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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
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
a 10 year conflict in which over 200,000 people

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have been internally displaced and they live
in camps.

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

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The living conditions and health status of
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
in which large numbers of people die from

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war, displacement and hunger owing to man
made disasters.

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This is a definition by Klugman.

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

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

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for Coordination of Humanitarian Affairs,
OCHA.

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Characteristics of a complex emergency include
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
of existing differences in civil society like

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economic differences, social differences,
political differences, religious differences,

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and others.

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

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or informal groups like rebels, insurgents,
etc.

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Vulnerable population is at greatest risk.

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Large scale humanitarian assistance is often
needed.

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

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

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Complex emergencies are usually political.

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They often result in catastrophic public health
problems.

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

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and other actions resulting in displaced persons
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
some of the effects of complex emergencies.

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Priority interventions in refugee or mass
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
for affected people.

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

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and site planning, health care, control of
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
of rapid collection and analysis of data.

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

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etc.

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It is important to use a guideline based on
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
emergencies.

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Both quality and quantity are important.

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

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

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Sanitation.

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

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

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family when the situation improves,
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
of food shortage.

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

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Food distribution should be planned, effective
and equitable

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Shelter and site planning is an important
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
and privacy.

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It is recommended that each person has 3.5 square
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
border, availability of land and access to

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

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

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Curative, preventive and rehabilitative care
is crucial.

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Manuals and guidelines should be available
for standardization of treatment.

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

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Determine human resource needs, recruit and
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
during complex emergencies.

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Intervention strategies include attacking
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 
sanitation, personal hygiene, and health education.

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Protect the susceptible patients like measles
immunisation, chemoprophylaxis, and provision

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of bed nets etc).

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There is need for continuous surveillance
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
of complex emergencies.

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

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

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

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

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among stakeholders.