priorities for displaced populations: getting it right in ......aphi : control of communicable...
TRANSCRIPT
Priorities for Displaced Populations:
Getting it right in the field
Dr Aroop Mozumder CBFRCGP FFPH MSc DTM&H DAvMed DMCC
Research Fellow Harris Manchester CollegeUniversity of Oxford
Dean Past President Faculty of Conflict & Catastrophe Medicine
Society of Apothecaries
Lecture Outline How to assess need in major displaced population crisis
UNHCR Emergency Priorities and related indicators
11 Humanitarian Priorities for intervention (MSF 2012)
Formerly MSF Top 10 priorities 1996
Urban and rural displaced populations in crisis
Marginalised groups in disasters
Coordination at field level
International guidelines –best practice
Epidemiology of Natural Disasters
Types of disaster Earthquake
Tsunami
Landslides
Floods
Volcanic eruptions
Cyclone/hurricane/typhoons
Drought
Underlying conflict
Famine
Population displacement
Epidemiology of Natural Disasters
Studied 20 years ago J Seaman SCF, Prof A
Redmond more recently
Potential
mortality
Deaths
exceed
injuries
Injuries exceed deaths
High >100k Tsunami
Flash
floods
Earthquake
Less high
>thousands
Floods Cyclone/
Typhoon/
Hurricane
Aim
SPHERE Project 1998 (2004,2014,2018)
“ Meeting essential human needs and restoring life with dignity are core principles that should inform all humanitarian action. Through the Humanitarian Charter and Minimum Standards in Disaster Response, defined levels of service in water supply, sanitation, nutrition, food aid, shelter, site planning and health care are linked explicitly to fundamental human rights and humanitarian principles”
SPHERE 2018
This edition of The Sphere Handbook is the result of the
most diverse and far-reaching consultation process in
the history of Sphere. Nearly 4,500 online comments
were received from 190 organisations, and more than
1,400 people participated in 60 in-person events hosted
by partners in 40 countries. Sphere gratefully
acknowledges the scale and breadth of the
contributions made, including from national, local and
international NGOs, national authorities and ministries,
Red Cross and Red Crescent societies, universities, UN
organisations and individual practitioners.
MSF 2012 11 Humanitarian Priorities for
Refugee Camps
Video tutorials
Health Priorities during Humanitarian Emergencies
Organisation of Medical Care
Initial Health status assessment
Each of Top Ten priorities
UNHCR Emergency Handbook
Emergency Protection Priorities to UNHCR Standards
Apply standard indicators, adapt to context
Collect and analyse data on health problems and risks,
aim to minimise morbidity and mortality
Prioritise and implement appropriate, feasible and
effective health services
Security & Protection
Basic Needs and services
Education
MSF: Refugee Health, An Approach to Emergency Situations
Zwi and Macrae: War and Hunger
UNHCR; Handbook for Emergencies
3rd Ed Conflict & Catastrophe Medicine
Disasters Journal; ODI
APHI : Control of Communicable Diseases in Man
JDP 3-52 Humanitarian and Disaster Relief Ops
SPHERE project 4th Edition 2018
Manson’s Tropical diseases
Priorities in Refugee Health Care
Initial Assessment
Measles Immunisation in Malnourished population
Water and Sanitation
Food and Nutrition
Shelter and Site Planning
Health Care in Initial Emergency Phase
Priorities in Refugee Health Care
Communicable Disease Control
Public Health Surveillance
Human Resources and Training
Coordination
Security Provision
Healthcare Priorities in Refugee Settings
Initial Assessment
Geographical impact of disaster
Demographics- age/sex breakdown
Average family size
Female heads of households/pregnant
Communicable disease types and incidence
Injuries and deaths- CMR : deaths/10k/d
Under 5 MR
Nutritional status of population
Healthcare Priorities in Refugee Settings Initial Assessment
Environmental conditions : wat/san, shelter, disease vectors etc
food availability and distribution
Status and quality of local health infrastructure
Transport/logs and communications infrastructure
levels of external assistance
Social political structure and potential problems
Insecurity and violence
Special groups at risk eg orphans
TIMELY REPORTING!
