1. Health and Human Rights in Complex Humanitarian Emergencies Jennifer Leaning, M.D., S.M.H. FXB Center for Health and Human Rights Harvard University Brown University March 2, 2013

2. Outline Forced movement of people as common element in armed conflict and natural disaster International norms that apply to armed conflict and crisis-induced forced migration Major issues of health and human rights in complex emergencies Examples

3. Forced Migration in Conflict and Disaster Creates emergency needs –Water, shelter health,food, security Imposes new categories of vulnerability –Raises risk of gender-based violence Requires temporary settlement that may last for decades Inflicts loss of family and community, livelihoods, culture, history

4. Legal Rights and Norms in CHEs International human rights law –Rights to life, home, property, freedom of movement, dignity, protection against torture and assault International humanitarian law –Obligations to distinguish civilians from combatants and protect civilians from harm Sphere standards

5. CHEs: Armed Conflict Conflicts 1990-2010 –Number ranges from 18-33 per year –Majority in Africa and Asia –Majority last for many years –Number of internally displaced persons greater than number of refugees –Forced migration from war is now a prevalent feature –Characterized by massive violations of human rights and IHL Targets are civilians

6. Examples Wars –Yugoslavia 1992-95 –Darfur 2003 to present –Post conflict Afghanistan and Angola Disasters –Hurricane Katrina August 29, 2005

8. Number of Refugees vs. IDPs over Time

9. High Costs of Conflict: Civilian Victims of War 1946-today WWI WWII

10. War in Former Yugoslavia 1992-95 Estimates of 200,000 killed Hundreds of thousands displaced in campaigns of ethnic terror and ethnic cleansing Large camps of IDPs and self settled in towns Concentration camps Wide-scale rape Forced migration

11. War in Former Yugoslavia Hundreds of thousands displaced in campaigns of ethnic terror and ethnic cleansing Large camps of IDPs and self settled in towns UN required to participate in creating more homogenous populations in order to reduce killings and assault

12. Sarajevo 1992-96

13. Bosnia 1992 13

14. Bosnia 1993-94

16. War in Darfur 2003-present Demands for regional autonomy and voice Armed Darfuri militias attacked Sudanese outposts Aggressive state and militia-based reprisal Campaign of terror and destruction of villages and community Catapulted over 2.5 million into IDP status and 400,000 refugees in Chad

17. Darfur 2004

18. Darfur 2005

19. Darfur 2004

23. Darfur 2005

24. Post-Conflict Afghanistan 2002

27. Post-Conflict Angola 2007

31. Natural Disasters Weather instability, powerful hurricanes/cyclones, disruptions in monsoons and seasonal rains Coastal and riverine flooding Flood induced mountain collapse Sea level rise Water scarcity, drought, food insecurity, drought, famine

32. Natural Disasters Increased intensity and frequency of major water-related natural disasters Increasingly important factor in forced migration Probably mediated through population growth and settlement patterns as well as through secular environmental change and climate change

33. Number of Disasters over Time

34. Hurricane Katrina Major category 3 hit very close to New Orleans, LA August 29, 2005 City of 485,000 on US Gulf Coast with one road north for evacuation Disaster resulted in rapid forced migration within and then out of the city Underlying racial and socio-economic fissures As of 2010, only 345,000 have returned

35. Hurricane Katrina 8/26/05

36. Hurricane Katrina 8/28/05

37. Hurricane Katrina 8/29/05

38. Hurricane Katrina 8/30/05

39. Hurricane Katrina 8/30-31/05

40. Hurricane Katrina 8/31/05

41. Hurricane Katrina 8/31/05 - 9/1/05

42. Hurricane Katrina 9/1/05

43. Hurricane Katrina

44. Health and Human Rights in War and Disaster (CHEs) All follow discernible patterns of onset and escalation All precipitate forced migration All inflict suffering on individuals and civilian populations All impose loss of family and community, livelihoods, culture, history

45. Health and Human Rights in War and Disaster (CHEs) Dynamics differ greatly But all are very difficult to stop once begun All with significant health impacts All laced with significant human rights violations These impacts and violations are tightly linked Emphasis must be on early prevention and mitigation