Overview of Military Medical Humanitarian Emergencies Learning Goals Know the terminology of HA ops Appreciate the variety of organizations involved in disaster relief & their specific.
Download ReportTranscript Overview of Military Medical Humanitarian Emergencies Learning Goals Know the terminology of HA ops Appreciate the variety of organizations involved in disaster relief & their specific.
Overview of Military Medical Humanitarian Emergencies Learning Goals Know the terminology of HA ops Appreciate the variety of organizations involved in disaster relief & their specific capabilities Know the health priorities in HA ops Acute situation affecting a large population where either the population or its government is incapable of providing its basic needs Many Types of Disasters Humanitarian Emergencies Man-Made Disasters Technological Chernobyl Union Carbide Spill Natural Disasters Civil / Economic War Embargo Genocide Hurricanes Drought Volcano Tsunami Earthquake Number of Humanitarian Disasters Worldwide 1985-95 60 50 40 30 20 10 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Manmade Natural Not All “Refugees” are the Same Refugee • Cross Political Boundaries • 15 million (1997) • Entitled to UN and int’l rights IDP (Internally Displaced Person) • Stay within own country • 20 million (1997) • Harder to intervene, assist Estimated Number of Displaced Persons Worldwide 1984 - 1997 30 25 20 15 10 5 0 '84 '85 '86 '87 '88 '89 '90 IDPs '91 '92 '93 '94 '95 '96 '97 Refugees ECOSOC, U.S. Mission to U.N. Civilian Deaths in Complex Humanitarian Disasters Country Sudan Ethiopia Rwanda Cambodia Somalia BosniaHerzegovina Deaths > 1 mill. 750k – 2 mill 500k – 1 mill > 1 mill 500 k 200 k Time Period 1983 – Pres 1984 – 1993 1994 – Pres 1975 – 1993 1988 – Pres 1992 - 1996 ECOSOC, UN 1996 How do you measure disaster severity? Crude Mortality Rate (CMR) the number of deaths per 10,000 people per day CMRs of Recent Emergencies Date Host Country Home Country Baseline CMR Crisis CMR Jul 90 Jun 91 Apr 91 Mar 92 Jun 94 Jul 94 Ethiopia Ethiopia Turkey Kenya Burundi Zaire Sudan Somalia Iraq Somalia Rwanda Rwanda 0.6 0.6 0.2 0.6 0.6 0.6 2.3 4.7 4.2 7.4 5.0 34.0 Infect. Dis Clinics NA Jun 95 The Vulnerable Suffer the Most (Kurdish Population, Northern Iraq 1991) 70 60 50 40 30 20 10 0 0-5 yrs 6 - 14 yrs 15 - 44 yrs 45 + yrs Other Vulnerable Populations Unaccompanied Minors Lactating Mothers Pregnant Women Woman Head-of-Households Type of Emergency Dictates Response Trauma Shelter Earthquake ++++ Flood +/- Civil Strife ++ Water - Food - Sanitation Medical - + ++++ ++++ +++ +++ +++ ++++ ++++ ++++ ++++ ++++ Phases of Emergencies 0 - 30 D --> D+30 – Chaos – High CMR – Assessment 30 - 60 D+30 --> D+60 – Relief Tailored – CMR drops – Continuing Assessment 60 -- ??? D+60 onward – Move towards selfsufficiency – CMR and quality of life returns to baseline The Players in Humanitarian Emergencies NATO World Food Program World Health Org. Host Government OFDA Host Military UNHCR NGOs NGOs Thousands out there Most are small with an even smaller focus – shoes for children, eyeglasses, irrigation training Most specialize in a type of emergency relief Compete for aid money from private and government donors – majority (~ $5 billion) from governments in 1995 International Committee of the Red Cross Unique among NGOs in that its mission is MANDATED by international law. – Geneva Convention 1949 & Protocols of 1977 Acts principally in civil disturbance and has RIGHT and DUTY to interfere in national and international conflicts Brokers relief assistance, assures legal protection for victims and POWs Has primary role in family reunification International Committee of the Red Cross Will go to maximal lengths to maintain NEUTRALITY – fully discloses activities to all parties in a conflict – Refuses participation in any activity that may be perceived as partial consequently, the ICRC is self-sustaining including airlift, logistics, and comm – Neutrality agreement refused in Iran-Iraq, Afghanistan; ignored in Chechnya NGOs Cooperative for American Relief Everywhere Logistics, Food Aid, Camp Management ($300 M) Doctors without Borders / MSF Medical Care ($ 150 M) Oxford Committee for Famine Relief Water and Sanitation ($ 200 M) Catholic Relief Food Distribution Save the Children Fund Food Aid and Development Irish Concern Supplemental Feeding USAID • U.S. Aid for International Development • coordinates US gov’t programs for int’l development and response to disasters • Disaster response is job of Office of Foreign Disaster Assistance (OFDA) • becomes involved when Asst Sec of State for that region