1. Natural Disaster and Complex Humanitarian Emergencies
Chapter 15: Natural Disaster and Complex Humanitarian Emergencies
Chapter 15

2. Lead to increased death, illness, and disability.
The Importance of Natural Disasters and Complex Emergencies to Global Health
Lead to increased death, illness, and disability.
Large economic impacts.
Measures taken to reduce costs of disaster and conflict would be most effective if those involved worked together on the most important priorities.
VIDEO: The worst natural disasters (3:59)
Complex Humanitarian Emergencies and natural disasters have a significant impact on global health as it can lead to increased death, illness and disability. The economic cost is also likely to be very large. Measures taken to reduce costs of disaster and conflict would be most effective if those involved worked together on the most important priorities.

3. Sandy victims critical to storm relief (2:48)
Key Terms
Disaster - Any occurrence that causes damage, ecological destruction, loss of human lives, or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from out the affected community area.
Natural and man-made
Rapid- and slow-onset
Video:
Sandy victims critical to storm relief (2:48)
Let us look at disaster and complex emergency terms in more details.
A Disaster could be natural or could be man-made. It also could be rapid onset such as an earthquake, or slow onset like a famine. Examples of natural disasters are earthquakes, hurricanes or flood. Man-made disasters include chemical spills, as it happened in the town of Bhopal, India or radiation or industrial accidents.
Flood in Nigeria 2012

4. Key Terms
Complex emergency - Complex, multi-party, intra-state conflict resulting in a humanitarian disaster which might constitute multi-dimensional risks or threats to regional and international security. Frequently within such conflicts, state institutions collapse, law and order break down, and banditry and chaos prevail, and portions of the civilian population migrate.
Complex emergencies are the ones that causes multi-dimensional risks or international threat. Frequently within such conflicts, state institutions collapse, law and order break down, and banditry and chaos prevail, and portions of the civilian population migrate.

5. One of the example for natural disaster in Japan
One of the example for natural disaster in Japan. Japan faced most devastating tsunami in decades following an earthquake.
Tohoku earthquake
Japan suffered its most devastating tsunami in decades following an earthquake in Tohoku in March 2011

6. Key Terms https://www.youtube.com/watch?v=d6Wdqnv5bgE
Refugee – A person who is outside his or her country of nationality or habitual residence; has a well-founded fear of persecution because of his or her race, religion, nationality, membership in a particular social group or political opinion; and is unable or unwilling to avail him- or herself of the protection of that country, or return there for fear of persecution
Refugees are accorded certain rights by international law
Video: Rohingya boat people stuck in limbo (2:55)
Complex emergencies create refugees. Under international law a refugee is a person who is outside his or her country of nationality or habitual residence; has a well-founded fear of persecution because of his or her race, religion, nationality, membership in a particular social group or political opinion; and is unable or unwilling to avail him- or herself of the protection of that country, or return there for fear of persecution.
The Video: In Thailand, dozens of people from the ethnic Rohingya group who fled Myanmar remain in limbo in a Bangkok detention centre a year after they were brought ashore on the Thai coast. Unwanted in their homeland and are given no rights, they now fear they will languish indefinitely in Thai jails. 

7. Key Terms
Internationally displaced people - People who are forced to flee or migrate and leave their homes during a disaster or complex humanitarian emergency but stay in the country in which they were living.
Legal status is not as well-defined as that for refugees
Some of the people who are forced to flee or migrate and leave their homes during a disaster or complex humanitarian emergency but stay in the country in which they were living and has not crossed international border are known as internally displaced person (IDP). The status of refugee and IDP vary because the label of refugee will only be applicable if he/she crosses the border.

8. Key Terms
Crude mortality rate - The proportion of people who die from a population at risk over a specified period of time.
Attack rate - Proportion of an exposed population at risk who become infected or develop clinical illness during a defined period of time.
Case fatality rate - Number of deaths from a specific disease in a given period, per 100 episodes of the disease in that same period.
Some of the health indicators of the complex humanitarian emergency are crude mortality rate, attack rate, and case fatality rate.

