1

The Physical Therapists’ Role in Humanitarian

Crises

Neena S. Jain MD MSTPH DTM&H

Tamara Struessel

PT, DPT, OCS, MTC

£ No conflicts of interest to disclose

£ Note: These materials are the property of emBOLDen Alliances and cannot be reproduced without permission.

2

£ Assisting vulnerable, populations worldwide

£ To achieve their own visions

£ And, build resilience WITH communities

£ Then, we step back.

On the Ground Experience

3

4

Session Objectives £ Describe international humanitarian

architecture including key organizations and standards.

£ Critically analyze inter-sectoral humanitarian responses from recent international crises.

£ Examine the role of Physical Therapists across sectors.

5

£ “Humanitarian assistance is generally accepted to mean the aid and action designed to save lives, alleviate suffering and maintain and protect human dignity during and in the aftermath of man-made crises and natural disasters, as well as to prevent and strengthen preparedness for the occurrence of such situations.”

£  Source: Good Humanitarian Donorship

What is humanitarian assistance?

What is a complex humanitarian emergency?

£ “ A complex emergency is a humanitarian crisis in a country, region, or society where there is a dramatic disruption in the political, economic, and social situation, resulting from internal or external conflict or natural disaster, seriously disrupting the population’s capacity to survive and the national authorities’ capacity to respond, and which requires a consolidated multi-sectoral international response.”

IASC (Inter-Agency Standing Committee) of the United Nations

6

£ “Complex emergencies” typically characterized by:   £ extensive violence and loss of life; massive

displacements of people; widespread damage to societies and economies

£ the need for large-scale, multi-faceted humanitarian assistance  

£ the hindrance or prevention of humanitarian assistance by political and military constraints  

£ significant security risks for humanitarian relief workers in some areas

Or, by inter-relationships of Key Factors

7

UNICEF definition of a CHE

£ UNICEF distinguishes three main types of emergencies; £ sudden disaster emergencies £ slow onset emergencies £ complex, conflict-related emergencies. £ The nature and duration of the problems and

approaches vary although there are also common features.

Level 3 Emergencies

Scale Complexity Urgency Capacity Reputational Risk

Exceptional in:

•  The IASC will meet within 48 hours of a

sudden-onset emergency to determine whether it is a Level 3 emergency or not.

8

Level 3 Emergencies •  How many Level 3 Emergencies

are currently going on? •  Four: •  Iraq •  Syria •  Yemen

•  What country was most recently

added to list? •  Yemen

What is a disaster?

£ “ An occurrence, either natural or man-made, that causes human suffering and creates human needs that victims cannot alleviate without assistance.”

---Skolnik, 2008

9

£ Categorize complex emergencies and natural disasters according to certain variables, like loss of life, injury, etc.

£ Think about what you expect to find in the blank boxes to describe the variable according to that situation.

£ Use “High,” “Common,” “Few,” “Variable”

Sphere Handbook

10

11

12

How long does an “emergency” last?

£  Response phase (immediate) £ Within 1 week

£ Lasts 1-2 months

£  Rehabilitation phase (short-term)

£ Within 1-2 months

£ Lasts 6 months £  Development or Reconstruction phase (long term)

£ Within months/years

£ Lasts years

£  Resiliency into Development

Direct Services Mentoring/training Education/training Support/supervision

The Disaster Cycle

Economic Recovery

Reconstruction

Quiescence

Pre-Impact Activity Emergency

Relief

Community Stabilization

Life Saving Developed by Paul Rebman and Brandon Pustejovsky, World Relief

13

The Disaster Continuum

The Humanitarian/Development Nexus

14

More information?

Inter-Cluster Coordination

15

16

£ Key Things to Remember £ Crisis response is ongoing £ Different sectors and specific locations

may be different places in the cycle at the same point in time.

£ Length of cycle depends largely upon severity of disaster.

Affected populations £ The UN refugee agency reported

£ Number of refugees, asylum-seekers and internally displaced people worldwide = 65.3 million at end of 2015.

