1. Introduction to Public Health in Emergencies
Muireann Brennan, MD, MPH
International Emergency and Refugee Health Branch CDC

2. Learning Objectives Humanitarian Principles - the ‘code of conduct’
Lessons learned in response to emergencies over the last thirty years
New structures in emergency response as a result of lessons learned

3. Humanitarian Conventions
International Humanitarian Law
International Human Rights Law
Refugee law
The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs

4. Humanitarian Principles
International Humanitarian Law
Assistance to civilians in time of conflict
Distinction between combatants and non-combatants
Refugee law
Principle of non-refoulement: a principle in international law, specifically refugee law, that concerns the protection of refugees from being returned to places where their lives or freedoms could be threatened
Non-refoulement: a principle in international law, specifically refugee law, that concerns the protection of refugees from being returned to places where their lives or freedoms could be threatened

5. Humanitarian Principles Contd
The Code of Conduct
Humanitarian imperative
- Assistance based on need
- Aid not used to further other aims
- Aid not an instrument of foreign policy
- Respect culture and custom
- Build on local capacity
- Involve beneficiaries
- Reduce future vulnerabilities
- Recognize dignity of disaster affected populations

6. Actors in Emergencies United Nations: WHO, UNICEF, WFP, OCHA, UNHCR
Donors: ECHO, DFID, OFDA, PRM, CIDA, SIDA
Organizations with special mandate: ICRC, IOM, IFRC
INGO: MSF, SC, ARC, IRC, CARE
FBO: WVI, ADRA
Government: MOH, Military, Disaster Minister
Local NGO: National Red Cross/red crescent, FBO
Military: national, Foreign, UN
Policy and advocacy: Amnesty international, Human rights watch, Physicians for Human Rights, International Crisis Group, Africa Watch
Conflict resolution: Carter center
Private foundations: Gates,
Academic institutes: Columbia, John Hopkins
Others: CDC, Epicenter

7. History of Emergencies
: Afghan refugees in Pakistan: Ethiopian refugees in Somalia, and Sudan (measles epidemic, scurvy)
: Mozambique, Malawi – general food distribution, lack of minerals/vitamins (Pellagra epidemic)
1991: Iraq – role of military, ‘non - refoulement’
1992-3: Somalia – UN military role
: Bosnia- Herzegovina – role of NATO, UN military, Sexual violence, ethnic cleansing
1993: Thailand (Cambodian refugees)
1994: Rwanda, DRC- Goma – genocide, refugee, quality of response, accountability, SPHERE
Thailand: Cambodian refugees in Thailand. Combatants including Khmer Rouge

8. History of Emergencies (Contd.)
2000: Kosovo – developed country, different public health perspective
: Ethiopia – food insecurity, measles, quality of nut surveys
2001: Afghanistan – independence, civil-military
2004: Tsunami – coordination, community participation, accountability
2005: Pakistan – ‘gender’ in humanitarian response
2005 – the Humanitarian reform: cluster approach, financing (CERF …), coordination, partnership
2006: Lebanon – quality of response, role of local CBOs
Fragile states: Entire countries considered in emergency or post-emergency
CERF: Common Emergency Response Fund

9. Crude Mortality Rate (CMR) Evolution in Different Emergencies (Salama Peter et al 2004)
Kosovo: Peak in middle was caused by elderly population left behind - unable to care for themselves and unable to flee
Sudanese refugee camps: More typical pattern – situation improves with time

10. CMR in Camp Versus Non-camp Situations : lessons learned from complex emergencies over the past decade

11. Natural Disasters Reported 1990 - 2006
Does not necessarily reflect number of disasters in the world – only number of disasters REPORTED. Increase can be attributed to better reporting mechanisms, increased relief response due to “CNN” effect, growing populations and urbanization, marginalized environments, etc.

12. Summary of Lessons Learned
Emergency response must be based on accurate information and use a public health approach
Major causes of mortality in emergencies are preventable through well-proven, low-cost public health interventions
Protection of affected populations, maintenance of humanitarian space and safety of humanitarian workers is becoming increasingly difficult

13. Summary of Lessons Learned (cont.)
Emergency response has evolved as a specialist field with its own indicators, policies, procedures, manuals, and reference materials
Agencies that have developed institutional expertise in the key technical areas of humanitarian aid and invested in staff training have proven their effectiveness
Relief agencies must be accountable to agreed standards
Better outcomes with involvement of host government staff and use of local skills
Preparedness and coordination between agencies is key for effective response.

14. Steps Taken Code of conduct
Some agreement on use of mortality and malnutrition indicators
The SPHERE guidelines
Cluster approach

15. Coordination
Coordination between international organizations, NGOs, host country government, local community, displaced population
Common objectives being pursued
Maximize use of resources and manpower
Ensure all sectors are covered
Avoid duplication of efforts
Sharing of information

16. Cluster Leadership Approach
Objective:
Address identified gaps in response and enhance the quality of humanitarian action by strengthening partnerships….aimed at improving effectiveness of response by ensuring greater accountability, predictability and partnership
Cluster approach evolved from UN reform with the idea that different sectors should form agreements on indicators, means of response, etc. BEFORE emergencies. Each cluster designates a leading member.

17. Cluster Leads Logistics WFP Shelter UNHCR Health WHO Nutrition UNICEF
WatSan UNICEF
Protection UNHCR
Camp Mgmt UNHCR / IOM
Communications OCHA
Early Recovery UNDP
Education UNICEF
SC is represented on Health and Nutrition clusters.

18. Thank You
Questions? Comments?