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Disasters

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Title: Disasters


1
Disasters
  • Medical humanities II
  • 2014-2015
  • Prof. Marija Definis-Gojanovic, MD, Ph.D.

2
Definitions
  • Cuny (in Prehospital and Disaster Medicine)
    defined a disaster as a situation resulting
    from an environmental phenomenon or armed
    conflict that produced stress, personal injury,
    physical damage, and economic disruption of great
    magnitude.

3
  • Perez and Thompson in their series on Natural
    Disasters, define a disaster as the occurrence
    of widespread, severe damage, injury, or loss of
    life or property, with which the community cannot
    cope, and during which the affected society
    undergoes severe disruption.

4
  • Both of these definitions note that a disaster
    disrupts the society stricken by the event.
  • Cuny stresses that the event resulting in a
    disaster does not comprise the disaster it is
    what results from the event that comprise the
    disaster, not the precipitating event itself.
  • The occurrence of an event may produce a
    disaster.
  • A disaster happens when the damage rendered by an
    event becomes so great that the local mechanisms
    for response become overwhelmed and outside
    assistance is required to cope with the damage.

5
  • The definition of a disaster adopted by the World
    Health Organization and the United Nations as
    established by Gunn
  • the result of a vast ecological breakdown in the
    relationships between man and his environment, a
    serious and sudden (or slow, as in drought)
    disruption on such a scale that the stricken
    community needs extraordinary efforts to cope
    with it, often with outside help or international
    aid.
  • This definition also indicates that it is the
    damage that results from the impact on society
    that constitutes the disaster, not the event that
    is the disaster.

6
Medical Disaster/Health Disaster
  • The most common medical definition of a disaster
    is an event that results in casualties that
    overwhelm the healthcare system in which the
    event occurs.
  • A health disaster often is considered a medical
    disaster.
  • A health disaster encompasses impaired public
    health and medical care to individual victims.
  • A medical disaster relates to the healthcare or
    break in healthcare to individuals as a result of
    an event.

7
  • Broadened definition of a health disaster to
    include a precipitous or gradual decline in the
    overall health status of a community with which
    it is unable to cope adequately.
  • The use of this definition requires an assessment
    of the pre-disaster event health status of the
    affected community.
  • By definition, the disaster begins when it first
    is recognized as a disaster, and is overcome when
    the health status of the community is restored to
    its pre-event state.

8
Responses to disaster aim to
  • 1) Reverse adverse health effects caused by the
    event
  • 2) Modify the hazard responsible for the event
    (reducing the risk of the occurrence of another
    event)
  • 3) Decrease the vulnerability (increase the
    resiliency) of the society to future events and
  • 4) Improve disaster preparedness to respond to
    future events.

9
  • An event that results in a large number of
    casualties (mass casualties) may or may not
    constitute a disaster.
  • If local resources are unable to cope with the
    numbers and/or types of casualties and outside
    medical help is requested, then the event has
    created a disaster.

10
  • Examples of events that may generate mass
    casualties include transportation accidents,
    tornadoes, terrorist bombers, avalanches in
    inhabited areas, etc.
  • The impact of such events depends upon the
    ability of the affected society to cope with the
    circumstances whether the society remains intact
    and mechanisms can be developed within the
    infrastructure to cope with the circumstances.

11
  • Many consider events that produce multiple or
    mass casualties as a disaster, since the
    immediately available local resources transiently
    may be overwhelmed but if such events rapidly
    are brought under control, and the effects on the
    medical community are short- lived, without a
    need for outside assistance, there is no
    disaster.

12
HAZARD (H)
  • All disasters are related to a specific hazard or
    combinations of hazards whether of a natural
    phenomenon or a result of human actions.
  • A hazard is anything that may pose a danger
    thus, it is used in this discussion to mean a
    natural or manmade phenomenon or a mixture of
    both that has the potential to adversely affect
    human health, property, activity, and/or the
    environment.

