International Humanitarian Intervention Topic Studies

Cordially presented by: Yang Cindy Xu

Evidence-Based Health Assessment Process in

Complex Emergencies

WHAT,WHERE,WHEN,WHY,HOW, WHAT THEN?

1Technicalities of

Disaster Assessment

2Disaster

Assessment Processes

3Effectiveness,

Summary, and Future

Directions

Disaster Assessment: Concepts, Ideas, Frameworks

Premise, Process, Indicators, Data, Analysis

1

What is “disaster assessment”?

• “survey of a real or potential disaster to estimate the actual or expected damages and to make recommendations for preparedness ,mitigation and relief action.”

Under what type of situation is disaster assessment needed?

• Complex Emergencies

Disaster Assessment vs. Complex Emergencies

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s What defines “complex emergencies”? According to World Health Organization (WHO):• Situations of disrupted livelihoods and threats to life

produced by warfare, civil disturbance and large-scale movements of people, in which any emergency response has to be conducted in a difficult political and security environment.

• Combine internal conflict with large-scale displacements of people (IDPs and refugees), mass famine or food shortage, and fragile or failing economic, political and social institutions.

• Usually exacerbated by natural disasters.

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s Direct and Indirect Effect of Complex

Emergencies

Complex Emergencies→ problems, chaos, issues, negative, long-lasting impacts on the affected region(s)

Direct Effect Indirect Effect• Injuries/illness• Deaths• Human Rights abuses• International

Humanitarian Laws violations and abuses

• Psychological stresses (i.e. PTSD)

• Disabilities

• Population displacement, internally displaced and/or refugees.

• Disruption of food• Destroyed health

facilities• Destroyed public health

infrastructure• Other problems: water

sanitation, hygiene, disease epidemic,

Why disaster assessment?

• Crucial to the effectiveness of humanitarian responses (policy, operational, and field levels) in both natural or human-generated disasters.

• Historically, response activities have often been ineffective because of poor assessment management, standardization and poor quality of information.

• Therefore, an effective response to complex emergencies requires timely, accurate public health information and data, and more.

• THINK business management, university administrative process, your annual health check-up, your exams from your college courses… All of these involve assessment process, very similar ideas.

Why disaster assessment?

Rationale to Assessment

• Identifying (health) issues (What are the problems?)

• Provide objective information for response planning. (What’s the supply vs. demand in chaos?)

• Prioritizing needs (what’s most needed? What problem(s) to address first?)

• Implementing health programs (How can we keep people alive, how can we do better?)• Evaluating the relief process (Are we doing a good job?)

The international humanitarian community (IOs, NGOs, Militaries, other response agencies) has a professional obligation to base the assistance on the best evidence possible

Assessment CONTINUED…

1. Prevention & Preparedness

2. Response

3. Recovery and rehabilitation

4. Reconstruction

Assessment KEYWORDS

Determining factor of all health or non-health interventions:

Rapid Assessment, focused surveys, and surveillance

Survey indicator and surveillance methodologies: • Relates to the ability to monitor relationships between

health, nutrition, environmental indicators, endemic disease, injury, gender/age specific vulnerabilities.

• collection of demographic and vital statistic data, are

all critical information to data collection.

OUR FOCUS:

RAPID HEALTH ASSESSMENT

2 Rapid Assessment: Processes, Indicators, Data, and more.

Stylize, edit, and animate your media

What are the

objectives?Situation assessment: A definition of the problem and an assessment or measurement of its extent

Needs Assessment: a systematic procedure for determining the nature and extent of problems experienced by a specified population that affect health (either directly or indirectly).

Strategic, Operational and Field levels of management and Response

• IDENTIFY: How bad is the situation? (Determine the magnitude of the emergency)

• What are the problems? (Identify existing and potential public health problems)

• EVALUATE: Supply & demand, trend, projections? (Measure present and potential impact, especially health and nutritional needs) (Assess resources needed, including availability and capacity of local response)

• SOLUTION: Recommendations? (Determine and plan an appropriate external response)

• ACTION! (Set up the basis for a health system)

ASSESS SITUATION AND NEEDS

DATA, FACTS, FIGURES.

What kind of data?

BACKGROUND DATA:• Political, social, economic status

of the country, refugee migration, size and demographics of the population, and vital health information.

Indispensible data for health personnel:• Mortality• Incidence of the most important

diseases• Nutritional status• Activities data (immunization

records• Vital sectors (namely, food, water,

sanitation, shelter and fuel)

DATA, FACTS, FIGURES.Origin of data:

Existing country profiles, maps, census data, previous demographic and health surveys, early warning system tools, and previous and ongoing in country assessments.

Who are gathering data?

• United Nations Agencies• International Committee of the

Red Cross• Office of Foreign Disaster

Assistance (OFDA)• Department of Foreign

International Development (DFID)• Academia and research centers• Almost anyone who is involved

with data collection and analysis.

