Hnmun 2011 Who Study Guide

8/6/2019 Hnmun 2011 Who Study Guide

1/681Harvard National Model United Nations 2011

Dear Delegates,

It is with great excitement that I welcome you to Harvard National Model United Nations 2011! My name is Ricky Hanzich,and I am humbled by the opportunity to serve as your Secretary-General for the 57th Session of HNMUN. I am currently a senior at Harvard University, concentrating in Government with a secondary eld in Global Health and Health Policy anda language citation in Spanish. Last year, I had the privilege of serving as the Under-Secretary-General for the Specialize

Agencies. And during HNMUN 2009, I directed the United Nations Security Council. From being a page for an MUNconference in Southern California, to Chairing the Security Council at WorldMUN 2010 in Taipei, I have committed myself to exploring international relations and diplomacy through experiential education for over eight years. HNMUN 2011 will bemy thirtieth MUN conference, and I am honored to share this incredible experience with all of you.

This document will provide you with Welcome Letters from your Under-Secretary-General and your Director, the Study Guide for your committee, and the Rules of Parliamentary Procedure. The entire Secretariat and Senior Staff have committedcountless hours to ensure that the substance and presentation of this document are of the highest quality, and that you areprovided with the most useful tools to succeed at conference. Each Director has worked over the past eight months to provideyou with the foundation necessary to continue your own exploration of the topic areas. We look forward to working with youto continue HNMUNs tradition of substantive excellence.

Apart from this document, you will also be able to access a number of additional documents that will aid in your preparationsfor conference. Our Guide to Delegate Preparation reviews the substantive side of HNMUN, highlights differences betweenour session and other MUN conferences, and explains our policies on substantive matters, such as the award selection processand position papers. It also includes our updated Rules of Parliamentary Procedure , which are also found at the end of thisdocument. Our Guide to First Time Delegations provides information regarding substantive and logistical issues for thosenew to HNMUN, and includes a timeline for delegate preparation. And the Guide to Starting an MUN Team outlines thesteps necessary to establish and expand a universitys MUN organization. Finally, Update Papers to committee Study Guides

will be posted in mid-November to provide further exploration and/or recent news developments concerning the topic areas.

If you have any questions about this document, the other Guides, or your committee in general, please do not hesitate to contactyour Director or your Under-Secretary-General. They are truly excited to meet you all and are eager to address any concernsyou may have before, during, or after the conference. I hope you enjoy reading the following Study Guide, and I cannot waitto see your solutions come February!

Sincerely,

Ricky J. HanzichSecretary-GeneralHarvard National Model United Nations 2011



G eneral a ssembly

Dear Delegates,

Welcome to the General Assembly at Harvard National Model United Nations 2011! My name is Dominik Nieszporowskiand I have the honour to serve as your Under-Secretary-General in the largest and most exciting organ at the conference. Tobrie y introduce myself, I am a junior at Harvard concentrating in Applied Mathematics and Economics. Originally from

Warsaw, Poland, I have participated in MUN for more than 7 years now, having attended several conferences in Europe, North America and Asia. Even though my primary areas of interest are focused on business and nance, I have always thoroughlyenjoyed the opportunity to discuss major world issues with people from other countries that MUN offers. My other passionsinclude international development and public service I have been particularly involved with programs creating educational

opportunities for children in Africa. Sports also play an important role in my life having been brought up as a big ChelseaLondon supporter, and having tried almost all major disciplines from rowing to fencing, I settled on regularly practicing tennisand swimming.

Besides me, the General Assembly is formed by an incredibly motivated and knowledgeable team of Directors and AssistantDirectors, who have worked with tremendous dedication to design the seven largest committees at HNMUN 2011. In additionto the four standing committees of the General Assembly the Disarmament and International Security Committee, theSpecial Political and Decolonization Committee, the Social, Humanitarian and Cultural Committee and the Legal Committeethe conference will also feature three more specialized bodies: the World Health Organization, the World Trade Organizationand the Historical General Assembly of 1991. I hope that the broad range of topics offered will provide you with a chance toengage with issues that fall within your areas of genuine interest.

The delegate experience in the General Assembly is truly unmatched it is precisely here that you can nd the true spirit of MUN. Delegates in the GA really get into the issues and actively interact with each other, and the resolutions inevitably re ectboth their preparation and their commitment to the principles of international cooperation. MUN is about creating a realsimulation of the world, encouraging ourselves to struggle unabashedly with problems beyond our local scope, and workingtogether with compromise, cooperation, and consensus for the betterment of all. I am con dent that you will be able to ndthis in your experience in the GA, and I promise to work tirelessly to ful ll your expectations. In that respect, please do nothesitate to contact me with any questions, concerns or suggestions regarding any committee of the General Assembly; I willmake sure to assist you to the best of my ability.

