Download presentation
Presentation is loading. Please wait.
1
In Complex Emergencies
Public Health & HUMAN SECURITY In Complex Emergencies Pierre Perrin MD, MPH IMSP Fac. Medecine University Geneva
2
Public Health The aim of public health is to improve health and the quality of life of the entire population through the rational organisations of health services. Most disasters have a tremendous impact on health and public health is a key component in the response.
3
Overview Part I: Health emergencies and public health
Part II: Public Health and Human Security Part III: Public health and « Political Affairs »
4
Part I: Health Emergencies and Public Health
(Classical role of public health)
5
Health Emergencies & Public Health
Population Public Health Event Systems Population Health Emergencies = Health Systems
6
Mortality rate in camps: Darfur
Crude mortality rates, expressed as deaths per 10 000 per day, were : 3.2 (95% confidence interval [CI], ) in Kass, 2.0 (95% CI, ) in Kalma, 2.3 (95% CI, ) in Muhajiria. Under 5-year mortality rates were: 5.9 (95% CI, ) in Kass, 3.5 (95% CI, ) in Kalma, 1.0 (95% CI, ) in Muhajiria. Mortality and Malnutrition Among Populations Living in South Darfur, Sudan Results of 3 Surveys, September 2004 Francesco Grandesso, MSc; Frances Sanderson, MD, PhD; Jenneke Kruijt, MPH; Ton Koene, MSc; Vincent Brown, MD, MPH JAMA. 2005;293:
7
Distribution of reported cause of death by age group, in a sample of IDPs, Kalma Camp, South Darfur, Sudan, 15 June – 15 August 2004 Reported causes of death 0 to 4 years 5 to 14 years 15 to 49 years 50+ years All ages Fever 17% 0% 25% 20% Respiratory disease 29% Diarrhoea 52% 57% 30% 42% Injury or Violence 63% 10% Other 12% 14% 13% Retrospective Mortality Survey Among the Internally Displaced Population – Greater darfur, Sudan, August WHO, 15 September 2004 Note: The total number of deaths in the table is 77 instead of 80 because cause of death was not recorded for three deaths Retrospective Mortality Survey, Darfur Sudan, August 2004
8
The health response in Darfur Psycho –Social Support
Food Security Water & Environment Health Promotion and Prevention Medical Care Psycho –Social Support
9
Kashmir: Relief operation for the wounded Triage - Stabilisation
First aid Triage - Stabilisation Evacuation Surgical care Rehabilitation
10
Kashmir: Relief Operation for the Population
Food Security Water & Environment Health Promotion and Prevention Medical Care
11
Relief Operations: A Public Health Framework
Food Security Water & Environment Health Promotion and Prevention Medical Care Psycho –Social Support Availability of food resources Water Health Promotion Outpatient Care Social welfare Accessibilité aux ressources alimentaires Habitat Shelter Hygien CD Prevention Hospital Care Mental Health
12
Health Emergency Interventions
PHC & HEI Strategy Health Emergency Interventions Strategy Primary Health Care Population Potable water Nutrition food resources Mother and Child Care Immunization (EPI) Prevention of comunicable diseases Hygiene Promotion Treatment of common diseases Essential drugs Reproductive health Mental health …… Community participation Cost !!! Immediat efficacy Approproiate Technology
13
Part II: Public Health and Human Security
(An wider role of public health)
14
Health & Access to health care
To deal with the immediat causes which prevent affected people to have access to health services Willingness to limit/stop access to health services Insecurity in accessing health services Food & Nutrition Water & Shelter Health Services
15
Public Health & Access to Health Services
By quantifying the impact on health of the lack of access to health services, including food and water, Public Health may play an important role to regain access to those services. For instance, negotiating for a cease-fire to carry on mass immunization campaingns.
16
Health & Human Rights Prohibiting, limiting access to health services is in itself a violation of the rights of people In armed conflicts violations of human rights may well extend to violations of the integrity of people
17
Individual & Community Integrity
Torture Disappearances Integrity . Individual - Physical - Psychological . Community - Family - Cultural - Etnic Sexual violences Forced displacements Splitting families Ethnic cleansing …..