9. The Characteristics of Natural Disasters
Include droughts, hurricanes, typhoons, cyclones, heavy rains, tsunamis, earthquakes, and volcanoes.
Number of natural disasters are increasing, affecting larger numbers of people, causing more economic losses, but causing proportionally fewer deaths.
Biggest relative impact is on the poor in low- and middle-income countries.
Cause damage to health systems and other infrastructure.
There are several types of natural disasters. Some of these related with weather for instance droughts, hurricanes, typhoons, cyclones, heavy rains, tsunamis, earthquakes, and volcanoes. It seems like number of natural disasters are increasing, affecting larger numbers of people, causing more economic losses, but causing proportionally fewer deaths. However, the biggest impacts fall on the poor in low- and middle-income countries. Natural disaster causes damage to health systems and other infrastructure. Health clinics, hospitals, water supply, sewage system all become affected in natural disaster and lead to a number of consequences.

10. Cyclone Ali, West Bengal, India
Earthquake in China
These pictures show the outcome of some natural disasters.
Drought in Africa

11. The Characteristics of Complex Emergencies
Often go on for long periods of time.
Sometimes groups that are fighting will not allow humanitarian assistance to be provided.
Combatants often target civilians.
Systematic abuse of human rights.
Food shortages.
Breakdown of publicly supported health system
Unhealthy living circumstances in refugee camps.
CHEs often go on for long periods of time. The strife in Sudan has gone more than a decade. In civil wars, sometimes groups that are fighting will not allow humanitarian assistance to be provided. During war, combatants often target civilians causing displacement, injury and death. Systematic abuse of human rights is also very evident in wars in the form of torture, rape, sexual abuse. The disruption of society leads to food shortages. Beside food shortage there might be total breakdown of publicly supported health system. In refugee camp since too many people live there in unhygienic condition diseases can spread faster among them.

12. The Health Burden of Natural Disasters
Direct and indirect effects depend on type of disaster.
Some effects are short-term such as death, others are long-lasting like mental problems.
Very old, very young and very sick are most vulnerable.
The direct and indirect effects depend on the type of disaster. Earthquake can kill so many people quickly and in short term period could lead to so many injuries. In the long run earthquake survivors may suffer disabilities, mental health problems, and chronic disease conditions. The most common problems that are seen in most disaster are communicable diseases, broken water supply and inadequate sanitation, and in the long run effect on mental health.

13. The Health Effects of Complex Humanitarian Emergencies
Large and underestimated.
About 250 million people affected by climate-related disasters.
In 2011, natural disasters caused a total of 30,773 deaths and 245 million victims globally.
In 2012, 9,655 people were killed and million were displaced.
Malnutrition, lack of safe water, food shortages, and breakdown of health services can lead to illness, disability and death.
The burden related with CHEs is large and underestimated because of the fact that it is difficult to obtain such data. About 250 million people are affected by climate-related disasters. Other illnesses come about as an indirect result of such emergencies. Malnutrition, lack of safe water, food shortages, and breakdown of health services are example of such indirect effects.

14. 2011 cholera outbreak in Kenya’s
The map here is showing areas of food shortage in East Africa as a result of drought.
Adopted from East Africa drought: Cholera outbreak in Kenya camp, BBC news available at

15. The Health Effects of Complex Humanitarian Emergencies
Causes of Death in CHEs
In the early stages, most deaths occur from diarrheal diseases, respiratory infections, measles, or malaria.
Populations affected are generally poor and may suffer from protein-energy malnutrition in a camp.
Most of the deaths occur after CHEs are from diarrheal disease, respiratory infections, malaria and measles. Diarrheal diseases are the most common cause of death in refugee camp. Major epidemics of cholera occurred in refugee camps of Malawi, Nepal, Bangladesh, and Tanzania. Case fatality rates are also high if the diarrheal diseases turn into dysentery. Measles have been the killer for displaced person because this population are malnourished and lack vaccination against measles. Respiratory infections and malaria incidences are also high among refugee and internally displaced person. On top of that people who are affected most by CHEs are poor and suffer from protein energy malnutrition.

