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2 Health

3 Each person to Think of one Major Effect of Emergencies on health Time to Think- 60 seconds Time for reply-10 seconds

4 Morbidity Mortality

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 Measles -Specially Children  Diarrhoeal Diseases  Acute Respiratory Infections  Malaria ( where prevalent)  Malnutrition 6 UNHCRUNHCR

 Correlation between malnutrition and disease/death especially amongst children is well established.  (TB, Meningitis, Sexually transmitted diseases, hepatitis, typhoid, typhus are also observed amongst refugees but the overall burden of these diseases are relatively small.) 7

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9 Endemic Epidemic Pandemic What do they mean???

9/13/ Terminologies: Reference to a disease that appears regularly in a given area or population Endemic Significant increase in cases of a disease compared to baseline. Epidemic Epidemic that crosses continents. Pandemic

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 The rate of death in the entire population of both sexes and all age. CMR can be expressed with different standard population denomination and for different time period however the most commonly used during emergencies is daily mortality rate per 10,000 population. Also called CMR for short. 13 Page 260 and 301 of Sphere Handbook

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 As a thumb rule when for adults the CMR is 1.  For Under 5 years, if it reaches as per Sphere-When the CMR becomes double of baseline data. (Guidance note 3, Page 260) as per Sphere-When the CMR becomes double of baseline data. (Guidance note 3, Page 260)

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17RegionCMR CMR emergency Threshold U5 CMR U5CMR emergency threshold Sub-Saharan Africa South Asia East Asia & Pacific UNICEF-2001 Page 261

 there were 2 deaths in a refugee camp of 5,000 people in one day, what is the CMR and would this be defined as an emergency?  There are 20 ‘under 5’ deaths in a refugee camp with ‘ Under 5’ population of 10,000 in one month. What is the CMR? Is this an emergency situation?  There are 39 deaths in a month in a refugee camp of the population of 26,000, What is the CMR?Is this an emergency? 18

 Q1-4, Emergency  Q2-2/3, not yet  Q3-0.5, not yet 19

Total death during10,000 the time period CMR= X Total populationTime period in number of days 20 (Page 301 of Sphere Handbook)

Location and Year CMR Somalia (Baidoa), /10,000/day 17/10,000/day Goma, Zaire(DRC), 1994 > 30/10,000/day > 30/10,000/day Southern Sudan, 1998 > 20/10,000/day > 20/10,000/day Kosovo, 1999 < 1/10,000/day < 1/10,000/day Ethiopia, /10,000/day 3-4/10,000/day 21 Source: Table compiled by CDC

22 Age and Disease Issues-Let’s see an example

23 Drought in Ethiopia

24 Age Distribution for Mortality, Gode District, Ethiopia, December July 2000 Age Source: P. Salama, CDC.

25 Causes of Death in Children <5 Years, Gode District, Ethiopia, December 1999 – July 2000 Causes Source: P.Salama CDC

26 Mortality Trends, Gode District, Ethiopia, December July 2000 Source: P. Salama CDC

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 Introduction 252  1.Health Systems and Infrastructure258  2.Control of Communicable Diseases 273  3.Control of Non-Communicable Disease285 29

 Form 3 groups-health people redistribute  Read the three major parts of Health chapter: 1. Health system and infrastructure 2. Control of Communicable diseases 3. Control of Non Communicable diseases  Present summary of Important/key standards(not all) indicators with guidance notes. DO NOT read from the book. Add your suggestions/recommendations /experience 30 Minutes for reading & preparation 5 Minutes per group for presentation 30

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32 Health Assessment Do you know what to do? Do you know your Handbook? Compare with standards Yes No Study

a. At your table b. Design a quick Health assessment TOR for an emergency in your area c. You can only ask a maximum of 6 questions d. Time 5 Minutes 33

 Demographic Profile-total and under 5  Base line health and disease epidemiology.  Existing health coverage & infrastructure  Mortality and Morbidity Rates  Available Resources  Gaps and needs 34

At the heart of any health related strategy in emergencies is the fact that the emphasis is on PREVENTIVE rather than CURATIVE action alone. 35

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37 Logistics Water & sanitation Nutrition Health Epidemiology Food Shelter People from the affected community

9/13/ Conclusions Understand before doing Control problems of disease and its spread (usually caused by failures in other sectors) Provide adequate health care for men, Women, and children Do this in a way that helps build health service capacity in the community

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40 Thank you