Working towards better health in humanitarian crises

Abstract

On the afternoon of Aug 19, 2003, a bomb on a truck was detonated outside the UN headquarters in Baghdad, Iraq. The UN Special Representative in Iraq, Sérgio Vieira de Mello, who had worked for the UN for more than 30 years, was killed in the attack, along with 22 of his colleagues. Since 2006, the date has marked World Humanitarian Day to commemorate them and all the people who have lost their lives in humanitarian service and to celebrate those presently working in crisis and disaster settings around the world. This year, the day is shining a spotlight on “humanitarian heroes”. There are many people who are working in extremely challenging circumstances that deserve recognition, not least in Syria and in the Ebola epidemic in west Africa, but also in lesser known situations such as the refugee crisis in Burundi and neighbouring countries (see World Report). Aug 19 should also be a day to remember the populations living in crises. Their health and wellbeing is dependent on good responses and planning from national and international groups. In some areas, however, gaps exist. A Global Evaluation 2012–14 report launched last week by the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises, a group of 18 international organisations including WHO and UNICEF, draws attention to shortfalls in funding and provision of services for women, children, and adolescent girls. It found that although requests from humanitarian and development agencies and local actors and absolute funding for reproductive health had increased since 2002, when the last global evaluation was done, only 43% of these requests had actually been met in the past 12 years. In maternal and newborn care, which received the largest share of the funding, money primarily supported less expensive, rather than life-saving, interventions. Family planning was neglected in most funding appeals; when it was covered, long acting or permanent methods of contraception were rarely mentioned. Less than 1% of proposals mentioned abortion, including post-abortion care, possibly reflecting donor sensitivities or the legal situation in recipient countries. Provision of emergency contraception and essential services for victims of rape in a clinical setting were also substandard. IAWG calls for sustained, dedicated, predictable funding for reproductive health; commodity management and security, including long acting family planning methods; and comprehensive clinical and psychosocial care for rape survivors. National, regional, and international humanitarian actors need a special focus on women and children in crises. They constitute the largest proportion (80%) of people who are displaced worldwide. Women in crisis settings have high rates of unintended pregnancies, maternal mortality, unsafe abortions, sexually transmitted diseases, and sexual violence, and, as the Global Evaluation shows, much more can be done to improve their care. The need to sharpen responses to health and humanitarian crises is becoming more acute. The number of people affected by such crises has almost doubled during the past decade, and is expected to keep increasing. 51·2 million people remained forcibly displaced because of conflict and persecution by the end of 2013—the largest number since World War 2. An additional 22 million were displaced by natural disasters in 2013. The humanitarian landscape has changed considerably over the past decades, with increasing urbanisation, population growth, and economic shifts, and it will continue to do so with new threats such as climate change. In response to these challenges, the UN Secretary General Ban Ki-moon, with the UN Office for the Coordination of Humanitarian Affairs, is convening the first World Humanitarian Summit to take place May 23–24, 2016, in Istanbul, Turkey. It will bring together governments, humanitarian organisations, and other partners to map out a new agenda for future humanitarian action. Eight regional consultations, which will be completed at the end of this year, are gathering views on how to address future needs under four themes: humanitarian effectiveness, reducing vulnerability and managing risk, transformation through innovation, and serving the needs of people in conflict. A new Lancet Series on humanitarian crises and health, due to be published next year, will review the evidence base for public health interventions in emergencies, assess public health information sources, and examine health and data in the ongoing Syrian crisis among other topics. We hope the Series will feed into the global conversation about the future of humanitarian action and improve the use of science to protect people living, and working, in crises. Violence in Burundi triggers refugee crisisPolitical turmoil in Burundi has caused tens of thousands of people to flee their homes, many to refugee camps in neighbouring countries. Andrew Green reports from the capital, Bujumbura. Full-Text PDF