Public Health in Humanitarian Crisis

Submitted by
Name: TARUN KUMAR KUSHWAHA
Registration Number: 12018958

In partial fulfillment for the requirements of the award of the degree of

Bachelor of Computer Science and Engineering

School of Computer Science and Engineering

Lovely Professional University
Phagwara, Punjab

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 Table of Content

Sr. No. TITLE Page No.

1. Certificate 3
2. Introduction 5-7
3. Problem Identification and Cause 8-9
4. Objective 10-11
5. Interventions 12-17
6. Effectiveness of the Project 18-20
7. Conclusion 21

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 Introduction
Today, more people are impacted by humanitarian crises than at any point in
recorded history. One in six children lives in close proximity to a conflict zone
while 70.8 million people have been forced to flee from their homes—the highest
number since World War II. Natural disasters, on average, affect roughly 200
million people each year. The 2014–2016 Ebola outbreak in West Africa
demonstrated how an infectious disease outbreak can become an international
humanitarian crisis. In recent years, humanitarian crises have become more
frequent, more protracted, more complex and more costly, stretching an
underfunded humanitarian response community to its limits.

Humanitarian crises include:

(1) Man-made disasters, including armed conflict, forced displacement and refugee
crises
(2) Natural disasters, such as floods, hurricanes, earthquakes and droughts
(3) Major infectious disease outbreaks
Often, multiple types of crises occur simultaneously, such as armed conflict or
natural disasters combined with famine and disease outbreaks. All of these types of
crises have a severe effect on human health, with a disproportionate impact on
disadvantaged populations and people in low and middle-income countries (LMIC)
who are impacted by humanitarian crises more often but are generally less
prepared for them. Immediately following the onset of a crisis, acute health
problems of trauma, injury and the spread of infectious disease are the primary
concern of humanitarian response organizations. However, humanitarian crises
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also have many long-term impacts on health and the environment. As health
systems are disrupted, damaged and/or overwhelmed, healthcare is challenging to
deliver. For many, crises also mean the loss of livelihoods, displacement from their
homes and communities, emotional distress and social suffering. Health problems
are exacerbated for people with pre-existing health conditions and new health
issues arise. Humanitarian crises impact almost every aspect of health, including
but not limited to: maternal and child health; infectious disease; injury and other
physical trauma; sexual and reproductive health; nutrition; and non-communicable
diseases such as diabetes, heart disease and mental health.

What is the role of the research community in addressing the health impacts
of humanitarian crises? How can research help improve the quality of health
services during and after crises? Are there important scientific questions that can
only be addressed by research in these contexts? How do researchers work in these
challenging settings without impeding humanitarian assistance and ensure that
research findings benefit affected populations? How are successful, equitable and
sustainable research collaborations built with local researchers in humanitarian
settings? Is there an advocacy role for health researchers?
This project highlights several of the findings and learnings from the course and
subsequent analysis, focusing on a few key messages:
1. Humanitarian health is integral to global health.
2. The global health research community plays a critical role in addressing the
significant evidence gap in humanitarian health.
3. There are important scientific questions of high public health relevance that can
only be answered by research in humanitarian settings.
4. While humanitarian health research is uniquely challenging, many effective
strategies and approaches can be used.
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 Developing global health strategies without significant attention to the
humanitarian context is like building a hospital without an emergency room. Far
too often, humanitarian crises are treated as outliers or exceptions, and
subsequently are neglected in the formulation of health programs and strategies.
The unfortunate reality is that humanitarian crises are common and widespread
experiences driving human health worldwide. If health in fragile contexts is not
prioritized by the global health research community, it will be very difficult to
achieve ambitious health goals on a global level. Much of the world made
remarkable progress on the Millennium Development Goals (MDG), which United
Nations (UN) member states committed to achieving by 2015. However, countries
affected by conflict and fragility consistently lagged behind other LMICs on these
goals and none of these countries achieved a single MDG. The UN’s updated 2030
Sustainable Development Goals (SDG) set even more ambitious targets for many
health-related areas. Populations affected by conflict, such as refugees and
internally displaced persons fleeing war, cannot be overlooked if we hope to
achieve the SDGs. Likewise, reducing the impacts of natural disasters and hazards
on health is critical to achieving the SDGs, as recognized by the UN Sendai
Framework for Disaster Risk Reduction. Ensure healthy lives and promote well-
being for all at all ages—includes targets for reducing maternal and child mortality.
While maternal and child mortality rates are declining globally, they are
significantly higher in fragile and conflict-affected countries than in stable
countries. In fact, children in fragile or conflict-affected countries are twice as
likely to die before the age of 5 compared with children in other, more stable
LMICs. It also includes targets for infectious diseases, which are incredibly
difficult to manage in conflict-affected settings as seen in the current Ebola
outbreak in the Democratic Republic of Congo, the recent cholera outbreak in
Yemen and stalled efforts to eradicate polio in parts of Afghanistan,
Pakistan and Nigeria. Similarly, the economic, political and healthcare crisis in
Venezuela is marked by the spread and re-emergence of vector-borne diseases,
such as malaria, Chagas disease and dengue, undermining efforts to eradicate these
diseases from Venezuela and neighboring countries. Other health-related targets, as
well as targets related to clean water and hunger, are also much more difficult to
achieve in humanitarian settings. Given the increasing frequency and impact of
humanitarian crises worldwide, along with their protracted nature, these settings
cannot be ignored. Rather, efforts that integrate humanitarian settings into
comprehensive approaches are likely to make more significant contributions to
global health goals.