£ 2014: total number displaced was 59.5 million.

According to the report, an average of 24 people were forced to flee their homes each minute in 2015. UNHCR Global Trends Report 2016

17

Affected populations

£ Refugee £ A person owing to well-founded fear of being

persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable, or owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.

£ Source: 1951 Convention Relating to the Status of Refugees

18

£  Internally Displaced Person (IDP) £ '' Internally displaced persons are persons

or groups of persons who have been forced or obliged to flee or leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized state border''.

£ Source: Guiding Principles on Internal Displacement

Indirect and Direct Effects

£ When we think of crises, we often measure the deaths occurring only during the Emergency Phase and those that may be only directly related to the incident.

£ Data on the effects of war in the Democratic Republic of Congo. £ Overall, ~6 million people died. £ Only 10% directly related to violence. £ Majority are due to preventable causes!

19

Key Humanitarian Principles

£  What marks out Humanitarian Assistance from other forms of aid and foreign assistance:

£ Humanity – saving human lives and alleviating suffering wherever it is found

£  Impartiality – acting solely on the basis of need, without discrimination between or within affected populations

£ Neutrality – acting without favoring any side in an armed conflict or other dispute where such action is carried out

£  Independence – the autonomy of humanitarian objectives from the political, economic, military or other objectives that any actor may hold with regard to areas where humanitarian action is being implemented.

20

£ Thus, the art and the science of Humanitarian Assistance.

£ In the midst of COMPLEXITY, we must act to save lives, reduce suffering, preserve dignity, and prevent/strengthen against any future crises.

21

22

History of the new Core Humanitarian Standards

£  “Bringing greater coherence to standards”

£  A move towards greater coherence began in 2006 £  Build links between the 2010 HAP Standard, People In Aid’s Code of

Good Practice and the Sphere Project’s Core Standards. £  The need for greater coherence in humanitarian standards became

even more important as the disasters in Haiti and Pakistan highlighted once again the gaps between the aid that was needed and that which was provided, and illustrated the need for greater effectiveness, impact, accountability and quality in humanitarian action.

23

£  Building on Sphere, the WHS could be seen as the next wave of humanitarian reform. It was an initiative of the United Nations Secretary-General.

£  The three main goals of the summit were:

1. “Reaffirm our commitment to humanity and humanitarian principles.” 2. “Initiate actions and commitments which enable countries and communities to prepare for and respond to crises and be more resilient to shocks.” 3. “Share best practices which help save lives around the world, placing affected people at the centre of humanitarian action and alleviating suffering.”

Source: http://www.unocha.org/about-us/world-humanitarian-summit

World Humanitarian Summit May 23-24, 2016

24

£  “The number of people affected by humanitarian crises has almost doubled over the past decade, and is expected to keep rising.

£  “The last global discussion on humanitarian action took place almost

25 years ago. Since then, the humanitarian landscape has changed tremendously. £  Global economic shifts £  Demographic changes £  Urbanization £  Technology £  Climate change £  Population growth

£  Source: worldhumanitariansummit.org

Why now?

The Global Humanitarian Architecture

25

Coordination Structure

£ The Inter-Agency Standing Committee (IASC): Primary mechanism for inter-agency coordination, UN and non-UN.

£ The IASC established in June 1992, on UN General Assembly Resolution for strengthening of humanitarian assistance.

Local and National agencies/communities are the first responders

(particularly true in natural disasters)

Time

Disa

ster

nee

ds a

nd c

apac

ities

in A

ceh

International civilInternational militaryNational militaryNational civilNeeds

Note: capacities are cumulative

Tsunami Evaluation Coalition, 2007, Joint evaluation of the international response to the Indian Ocean tsunami

26

Clusters

Aims to: £  Identify and address gaps £  Strengthen humanitarian partnerships £  Collective planning, pooled funding, joint

implementation and joint reviews £  Ensure predictability and accountability

The Cluster Approach

27

£ All clusters have lead organizations, known as Cluster Lead Agencies, which operate at the global and country level.