16. The Health Effects of Complex Humanitarian Emergencies
Mental Health
Social and psychological shocks due to changes in way of living, loss of livelihoods, damaged social networks, and physical and mental harm.
Children and adults suffer from high rates of depression and PTSD.
Important to help people rebuild their lives and social networks as quickly as possible.
Post traumatic stress disorders among adults ranged from 4.6% among Burmese refugee in Thailand to 37.2% among Cambodian refugee in Thailand. The rate of PTSD is about 1% in the population of USA. Among children the result of trauma could be long lasting. One survey of 170 Adolescent Cambodian indicates that almost 27% of them suffer from PTSD.

17. Addressing the Health Effects of Complex Humanitarian Emergencies
Assessment and Surveillance
Carry out assessment of displaced population.
System for disease surveillance for diseases that cause epidemics among displaced persons.
Daily crude mortality rate is used as an indicator of the health of the affected group and will signify a public health emergency.
It is very important to assess the health situation immediately after the disaster has occurred. As the assessment is going on, it is also necessary to begin care for the victims. In the earliest stage of disaster some important public health functions like establishment of continuous diseases surveillance among affected people needs to be carried out.

18. Addressing the Health Effects of Natural Disasters
Health situation assessed immediately.
Care for trauma cases.
Other injured people who are in need of early treatment.
Establishment of continuous disease surveillance.
Provision of food, water and shelter.
It is very important that the health situation be assessed immediately after the disaster. Once the immediate care for trauma cases are taken care for , relief care workers should pay attention to other injured people who are in need of early treatment. In the earliest stage it is also important to establish continuous disease surveillance among the affected population and to provide food, water and shelter.
Funds Spent for Haiti Earthquake Response

19. Addressing the Health Effects of Natural Disasters
External assistance will have to:
Include all external partners.
Be based on a cooperative relationship.
Have partners working in complementary ways.
Be evidence-based and transparent.
Involve affected communities.
*Disaster preparedness plans are also helpful for reducing impact.
To be most helpful, external assistance will have to: include all external partners, be based on a cooperative relationship, have partners working in complementary ways, be evidence-based and transparent, and should involve affected communities.

20. Addressing the Health Effects of Complex Humanitarian Emergencies
A Safe and Healthy Environment
Maintenance of environmental and personal hygiene.
Adequate clean water for drinking, cooking and bathing.
Adequate number of toilets segregated by sex.
Effective and culturally appropriate shelter.
Given the fact that extent and nature of conflict is difficult to predict, it would be wise for the concerning organizations to have some plan for the areas where it likely to have conflict. Plans should include maintenance of environmental and personal hygiene, supply of adequate clean water for drinking, cooking and bathing, providing adequate number of toilets segregated by sex and to have effective and culturally appropriate shelter.

21. Addressing the Health Effects of Complex Humanitarian Emergencies
Food
At least 2100 kilocalories of energy per day for adults.
Care taken to make sure that female-headed households and children get their rations.
Vitamin A given to all children.
Urgent nutrition supplementation to children who need it.
It is suggested that each adult in a camp should get at least 2100 kilocalories of energy sufficient food per day. Care must be taken to make sure that female-headed households and children get their rations. Vitamin A should be given to all children and there should be supply of urgent nutrition supplementation for children who need it. In Syria, shortages of fuel and flour have made bread production erratic across the country.

22. Addressing Health Effects of Complex Humanitarian Emergencies
Disease Control
Vaccinate all children from 6-15 years for measles.
Ensure children up to 5 years get vitamin A.
Proper management of diarrhea.
Appropriate diagnosis and treatment for malaria.
Health education and hygiene promotion.
In the humanitarian crisis the goal of disease control is to prevent and reduce excess morbidity and mortality and to promote a return to normalcy. With this goal in mind one of the target is to prevent epidemic of measles. All children from 6-15 years should be vaccinated for measles. It is also important to ensure children up to 5 years get vitamin A. Other priorities include proper management of diarrhea, appropriate diagnosis and treatment for malaria and health education and hygiene promotion.

23. Future Challenges Reducing negative health impact.
Developing and using standard approaches among all actors.
Responding with the most cost-effective approaches.
Among a number of challenges, one of the challenges for the future is to reduce negative health impact. Developing and using standard approaches among all actors is crucial to guide work in emergencies. Responding with the most cost-effective approaches for low and middle income countries is one of the priorities to combat natural and complex humanitarian emergencies.