13
RISK (R)
  • Risk is the objective (mathematical) or
    subjective (inductive) probability that something
    negative will happen.
  • For example, the probability of an earthquake
    occurring in the northern Europe is quite low
    compared to such a hazard be- coming realized in
    California or Turkey.
  • The probability of a cyclone becoming realized in
    India or Central America is huge compared to the
    probability that such an event will occur in
    Canada
  • Risk applies only to one specific hazard.

14
PREVENTION
  • To prevent means to keep the event from
    happening, and thus, prevention is the aggregate
    of approaches and measures taken to ensure that
    human actions or natural phenomena DO NOT cause
    or result in the occurrence of an event related
    to the identified or unidentified hazard.
  • It does NOT mean decreasing the amplitude,
    intensity, scale, and/or magnitude of the event.

15
MODIFICATION
  • Modification of the event does not mean that the
    event will not occur.
  • Modification can change either the nature of the
    hazard or the risk that the hazard will evolve
    into an event.
  • In terms of the hazard, it is the aggregate of
    all approaches and measures taken to modify the
    amplitude, intensity, magnitude, scale and/or the
    probability of the actuation of the event that
    would have occurred without human intervention.

16
  • Thus, through human activities, the resulting
    event either may be augmented (increased) or
    attenuated (decreased) both in magnitude and
    frequency.
  • Risk management involves human actions that are
    directed towards modification of the probability
    that an event will become realized.

17
EVENT
  • An event occurs when the hazard is realized or
    becomes manifest.
  • It means an occurrence that has the potential to
    negatively affect living beings and/or their
    environment.
  • Such occurrences have a characteristic type of
    onset, intensity, duration, scale, and magnitude.
  • Temporally, events may be sudden, gradual, slow,
    or delayed in onset

18
  • Sudden-onset events include those with onsets
    lasting seconds to hours (e.g. earthquakes,
    tsunamis, cyclones, fire, etc.)
  • Gradual-onset events have an onset over days to
    weeks (e.g. floods, climate changes, epidemics,
    armed conflict), and may or may not present with
    warning of several days to weeks.
  • Slow-onset events have a prolonged and gradual
    onset (famine, drought, epidemics, nuclear
    contamination, etc.).

19
  • Delayed onset events occur some time after the
    discovery of the likelihood that the hazard will
    become realized. Such events usually allow for
    warnings to the population that potentially will
    be impacted by the event (cyclones, tsunamis,
    burst of weakened dams, famine).

20
  • The duration of events may be brief, short,
    intermediate, or prolonged.
  • Events of brief duration last only seconds to
    minutes, and therefore, necessarily must
    correlate with a sudden mode of onset
    (earthquake, tsunamis, avalanches, landslides,
    volcanic eruption may go on to be prolonged,
    etc.).
  • Events of short duration continue in some form,
    for hours to days. Examples include tropical
    cyclones and floods.

21
  • Events of intermediate duration may include
    epidemics, toxic or nuclear contamination, fires,
    etc. Intermediate duration events last days to
    weeks.
  • Events that last for prolonged periods (months to
    years) include drought, famine, epidemics,
    complex emergencies, nuclear contamination, etc.

22
  • The scope of an event includes its
  • 1) amplitude
  • 2) intensity (amplitude / time interval)
  • 3) scale (intensity x area impacted) and
  • 4) magnitude (scale x total duration)

23
  • The amplitude is the degree of departure from the
    point of equilibrium (pre-event state). Examples
    of amplitude include a flood crest, storm surge,
    and wave height.
  • The intensity consists of the amplitudes
    integrated over a given period of time. Examples
    of intensity include the amount of rain falling
    in an hour and the quantity of ash falling in a
    specific location per hour.

24
  • The scale of an event is the intensity of the
    event in the geographical area involved. Examples
    include the incidence of a specific infectious
    disease in a country, the depth of rain that
    accumulated in a specific city in a given period
    of time, and the number of hectares under an
    accumulation of water due to flooding.
  • Magnitude is the total energy encompassed by the
    event, the combination of the integral of the
    amplitudes, the area involved (being studied),
    and total duration of the event. Examples include
    the kiloton explosive equivalent of a nuclear
    bomb explosion, and the total rainfall
    accumulated over an area during the entire course
    of a storm.

