Transcript UN Civil-Military Coordination and Health Cluster

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•PAN AMERICAN HEALTH
ORGANIZATION
•Pan American Sanitary Bureau, Regional
Office of the
•WORLD HEALTH
ORGANIZATION
United Nations:
Civil-Military Coordination
and the Cluster System
Dr. Ciro R. Ugarte
Pan American
Health
Organization
Emergency Preparedness and
Disaster Relief
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Outline:
• UN Humanitarian Civil-Military Coordination
• UN Cluster System.
• Challenges & opportunities of DOD /
International Organizations Coordination.
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Health
Organization
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UN Civil-Military Coordination
• The focal point for UN civil-military coordination
is the Civil-Military Coordination Section (CMCS)
of OCHA.
• CMCS often deploys a Coordination Officer to
support field-effective mechanisms.
• The most common interface mechanisms are:
– Civil-Military Operations Centre (CMOC)
– Civil-Military Cooperation House (CIMIC House)
– Humanitarian Operation Centre (HOC)
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UN Civil – Military Coordination
Humanitarian organizations and military forces have
different mandates
• Humanitarian organizations endeavour to provide
assistance to affected populations based on assessed
needs and on the humanitarian principles.
• Civil defense units are deployed in a humanitarian crisis
based on the agenda of their government.
• Militaries are deployed with a specific security and
political agenda or in support of a security and political
agenda.
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Range of civil-military relationship
PEACE
TIME
High opportunities of CM
cooperation / low risks for
humanitarians
of being
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into conflict dynamics
COMBAT
Low opportunities of CM
cooperation / high risks for
humanitarians of being
drawn into conflict dynamics
Principles on military-civilian relations
• Humanitarian criteria to use/accept military assets.
• Military assets unique and only as a last resort.
• A humanitarian operation retains its civilian nature.
• Follows principles of humanitarian assistance.
• Avoid direct delivery of humanitarian assistance.
• Retains its international and multilateral character.
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UN Civil-Military coordination
in the health sector
• The mission of the Global Health Cluster (GHC) is
to build consensus on humanitarian health
priorities and related best practices, and
strengthen system-wide capacities to ensure an
effective and predictable response.
• The GHC looks at how civil-military coordination
might affect humanitarian agencies’ ability to
access affected populations and provide health
assistance.
Global Health Cluster - Position Paper
Civil-military coordination during humanitarian health action
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Building a Stronger, More Predictable
Humanitarian Response System
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Changing Environment
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Proliferation of humanitarian
actors
Demands for more structured
international responses
Changing role of the UN (less
direct implementation, more
standard-setting and facilitation,
more capacity-building)
Competitive funding
environment
Increased public scrutiny of
humanitarian action
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Inter-Agency Standing Committee
Full Members and Standing Invitees
Full Members
Whose reform?
Inter-Agency Standing
Committee (IASC)
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Standing Invitees
Food and Agricultural
International Committee of the
Organisation (FAO)
Red Cross (ICRC)
Office for the Coordination of
International Council of Voluntary
Humanitarian Affairs (OCHA)
Agencies (ICVA)
United Nations Development
International Federation of Red
Programme (UNDP)
Cross and Red Crescent
Societies (IFRC)
United Nations Population Fund
(UNFPA)
American Council for Voluntary
International Action (InterAction)
United Nations High Comissioner
for Refugees (UNHCR)
International Organisation for
Migration (IOM)
Composed of NGO
consortia, Red Cross and
Red Crescent Movement,
IOM, World bank and UN
agencies
United Nations Children’s Fund
(UNICEF)
Office of the High Commissioner
for Human Rights (OHCHR)
World Food Programme (WFP)
Office of the Special
Representative of the Secretary
General on the Human Rights of
Internally Displaced Persons
World Health Organisation
(RSG on HR of IDPs)
(WHO)
Steering Committee for
Humanitarian Response (SCHR)
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World Bank (World Bank)
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FOUR PILLARS OF REFORM
CLUSTER APPROACH
Adequate capacity and
predictable leadership in all
sectors
HUMANITARIAN
FINANCING
Adequate, timely and
flexible financing
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HUMANITARIAN
COORDINATORS
Effective leadership and
coordination in humanitarian
emergencies
PARTNERSHIP
Strong partnerships
between UN and non-UN
actors
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Cluster mechanism
General Assembly Resolution 46/182 on
humanitarian assistance: IASC (Inter
Agency Standing Committee)
– Cluster lead agencies identified, PAHO/WHO
for health cluster,
– UNICEF for WASH cluster and nutrition
cluster
– WFP for food
– Others…
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Links with Government and national
authorities
“Each State has the responsibility first and
foremost to take care of the victims of natural
disasters and other emergencies occurring on its
territory. Hence, the affected State has the
primary role in the initiation, organization,
coordination, and implementation of humanitarian
assistance within its territory.”
UN General Assembly Resolution 46/182
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Health
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AIM
• High standards of predictability,
accountability and partnership in all sectors
or areas of activity
• More strategic responses
• Better prioritization of available resources
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United Nations Cluster Approach
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New global cluster leads
Technical areas
Nutrition
Water/Sanitation
Health
Emergency Shelter:
UNICEF
UNICEF
Conflict IDPs
Disasters
WHO
UNHCR
IFRC ‘Convenor’
Cross-cutting areas
Camp Coord/Mgmt:
Protection:
Conflict IDPs
Disasters
Conflict IDPs
Disasters & civilians
in conflict (non-IDPs)
Early Recovery
UNHCR
IOM
UNHCR
HCR/OHCHR/UNICEF
UNDP
Common service areas
Logistics
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WFP
OCHA/UNICEF/WFP
Responsibilities of
global cluster leads
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• Standard setting
- Standard setting and consolidation of
‘best practice’
• Building response capacity
- Training and system development at
local, regional and international levels
- Surge capacity and standby rosters
- Material stockpiles
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• Providing operational support
• Emergency preparedness
• Advocacy and resource mobilization
Designating sector/cluster
leads at the country level
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The UN consults the host government and
national/international humanitarian actors to
determine priority sectors.
