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![Page 1: 1 From Disasters to Development Pierre Perrin, MD, MPH Chief Medical Officer International Committee of the Red Cross.](https://reader035.fdocuments.net/reader035/viewer/2022062618/551501c055034693478b658a/html5/thumbnails/1.jpg)
1
From Disasters
to Development
Pierre Perrin, MD, MPH
Chief Medical Officer
International Committee of the Red Cross
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2
Section A
Disasters and Development
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Disasters and Development
Let us define two concepts
1. What is a disaster?
2. What is development?
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4Continued
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Disaster
A disaster is a disruption in the normal pattern of life generating . . .
– Suffering
– Socioeconomic breakdown
– Modification of the environment
– To such an extent that there is a need for assistance (PAHO)
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Armed Conflicts Do NotOccur Unexpectedly
Behind the immediate factors that trigger conflicts, analysis reveals deeper causes, such as . . .
– Territorial demands
– Socioeconomic inequalities
– Economic interests
– The defense of political ideologies
Continued
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Armed Conflicts Do NotOccur Unexpectedly
Behind the immediate factors that trigger conflicts, analysis reveals deeper causes, such as . . .
– Burgeoning nationalism
– The struggles of ethnic minorities
– Racism and arms proliferation
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Understanding Disasters
We want to understand
– What causes a disaster
– What the impact will be
To do this, we need to define a frame that shows the functioning of a society
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Development
The interaction between the three systems can be called development when changes in any of them contribute to a better overall equilibrium
Continued
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Development
Development is a comprehensive economic, social, and political process . . .
– That aims at the constant improvement of the well-being of the population and all individuals
– On the basis of their active, free, and meaningful participation in development
Continued
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Development
Development is a comprehensive economic, social, and political process . . .
– And in the fair distribution of benefits resulting therefrom
– (UN Gen. Assembly, The Right to Development, 1986)
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Reality of Development
The reality is often far from the ideal view of a society
Dysfunction of society leads to inequalities among the people
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Vulnerabilities
Vulnerabilities—the weak points of a society
There are different levels
– Ecological
– Economic
– Social
– Human
– Political
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Vulnerabilities are Linked
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Effect of Vulnerability
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Aim ofHumanitarian Response
For humanitarian organizations, the link between emergencies and development is clearly the reduction of vulnerabilities
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Rural PopulationsStricken by Drought
Vulnerabilities
– Economic
– Environmental
– Social
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Environmental Vulnerabilities
Environmental measures
– Improve water storage ystem
– Reduce erosion
– Reforest
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Environmental Vulnerabilities
Economic measures
– Diversify the means of subsistence
– Institute cooperatives
– Improve methods of raising livestock
– Encourage saving
– Develop markets
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Social Vulnerabilities
Social measures
– Develop local aid organizations
– Respect traditional mechanisms of mutual aid
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From Relief to Development
It is essential to analyze vulnerabilities exposed by a disaster
People have to define the systems (political, economic, socio-cultural) that they want to build after the disaster so that they will be less vulnerable to future disasters
Continued
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From Relief to Development
When planning relief activities, always define
long term objectives aimed at restoring the
systems as defined by the people
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Section A
Health, Ethics, Law, and Policies in Armed Conflict
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Main Causes of Armed Conflicts
Fight for territories
Scarcity of resources
Competition for natural resources
Religious antagonism
Ethnic discrimination
Ideological struggle
Bad governance
Arms availability
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Civilians in Armed Conflicts
Civilians are victims of armed conflicts
In some cases, the objective of the war is the elimination of populations
– Ethnic cleansing, genocide In other situations, uncontrolled armed groups
make their living by exploiting populations
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Health Impact of ArmedConflicts
On Populations
Malnutrition
High morbidity
High mortality
Continued
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Health Impact of ArmedConflicts
On Populations
Malnutrition
High morbidity
High mortality
Continued
On Health System
Disruption of health services
Destruction of health
structures
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Health Impact of ArmedConflicts
On Populations
Malnutrition
High morbidity
High mortality
On Health System
Disruption of health services
Destruction of health
structures
No access to
health care
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Assistance and Protection
At times, protection is assistance and vice
versa The ICRC provides protection
ICRC prison visits
– Correct torture and mistreatment
– Distribute goods and medical services
Source: David Forsythe, Choices More Ethical than Legal: The ICRC and Human Rights Ethics and International Affairs (1992)
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Ethical Decisions
Choices must be made on a strong ethical
basis
Continued
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Ethical Decisions
A good ethical decision tends to . . .