25
  • Events may be precipitating (primary) or
    secondary.
  • Precipitating events are those responsible for
    initiating the damage
  • Secondary events occur as a result of the impact
    of the precipitating event.
  • Human actions may result in an increase in the
    magnitude of the damage and/or may be the nidus
    for the development of secondary events.

26
IMPACT
  • Impact is defined as the actual process of
    contact between an event and a society or a
    societys immediate perimeter.
  • The impact refers to both positive and negative
    influences produced by the event on the
    environment.

27
MITIGATION
  • In this context - any process that is undertaken
    to reduce the immediate damage otherwise being
    caused by a destructive force on the society.

28
PREPAREDNESS
  • Preparedness is the aggregate of all measures and
    policies taken by humans before the event occurs
    that reduces the damage that otherwise would have
    been caused by the event.
  • Preparedness is comprised of the ability to
    mitigate the immediate result of the impact of an
    event and our ability to alleviate suffering and
    accelerate recovery.

29
  • Preparedness includes warning systems,
    evacuation, relocation of dwellings (e.g., for
    floods), stores of food, water, and medical
    supplies, temporary shelter, energy, response
    strategies, disaster drills and exercises, etc.
  • Contingency plans and responses are included in
    preparedness as used in this document and are
    part of overall disaster management.
  • Preparedness consists of actions taken before an
    event occurs.

30
DAMAGE
  • Damage is defined as harm or injury impairing the
    value or usefulness of something, or the health
    or normal function of persons.
  • Damage is the negative result of the impact of an
    event on the society and environment.
  • Damage may manifest in multiple ways and forms.
  • Events may produce damage that may or may not be
    of sufficient magnitude to result in a disaster.

31
  • It is the amount and characteristics of the
    damage that result from an event, tempered by the
    place of occurrence, society and culture, level
    of development, and degree of preparedness that
    determine whether an event results in a disaster.
  • Damage may involve humans, other creatures,
    and/or the environment.
  • The severity of the damage is a function of the
    magnitude of the event buffered by the resilience
    of the society and the environment impacted.

32
VULNERABILITY AND RESILIENCE
  • In this context, vulnerability means the
    susceptibility of the population and environment
    to the type (nature) of the event.
  • The resilience of the population/environment
    against the event is its pliability, flexibility,
    or elasticity to absorb the event.

33
RESILIENCE
  • Resilience has two components
  • 1) that provided by nature
  • 2) that provided through the actions of humans.
  • It is comprised of
  • the absorbing capacity
  • the buffering capacity
  • response to the event and recovery from the
    damage sustained.

34
DISASTER MANAGEMENT
  • Disaster Management is the aggregate of all
    measures taken to reduce the likelihood of damage
    that will occur related to a hazard(s), and to
    minimize the damage once an event is occurring or
    has occurred and to direct recovery from the
    damage.
  • The effectiveness of disaster management
    determines the final result of the impact of the
    event on the environment and society impacted.

35
DISASTER RESPONSE
  • Disaster Response is the aggregate of all
    measures taken to cope with the damage sustained.
  • The effectiveness of disaster response is part of
    disaster management that determines the final
    result of the impact of the event on the
    environment and society impacted.

36
RECOVERY
  • Recovery occurs when all of the damage from an
    event has been repaired or replaced
  • In the context of a disaster, recovery means
    bringing all of the societal components back to
    their pre-event status.
  • All of the responses (interventions) to the
    damage sustained must have goals that contribute
    to the recovery of the society affected.

37
  • Roles and duties of doctors during extraordinary
    circumstances
  • Local organizations must foster a spirit of
    collaboration in the response to a disaster.
  • It is also the responsibility of each agency
    involved in the emergency to recognize that the
    primary purpose of coordination is to achieve
    maximum impact with the given resources and to
    work with one another to reach this endpoint.

