WEBVTT 00:00:00.000 --> 00:00:04.000 (English captions by Trisha Paul, University of Michigan.) 00:00:05.000 --> 00:00:11.000 In this session, we are going to look at complex emergencies, a major form of public health 00:00:11.000 --> 00:00:15.000 disasters in the Eastern Africa region. 00:00:21.000 --> 00:00:25.000 Let us start by looking at this scenario. 00:00:25.000 --> 00:00:34.000 A certain district Y has been affected by a 10 year conflict in which over 200,000 people 00:00:34.000 --> 00:00:38.000 have been internally displaced and they live in camps. 00:00:38.000 --> 00:00:42.000 They cannot return to their homes for fear of the rebels. 00:00:42.000 --> 00:00:47.000 The living conditions and health status of people in these camps is very poor. 00:00:47.000 --> 00:00:52.000 This is an example of a complex emergency. 00:00:52.000 --> 00:00:56.000 What then is a complex emergency? 00:00:56.000 --> 00:01:05.000 A complex emergency is a deep social crisis in which large numbers of people die from 00:01:05.000 --> 00:01:11.000 war, displacement and hunger owing to man made disasters. 00:01:11.000 --> 00:01:15.000 This is a definition by Klugman. 00:01:15.000 --> 00:01:23.000 It is also defined as a humanitarian crisis with a breakdown in authority due to internal 00:01:23.000 --> 00:01:30.000 or external conflicts that requires international response. This definition is by the UN Office 00:01:30.000 --> 00:01:39.000 for Coordination of Humanitarian Affairs, OCHA. 00:01:39.000 --> 00:01:46.000 Characteristics of a complex emergency include violence and massive displacement of people and, 00:01:46.000 --> 00:01:50.000 administrative, economic, and political collapse. 00:01:50.000 --> 00:01:55.000 It is long lasting and widespread. 00:01:55.000 --> 00:01:57.000 That means it affects a large number of people. 00:01:57.000 --> 00:02:07.000 There is usually exploitation and worsening of existing differences in civil society like 00:02:07.000 --> 00:02:14.000 economic differences, social differences, political differences, religious differences, 00:02:14.000 --> 00:02:18.000 and others. 00:02:18.000 --> 00:02:27.000 These often dispute over legitimacy of authority, usually between government and other formal 00:02:27.000 --> 00:02:33.000 or informal groups like rebels, insurgents, etc. 00:02:33.000 --> 00:02:38.000 Vulnerable population is at greatest risk. 00:02:38.000 --> 00:02:41.000 Large scale humanitarian assistance is often needed. 00:02:41.000 --> 00:02:49.000 There is usually hindrance of assistance by political or military forces, meaning that 00:02:49.000 --> 00:02:56.000 some groups that have power may prevent others from receiving assistance. 00:02:56.000 --> 00:03:00.000 Complex emergencies are usually political. 00:03:00.000 --> 00:03:10.000 They often result in catastrophic public health problems. 00:03:10.000 --> 00:03:18.000 Complex emergencies often include wars and civil strife, armed aggression, insurgency 00:03:18.000 --> 00:03:23.000 and other actions resulting in displaced persons and refugees. 00:03:23.000 --> 00:03:26.000 They usually have a political undertone. 00:03:26.000 --> 00:03:32.000 Can you name some in your region? 00:03:32.000 --> 00:03:42.000 Look at these pictures and try to understand some of the effects of complex emergencies. 00:03:42.000 --> 00:03:49.000 Priority interventions in refugee or mass displacement of people situations. 00:03:49.000 --> 00:03:51.000 There is need for Rapid Needs Assessment. 00:03:51.000 --> 00:03:56.000 There is need to provide water and sanitation for affected people. 00:03:56.000 --> 00:04:02.000 There is need to provide food and nutrition for affected people, need to provide shelter 00:04:02.000 --> 00:04:09.000 and site planning, health care, control of communicable diseases, and coordination of 00:04:09.000 --> 00:04:16.000 the humanitarian response. 00:04:16.000 --> 00:04:20.000 What is important in Rapid Needs Assessment? 