Recommended readings
Lessons learned from complex emergencies over past decade
What are the major causes of death in conflict affected areas?
Authors:
P. Salama; P. Spiegel; L. Talley; R. Waldman
Publisher:
The Lancet, 2004
Major advances have been made during the past decade in the way the international community responds to the health and nutrition consequences of complex emergencies. The public health and clinical response to diseases of acute epidemic potential has improved, especially in camps. Case-fatality rates for severely malnourished children have plummeted because of better protocols and products. This article in The Lancet argues how renewed focus is required on the major causes of death in conflict-affected societies. This is particularly important for acute respiratory infections, diarrhoea, malaria, measles, neonatal causes, and malnutrition, outside camps and often across regions and even political boundaries. In emergencies in sub-Saharan Africa, particularly southern Africa, HIV/AIDS is also an important cause of morbidity and mortality. Stronger coordination, increased accountability, and a more strategic positioning of non-governmental organisations and UN agencies are crucial to achieving lower maternal and child morbidity and mortality rates in complex emergencies and therefore for reaching the UN's Millennium Development Goals. The authors use a number of case studies to illustrate their points including Southern Sudan, Ethiopia, Afghanistan and Kosovo.
The authors show how there are three major constraints to reducing morbidity and mortality in complex emergencies. First, both the epidemiological science and programmatic interventions need to go beyond the refugee and internally displaced people camp paradigm upon which much of the original research was based. Second, public health interventions in all settings must attain high coverage. Although high coverage rates for health and nutrition interventions are relatively easy to attain in camps, challenges can seem insurmountable when an affected population covers a large and insecure area. Thirdly, there is a need to address the more distal underlying causes of complex emergencies, and thus work at the levels of primary and secondary prevention. In complex emergencies in both camp and non-camp settings, humanitarian interventions provide a response that is limited to the health and other social sectors; such interventions might minimise the consequences of societal disruption, but they cannot undo existing damage.