38
Consequences of disasters on health services
  • Disasters can cause serious damage to health
    facilities, water supplies and sewage systems.
    Structural damage to facilities poses a risk for
    both health care workers and patients.
  • Limited road access makes it at least difficult
    for disaster victims to reach health care
    centers.
  • Disrupted communication systems lead to a poor
    understanding of the various receiving
    facilities, military resources and relief
    organizations' actual capacity. Consequently, the
    already limited resources are not effectively
    utilized to meet the demands.

39
Consequences of disasters on health services
  • Increased demands for medical attention
  • Climatic exposure because of rain or cold weather
    puts a particular strain on the health system
  • Inadequacy of food and nutrition exposes the
    population to malnutrition, particularly in the
    vulnerable groups such as children and the
    elderly and
  • If there is a mass casualty incident, health
    systems can be quickly overwhelmed and left
    unable to cope with the excessive demands.

40
Consequences of disasters on health services
  • Population displacement
  • A mass exodus from the emergency site places
    additional stress and demands on the host
    country, its population, facilities and health
    services, particularly.
  • Depending on the size of the population
    migration, the host facilities may not be able to
    cope with the new burden, and
  • Mass migration can introduce new diseases into
    the host community.

41
Consequences of disasters on health services
  • Major outbreaks of communicable diseases
  • While natural disasters do not always lead to
    massive infectious disease outbreaks, they do
    increase the risk of disease transmission. The
    disruption of sanitation services and the failure
    to restore public health programmes combined with
    the population density and displacement, all
    culminate in an increased risk for disease
    outbreaks.
  • The incidence of endemic vector-borne diseases
    may increase due to poor sanitation and the
    disruption of vector control activities.

42
Role of emergency health services in disasters
  • To minimize mortality and morbidity, it is also
    necessary to organize the relief response
    according to three levels of preventive health
    measures
  • Primary prevention is the ultimate goal of
    preventive health care. It aims to prevent the
    transmission of disease to generally healthy
    populations.
  • Secondary prevention identifies and treats as
    early as possible diseased people to prevent the
    infection from progressing to a more serious
    complication or death.
  • Tertiary prevention reduces permanent damage from
    disease such as a patient being offered
    rehabilitative services to lower the effects of
    paralysis due to polio or land mine injuries.

43
The role of the military in disaster response
  • The militarys hierarchical command structure
    allows it to respond to disasters in a rapid and
    coordinated manner.
  • Military services generally have easy access to
    resources and are equipped to perform vital
    functions in disaster response such as resource
    distribution, security services, search and
    rescue, logistics assistance, transportation to
    otherwise unreachable communities and field
    hospital staffing and management.
  • If the political climate allows for
    collaboration, the host countrys ministry of
    health and the lead health agency should consider
    coordinating with the military in the response to
    a disaster as well as in the disaster
    preparedness plan.

44
Disaster preparedness
  • The health objectives of disaster preparedness
    are to
  • Prevent morbidity and mortality
  • Provide care for casualties
  • Manage adverse climatic and environmental
    conditions
  • Ensure restoration of normal health
  • Re-establish health services
  • Protect staff and
  • Protect public health and medical assets.

45
Policy development
  • National governments must designate a branch of
    the ministry or organization with the
    responsibility to develop, organize and manage an
    emergency preparedness programme for the country.
  • This group must work with central government,
    provincial and community organizations and NGOs .

46
Vulnerability assessment
  • Potential hazards for the community are
    identified and prioritized in a vulnerability
    assessment.
  • Once the vulnerabilities are identified, the
    assessment must also recommend how to address
    each of the vulnerabilities.

47
Disaster planning
  • A disasters outputs plan must provide
  • An understanding of organizational
    responsibilities in response and recovery
  • Stronger emergency management networks
  • Improve community awareness and participation
  • Effective response and recovery strategies and
  • A simple and flexible written plan.

48
Training and education
  • must provide the important skills and knowledge
    needed to show an effected community how it can
    participate in emergency management and also show
    it the appropriate and critical actions needed in
    an emergency.