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The UN ensures lead agencies are designated for all
the key sectors. Where possible, lead agencies at
the country level should mirror those at the global
level.
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Sector/cluster leads are the provider of last resort,
subject to access, security and funding.
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United Nations Cluster System
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Cluster Approach in Haiti:
Specific Challenges in Haiti:
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Too many people
Civil-military cooperation
Over coordination (10 meetings a day)
Weakness of national authorities
No legal or formal authority of the cluster
coordinator to triage….
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External actors in Haiti,
an unregulated industry
• Urban SAR teams: from 30 countries (1,800
rescuers)
• UN agencies
• Red Cross societies
• International NGOs
• Bilateral non state institutions (universities)
• Religious associations
• Ad-hoc initiatives
• Total of 43,000 Internationals
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Health Cluster in Haiti
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Coordination: the Health Cluster in
Haiti
• The Cluster began operating 3 days after the
earthquake and a full time HC Coordinator.
• By February 16, 390 agencies registered with the
HC.
• Sub-working :
– primary care,
– hospital care
– referral system
– medical supplies
– rehabilitation.
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Health Cluster in Haiti
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Hospitals
• Day 10: 8 foreign field
hospitals/40 health facilities
• Day 13: 12 foreign field
hospitals( 2 ships)/ 48 health
facilities
• Day 15: first military hospital
leaving, others schedule their
departure
• Day 21: two more hospital
ships arrived
• Day 24: 21 foreign field
hospitals/91 health facilities
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Russian Field Hospital
Land based Foreign Field Hospitals: 21
• MSF (Doctors without borders): 5 field
hospitals,
16 Operating theatres and 1,237 bed capacity, 800
internationals and over 3,000 nationals, 5,707
surgical interventions (first month 2,386; second
1,902 and third 1,419). No patients were rejected.
• Israel military Hospital: arrived on day 4
1,100 treated patients. 242 surgical procedures
under anesthesia were performed on 205 patients.
Patients with brain injuries; paraplegia, low Glasgow
coma score not accepted.
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Other disasters
• Bam: 11 FFH 550 beds /Ukrainian first
• Banda Aceh: 9 FFH /Singapore first/beds?
• Pakistan: 10 FFH/Turkish first/ 38 Cuban
FFH???
• Costs/bed/day: +/- 2,000 USD
• No FFH arrives early enough for trauma care
Source: Karolinska/Sweden PDM vol 23.no 2, 2008
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Challenges:
• Field hospitals concentrate on what they do best.
• Rapid turnover of patients to achieve efficient use
of theatres.
• No post op care. the least sophisticated facilities
were the most overworked.
• No referral system between facilities.
• No internationally accepted standards but
professional groups (military, Red Cross, MSF)
developed their own guidelines.
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The problems
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Unacceptable practices.
Questions about clinical competencies.
Accountability and coordination.
Complementarity of deployed medical teams
(trauma, plastic surgery, crush syndrome, post
op, rehab.)
• Better match btw supply and demand (time of
arrival).
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Opportunities: establishing an international
registry of FMT (Foreign Medical Teams)
• Faster deployment (if governments can rapidly
identify and approve FMT).
• Better complementarities.
• Reduction of duplications or overlap.
• Better transparency and coordination with
national authorities/cluster
• Donors encouraged to support a registered FMT.
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Thinking big…
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Other initiatives
• Registration: database of foreign medical
teams, no validation required.
• Certification: technical evaluation, implies
liability for the certifying agency (INSARAG
classification).
• Accreditation: formal compliance with
predetermined standards: is usually voluntary.
• Licensure: Government permission( UK, Spain).
• Emergency surgery coalition( ESC).
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The three wishes of the humanitarian organizations
“We know what to do”,
the military should provide:
– Security …
without inconvenience
– Transport …
at no cost
– Communications... without controls
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In normal times . . .
¡ I NEED A
DOCTOR !
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In disaster situations. . .
I NEED
ONE DOCTOR!
DISASTER
ZONE
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Lessons Learned from Tsunami
Recovery
Key Propositions for Building Back Better
Beneficiaries deserve the kind of agency
partnerships that move beyond rivalry and
unhealthy competition.
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A Report by the UN Secretary-General’s
Special Envoy for Tsunami Recovery,
William J. Clinton. December 2006
The real challenge: Coordination
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Hospitals INTERPOL
CDC Donor countries
USAID
CIDA DOD
HHS
Private health centers
MSF ECHO
OAS
CAPRADE
National Emergency Agency Universities
ACNUR SCR Ministry of health UK
France CARE
Japan
PAHO
WHO
MC
South Com
Netherlands FNUAP OXFAM
WFP
ICRC
Red
Cross
CEPREDENAC
UNDAC
ORAS CONHU
Local NGO
Health Canada PRESS
CARITAS
Church Security
UNICEF
IFRC
CDERA
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Lessson…learned?
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•PAN AMERICAN HEALTH
ORGANIZATION
•Pan American Sanitary Bureau, Regional
Office of the
•WORLD HEALTH
ORGANIZATION
United Nations:
Civil-Military Coordination
and the Cluster System
Dr. Ciro R. Ugarte
Pan American
Health
Organization
Emergency Preparedness and
Disaster Relief