£ Globally, Cluster Leads are responsible for strengthening system-wide preparedness and coordinating technical capacity to respond to humanitarian emergencies in their respective sector.

The Cluster Approach

The Cluster Approach

£ Decisions on how many clusters are required in-country and which organization is best placed to lead each of them based on specific needs identified in response plan.

£ The goal = clarify the division of labor among all organizations and better define roles and responsibilities of organizations in each sector.

28

PT in the Cluster system Injury and Rehabilitation Sub-Cluster (IRSC) • Not considered part of health cluster prior to Nepal 2015 earthquake

• Instrumental in rapid mapping of injury “need” and rehabilitation services in Nepal (2015) with ongoing communication throughout the crisis

• Mike Landry PT, PhD (Duke University) heavily involved in IRSC efforts

Landry, 2016, PTJ

From Johns Hopkins School of Public Health

29

Inter-Cluster Coordination

Sendai, Japan Framework for Action for PTs, 2015

£ Mechanism of case registry [e.g., for those injured] to be established

£ Provision of psychosocial support and mental health services for all people in need

£ National and local training of the workforce in disaster response

30

31

Self-Reflection

£ Do I have the professional qualities to enter a hardship zone?

£ Am I healthy and physically fit enough to cope?

£ Am I able to make decisions under high stress, and with incomplete information?

£ Do I have the personal qualities to enter a hardship zone? £ Potentially unstable environments and high stress? £ Less than ideal accommodation? Housing, water/food, electricity £ Can I financially support myself for the period of the commission?

£ Are you prepared to accept societies who have different priorities and values than your own?

(adapted from WCPT website and Mahmood 2006)

More information

32

£ Neena S. Jain, MD MSTPH DTM&H £ emBOLDen Alliances £ info@emboldenalliances.org

£ Tamara Struessel, PT, DPT, OCS, MTC £ University of Colorado Physical Therapy Program £ Tami.Struessel@ucdenver.edu

More information

33

Resources (web-based) £ APTA.org £ APTA Health Policy Administration (HPA)

Section Global Health SIG

£ World Confederation for Physical Therapy Disaster Management

References: £ Burns A, O’Connell C, Landry M. Spinal Cord Injury in Post-earthquake Haiti: Lessons Learned and Future Needs. PM & R. 2010. £  Irshad H, Mumtaz Z, Levay A. Long-term gendered consequences of permanent disabilities caused by the 2005 Pakistan earthquake. Disasters. 2012.  £ Klappa S, Audette J, Do S. The roles, barriers and experiences of rehabilitation therapists in disaster relief: post-earthquake Haiti 2010. Disability and Rehabilitation. 2013. £ Landry M. Disability as an Emerging Public Health Crisis in Post-earthquake Nepal. American Journal of Public Health. 2015. £  Landry M, Quigley A, Nakhle A, Nixon S. Implications of a Gap between Demand and Supply for Rehabilitation in Post-Earthquake Haiti Physiother. Res. Int. 2010. £  Landry M. Physical Therapists in Post-Earthquake Haiti: Seeking a Balance Between Humanitarian Service and Research. Phys Ther J. 2010. £  Landry M, Sheppard P, Leung K, Retis C, Salvador E, Raman S. The 2015 Nepal Earthquake(s): Lessons Learned From the Disability and Rehabilitation Sector’s Preparation for, and Response to, Natural Disasters. Phys Ther J. 2016. £  Landry M. Spinal cord injury rehabilitation in post-earthquake Haiti: the critical role for non-governmental organisations . Physiotherapy 2010. £  Nixon S, Cleaver S, Stevens M, Hard J, Landry M. The Role of Physical Therapists in Natural Disasters: What Can We Learn from the Earthquake in Haiti? Physiotherapy Canada. 2010. £  Tepper D. Making the Most of International Volunteer and Learning Opportunities. PT in Motion. 2016.