declares a state of disaster USAID cont’d In disaster, deploys a DART (Disaster Assistance Response Team) composed of experts – they evaluate and prioritize overall relief needs – release pre-positioned disaster relief commodities stockpiled in disaster-prone regions (plastic sheeting, water containers, chain saw kits, body bags, hard hats, gloves, water purification supplies – review NGO / UN proposals and “award” funds for the hands-on work of relief Other Governmental Agencies European Community Humanitarian Organization (ECHO) Overseas Development Agency (UK) Canada International Developmental Agency (CIDA) Japan International Cooperation Agency (JICA) United Nations Limited ability to provide unless invited by a host government UN Chapter VII provides for forceful intervention only if “international security” is threatened UN Agencies • UN High Commissioner for Refugees •coordinates a material response •advocacy for displaced people rather than on camp management • World Food Program • coordinates delivery of food stuffs More UN Agencies UNICEF – a fund, not an agency – can provide assistance without permission of host government – focuses on social programs for kids, pregnant and lactating women •World Health Organization • Consultation and policy in preventive and curative health care Still More UN Agencies UN Development Program – coordinates pre-disaster UN programs Off. for Coord. of Humanitarian Affairs – Created 1992 to coordinate all UN agencies and liaison with NGOs, militaries U.S. Military Increasingly drawn into HA operations Why the U.S. Military? Speed: no other organization can mount as large a logistical operation as rapidly Security: arrives fully prepared to secure people and material Why the U.S. Military? Transportation: Possess array of assets to deliver anything, anywhere, anytime Why the U.S. Military? Logistics: Can maintain supply lines in austere environments Command and Control: well-defined structure Self-sufficiency Specialty Units: Engineers, Medical Drawbacks of U.S. Military Participation Medical Care: Oriented to combat casualty care, not civilian disaster victims Focus: Short term objective driven; not aimed at re-development Political Ramifications Expense ... Humanitarian Operations are Expensive Difficult to provide cost-effective assistance Somalia: $ 100 M per month Ethiopia: coalition airlift for famine of 1980s was cost-inefficient and provided no medium or long-term benefit (good publicity, though) Cost of 1 C-130 flight with 15 tons of grain = Cost of purchasing a 30 ton capacity grain truck and fueling it for 6 months Root Causes of Mortality Disruption of food sources Disruption of Health Services Loss of Shelter Disrupted Sanitation Loss of Income Crowding Lack of Water Leading Causes of Death in Humanitarian Disasters in the Developing World • • • • • Diarrhea / Dehydration Measles Malaria Respiratory Infections Malnutrition Causes of Death, by % Wad Kowli Camp, Sudan, 1985 Malaria Resp. Infection Measles Diarrhea MMWR 41:RR-13 Causes of Death,by % Malawi, 1990 Malnutrition Resp. Infection Malaria Malaria Other Diarrhea Measles MMWR 41:RR-13 Causes of Death, by % Lisungwe Camp, Malawi, 1990 Measles Diarrhea Malaria Resp Malnutrition Other MMWR 41:RR-13 CMR by Malnutrition Prevalence 16 14 12 10 8 6 4 2 0 <5 5-9.9 10-19.9 20-39.9 >40 Malnutrition Prevalence (%) malnutrition = < 80% Wt/Ht of WHO Reference Population Ten Essential Emergency Relief Measures #1 Rapid Assessment of magnitude, environment, needs, local response capacity Assess the “Standard of Care” and stick to it! #2 Provide Shelter and Clothing exposure to elements increases vulnerability as well as caloric requirements #3 Provide Adequate Food minimum of 2000 kcal / person / day equitable distribution system targeted feeding programs for the most vulnerable “Low-value” foods work best #4 Sanitation and Clean Water minimum of 3-5 L / person / day (~ 20 is comfortable) #5 Diarrhea Control Program personal hygiene, improved sanitation, proper medical management of dehydration #6 Prophylax Against Measles Vaccine to most susceptible, quarantine, Vitamin A supplementation #7 Primary Care Algorithms Based on prevalent diseases, resources, and local standards of care #8 Disease Surveillance Necessary to monitor interventions and re-align priorities #9 Organize Human Resources Most under-recognized asset -disaster victims themselves # 10 Coordinate Activities Establish liaison with local government, local military, int’l groups, NGOs Change your frame of reference. You are there to provide the local standard of care, not the “American” standard of care.