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 Problem Identification and Causes
A humanitarian crisis is a generalized emergency situation that affects an
entire community in a region, which involves high levels of mortality or
malnutrition, the spread of disease and epidemics and health emergencies. It can
also involve a lack of clean water, food security, sanitation and shelter. Generally
speaking, this situation derives from the previous lack of protection in parts of
world already suffering from constant inequality, poverty and a lack of basic
services; and a trigger that makes things worse: Political events such as armed
conflicts, coups, ethnic and religious persecution, etc. and environmental
catastrophes like tsunamis, earthquakes, typhoons, etc.
When the situation deteriorates, and because the country is unable to deal
with the consequences, humanitarian aid is essential to meet the needs of
vulnerable people. This can take the form of food aid, medical care, rebuilding
infrastructures, etc. Reducing the number of victims would end the crisis and start
a period of development cooperation activity.

Causes:

Political unrest: As well as causing famine and death, armed conflicts and civil
war create refugee crises. According to ACNUR — the United Nations Refugee
Agency — at the end of 2019, almost 80 million people around the world had been
forced to flee their homes because of conflict and persecution. Yemen, Somalia,
South Sudan and the north of Nigeria are examples of crises caused by political
conflict.

Environmental causes: These attract less media attention and uproar, but climate
change is having a massive impact on humanitarian crises. According to the
UN, 90 % of disasters are caused by climate change. In the last 20 years, the
number of disasters has doubled: floods, droughts, heat waves and devastating
storms are sweeping away human lives and causing shortages that force them to
emigrate in search of refuge (climate displacement). The world still remembers the
tsunami in the Indian Ocean (2004), the earthquake in Haiti (2010), the worst
drought in the last 60 years that hit Somalia in 2017 or cyclones Eta and Iota that
hit Honduras consecutively (2020). According to the United Nations Office for
Disaster Risk Reduction (UNDRR), 1.23 million people were killed by natural
disasters between 2000 and 2019.

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Healthcare emergencies: Epidemics can cause massive humanitarian crises
considering that the World Health Organization (WHO) says that 1.6 billion people
in the world have no access to basic medical care, infectious disease is a huge
challenge to humanitarian aid. Ebola, with a mortality rate of between 50% and
90%, infected almost 30,000 people in West Africa between 2014 and 2016, killing
11,000 of them. Malaria took the lives of 405,000 people in 2018, almost all of
them in Sub-Saharan Africa. HIV has already killed 33 million people, and it is
still a major global public health problem. Cholera, which is caused by poor
sanitation and contaminated water, claims up to 140,000 lives every year.