49
Monitoring and evaluation
  • The objective is to measure how well the disaster
    preparedness programme has been developed and is
    being implemented.
  • International Federation of Red Cross and Red
    Crescent Societies - created preparedness and
    press the button response systems with
    equipment ready for immediate use.
  • Between disasters, the International Federation
    pays a lot of attention to training volunteers in
    the community.
  • During a disaster, the International Federation
    uses Regional Disaster Response Teams (RDRT) and
    Field Assessment and Coordination Teams (FACT).

50
Facility-based health carekey points
  • All services should function effectively and be
    well coordinated to achieve the following
  • Comprehensive carelooking for other conditions
    that a patient may not report such as depression
    with persistent headaches or abdominal pain
    (summarization)
  • Continuity of carefollowing up referrals,
    defaulters of TB treatment or immunization and
  • Integrated carelinking curative with preventive
    care at every opportunity such as combining child
    immunization with antenatal clinic days.

51
Mass Casualty Incident (MCI)
  • is any event where the needs of a large number of
    victims disrupt the normal capabilities of the
    local health service
  • Requires
  • the pre-establishment of basic guidelines and
    principles of an Incident Command System (ICS),
  • triage and
  • patient flows according to the hospitals plan

52
The incident command system
  • is composed of five major components
  • Incident command
  • Operations
  • Planning
  • Logistics and
  • Finance

53
Triage
  • In a disaster medical response, triage sorts and
    priorities victims for medical attention
    according to the degree of injury or illness and
    expectations for survival.
  • Triage reduces the burden on health facilities.
  • Triage categorization of patients is based on the
    following criteria
  • The nature and life-threatening urgency
  • The potential for survival

54
Triage classification system
  • Immediate medical care
  • Delayed care
  • Non-urgent or minor and
  • Dead or near dead.

55
Medical response
  • Fairness This value requires that health care
    resources be allocated fairly with a special
    concern that those most vulnerable are treated
    fairly.
  • Respect for Person This value states that each
    person is a unique individual and is to be valued
    despite gender, ethnicity, age, religion,
    social status, economic value or any other
    variable.
  • Solidarity Each person makes a commitment not
    only to family and loved ones but also to the
    community.
  • Limiting Harm Each physician and health care
    professional commits to do no harm.

56
Medical response
  • Procedural Values
  • Reasonableness treatment decisions are to be
    based on science, evidence, practice, experience
  • Transparency/Openness open to public discussion
    and scrutiny
  • Inclusiveness any decisions are to be made
    explicitly with the intent of including the views
    of health care workers and the public
  • Responsiveness mechanisms to address comments,
    recommendations, disputes and complaints
  • Responsibility health care workers and the
    public have an obligation to participate to the
    extent possible in discussions and to offer their
    opinions and recommendations

57
Medical profession and human rights
  • It is my aspiration that health will finally be
    seen not as a blessing to be wished for, but as a
    human right to be fought for.
  • United Nations Secretary General,
    Kofi Annan

58
What is the link between health and human rights?
  • There are complex linkages between health and
    human rights
  • - Violations or lack of attention to human rights
    can have serious health consequences
  • - Health policies and programmes can promote or
    violate human rights in the ways they are
    designed or implemented
  • - Vulnerability and the impact of ill health can
    be reduced by taking steps to respect, protect
    and fulfil human rights.

59
What is meant by the right to health?
  • The right to health does not mean the right to
    be healthy, nor does it mean that poor
    governments must put in place expensive health
    services for which they have no resources. But it
    does require governments and public authorities
    to put in place policies and action plans which
    will lead to available and accessible health care
    for all in the shortest possible time. To ensure
    that this happens is the challenge facing both
    the human rights community and public health
    professionals.
  • United
    Nations High Commissioner
    for Human Rights, Mary Robinson

60
The right to the highest attainable standard of
health
  • Opening text of the Constitution of WHO (1946)
  • The States Parties to this Constitution declare,
    in conformity with the Charter of the United
    Nations, that the following principles are basic
    to the happiness, harmonious relations and
    security of all peoples.

