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Overview%20of%20Military%20Medical%20Humanitarian%20Emergencies

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Title: Overview%20of%20Military%20Medical%20Humanitarian%20Emergencies


1
Overview of Military Medical Humanitarian
Emergencies
2
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

3
Humanitarian Emergency
  • Acute situation affecting a large population
    where either the population or its government is
    incapable of providing its basic needs

4
Many Types of Disasters
Hurricanes Drought Volcano Tsunami Earthquake
Chernobyl Union Carbide Spill
War Embargo Genocide
5
Number of Humanitarian Disasters Worldwide 1985-95
6
Not All Refugees are the Same
IDP (Internally Displaced Person)
Refugee
  • Cross Political Boundaries
  • 15 million (1997)
  • Entitled to UN and intl rights
  • Stay within own country
  • 20 million (1997)
  • Harder to intervene, assist

7
Estimated Number of Displaced Persons Worldwide
1984 - 1997
ECOSOC, U.S. Mission to U.N.
8
Civilian Deaths in Complex Humanitarian Disasters
ECOSOC, UN 1996
9
How do you measure disaster severity?
10
Crude Mortality Rate (CMR)
  • the number of deaths per 10,000 people per day

11
CMRs of Recent Emergencies
Infect. Dis Clinics NA Jun 95
12
The Vulnerable Suffer the Most(Kurdish
Population, Northern Iraq 1991)
13
Other Vulnerable Populations
  • Unaccompanied Minors
  • Lactating Mothers
  • Pregnant Women
  • Woman Head-of-Households

14
Type of Emergency Dictates Response
15
Phases of Emergencies
30 - 60
60 -- ???
0 - 30
  • D --gt D30
  • Chaos
  • High CMR
  • Assessment
  • D30 --gt D60
  • Relief Tailored
  • CMR drops
  • Continuing Assessment
  • D60 onward
  • Move towards self-sufficiency
  • CMR and quality of life returns to baseline

16
The Players in Humanitarian Emergencies
NATO
World Food Program
World Health Org.
Host Government
UNHCR
Host Military
OFDA
NGOs
17
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

18
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

19
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

20
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
21
USAID
  • U.S. Aid for International Development
  • coordinates US govt programs for intl
    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

22
USAID contd
  • 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

23
Other Governmental Agencies
  • European Community
  • Humanitarian Organization (ECHO)
  • Overseas Development Agency (UK)
  • Canada International Developmental Agency (CIDA)
  • Japan International Cooperation Agency (JICA)

24
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

25
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

26
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

27
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

28
U.S. Military
  • Increasingly drawn into HA operations

29
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

30
Why the U.S. Military?
  • Transportation Possess array of assets to
    deliver anything, anywhere, anytime

31
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

32
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 ...

33
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
34
Root Causes of Mortality
  • Disruption of food sources
  • Disruption of Health Services
  • Loss of Shelter
  • Disrupted Sanitation
  • Loss of Income
  • Crowding
  • Lack of Water

35
Leading Causes of Death in Humanitarian Disasters
in the Developing World
  • Diarrhea / Dehydration
  • Measles
  • Malaria
  • Respiratory Infections
  • Malnutrition

36
Causes of Death, by Wad Kowli Camp, Sudan, 1985
Malaria
Resp. Infection
Measles
Diarrhea
MMWR 41RR-13
37
Causes of Death,by Malawi, 1990
Other
Malnutrition
Diarrhea
Resp. Infection
Measles
Malaria
MMWR 41RR-13
38
Causes of Death, by Lisungwe Camp, Malawi, 1990
Measles
Malaria
Diarrhea
Resp
Malnutrition
Other
MMWR 41RR-13
39
CMR by Malnutrition Prevalence
40
Ten Essential Emergency Relief Measures
  • 1
  • Rapid Assessment
  • of magnitude, environment, needs,
  • local response capacity
  • Assess the Standard of Care and stick to it!

41
2 Provide Shelter and Clothing exposure to
elements increases vulnerability as well as
caloric requirements
42
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
43
4 Sanitation and Clean Water minimum of 3-5 L
/ person / day ( 20 is comfortable)
44
5 Diarrhea Control Program personal hygiene,
improved sanitation, proper medical management
of dehydration
45
6 Prophylax Against Measles Vaccine to most
susceptible, quarantine, Vitamin A
supplementation
46
7 Primary Care Algorithms Based on prevalent
diseases, resources, and local standards of care
47
8 Disease Surveillance Necessary to monitor
interventions and re-align priorities
48
9 Organize Human Resources Most
under-recognized asset -- disaster victims
themselves
49
10 Coordinate Activities Establish liaison
with local government, local military, intl
groups, NGOs
50
Change your frame of reference. You are there to
provide the local standard of care, not the
American standard of care.
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