Let me nish with some wise words by one of the most inspiring statesmen of all times, Sir Winston Churchill: Attitude is alittle thing that makes a big difference. In the General Assembly, we do have the right attitude and we will make a difference.

I am looking forward to seeing you in Boston in February.Sincerely,

Dominik P. H. Nieszporowsk234 Kirkland House Mail CenterCambridge, MA [email protected]



World Health Organization

W orld H ealtH

o rGanization

Topic Area A: Fighting Disease Following Natural DisastersTopic Area B: Ethics in Drug Research and Development

Dear Delegates,

My name is Billy Gorman, your committees director, and Im thrilled to welcome you to what will most de nitely become the

most exciting committee of HNMUN 2011, the World Health Organization!

I am currently a sophomore at Harvard, residing in the fabulous Kirkland House, and I can surely say my short time here hasbeen a whirlwind. Growing up in the ever-so-distant Whitman, MA, I am forced to travel an eternal 35 minutes wheneverI make the trek back home. Despite essentially attending school in my backyard, I can honestly say that I have learned moreabout myself and the world during my brief stay here than I ever have before. Ill likely be concentrating in government andearning a citation in Spanish, which I can hopefully use to pursue a career that focuses on international development. Collegehas been my rst experience with Model UN, though Ive de nitely made up for lost time, staf ng both HNMUN and our highschool conference, HMUN, as well as traveling with our own team, ICMUN. Outside Model UN, my hobbies include running,following the greatest team on Earth, the Red Sox, and studying marine biology.

Im thrilled to be directing the World Health Organization, as it truly presents an amazing opportunity for me, as well as you.

As a lover of history and social science, I really want to evolve the discussion of this committee to more than simply talks of medicine and disease control. As much as we can drill into societys ears the dangers of H1N1, bird u, or terrorism, we mustaccept that our globe is a fast paced, chaotic mess that we cant entirely control. Accepting our subordinate position, it is ourduty to prepare ourselves for the worst. What if natural disaster strikes? How do we cope? And as we try to keep pace withthe speed of our planet, how do we best ensure the rights and liberties of all Earths people, without sacri cing our abilities tomaintain our development pace? Despite the efforts of great men and women in the past, these questions remain unanswered.I look forward to discovering if we can outdo our predecessors and really make some headway on these topics.

If you have any questions leading up to conference, please dont hesitate to ask. Im already counting down the days and weeksuntil conference, and I hope you will become as excited as me for what will certainly turn out to be the best committee of the

weekend.

Sincerely,

William Gorman William Gorman298 Kirkland House Mail CenterCambridge, MA 02138

[email protected]


4/684


General Assembly

INTRODUCTION

The World Health Organization is one of the mostimportant international bodies in existence, with its history stemming back to the League of Nations - formed following

World War I. Working alongside the United Nations, the WHO is responsible for addressing all the pertinent issuesregarding health and medicine in todays global affairs. With193 member-states, the WHO is a vital organization to every country in the world, and its actions affect all corners of theglobe.

At HNMUN 2011, the World Health Organization willdiscuss two topics that are steadily gaining coverage andsigni cance in global affairs. The rst is something seen onthe news unfortunately far too often. When natural disastersstrike, they understandably leave widespread devastation in allfacets of a community. Though safety is certainly a concernduring the immediate disaster, perhaps equally importantis the health and well being of the survivors of a disaster.

When the human body is stressed, as it may be during acrisis, it is most susceptible to the dangers of disease. How exactly can illness, both infectious and chronic, be mediatedin times of chaos? It is not purely a domestic issue, and allnations need to come to a consensus on how to minimizethe pain that has already begun following such tragedies.

Additionally, though studied and critiqued for years, issuesregarding human research ethics remain major concerns formany. Ethics regarding both research design and the rightsand responsibilities of researchers and participants havecome into question, and it is time that the globe sits down

once again to address them. When researchers cross borders,must they provide the best care they possibly can? If not, willrestrictions prevent researchers from fully performing theirduties, forcing them to act as health care providers instead of

what they really are scientists? As delegates, it is your duty to engage in these topics

and work with one another to discover an amicable solution.Solving either issue is not easy, but with diligence, cooperation,and will, resolutions can be attained.