61
  • Criteria by which to evaluate the right to
    health
  • (a) Availability. Functioning public health and
    health-care have to be available in sufficient
    quantity.
  • (b) Accessibility. Health facilities, goods and
    services have to be accessible to everyone
    without discrimination. Accessibility has four
    overlapping dimensions
  • Non-discrimination Physical accessibility
  • Economic accessibility Information
    accessibility.
  • (c) Acceptability. All health facilities, goods
    and services must be respectful of medical ethics
    and culturally appropriate, sensitive to gender
    and life-cycle requirements, as well as designed
    to respect confidentiality and improve the health
    status of those concerned.
  • (d) Quality. Health facilities, goods and
    services must be scientifically and medically
    appropriate and of good quality.

62
What is meant by a rights-based approach to
health?
  • Justice as a right, not as charity
  • A rights-based approach to development describes
    situations not simply in terms of human needs, or
    of developmental requirements, but in terms of
    societys obligations to respond to the
    inalienable rights of individuals empowers
    people to demand justice as a right, not as
    charity and gives communities a moral basis from
    which to claim international assistance when
    needed.
  • Kofi Annan, UN Secretary-General

63
Rights-based approach to health?
  • Substantive elements to apply, within these
    processes, could be as follows
  • ?Safeguarding human dignity.
  • ?Paying attention to those population groups
    considered most vulnerable in society.
  • ?Ensuring health systems are made accessible to
    all, in law and in fact, without discrimination
    on any of the prohibited grounds.
  • ?Using a gender perspective, recognizing that
    both biological and socio-cultural factors play a
    significant role in influencing the health of men
    and women.
  • ?Ensuring equality and freedom from
    discrimination.
  • ?Disaggregating health data to detect underlying
    discrimination.
  • ?Ensuring free, meaningful and effective
    participation of beneficiaries of health
    development policies or programmes....

64
Rights-based approach to health?
  • .......
  • ?Articulating the concrete government obligations
    to respect, protect and fulfill human rights.
  • ?Identifying benchmarks and indicators to ensure
    monitoring of the progressive realization of
    rights in the field of health.
  • ?Increasing transparency in, and accountability
    for, health as a key consideration at all stages
    of programme development.
  • ?Incorporating safeguards to protect against
    majority threats upon minorities, migrants and
    other domestically unpopular groups in order to
    address power imbalances.
  • A key factor in determining if the necessary
    protections exist when rights are restricted is
    that each one of the five criteria of the
    Siracusa Principles must be met.

65
Possible ingredients in a rights-based approach
to health
Right to health Information Gender Human
dignity Transparency Siracusa principles
Benchmarks and indicators Accountability Safegu
ards Equality and freedom from
discrimination Disaggregation
Attention to vulnerable groups Participation Priv
acy Right to education Optimal balance between
public health goals and protection of human
rights Accessibility Concrete government
obligations Human rights expressly linked
66
Human Rights Medical Personnel
  • An inadequate level of health care can lead
    rapidly to
  • situations falling within the scope of the term
  • inhuman and degrading treatment
  • CPT 3rd General Report

67
Human rights and International Conventions
concerning medical personnel
  • The UN Universal Declaration of Human Rights
    clearly stipulates No one shall be subjected to
    torture or cruel, inhumane or degrading treatment
    or punishment.
  • The World Medical Association's (WMA)
    "Declaration of Tokyo" in 1975 states "The
    physician shall not countenance, condone or
    participate in the practice of torture or other
    cruel, inhuman or degrading procedures, whatever
    the offence of which the victim of such procedure
    is suspected, accused or guilty, and whatever the
    victim's belief or motives, and in all
    situations, including armed conflict and civil
    strife."

68
Human rights violations under military regime
  • An extreme case in recent history occurred in
    Nazi death camps
  • US soldiers in Vietnam
  • Since the September 11 attacks, terrorism has
    been linked inextricably to the public mind (in
    the west) to people from middle-eastern and
    Muslim backgrounds Abu Ghraib and
    Guantanamo
  • Military medical personnel are placed in a
    position of a "dual loyalty" conflict.

