Health priorities are identified on the basis[br]of rapid collection and analysis of data.

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Information is collected on background of[br]displacement, risk factors, resources required

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etc.

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It is important to use a guideline based on[br]standards.

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For instance, the SPHERE Standards.

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Water and Sanitation.

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Drinking water is top priority in complex[br]emergencies.

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Both quality and quantity are important.

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During first days 20 litres of water [br]per person per day should be the target.

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Poor and inadequate water supply is associated [br]with sanitation related diseases.

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Sanitation.

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In the first days of the displacement, emergency[br]latrines for every 50-100 persons.

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But these should be improved to 1 latrine[br]for 20 persons, and ideally 1 latrine per

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family when the situation improves,[br]or the humanitarian situation

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is addressed.

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Food and Nutrition.

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Population movement is both a cause and consequence[br]of food shortage.

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Malnutrition is an important contributory[br]cause of death during complex emergencies.

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Food distribution should be planned, effective[br]and equitable

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Shelter and site planning is an important[br]aspect of complex emergencies, especially

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when large numbers of people are displaced.

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Shelter is important for protection, security[br]and privacy.

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It is recommended that each person has 3.5 square[br]metres of available space for their personal use.

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Appropriate shelter sites should be selected.

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It should be in a secure location away from[br]border, availability of land and access to

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water, and the location should be socially[br]and culturally agreeable to the affected persons.

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Health care aims to reduce mortality[br]in the emergency phase of displacement.

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Curative, preventive and rehabilitative care[br]is crucial.

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Manuals and guidelines should be available[br]for standardization of treatment.

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A Tier system of health care, that is hospital,[br]health centre and outreach services.

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Determine human resource needs, recruit and[br]train health workers and place them where

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they are needed.

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Control of communicable diseases is very important[br]during complex emergencies.

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Intervention strategies include attacking[br]the sources of infection like curative care,

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isolation of highly infectious patients.

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Prevent transmission of illness through environment [br]sanitation, personal hygiene, and health education.

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Protect the susceptible patients like measles[br]immunisation, chemoprophylaxis, and provision

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of bed nets etc).

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There is need for continuous surveillance[br]to detect epidemics and to assess the effectiveness

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of interventions.

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Coordination is another vital part of management[br]of complex emergencies.

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The rationale is that there are usually many[br]actors involved in the response.

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The goal is to achieve the greatest impact[br]through integration of activities, establish

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clear leadership and co-ordination, ensure[br]priorities are shared between the intervening

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partners, rationalise services by establishing[br]common standards, and ensure good communication

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among stakeholders.