18
Health & Human Security
Forced displacements Ethnic cleansing Torture Disappearance Extra judicial killing ….. Limiting access to health services Prohibiting access to health services Insecurity in accessing health services …. Integrity Food & Nutrition Water & Shelter Health Services
19
Public Health Global Approach
Integrity Food & Nutrition Public Health Global Approach Water & Shelter Health Services
20
Congo - MSF Sexual abuses
Basankusu: Impact of violence on population from 1998 to 2001 Type of violence (n=771) Nb. % C.I. Theft 596 77.3% 65.8 – 88.8 Destruction Houses/field 362 47.0% 33.0 – 60.9 Physical assault 160 20.8% 10.2 – 31.3 Imprisonment 85 11.0% 5.7 – 16.4 Torture 118 15.3% 8.5 – 22.1 Sexual abuses 103 13.4% 5.8 – 20.9 Mines 3 0.4% 0 – 0-8 Bullet wounds 41 5.3% 0.4 – 10.2 Knife/machete wounds 34 4.4% 0.2 – 8.6 Forced recruitment 82 10.6% 2.1 – 19.2 Sexual abuses Note pour le planning Of the 912 households questionned, 771, or 84.9% stated that at least one member had experienced violence from 1998 to 2001 Source: MSF, Access to health and violence in Congo (RDC) – Results of five epidemiological sureys – Dec 2001
21
A Framework for Complex Emergencies
Integrity Food & Nutrition Health Services Water & Shelter Providing health services Providing water Psychosocial support Immunization Providing food support Providing economic support Providing shelter Dissemination IHL Dealing with sexual violences Monitoring HR Preventing HR violations Assessing conduct of hostilities Humanitarian Diplomacy Promoting HR Law Note pour le planning
22
Health Professional & the management of the « Political Affairs »
Note pour le planning
23
The Framework of Complex Emergencies
Political Field The Framework of Complex Emergencies Humanitarian Field Note pour le planning PPR
24
Crisis Management and Health Interventions
Preventive diplomacy Coercitive diplomaty Demobilization of soldiers Peacekeeping operations Embargo on weapons Economic embargo Peace enforcement with military means Organization and monitoring of elections Conduct of hostilities Democratization Conflict resolution Organizing the Police Affected Population Crisis Armed Conflict Transition Note pour le planning
25
Study in DRC Study in Iraq
Note pour le planning
26
Health Zones reporting violence 3.0 (2.6 – 3.4) 6.4 (5.7 – 7.2)
Mortality in the Democratic Republic of Congo: a nationwide survey The lancet Vol 367 January 7, 2006 CMR Under 5 Mortality rate Health Zones reporting violence 3.0 (2.6 – 3.4) 6.4 (5.7 – 7.2) Health zones not reporting violence 1.7 (1.5 – 1.9) 3.1 (2.7 – 3.5) Note pour le planning Mortality rates expressed as deaths per 1000 per month (95% CI) Comparison of east health zones with and without violence
27
Example of statistical analysis
Mortality in the Democratic Republic of Congo: a nationwide survey The lancet Vol 367 January 7, 2006 Example of statistical analysis "A Poisson regression analysis of all eastern health zones suggested that the CMR would be 1.7 peer 1000 population per month (95% CI 1.6 – 1.9) in the absence of all violence" Note pour le planning
28
Mortality in the Democratic Republic of Congo: a nationwide survey
Stating the Issue "These findings show that the DRC remains in the grip of a major humanitarian crisis that continues to be most severe in the eastern provinces." Mortality in the Democratic Republic of Congo: a nationwide survey The lancet Vol 367 January 7, 2006
29
Mortality in the Democratic Republic of Congo: a nationwide survey
Stating the Cause "the reductions in crude mortality are closely associated with reductions in violence and by, extension, improvements in security" Mortality in the Democratic Republic of Congo: a nationwide survey The lancet Vol 367 January 7, 2006
30
Mortality in the Democratic Republic of Congo: a nationwide survey
Giving proposals "…another key finding of the survey was that most deaths were due to preventable causes such as malnutrition and infectious diseases….Moreover young children are disproportionately affected by theses illnesses. Improving food security and increasing access to to essential health services, such as immunisations, clean water, insecticide-treated bednets and case management of common diseases, have the potential to contribute greatly to reductions in excess mortality." Mortality in the Democratic Republic of Congo: a nationwide survey The lancet Vol 367 January 7, 2006
31
Mortality in the Democratic Republic of Congo: a nationwide survey