Information include: Endemic diseases, mortality rates, morbidity-incidence rates, nutritional status, sources of health care, IMPACT OF DISRUPTION OF HEALTH SERVICES.

Team work matters!• An experienced interdisciplinary team is required for a rapid health

assessment.• Totally independent, non biased.• An Assessment Team: 3-5 members skilled in public health, epidemiology,

nutrition, water and sanitation, and logistics.• Members should include from the country at conflict, trained interpreters.• Assessment must be sensitive and specific enough to identify the most

vulnerable groups and to target them with assistance.

More on Assessment:

• Initial assessments serve to provide a structural cornerstone for a more robust survey and surveillance system.

• All stages overlap with each other.• Population based health, nutritional, environmental data are constantly

collected. • Surveys are repeated after some intervention (i.e. Vitamin A).

RAPID ASSESSMENT INDICATORS

Population size & demographics:

Determine who and how many people are entitled to assistance

Identify vulnerable groups and target necessary assistance programs

Obtaining data from: Camp registration system

Majority of the world’s poor now reside in urban setting household, therefore city and country records are also very important to obtain.

Vital Health Data The goal is to confirm or deny background data against actual field data.

Crude Mortality Rate (CMR):Most Specific indicator of a population’s health.

Under Age 5 mortality Rate (U5MR): Children matters

Cause- specific Mortality Rates: specifies reasons of deaths.

Case Fatality Rates (CFR): Proportion of individuals with a specific disease that die within a specified time, e.g., CR for Children with malnutrition that die from measles.

Age and Gender Specific Mortality Rates: Incidence rates collected during survey phase

Most COMMON CAUSES OF DEATH: DIARRHEAL DISEASES, MASLES, ACUTE RESPIRATORY INFECTIONS, MALARIA.

A concerted effort must be made during the assessment process to identify vulnerable populations.

Verbal Autopsy,…etc.

Fancy Terms for Nutritional Assessment.• Protein energy malnutrition (PEM): used to define the

state of illness.• Mid-upper arm circumference (MUAC) studies: performed

through cluster sampling provides the decision makers information to determine whether a serious malnutrition problem exists.

• https://www.youtube.com/watch?v=3pQUtOsjjSY• Primary Health Care (PHC): strongly emphasized in relief

programs; Focusing on oral rehydration, feeding centers, immunization, promoting involvement by the refugee community in the provision of health services.

Environmental Health Assessments• Disruptions in basic water, sanitation, shelter and fuel

indicators.

• Becoming increasingly a critical means of defining the causes of the mortality and morbidity seen in complex emergencies.

• Example: In Eastern Democratic Republic of Congo, the assessment surveys revealed that the war casualties were not limited to victims of violence, but rather that 90% of the deaths were attributed to infectious diseases (malaria, diarrheal diseases) and other non-violent causes that were directly and indirectly related to environmental disruptions.

Epidemiological-Based Definition of Complex

Emergencies

“having acute, late, and post-emergency phases, each of which is characterized by predictable patterns of health indicators and expected public health responses”

Violent trauma from advanced weaponry and untreated chronic diseases appears to be main characteristics of complex emergencies in developed countries.

3 Effectiveness, Summary, and Future Directions

NOT REALLY.

Majorly lack clearly stated programs in relief efforts.

The humanitarian community is mandated to use clear and explicit statements of objectives.

What are the measures of effectiveness?MOEs (Measures of effectiveness)

• correlate a variety of diverse but interrelated humanitarian, security, economic and infrastructure indicators.

• determining whether effectiveness or success of assistance goals exists within the overall relief program.

Are we doing a good job?

AN EXAMPLE OF “MOE”

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s Assessment Interpretation

by the Humanitarian Community UNHCR • Provide UNHCR with a clear and concise picture of the emergency situation, in both

quantitative and qualitative terms.”

World Health Organization (WHO)• “to ensure Ministry of Health and WHO country representative response by collecting

and circulating information and assisting to coordinate health relief”

Nongovernmental Organizations (NGOs)• “vary greatly depending on the type, size, and work mission the individual NGOs, sees

a first-phase priority as a rapid decision on whether or not to intervene…”

Military• “for purposes of civil safety, relief security or logistical expertise, will focus first on the

mIlitary force health protection”• “Civil-Military Information Centers (CMICs), mandated by UN peacekeeping forces, are

designed to be a coordination tool for relief convoys and security issues BUT INFORMALLY FUNCTION AS AN ASSESSMENT FUNCTION.”

» Assessment bias:

» The nature and characteristics of Complex emergencies?

» The nature and characteristics of Rapid assessment?

» Media and Political Agenda?

Issues to think about

How can we do better? RULES? Recipes?

• Rule No.1 : If you don’t have proof, don’t BS.• Rule No.2 : Don’t focus on one thing, pay attention to

other relevant indicators, look at the big picture.• Rule No.3 : Trust but verify, at all levels possible:

Strategic, operational, and field.• Rule No.4: Build your own database if you are able. It

takes time, but it will be useful in the long term.

What’s Your Message?What’s the future?