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COMPLEX EMERGENCIES: What do we measure and why?

COMPLEX EMERGENCIES: What do we measure and why?. Frederick M. Burkle, Jr., MD, MPH Deputy Assistant Administrator Bureau for Global Health/USAID Senior Scholar, Scientist & Visiting Professor The Center for International Emergency, Disaster & Refugee Studies

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COMPLEX EMERGENCIES: What do we measure and why?

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  1. COMPLEX EMERGENCIES: What do we measure and why? Frederick M. Burkle, Jr., MD, MPH Deputy Assistant Administrator Bureau for Global Health/USAID Senior Scholar, Scientist & Visiting Professor The Center for International Emergency, Disaster & Refugee Studies Schools of Public Health & Medicine The Johns Hopkins University Medical Institutions

  2. Natural and Technological Disasters: • Defines the public health • Exposes its vulnerabilities • Direct effects dominate • Easy to define

  3. 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

  4. Inequities Poverty Injustice Cultural incompatibilities Ignorance Racism Oppression Religious fundamentalism Complex Emergencies: Lethal Mix of ………...

  5. DIRECT EFFECTS Injuries/Illness Deaths Human rights abuses International Humanitarian Law abuses Psychological stress Disabilities INDIRECT EFFECTS Population displacement Disruption of food Destroyed health facilities Destroyed public health infrastructure Complex Emergencies: …....

  6. In Complex Emergencies: a similar requirement to: • developevidence based indicators….. • that characterize and define the public health consequences ofconflict…… • on populationsaffected….. • and to ensure theeffectiveness and accountability of humanitarian response……..

  7. 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……...

  8. Evolution…... • Hostile environment “dirtied” the data • Significant inconsistencies in data gathering and reporting; frequently self-serving * * JAMA: 1994;272:371-376

  9. 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

  10. 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

  11. Evolution…... • Indicators used to drive delivery of aid led to decreases in mortality and morbidity • Led to numerous sources of indicators…NGOs, IOs, Donors, Military, etc…….

  12. 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…...

  13. 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 evolve……

  14. Future...... Research: Evidence based * • across all phases of disasters …… • direct and indirect, quantitative and qualitative, health and non-health, political , economic, social indicators • to ensure measurable outcomes, appropriate decision-making, leading to sustainable development……… * Spiegel P: PDM 2002;16 (4):281-285

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