Giving proposals "more robust peacekeeping force than the current MONUC contingent of 16,700 is urgently needed to effectively address the security concernss and associated humanitarian needs in DRC" Mortality in the Democratic Republic of Congo: a nationwide survey The lancet Vol 367 January 7, 2006
32
Mortality Study in Iraq The lancet Published on line October 11, 2006
Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey The lancet Published on line October 11, 2006
33
Mortality Study in Iraq The lancet Published on line October 11, 2006
« We estimate that as of July 2006, there have been ( ) excess Iraqi deaths as a consequence of the war, which corresponds to 2.5% of the populaiton of the study area. Of post-invasion death, ( ) were due to violence, the most common cause being gunfire » Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey The lancet Published on line October 11, 2006
34
Mortality Study in Iraq The lancet Published on line October 11, 2006
Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey The lancet Published on line October 11, 2006
35
Mortality Study in Iraq The lancet Published on line October 11, 2006
Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey The lancet Published on line October 11, 2006
36
Mortality Study in Iraq The lancet Published on line October 11, 2006
Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey The lancet Published on line October 11, 2006
37
Mortality Study in Iraq The lancet Published on line October 11, 2006
Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey The lancet Published on line October 11, 2006
38
Mortality Study in Iraq: Response from the Political Actors
39
Mortality Study in Iraq: Response from the Political Actors
40
Human Security of Affected Population
Preventive diplomacy Coercitive diplomaty Demobilization of soldiers Peacekeeping operations Embargo on weapons Economic embargo Peace enforcement with military means Organization and monitoring of elections Conduct of hostilities Democratization Conflict resolution Organizing the Police Human Security of Affected Population Providing health services Providing water Psychosocial support Immunization Providing food support Providing economic support Providing shelter Dissemination IHL Dealing with sexual violences Monitoring HR Preventing HR violations Assessing conduct of hostilities Humanitarian Diplomacy Promoting HR Law Note pour le planning
41
Armed Conflicts Political Humanitarian Maintain Protect Human Security
Belligerants States UN General Assembly UN Security Council PK Forces, NATO Private companies USAID ECHO Medias Human rights organisations National Societies of RC/RC UNHCR UNICEF WHO NGOs ICRC Coercitive diplomaty Conduct of Hostilities Organizing the Police Peacekeeping operations Human Right Promotion Embargo on weapons Maintain Protect Human Security Democratization Economic embargo Conflict Prevention Peace enforcement with military means Organization and monitoring of elections Preventive diplomacy Conflict resolution Education Assessing violations of IHL Early Warning Providing health services Adapting National Law Supporting social services Note pour le planning Dissemination IHL Providing economic support Looking for the missing Tracing family members Protection of the POW Demobilization of soldiers Humanitarian Diplomacy Advocacy
42
Normative Framework: Values, Law, Principles, Policies, Guidelines
Armed forces / groups UN: Security Council PK forces, NATO States Belligerants ………. Preventive diplomacy Coercitive diplomaty Demobilization of soldiers Peacekeeping operations Embargo on weapons Economic embargo Peace enforcement with military means Organization and monitoring of elections Conduct of hostilities Democratization Conflict resolution Organizing the Police Human Security of Affected Population Providing health services ICRC National RC/RC societies IOM UNHCR NGOs WHO ……… Dissemination IHL Dealing with sexual violences Monitoring HR Preventing HR violations Assessing conduct of hostilities Humanitarian Diplomacy Providing food support Providing economic support Note pour le planning Providing shelter Providing water Immunization Promoting HR Law Psychosocial support Time frame: Stability Crisis Armed Conflict Transition Stability
43
Playing with the Framework
Impact sur les besoins, WW, accès à la nourriture……priorités différentes dans l'expression des besoins securité avant santé ou vice versa ?
