COMPLEX COMPLEX EMERGENCIES:EMERGENCIES: What do we What do we measure and why?measure and why?

Frederick M. Burkle, Jr., MD, MPHFrederick M. Burkle, Jr., MD, MPH

Deputy Assistant AdministratorDeputy Assistant Administrator

Bureau for Global Health/USAIDBureau for Global Health/USAIDSenior Scholar, Scientist & Visiting ProfessorThe Center for International Emergency, Disaster & Refugee StudiesSchools of Public Health & MedicineThe Johns Hopkins University Medical Institutions

Natural and Technological Natural and Technological Disasters:Disasters:

Defines the public healthExposes its vulnerabilitiesDirect effects dominateEasy to define

Complex Emergencies:Complex Emergencies:

“…situations in which the capacity to sustain livelihood and life is threatened primarily by political factors, and, in particular, by high levels of violence.”

A. ZWI: London Sch of HTM

Complex Emergencies: Lethal Complex Emergencies: Lethal Mix of ………...Mix of ………...

InequitiesPovertyInjusticeCultural incompatibilities

Ignorance RacismOppressionReligious fundamentalism

Complex Emergencies: …....Complex Emergencies: …....DIRECT EFFECTS

Injuries/Illness

Deaths

Human rights abusesInternational Humanitarian Law abuses

Psychological stress

Disabilities

INDIRECT EFFECTSPopulation displacementDisruption of foodDestroyed health facilitiesDestroyed public health infrastructure

In Complex Emergencies:In Complex Emergencies:a similar requirement to:• develop evidence based indicatorsevidence based indicators….. • that characterize and define the public

health consequences of conflictconflict……• on populationspopulations affected…..• and to ensure the effectiveness and effectiveness and

accountability of humanitarian accountability of humanitarian responseresponse……..

Measuring process in complex emergencies:

Many layers of data (both quantitative and qualitative) building on one another…...

Constantly characterizing and clarifying what complex emergencies seem to represent……...

From this emerge dominate indicators (criteria) that both define and measure……...

Evolution…...

Hostile environment “dirtied” the data

Significant inconsistencies in data gathering and reporting; frequently self-serving *

* JAMA: 1994;272:371-376

Evolution…... Crude mortality rate (CMR) emerged as a unifying indicator

CMR , cause specific mortality rates, and nutritional indicators in under age 5 (U5MR) emerged to ‘characterize’ complex emergencies in developing countries

Evolution…...New and more sensitive indicators required in developed country emergencies (advanced weaponry, elderly, raped, mental health)*….and….In each phase of a disaster…..prevention, preparedness, emergency response, recovery, rehabilitation, transition, sustainable development….. Spiegel PB, Salama P: War & mortality in Kosovo, Lancet, 2000

Evolution…...

Indicators used to drive delivery of aid led to decreases in mortality and morbidityLed to numerous sources of indicators…NGOs, IOs, Donors, Military, etc…….

Evolution…...

Attempts to collaborate to provide standards in water/sanitation, nutrition, food aid, shelter/site planning,health services….And controversies in their implementation…..proved to be insensitive to the phases and politics of relief…...

Future......

By measuring complex emergencies we chose to intervene…bring order to chaos….reduce suffering….and become more effective and efficient….Standards and professionalism of response to complex emergencies will continue to evolvewill continue to evolve……

Future......Research: Evidence based *

across all phases of disasters ……direct and indirect, quantitative and qualitative, health and non-health, political , economic, social indicatorsto ensure measurable outcomes, appropriate decision-making, leading to sustainable development………

* Spiegel P: PDM 2002;16 (4):281-285