Healthcare Priorities in Refugee Settings
Measles vaccination and Vitamin A programme
6 mths-12 years ,take epidemiological advice
<20% mort in nutritionally at risk, exponential spread
mass campaign priority in first week target 100%
not to be delayed until other vaccines are available
cold chain considerations
field definition:
generalised erythematous rash lasting 3d
temperature over 38C
one of : cough, red eyes, nasal discharge
Healthcare Priorities in Refugee Settings
Water and sanitation
20 l per person per day
Water quality -tube wells/bowsers
Water provisioning points per unit of population (250)
latrines per unit of population
hand washing facilities
family water storage
solid waste disposal
drainage of waste water
Hygiene promotion- involve refugee community
Vector Control
Priorities in Refugee Settings
Shelter and site planning
UNHCR standards for tent size, density, distance apart
Quality of tents/shelters protection against elements
Initial Health Care
Health screening facility for newcomers
Primary care facility
Involve EH staff
Cooperation with specialist NGOs
Simple diagnostic and treatment protocols
Healthcare Priorities in Refugee Settings
Nutrition - involve specialist NGOs
Assessment of nutritional status
MUAC
Wt for Ht estimation
Marasmus/ Kwashiorkor
Dry ration provision
Support to families-self cooking incl utensils
Wet ration provision
Cooked food
Supplementary feeding programmes- below 85 %wt/ht
Therapeutic feeding programmes - below 75 %wt/ht
Severe malnutrition- below 75%
wt/ht
Intensive 24-hour care unit
Rehydrate
Oral fluids
Routine care of infections and intestinal parasites
Systematic measles and Vitamin A
3 hourly high energy milk therapy
Continue breast-feeding
Avoid Iron supplements
Second phase – more solids, local foods, fewer feeds, higher calories, eg “Plumpy Nut”
Healthcare Priorities in Refugee Settings
Appropriate levels of Health Care
Family level
Community level incl CHW and home visitors : 1 per 500
Primary Care OP- dispensary, health posts : 1 per 5000
Central Health Facility with doctor : 1 per 30-50,000 but may require
more in acute early phase
Referral Hospital
Use of primary care and EH more urgent than hospital care
Healthcare Priorities in Refugee Settings
Communicable Disease Control
Diarrhoeal disease- ORT networks and awareness
Dysentery/Cholera (water supply)
ARI
Malaria
Field definitions, treatment protocols
Locally endemic diseases
meningococcal meningitis
typhoid
typhus and relapsing fever (louse borne)
hepatitis A
Healthcare Priorities in Refugee Settings CD monitoring
field surveillance case reports, reporting chain
CD investigation
internationally accepted control and reporting
case reports investigated by qualified staff
CD outbreak control measures
attacking source eg cholera
protect susceptible groups eg meningitis
interrupt transmission eg handwashing facilities
Healthcare Priorities in Refugee Settings Human Resources and Training
interpreters
local health workers, eg birth attendants
training of local HW and cooperation of community elders
liaise with experienced NGOs
Coordination of Effort
attend meetings with NGOs, UNHCR, elders etc
encourage coordination- NGOs not always good at it!
Be mindful of own limited resources
Security provision
Urban displaced persons
Hostile environment
Less order
No UNHCR activity
More hidden morbidity
Less control : Watsan, shelter
IDPs my have to come to health facility
Health facility may be targeted
Food distribution/health facility works
The Code of Conduct: Principles of Conduct for the International
Red Cross and Red Crescent Movement and NGOs in Disaster
Response Programmes
The Code of Conduct: 10 Core Principles
1. The humanitarian imperative comes first.
2. Aid is given regardless of the race, creed or nationality of the recipients
and without adverse distinction of any kind. Aid priorities are calculated on
the basis of need alone.
3. Aid will not be used to further a particular political or religious
standpoint.
4. We shall endeavour not to act as instruments of government foreign
policy.
5. We shall respect culture and custom.
The Code of Conduct: Principles of Conduct for the International
Red Cross and Red Crescent Movement and NGOs in Disaster
Response Programmes
6. We shall attempt to build disaster response on local capacities.
7. Ways shall be found to involve programme beneficiaries in the
management of relief aid.
8. Relief aid must strive to reduce future vulnerabilities to disaster as well
as meeting basic needs.
9. We hold ourselves accountable to both those we seek to assist and those
from whom we accept resources.
10. In our information, publicity and advertising activities, we shall recognise
disaster victims as dignified human beings, not hopeless objects.
Issues to consider
Think outside “healthcare”
Carry out an effective needs assessment
Think of top ten priorities initially, can be modified
Think how to support coordination for best outcomes
Think of your organisation’s limitations
Consider features of a post emergency (and post conflict) society and health system
Consider the complexity of numerous actors
Remember the core post-emergency health interventions
Questions?
