Lessons Learned From Complex Emergencies

Published paper¹

Children being fed in MFS-H feeding programme

Another paper in the same series in the LANCET reviewed the lessons learned from complex emergencies over the past decade. The review was based on a literature search done on the WHO website and OVID data base (which include preMEDLINE and MEDLINE 1966 to May 2004). The combination of search terms used were; mortality, mortality and emergencies; mortality and complex emergencies; complex emergencies; refugees; and humanitarian emergencies. Papers fitting the content criteria were requested. 1992 matches were made on the WHO website and 6414 matches on OVID.

The paper highlights the lessons in relation to specific emergencies and responses. These were; Goma, Zaire, 1994; DRC 1999-2000; Southern Sudan 1998; Kosovo, 1999; Ethiopia, 2000; and Afghanistan, 2001-3.

The main conclusion of the paper were that 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- Sahran 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 assert that key policy issues remain - in particular the ad hoc designation of lead agencies for coordinating non-refugee humanitarian activities and the lack of capacity of these agencies to deal with the burden. There are also still major challenges in ensuring adoption and implementation of minimum standards of response in spite of the Sphere project.

In order to improve outcomes, the authors argue that the skills of health and nutrition professionals working in complex emergencies need to be broadened and reinforced. Also, focus on the requirenutrition systems needs to increase so that the skills of relief workers match the needs of major emergencies. Most of all, if gains in health and nutrition during emergencies are to be sustained, graduates need to understand the importance of capacity building of national staff and institutions.

¹Salama P, et al (2004): Lessons learned from complex emergencies over the past decade. The LANCET, vol 364, Nov 13th, pp 1801-1813.