00:04:20.000 --> 00:04:27.000 Health priorities are identified on the basis of rapid collection and analysis of data. 00:04:27.000 --> 00:04:34.000 Information is collected on background of displacement, risk factors, resources required 00:04:34.000 --> 00:04:36.000 etc. 00:04:36.000 --> 00:04:40.000 It is important to use a guideline based on standards. 00:04:40.000 --> 00:04:47.000 For instance, the SPHERE Standards. 00:04:47.000 --> 00:04:50.000 Water and Sanitation. 00:04:50.000 --> 00:04:55.000 Drinking water is top priority in complex emergencies. 00:04:55.000 --> 00:04:59.000 Both quality and quantity are important. 00:04:59.000 --> 00:05:07.000 During first days 20 litres of water per person per day should be the target. 00:05:07.000 --> 00:05:19.000 Poor and inadequate water supply is associated with sanitation related diseases. 00:05:19.000 --> 00:05:22.000 Sanitation. 00:05:22.000 --> 00:05:30.000 In the first days of the displacement, emergency latrines for every 50-100 persons. 00:05:30.000 --> 00:05:37.000 But these should be improved to 1 latrine for 20 persons, and ideally 1 latrine per 00:05:37.000 --> 00:05:47.000 family when the situation improves, or the humanitarian situation 00:05:47.000 --> 00:05:50.000 is addressed. 00:05:50.000 --> 00:05:53.000 Food and Nutrition. 00:05:53.000 --> 00:06:02.000 Population movement is both a cause and consequence of food shortage. 00:06:02.000 --> 00:06:08.000 Malnutrition is an important contributory cause of death during complex emergencies. 00:06:08.000 --> 00:06:17.000 Food distribution should be planned, effective and equitable 00:06:17.000 --> 00:06:22.000 Shelter and site planning is an important aspect of complex emergencies, especially 00:06:22.000 --> 00:06:26.000 when large numbers of people are displaced. 00:06:26.000 --> 00:06:33.000 Shelter is important for protection, security and privacy. 00:06:33.000 --> 00:06:43.000 It is recommended that each person has 3.5 square metres of available space for their personal use. 00:06:43.000 --> 00:06:46.000 Appropriate shelter sites should be selected. 00:06:46.000 --> 00:06:53.000 It should be in a secure location away from border, availability of land and access to 00:06:53.000 --> 00:07:02.000 water, and the location should be socially and culturally agreeable to the affected persons. 00:07:02.000 --> 00:07:09.000 Health care aims to reduce mortality in the emergency phase of displacement. 00:07:09.000 --> 00:07:14.000 Curative, preventive and rehabilitative care is crucial. 00:07:14.000 --> 00:07:19.000 Manuals and guidelines should be available for standardization of treatment. 00:07:19.000 --> 00:07:28.000 A Tier system of health care, that is hospital, health centre and outreach services. 00:07:28.000 --> 00:07:35.000 Determine human resource needs, recruit and train health workers and place them where 00:07:35.000 --> 00:07:41.000 they are needed. 00:07:41.000 --> 00:07:47.000 Control of communicable diseases is very important during complex emergencies. 00:07:47.000 --> 00:07:53.000 Intervention strategies include attacking the sources of infection like curative care, 00:07:53.000 --> 00:07:58.000 isolation of highly infectious patients. 00:07:58.000 --> 00:08:07.000 Prevent transmission of illness through environment sanitation, personal hygiene, and health education. 00:08:07.000 --> 00:08:16.000 Protect the susceptible patients like measles immunisation, chemoprophylaxis, and provision 00:08:16.000 --> 00:08:19.000 of bed nets etc). 00:08:19.000 --> 00:08:26.000 There is need for continuous surveillance to detect epidemics and to assess the effectiveness 00:08:26.000 --> 00:08:31.000 of interventions. 00:08:31.000 --> 00:08:37.000 Coordination is another vital part of management of complex emergencies. 00:08:37.000 --> 00:08:42.000 The rationale is that there are usually many actors involved in the response. 00:08:42.000 --> 00:08:49.000 The goal is to achieve the greatest impact through integration of activities, establish 00:08:49.000 --> 00:08:55.000 clear leadership and co-ordination, ensure priorities are shared between the intervening 00:08:55.000 --> 00:09:02.000 partners, rationalise services by establishing common standards, and ensure good communication 00:09:02.000 --> 00:09:06.000 among stakeholders.