The effects of humanitarian aid are devastating to the societies they affect. These
include:
Population displacement: To escape from armed conflict, famine and climate
disasters. According to ACNUR, 80 % of displaced people are in countries
suffering from severe food insecurity and malnutrition. Syria heads the list of
migrants with 6.6 million.

Hunger and malnutrition: Wars destroy farmland and infrastructures, making it

impossible to transport food to where it is needed. Climate change is also
damaging crops by changing rainfall patterns and drought, and plagues are ruining
farms.

Lack of basic services: Schools, hospitals and their staff are protected by
international law. However, they are still targeted on many occasions. The United
Nations is urging protection for these basic services in conflict areas to prevent
indiscriminate attacks on schools and universities like those occurring in
Afghanistan, as well as healthcare facilities trying to deal with the COVID-19
crisis in Libya, which are being bombed.

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 Objective
When dealing with armed conflict, natural disasters and other disaster situations,
humanitarian assistance is one of the most effective and tangible means of
alleviating the sufferings of those in need. The overall goal of this project is to save
lives, to alleviate sufferings to maintain human dignity for the benefit of people in
need who are, or at risk of becoming, affected by armed conflicts, natural disasters
or other disaster situations. This project illustrates how to deal with humanitarian
crisis from public health standpoint and discusses the method which can be
implemented for the betterment of humans.

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In this project we discuss following aspects of public health:
 Water and Sanitation
 Food Security in Humanitarian Crisis
 Management of Disease Humanitarian Crisis
 Healthcare in Humanitarian Emergencies
 Shelter in Humanitarian Setting
 Protection of Displaced Populations: Human Rights and Humanitarian Law
 Emerging Risks, Challenges, and opportunities for Future Humanitarian
Emergencies

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 Implementation
Water and Sanitation
Water is one of the essential needs for our survival is getting clean water is
very important. There are several ways of getting pure water one of them is
collecting rainwater. Rainwater falls from the sky microbiologically pure. First you
should let the first flush of rain to wash all the dirt that is collected over your house
then you can store the rest of the rainwater in pots and buckets. Another problem is
with contamination of water so to prevent this you can build a water storage unit
that is elevated and having a solid platform will help it sustain damage. Pipe water
supplies can be very helpful in case they are free from damage as you can provide
clean water to a lot of people and even if it gets contaminated it will be easy to
chlorinate. We can also save lives by providing trucking water to places where it is
inaccessible.

Sanitation is about more than just toilets. After a disaster, demarcation and
cordoning off defecation areas, and building communal toilets should be completed
as soon as possible. We can support people facing humanitarian crisis by providing
them affordable toilets and making them aware not open defecate. We can also

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build temporary latrines, provide essential hygiene items and delivering hygiene
messages. A safe disposal process creates the first barrier to sanitation.

Food Security
Ensuring that people have access to adequate nutrient rich food is essential
for protecting the safety, health and well-being of people. Humanitarian crisis have
a devastating effects on infants and women. We should ensure that there is proper
supply system that can manage the food availability to these people in situations of
crisis. Governments and NGO’s can promote food storage in crisis prone areas.

Public funding can also be helpful in buying food for people in need in times of
crisis. Improve early warning and action centers so that people who are going to be
affected can prepare for the crisis and can store sufficient food. Governments
should also support local markets as people living there are majorly dependent on
local market for food than humanitarian aid. Social networks are reliable source of
food in case of crisis.

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Management of Disease
Management of diseases can be done by following this cycle:
1. Situational analysis
2. Surveillance system
3. Understanding time, person, place, causes
4. Taking actions
5. Monitoring outcomes
6. Documenting
7. Improving preparedness

Healthcare in Humanitarian Emergencies

Disasters put special strains on the provision of health services as demand
increase and resources to meet these demands diminish. This is enacted by
providing vaccination and feeding programs, setting up treatment centers,
providing primary care in refugee camps, establishing field hospitals to deliver
surgical care during humanitarian crisis.

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Building high quality health care system is also important and deploying them
correctly is a matter of great concern which should be done after analyzing the
situation carefully. Governments should also ensure that they have adequate
workforce to deal with the crisis and local participation should be encouraged.
Coordination should be encouraged between governments and NGOs to provide
medicines and other relief material to the communities affected.

