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Despite improvements in the coordination and delivery of humanitarian assistance in recent decades, armed conflict remains a leading public health concern. Mortality rates have declined in camps for refugees and internally displaced persons (IDP), but overcrowding in camps, limited supplies of potable water, and poor sanitation have still contributed to some of the worst outbreaks of communicable diseases in history.

Furthermore, some humanitarian professionals have expressed concern that health-care provision in conflict is based on an outmoded model of humanitarian relief. Changes in geopolitics, global economic growth, and demographics have altered the profile of contexts in which armed conflict occurs. Conflict-affected countries increasingly have higher incomes, higher life expectancy, and a higher burden of non-communicable diseases. Violence occurs more frequently against a backdrop of urbanization and ageing populations. And intrastate conflicts have swelled the number of IDPs while the refugee population has gradually decreased. Endemic diseases, more prevalent in such scenarios, result in far greater morbidity and mortality than some epidemic diseases, and yet are often neglected during emergency responses.

For professionals in humanitarian assistance and protection, reducing excess mortality is the immediate goal. Though existing guidelines provide minimum standards for health services, they do not address the underlying social and environmental determinants of disease. Humanitarian policymakers continually struggle to apply these standards to different contexts. When weighing numerous considerations — including the feasibility, maximum opportunity benefit, minimum opportunity cost, maximum effectiveness, maximum cost-effectiveness, and timeliness of various intervention options — technical questions can quickly morph into major ethical dilemmas.

In this context, this Humanitarian Assistance Webcast will address the following questions:

1. Should humanitarians define certain health factors — such as excess morbidity and excess mortality — on a context-specific basis?
2. Should humanitarian organizations provide medical care that would not be available during peacetime?
3. In a protracted crisis, how can humanitarians devise a health-care system that does not create dependency on foreign assistance?

Hosts:
Christina Blunt (ATHA Project Coordinator, HPCR)
Robert Grace (Junior Associate, HPCR)

Panelists:
Johan von Schreeb, MD, PhD (Karolinska Institutet)
Michael Van Rooyen, MD, MPH, FACEP (Harvard Humanitarian Initiative)
Enrique Steiger, MD (SwissCross)

Further Reading:

Public Health in Humanitarian Crises

Articles

• WHO, Bayard Roberts, Preeti Patel & Martin McKee, Noncommunicable Diseases and Post-Conflict Countries, Bulletin of the World Health Organization, January 2012.
• CSIC Global Health Policy Center, Leonard Rubenstein, Protection of Health Care in Armed and Civil Conflict: Opportunities for Breakthroughs, January 2012.
• Francesco Checchi, Estimating the Number of Civilian Deaths from Armed Conflicts, The Lancet, January 22, 2010.
• Paul Spiegel, Francesco Checchi, Sandro Colombo & Eugene Paik, Health-Care Needs of People Affected by Conflict: Future Trends and Changing Frameworks, The Lancet, January 23, 2010.

Reports:

• Center for Research on the Epidemiology of Disasters, Health in Complex Emergencies: Trends in 8 African Countries, 2011,
• Center for Research on the Epidemiology of Disasters, Mortality in Darfur: Lessons for Humanitarian Policy, Policy Brief, 2011,
• Humanitarian Practice Network, Francesco Checchi, Michelle Gayer, Rebecca Freeman Grais & Edward Mills, Public Health in Crisis-Affected Populations: A Practical Guide for Decision-Makers, December 2007.
• WHO, World Health Report 2007: A Safer Future: Global Public Health Security in the 21st Century, 2007
• Center for Research on the Epidemiology of Disasters, Armed Conflict and Public Health: A Report on Knowledge and Knowledge Gaps, 2002
• Christopher JL Murray et al, Armed Conflict as a Public Health Problem, 2002,

Refugee Specific:

• UN High Commissioner for Refugees, Global Factsheets 2011: Public Health, Nutrition, HIV and WASH: Annual Country Factsheets, June 2012,
• UN High Commissioner for Refugees, Ensuring Access to Health Care: Operational Guidance on Refugee Protection and Solutions in Urban Areas, 2011,

Mental Health Specific:

• The Lancet, Mental Health and Psychosocial Support in Humanitarian Settings: Linking Practice and Research, October 2011

Websites:

• Center for Research on the Epidemiology of Disasters - Complex Emergency Database
• UNHCR Standards and Indicators Report
• WHO Armed Violence webpage
• WHO Fact Sheet on Collective Violence

Assessment Tools:

• MSF, Rapid Health Assessment of Refugee or Displaced Populations, 2006, full book (NOTE: If you intend to download and distribute the files present on this website you must contact MSF International Technical Coordination(ITC) to sign an agreement. Write to itc-info at msf dot org.)