HISTORY OF THE COMMITTEE

The World Health Organizations roots stretch back tothe early twentieth century. In 1922, the League of Nations,predecessor to the United Nations, created the League of Nations Health Committee and Health Section, in hopes of accomplishing the Leagues goal of controlling and preventing disease.1 During its existence, the Health Committee workedto battle diseases such as malaria, typhus, leprosy, and yellow fever. Ultimately, however, the League of Nations, along withits Health Organization, had fully disbanded and folded by 1946, following the end of World War II.

Founded on 24 October 1945, the United Nations was established as the premier international relations bodyinheriting many of the responsibilities, goals, and ambitions ofthe League of Nations. In particular, the United Nations agreedto combat the issues of world health. Thus, on 7 April 1948the charter to the World Health Organization was of ciallyestablished. In June of that year, 53 of the original 55 member

states met for the rst time, discussing many issues that stillsurface today, including, malaria, women and childrens healthtuberculosis, venereal disease, nutrition, and environmentalsanitation2. According to its original constitution, the

WHOs focus is to work alongside the UN to combat disease,as well as providing active assistance when called upon. Morbroadly, however, it also works to make recommendationson health procedures, encourage international cooperationbetween states, to establish international standards and labelsfor diseases, pharmaceuticals, food, and biological products.

The Health Assembly, consisting of all 193-member statemeets annually to discuss pertinent health issues of the day.

The Health Assembly of the WHO is an incrediblyin uential body in the UN. In addition to meeting annually,it holds the power to convene whenever necessary to discusstopics pertinent to the organizations scope. Requiring two-thirds majority for any agreement, anything passed directlyaffects all states. Any regulations established are requirementsfor all member nations.4 The WHO exists under Article 57 of the United Nations Charter as a specialized agency of the UN,making it work closely with the other General Assemblies, asboth have the ability to make recomamendations and presentsigni cant information to one another. The United Nationsalso possesses the ability to request periodic reports fromthe WHO, and like all specialized agencies, the WHO has anestablished agreement outlining their speci c relationship, asoutlined in Article 63 of the UN Charter. 6 With such a broadscope and strength, the WHO has not only the respect of itsmember nations but also the responsibility for ensuring thehealth and safety of all the citizens it works to protect.

Since its creation, the WHO has been instrumental inmany of the medical breakthroughs witnessed in the past halfcentury. Accomplishing one of its early objectives, in 1948the International Classi cation of Diseases was completedestablishing international standards across the globe. In 1979the WHO was instrumental in the eradication of smallpoxOther diseases such as polio are well on their way to similarlybeing tamed, much to the organizations credit. 7 In morerecent years, the WHO has worked in controlling epidemicssuch as SARS and H1N1 and has been a leader in HIV/AIDS,tuberculosis and malaria research and development. Today

The WHO celebrates the anniversary of its founding, 7 April,as World Health Day and continues to lead in research andadvancement in issues of global health.




TOPIC A: FIGHTING DISEASEFOLLOWING NATURAL DISASTERS.

H istory and d iscussion of tHe P roblem

What Constitutes a Natural DisasterNatural disasters differ primarily from man-made disasters

in that they are not directly caused by mankinds actions.Some of the most common natural disasters are avalanches,earthquakes, oods, hurricanes, lightning, tornados, tsunamis,

volcanic eruptions, and wild res.8 Manmade disasters, whether they are plane crashes, oil spills, or wars, share many of the same problems and concerns as natural disasters, andpreparing for one can simultaneously prepare for the other.Many of these disasters are expected well in advance. Withtodays technology, for example, forecasters can make accuratepredictions regarding a hurricanes landfall 24 hours beforeit hits land.9 Others are more complicated. Earthquakes, for

instance, can provide some clues when scientists analyzeseismic activity, but it technology is still too primitive forgeologists to accurately predict their locations or severities.10

The events themselves can cause great harm due to injury ortrauma, but disease is also a concern for disaster management

The US Center for Disease Control and Prevention listsinsects, carbon monoxide, environmental concerns, food and

water, hygiene, wounds, mental health, and infectious diseaseas risks to illness after a disaster.11

The Beginning of an EpidemicDisease and disaster have naturally been frustrating

mankind for years, but only in the modern era of civilizationhas disaster brought forth the epidemics we fear today. Germsand bacteria have always infected humans, with or withoutdisaster, but it was not until humans established large, denselypopulated settlements that disease became able to spreadrapidly. Cholera, for example, has been known to exist sincethe days of Hippocrates, but the rst epidemics were notrecorded until much more recently, in the 19 th century.12

One early epidemic is the bubonic plague, morecommonly known as the Black Plague or Black Death

Though outbreaks occurred throughout Europe as early as588 AD, it was not until the 15 th and 16th centuries that theplague became pandemic.13 Transmitted by rats, the plague

Two young girls attempt to protect themselves from SARS with face masks. An outbreak in China killed nearly 1000 people, proving that despitetodays increased heathcare capabilities, infectious disease is still a signi cant threat to modern, highly urbanized areas of the world..