Shelter in Humanitarian Setting

Providing shelter units, such as tents, cam be appropriate in some situations,
although the climate may dictate their relevance. Tents can be mobilized quickly,
and transported easily. A transitional shelter can be built with frames such as
bamboo or wood, or in some cases by steel frames, then further material can be
added incrementally to improve the shelter. Another shelter option is providing
support to renting available accommodation.

Provision of money, and possibly help with contracts, to enable people to find
alternative rental accommodation on the open housing market. Supporting families
that can provide their land for building shelter and providing them with shelter kits
should be encouraged. People are often encouraged to offer unused rooms or

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buildings to those needing them. Shelter should also be made in such places which
are close to availability of water, and sanitation, and other services. Provision of
support needs to be part of a broader shelter strategy looking at all aspects of the
community’s life. One should also ensure proper availability of food, clean water,
and sanitation while selecting a place for shelter.

Protection of Displaced Populations: Human Rights and Humanitarian Law

Internally displaced people are those who have been forced or obliged to
leave their homes behind, notably for reasons related to armed conflict or other
violence, and who remain within the borders of their country. International
humanitarian law or IHL seeks to limit, for humanitarian reasons, the effects of
armed conflict by protecting people not participating in the hostilities, such as
civilians, health workers, and aid workers, as well as those who are no longer
participating in hostilities, such as the wounded or prisoners of war. The fourth
Geneva Convention addresses the protection for civilians, particularly foreign
nationals in the territory of a party to the conflict or in an occupational territory,
and it contains detailed provisions on humanitarian relief. Most importantly
civilians cannot be targeted in war crime. Governments are supposed to guarantee
the basic human rights and physical security of their citizens.

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 Refugee protection involves upholding human rights for refugees, which
includes minimizing the threat of violence and making sure that their basic needs
are provided for. But the most fundamental responsibility in refugee protection is
to ensure that the refugees are not forcibly returned to the place from which they
fled. The UNHCR (United Nations Refugee Agency) was created to protect the
millions of Europeans who flee their homes during World War II. Major areas of
assistance provided by UNHCR and partner agencies include shelter, food, clean
water, education, and medical care. UNHCR also works to prevent and respond to
gender-based violence and other harm and helps refugees and other uprooted
people become self-sufficient through vocational training and income-generating
projects.

Emerging Risks, Challenges, and opportunities for Future Humanitarian

Emergencies
The potential for future disasters is great, and each having important public
health components. New resources and new approaches will be needed to address
these disasters and to help countries to recover economies and livelihoods. These
crises share the common thread of being major public health emergencies which,
with a preponderance of excess or indirect mortality and morbidity dominating the
consequences, requires new approaches, including unprecedented improvements
and alterations in education, training, research, strategic planning, and policy and
treaty agendas. Unfortunately, political solutions offered up to date are nation-state
centric and miss opportunities to provide what must be global solutions. Public
health, redefined as the infra-structure and systems necessary to allow
communities, urban setting, and nation-states to provide physical and social
protections to their populations has become an essential element of all disciplines
from medicine, engineering, law, social sciences, and economics. Public health,
which must be recognized as a strategic and security issue should take precedence
over politics at every level, not be driven by political motives, and be globally
monitored.

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 Effectiveness of Project
Humanitarian performance should be defined in terms of both its effects on
those affected by crisis and according to core humanitarian principles. A more
integrated approach to performance, bringing together different levels, functions
and initiatives within the system, could help to overcome many of the perceived
failures of humanitarian assistance. The effectiveness of any humanitarian aid can
be measured by Response monitoring process.
Response monitoring is a continuous process that tracks the humanitarian
assistance delivered to affected populations compared to targets set out in the
Humanitarian Response Plan (HRP). Monitoring tracks the inputs, and the outputs
resulting from interventions to affected populations, charts the outcomes of cluster
activities, and measure progress towards the strategic objectives of the HRP, while
considering the diversity of the affected population and their perspectives of the
response. Response monitoring seeks to achieve two main goals:
 To identify shortcomings in the delivery of humanitarian aid as
planned in the HRP, and
 To improve accountability to affected populations and other
stakeholders

Preparing – Monitoring – Reporting

In the preparation stage, the clusters and inter-cluster coordination group
prepare monitoring plans. This framework is a set of practice, performed by all
humanitarian actors, to collect and analyze response monitoring data. At the
preparatory stage response monitoring has strong linkages to three levels in the
HRP process, namely when selecting indicators and setting targets for measuring
against strategic objectives, and cluster objectives and outputs of cluster member
activities.

