Elsevier

The Lancet

Volume 364, Issue 9447, 13–19 November 2004, Pages 1801-1813
The Lancet

Series
Lessons learned from complex emergencies over past decade

https://doi.org/10.1016/S0140-6736(04)17405-9Get rights and content

Summary

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. Renewed focus is required on the major causes of death in conflict-affected societies—particularly 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.

Section snippets

Goma, Zaire, 1994; Democratic Republic of Congo, 1999–2000

The flight of 500000 to 800000 Rwandan refugees into the North Kivu region of eastern Zaire in 1994 overwhelmed the world's capacity to respond. An average crude mortality rate of 20–35 deaths per 10000 people per day was reported during the first month after the influx, during which an estimated 50000 people died.69 These rates, which resulted from serial epidemics of cholera and shigellosis, were two-fold to three-fold the highest rates previously reported among refugees or internally

Technical issues

The use of mortality rates for monitoring complex emergencies needs to be reviewed. Previous thresholds and definitions of phases remain useful for refugee and internally displaced people camps but may be less helpful in prolonged emergencies affecting large populations and large areas. More data on baseline mortality rates at the country or at least regional level should be gathered by UN agencies and academic institutions. The rule of a doubling of the baseline mortality rate could then be

Policy issues

Despite the importance of coordination in humanitarian activities, little progress has been made in the past decade.108 In refugee camps, UNHCR, in keeping with its mandate, usually coordinates health and nutrition interventions but does not have sufficient personnel and technical capacity to fulfil this role globally. In situations involving internally displaced people or where no national government functions, UNHCR does not have the mandate, and the representative of the Secretary-General

The future

To improve outcomes, the skills of health and nutrition professionals working in complex emergencies need to be broadened and reinforced. The curricula of short-courses and master's degrees should be reviewed. Programmes should focus on the practical and analytical skills needed by relief workers—how to do assessments and surveys, use basic epidemiological methods, prevent and treat diarrhoea, acute respiratory infections, malaria, measles and malnutrition, manage vaccination campaigns, and

Search strategy and selection criteria

Literature searches were done on the WHO website and the OVID database (which includes preMEDLINE and MEDLINE 1966 to May, 2004. Searches were not limited to English. The following combinations of search terms were used: mortality; mortality and emergencies; mortality and complex emergencies; complex emergencies; refugees; and humanitarian emergencies. All abstracts were reviewed for content consistent with the objectives of the paper. Papers fitting the content criteria were requested.

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