(English captions by Trisha Paul, University of Michigan.)
In this session, we are going to look at complex emergencies, a major form of public health
disasters in the Eastern Africa region.
Let us start by looking at this scenario.
A certain district Y has been affected by a 10 year conflict in which over 200,000 people
have been internally displaced and they live in camps.
They cannot return to their homes for fear of the rebels.
The living conditions and health status of people in these camps is very poor.
This is an example of a complex emergency.
What then is a complex emergency?
A complex emergency is a deep social crisis in which large numbers of people die from
war, displacement and hunger owing to man made disasters.
This is a definition by Klugman.
It is also defined as a humanitarian crisis with a breakdown in authority due to internal
or external conflicts that requires international response. This definition is by the UN Office
for Coordination of Humanitarian Affairs, OCHA.
Characteristics of a complex emergency include violence and massive displacement of people and,
administrative, economic, and political collapse.
It is long lasting and widespread.
That means it affects a large number of people.
There is usually exploitation and worsening of existing differences in civil society like
economic differences, social differences, political differences, religious differences,
and others.
These often dispute over legitimacy of authority, usually between government and other formal
or informal groups like rebels, insurgents, etc.
Vulnerable population is at greatest risk.
Large scale humanitarian assistance is often needed.
There is usually hindrance of assistance by political or military forces, meaning that
some groups that have power may prevent others from receiving assistance.
Complex emergencies are usually political.
They often result in catastrophic public health problems.
Complex emergencies often include wars and civil strife, armed aggression, insurgency
and other actions resulting in displaced persons and refugees.
They usually have a political undertone.
Can you name some in your region?
Look at these pictures and try to understand some of the effects of complex emergencies.
Priority interventions in refugee or mass displacement of people situations.
There is need for Rapid Needs Assessment.
There is need to provide water and sanitation for affected people.
There is need to provide food and nutrition for affected people, need to provide shelter
and site planning, health care, control of communicable diseases, and coordination of
the humanitarian response.
What is important in Rapid Needs Assessment?
Health priorities are identified on the basis of rapid collection and analysis of data.
Information is collected on background of displacement, risk factors, resources required
etc.
It is important to use a guideline based on standards.
For instance, the SPHERE Standards.
Water and Sanitation.
Drinking water is top priority in complex emergencies.
Both quality and quantity are important.
During first days 20 litres of water per person per day should be the target.
Poor and inadequate water supply is associated with sanitation related diseases.
Sanitation.
In the first days of the displacement, emergency latrines for every 50-100 persons.
But these should be improved to 1 latrine for 20 persons, and ideally 1 latrine per
family when the situation improves, or the humanitarian situation
is addressed.
Food and Nutrition.
Population movement is both a cause and consequence of food shortage.
Malnutrition is an important contributory cause of death during complex emergencies.
Food distribution should be planned, effective and equitable
Shelter and site planning is an important aspect of complex emergencies, especially
when large numbers of people are displaced.
Shelter is important for protection, security and privacy.
It is recommended that each person has 3.5 square metres of available space for their personal use.
Appropriate shelter sites should be selected.
It should be in a secure location away from border, availability of land and access to
water, and the location should be socially and culturally agreeable to the affected persons.
Health care aims to reduce mortality in the emergency phase of displacement.
Curative, preventive and rehabilitative care is crucial.
Manuals and guidelines should be available for standardization of treatment.
A Tier system of health care, that is hospital, health centre and outreach services.
Determine human resource needs, recruit and train health workers and place them where
they are needed.
Control of communicable diseases is very important during complex emergencies.
Intervention strategies include attacking the sources of infection like curative care,
isolation of highly infectious patients.
Prevent transmission of illness through environment sanitation, personal hygiene, and health education.
Protect the susceptible patients like measles immunisation, chemoprophylaxis, and provision
of bed nets etc).
There is need for continuous surveillance to detect epidemics and to assess the effectiveness
of interventions.
Coordination is another vital part of management of complex emergencies.
The rationale is that there are usually many actors involved in the response.
The goal is to achieve the greatest impact through integration of activities, establish
clear leadership and co-ordination, ensure priorities are shared between the intervening
partners, rationalise services by establishing common standards, and ensure good communication
among stakeholders.