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 Based on monitoring framework humanitarian actors monitor the activities
planned in the HRP, collecting and analyzing the results at an agreed upon
schedule. The monitoring is done on periodic basis so that appropriate
interventions can be taken to minimize the effects of the on-setting disaster.
Based on this monitoring system further reports are made to regularly
examine whether sufficient progress is being made in reaching strategic and cluster
objectives. It is designed to aid in determining why any of the objectives are not
being met and to provide an evidence base for taking decisions about the direction
of the response. In addition, the report provides a structure to analyze changes in
context and needs, provide an update on funding received versus requirements, and
identify constraints and gaps.

OHCA
OHCA stands for United Nations Office for the Coordination of
Humanitarian Affairs. With its partners, OHCA contributes to principled and
effective humanitarian response through coordination, advocacy, policy,
information management and humanitarian financial tools and services. OHCA’s
county and regional office are responsible doe delivering the core functions in the
field by leveraging functional expertise throughout the organization.

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 Coordination: OHCA coordinates humanitarian response to expand the reach
of humanitarian action, improve prioritization and reduce duplication, ensuring that
assistance and protection reach the people who need it most.
Humanitarian Financing: OHCA aims to mobilize and engage the full range
of financing instruments, mechanisms and partners to ensure that growing
humanitarian needs are met, humanitarian leadership and coordination mechanisms
are promoted at the country level, and the large array of global humanitarian
financing mechanisms are complementary among themselves and coherent with
development funding.
Policy: Through leadership in developing humanitarian policy, OHCA helps
set the agenda for humanitarian sector reform and effectiveness in response to
shifting global landscape, new global frameworks, and increases capacities of
national Governments and local actors.
Advocacy: OHCA’s public and private advocacy raises awareness of
forgotten crisis, promotes respect for International Humanitarian Law (IHL),
brings the voices of crisis-affected people to the forefront, and helps people obtain
access to humanitarian assistance.
Information Management: OHCA provides information management
services to the humanitarian community to inform a rapid, effective and principled
response. It gathers, shares and uses data and information, underpinning
coordination, decision-making and advocacy.

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 Conclusion
Humanitarian crises are having a bigger impact on human health now than at
any time in recent history, yet the evidence base that informs humanitarian practice
and policy is lacking. While research in these settings is especially challenging,
there are reasons to be optimistic. Awareness of the need for evidence in
humanitarian health is growing among academics, humanitarians and research
funders. In some protracted crises, such as for Syrian and Palestinian refugees,
significant research efforts are building a formidable evidence base. And while
there are limited research funding opportunities specific to humanitarian crises,
several research funding agencies are supporting humanitarian research through
other non-specific funding calls. Furthermore, humanitarian NGOs, such as
Médecins Sans Frontières and the International Rescue Committee, are
strengthening the internal research capacities of their staff and deepening
partnerships with academic researchers. Several universities have established
humanitarian programmes with research components, including Harvard, Johns
Hopkins, the London School of Hygiene and Tropical Medicine and the American
University of Beirut in Lebanon. Still, humanitarian health needs remain
formidable. Humanitarian health should be recognized as a key research priority
and integral to progress in global health, not an outlier. Without this, we will never
be able to comprehensively address high-burden global health needs nor achieve
the ambitious SDGs. Global health research funders must also recognize that
researchers face unique challenges in conducting research in humanitarian crises
and should consider strategies that address these challenges. These include
investing in humanitarian health research capacity, supporting multisector
partnerships, accounting for complex ethical and methodological issues and
ensuring that local partners are engaged and play leadership roles whenever
possible. Collectively, improving the evidence base for humanitarian health can
improve the lives of millions people world-wide.

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