69
Dual Obligations
  • Primary duty to the patient and secondary duty to
    employer and/or society
  • Clinical independence is essential for both
    therapeutic care and forensic documentation
  • Complicity may result in criminal prosecution
  • Forensic clinicians have a duty to the court and
    must inform individuals of their role and any
    limits of confidentiality
  • Consensus in international ethical precepts that
    legal and other imperatives cannot oblige health
    professionals to act contrary to medical ethics

70
Human Rights and human experimentation
  • on 16 December 1966, the International Covenant
    on Civil and Political Rights was adopted by the
    United Nations General Assembly, which came into
    force ten years later, on 23 May 1976
  • Article 7 was influenced by the events that led
    to the Nuremberg Code, as well as by other
    inhuman practices during World War II. It lays
    down that
  • "no one shall be subjected without his free
    consent to medical or scientific experimentation.

71
Human Rights and human experimentation
  • Declaration on the Human Rights of Individuals
    who are not nationals of the country in which
    they live, proclaimed by the General Assembly on
    13 December 1985. Article 6 lays down that
  • "no alien shall be subjected without his or her
    free consent to medical or scientific
    experimentation"

72
Poverty
  • Poverty is general scarcity or dearth, or the
    state of one who lacks a certain amount of
    material possessions or money.
  • Absolute poverty or destitution refers to the
    deprivation of basic human needs, which commonly
    includes food, water, sanitation, clothing,
    shelter, healt care and education.
  • Relative poverty is defined contextually as
    economic inequality in the location or society in
    which people live.

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Poverty
  • The World Bank estimated 1.29 billion people were
    living in absolute poverty in 2008. Of these,
    about 400 million people in absolute poverty
    lived in India and 173 million people in China.
  • In terms of percentage of regional populations,
    sub-Saharan Africa at 47 had the highest
    incidence rate of absolute poverty in 2008.
    Between 1990 and 2010, about 663 million people
    moved above the absolute poverty level.
  • Still, extreme poverty is a global challenge it
    is observed in all parts of the world, including
    developed economies. UNICEF estimates half the
    worlds children (or 1.1 billion) live in poverty.

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Human migration
  • is the movement by people from one place to
    another with the intention of settling
    temporarily or permanently in the new location.
    The movement is typically over long distances and
    from one country to another, but internal
    migrations is also possible.
  • Migration has continued under the form of both
    voluntary migration within one's region, country,
    or beyond and involuntary migrations (which
    includes the slave trade, trafficking in human
    beings and ethnic cleansing).

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Human migration
  • The World Bank Migration and Remittances Factbook
    of 2011 lists the following estimates for the
    year 2010 Total number of immigrants 215.8
    million or 3.2 of world population. Often, a
    distinction is made between voluntary and
    involuntary migration, or between refugeesfleeing
    political conflict or natural disaster vs.
    economic or labour migration, but these
    distinctions are difficult to make and partially
    subjective, as the various motivators for
    migration are often correlated. The World Bank
    report estimates that as of 2010, 16.3 million or
    7.6 of migrants qualified as refugees.

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Human trafficking
  • is the trade in humans, most commonly for the
    purpose of sexual slavery, forced labor or
    commercial sexual exploitation for the trafficker
    or others or for the extraction of organs or
    tissues, including surrogacy and ova removal or
    for providing a spouse in the context of force
    marriage.
  • Human trafficking can occur within a country or
    trans-nationally.

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Human trafficking
  • Human trafficking is a crime against the person
    because of the violation of the victim's rights
    of movement through coercion and because of their
    commercial exploitation. Human trafficking is the
    trade in people, and does not necessarily involve
    the movement of the person from one place to
    another.
  • Human trafficking represents an estimated 31.6
    billion of international trade per annum in 2010.
    Human trafficking is thought to be one of the
    fastest-growing activities of trans-national
    criminal organizations.

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Human trafficking
  • Human trafficking is condemned as a violation of
    human rights by international conventions. In
    addition, human trafficking is subject to a
    directive in the European Union.
  • Slave trade and human trafficking are forbidden
    by the Protocol to Prevent, Suppress and Punish
    Trafficking in Persons, especially Women and
    Children (also referred to as the Trafficking
    Protocol) was adopted by the United Nations and
    came into force in 2003.
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