44
The example of AP Landmines
Note pour le planning PPR plapretoria
45
Normative Framework: Values, Law, Principles, Policies, Guidelines
Belligerants Armed forces / groups UN: Security Council Use of antipersonel landmines PK forces Human Security of Affected Population States ………. NGOs WHO National RC/RC societies Providing health services IOM Note pour le planning UNHCR ICRC ………
46
Prohibition of Antipersonal landmines
Public Health and Law Prohibition of Antipersonal landmines Political step The treaty of Ottawa Lessons HEALTH LAW Legal Step: CCW 80 Institutional step Epidemiological step Note pour le planning Use of Antipersonal landmines Surgical step
47
The example of Economic Embargo
Note pour le planning PPR plapretoria
48
Normative Framework: Values, Law, Principles, Policies, Guidelines
Belligerants Political management of the crisis Political Dilemma Armed forces / groups UN: Security Council Economic embargo Peace enforcement with military means PK forces Human Security of Affected Population States ………. NGOs ICRC National RC/RC societies IOM Note pour le planning UNICEF WHO ……… PPR
49
Normative Framework: Values, Law, Principles, Policies, Guidelines
Belligerants Political management of the crisis Armed forces / groups UN: Security Council Economic embargo PK forces Human Security of Affected Population States ………. Humanitarian consequences of economic embargo NGOs Monitoring the impact of economic embargo ICRC Providing health services National RC/RC societies Providing economic support IOM Note pour le planning UNICEF WHO ……… PPR
50
Normative Framework: Values, Law, Principles, Policies, Guidelines
Armed forces / groups UN: Security Council PK forces, NATO States Belligerants ………. Preventive diplomacy Coercitive diplomaty Demobilization of soldiers Peacekeeping operations Embargo on weapons Economic embargo Peace enforcement with military means Organization and monitoring of elections Conduct of hostilities Democratization Conflict resolution Organizing the Police Sexual Violences Providing health services ICRC National RC/RC societies IOM UNHCR NGOs WHO ……… Dissemination IHL Dealing with sexual violences Monitoring HR Preventing HR violations Assessing conduct of hostilities Humanitarian Diplomacy Providing food support Providing economic support Note pour le planning Providing shelter Providing water Immunization Promoting HR Law Psychosocial support
51
Health Management of Sexual Violences
Infections Pregnancy Sexual Violences Health Consequences Injuries Health Management Psychological Impact Social Impact
52
Epidemiological Management of Sexual Violences
Health Consequences Epidemiological approach As part of health responsibilities, look for: Descriptive: Time, Place, Persons Protection Analytic: Circumstances, Environment Prevention
53
Legal Management of Sexual Violences
Legal approach Justice Health Informations Epi. Informations Sexual Violences Health Consequences Epidemiological approach Protection Prevention
54
Public Health at three levels
Legal approach Justice Health Informations Epi. Informations Sexual Violences Infections Health Consequences Pregnancy Health Management Psychological Impact Social Impact Injuries Epidemiological approach Descriptive: Time, Place, Persons Prevention Protection Analytic: Circumstances, Environment
55
Normative Framework: Values, Law, Principles, Policies, Guidelines
Armed forces / groups UN: Security Council PK forces, NATO States Belligerants ………. Preventive diplomacy Coercitive diplomaty Demobilization of soldiers Peacekeeping operations Embargo on weapons Economic embargo Peace enforcement with military means Organization and monitoring of elections Conduct of hostilities Democratization Conflict resolution Organizing the Police Forced Displacements Providing health services ICRC National RC/RC societies IOM UNHCR NGOs WHO ……… Dissemination IHL Dealing with sexual violences Monitoring HR Preventing HR violations Assessing conduct of hostilities Humanitarian Diplomacy Providing food support Providing economic support Note pour le planning Providing shelter Providing water Immunization Promoting HR Law Psychosocial support
56
Forced displacements: a root cause of insecurity
57
Normative Framework: Values, Law, Principles, Policies, Guidelines
Armed forces / groups UN: Security Council PK forces, NATO States Belligerants ………. Preventive diplomacy Coercitive diplomaty Demobilization of soldiers Peacekeeping operations Embargo on weapons Economic embargo Peace enforcement with military means Organization and monitoring of elections Conduct of hostilities Democratization Conflict resolution Organizing the Police Forced Displacements Providing health services NGOs Dissemination IHL Dealing with sexual violences Monitoring HR Preventing HR violations Assessing conduct of hostilities Humanitarian Diplomacy Providing food support ICRC Providing economic support National RC/RC societies Providing shelter IOM Note pour le planning Providing water UNHCR WHO Immunization ……… Promoting HR Law Psychosocial support Helping stakeholders to define their activities and their relationship with other stakeholders
58
Summary From health to HR issues Mutidisciplinary approach
Linkage between activities Interaction between stakeholders Note pour le planning PPR
Similar presentations
