With 6.5 million people in need of humanitarian aid, this year’s El Nino–induced drought constitutes the largest humanitarian emergency that Malawi has ever confronted.
It also brings the second consecutive harvest failure to this small, landlocked country, which has yet to recover from last year’s severe flooding. Inadequate governance has amplified the negative impacts of both, compounding natural disasters with political and economic malfeasance.
In a humanitarian crisis a population’s needs are great and many–for medical attention, shelter, safe water and adequate sanitation, food, and security. Disasters that occur in places that are already resource-poor and underserviced are more devastating than they might otherwise be.
The catastrophic January 12 earthquake in Haiti is currently in the spotlight, but other disasters, such as the 2008 earthquake in China, Hurricane Katrina and the northern Pakistan earthquake in 2005, and the Indian Ocean tsunami in 2004 also remain clear in recent memory.
This research was prompted by a growing consensus that “the nature of humanitarian emergencies is changing” (UNOCHA, 2011a), with future emergencies increasingly driven over time by “a combination of complex and inter-related circumstances”, rather than single, identifiable shocks (ibid). Such observations resonate closely with those of humanitarian actors within southern Africa who increasingly face new, ‘atypical’ challenges.Members of southern Africa’s Regional Interagency Standing Committee (RIASCO) have long acknowledged that effective humanitarian planning presupposes a clear understanding of the region’s risk profile.
This prompted a call to investigate the threats to lives and livelihoods likely to confront southern Africa over the next decade, along with available capacities to address these challenges. RIASCO also sought greater clarity on the causal processes that may exacerbate population displacement, food insecurity, health emergencies, livelihood loss, as well as at-risk groups, including children and people living with HIV/AIDS.
Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment.
Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies,
Complex humanitarian emergencies are characterised by a break-down of health systems. All-cause mortality increases and non-violent excess deaths (predominantly due to infectious diseases) have been shown to outnumber violent deaths even in exceptionally brutal conflicts. However, affected populations are very heterogeneous and refugees, internally displaced persons (IDPs) and resident (non-displaced) populations differ substantially in their access to health services. We aim to show how this translates into health outcomes by quantifying excess all-cause mortality in emergencies by displacement status. As standard data sources on mortality only poorly represent these populations, we use data from CEDAT, a database established by aid agencies to share operational health data collected for planning, monitoring and evaluation of humanitarian aid. We obtained 1759 Crude Death Rate (CDR) estimates from emergency assessments conducted between 1998 and 2012. We define excess mortality as the ratio of CDR in emergency assessments over ‘baseline CDR’ (as reported in the World Development Indicators).