– Maximize all interests
– Minimize negative side effects
– Respect the values of victims, societies,
and institutions
Source: P. Lesage-Jarjoura, Nouveaux défis Professionnels pour le médecin des années 2000. Collège des médecins du Québec, 1998.
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Ethical Framework
Let us have a look at some issues involved in making a difficult decision in the field
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Respect for the Valuesof Beneficiaries
“Stripped of reality, the identity of these
beneficiairies—being the ‘objects’ of
humanitarian action—undergoes a culturalist
levelling. At worst, the beliefs, practices, and
values of these victims no longer have any
importance.”
Source: Bernard Hours, L’idéologie humanitaire anthropophage de l’humanité, Journal des anthropologues, 77–78, 1999.
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The International HumanitarianLaw (IHL)
“The existence of a large body of International Humanitarian Law and Human Rights Law is an important part of the moral landscape in which relief agencies make their moral decisions.
These international legal instruments often spell out what is right and wrong under law. In their decision making, relief agencies should be increasingly familiar with this body of law and be able to refer to relevant sections of it appropriately and abide by, wherever possible.”
Continued
Source: Hugo Slim. Doing the Right Thing: Relief agencies, moral dilemmas, and moral responsibility in political emergencies and war report, no. 6.
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The International HumanitarianLaw (IHL)
The main rules of the IHL are contained in the following:
– The Geneva Convention of 1949
– The Additional Protocols to the Geneva Convention of 1977
– The Law of War
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The Human Rights Law
International instruments of the Human Rights Law
– The Universal Declaration of Human Rights (1948)
– The International Covenant on Economic, Social, and Cultural Rights (1966)
Continued
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The Human Rights Law
International instruments of the Human Rights Law
– The International Covenant on Civil and Political Rights (1966)
– The Convention relating to the Status of Refugees (1951)
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Codes in Armed Conflicts
Examples of codes relevant in armed conflicts
– The code of conduct for International Red Cross and Red Crescent Movement and Non-Governmental Organizations in Disaster Relief
Continued
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Codes in Armed Conflicts
Examples of codes relevant in armed
conflicts
– People in Aid
– Sphere project
– RC/RC Principles
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Professional Codesand Resolutions
The Declarations of the World Medical Association
– The Helsinki Declaration (1964) related to bioethics and biomedical research
– The Statement on medical ethics in the event of disasters (Stockholm, 1994)
The Resolutions of the International Council of Nurses
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Mandate and Statutes ofHumanitarian Organizations
Know the mandate and strategies of action of different humanitarian organizations to understand their complementarity
Continued
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Mandate and Statutes ofHumanitarian Organizations
For example, the principle of confidentiality
espoused by the ICRC should not be placed
in opposition to the principles of denunciation
adopted by other human rights agencies
The two approaches are complementary, and
both are necessary
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Decision Making
Quality assurance is a tool for improving the
quality of the decision-making process
– Therefore, to prepare health care workers to make ethical decisions
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Ethics and Researchin an Emergency
An Evidence-Based Approach (EBA) may lead to research
Continued
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Ethics and Researchin an Emergency
Ethical considerations
– Risk-benefit
– Informed consent
– Confidentiality
Source: Adapted from J. Ovretveit.
Evaluating Health Treatments Services
and Policies. he Nordic School of Public Health, Goteborg.
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Summary
The bases for ethical decisions are as follows:
– Learning from experiences
– Respecting the values of people
– Adhering to fundamental principles of action
– Looking critically at codes, norms, etc.
– Looking at choices systematically
– Justifying options rationally