6/686


General Assembly

affected developed countries like England, where people livedin close proximity to one another. Not surprisingly, England

was also dealing with severe famine, poverty, and the hardshipof war, and these added hardships may have been, for many people, additional risk factors for increased susceptibility to disease.14 Unfortunately, as medicine was nowhere nearadvanced enough to deal with the plague at the time, there

was little to be done as far as tackling the disease. Nations did,however, begin to quarantine and segregate their populations

during outbreaks, taking lessons learned from leprosy casesand though certainly not stopping the disease, governmentsdid signi cantly slow it down. 15

When People Begin to MoveUpon the discovery of the New World, Europeans began

to interact with North American natives for the rst time,and this meeting brought new diseases to both populations.Following one of Christopher Columbuss early trips to theNew World in the late fteenth century, a new disease, the

The Black Death rapidly spread across Europe in the fourteenth century, revealing the strength and spreading potential of infectious diseases.




French Pox- later to be known as syphilis- surfaced in Italy and quickly spread throughout Europe. 16 Though this case didnot result from a disaster of any kind, it did reveal the dangersthat surface when populations move to places that they havenot been in contact with before. Known as the Virgin SoilEpidemic, these cases can be devastating, because the nativepopulation has built no immunity to the disease, making them

much more susceptible to transmission.17

This has occurredmore recently as well. In the 1940s and 1950s, there wereseveral cases of workers in malaria-infested areas that traveledto malaria-free zones and brought the disease to the sitting communities.18 In todays society, the chance of a Virgin SoilEpidemic is certainly diminished. Despite a 6% decrease inyearly rates, the World Trade Organization (WTO) estimatedthat there were approximately 880 million tourist arrivalsin 2009.19 That being said, with more people visiting moreplaces, the chances that individuals encounter diseases thattheir bodies have not built immunity for has increased.

The Spread of DiseaseIn everyday life, the threat of death from infectious disease

has certainly decreased since the times of the plague but thathas not necessarily eliminated the dangers of them. In lessindustrialized nations, infectious disease is still responsiblefor as much as 70% of ill health, whereas the average rateis only 10% in industrialized nations.20 Even in industrializedcountries, however, there is still a major threat of diseasedue to its ability to spread. In todays global world, peoplemove between nations at a much greater rate than ever before,increasing the risk of disease passing from one populationto another. In the 1990s, the World Tourism Organization

estimated that over 500 million y over international borderseach year, while 70 million work in a country that is not theirown.21 Thus, when outbreaks do occur, the ability to identify and quarantine the ill becomes imperative.

Currently, the internationally quarantinable diseases arecholera, yellow fever, the plague, and smallpox22 (though the

world has been declared free of the disease). Many nationsdo quarantine for other diseases, however. In the UnitedStates, for instance, following a global outbreak of Severe

Acute Respiratory Syndrome (SARS), President George W.Bush added the disease to the nations list of QuarantinableCommunicable Diseases.23 The WHO and other nations

followed similar actions, and though over 8000 were infectedand over 800 died from the disease, SARS was contained anda prolonged epidemic was averted.24

One of the lessons learned from the SARS case was thatthe world needs to better manage disease control to preventan epidemic from the very beginning, because it can spreadrapidly within the rst few cases. SARS was originally reportedin two provinces in China as severe in uenza cases, withover 100 cases of an atypical pneumonia that withstoodantibiotics. Despite initial efforts, the disease was allowed to

spread. It was not until 14 March, one month after the initialreports in China, that the WHO released a travel advisoryand categorized the disease as SARS.25 The travel warningproved ineffective, however, and it was then recommendedthat travelers coming from infected regions be screened atairports, though ultimately a travel ban was nally enacted.2

Many believe that the world was lucky to have weathered

the SARS outbreak, because it was spread through dropletsand not through the air like in uenza, and the disease neverreached the least developed countries- where its impact couldnot be measured. 27 SARS revealed glaring weaknesses in oudetection capabilities and early quarantine policies.

Disasters that Foster Disease Apart from a disaster itself, many of the most dif cult

tasks with dealing with a natural disaster are managing the manyhealth risks that a disaster can cause. Perhaps the most directlink between a disaster and disease is drought. As it standstoday, there are already many problems with providing clean

water to populations, as over 1.2 billion people live withoutsafe water.28 Naturally, this increases the risk for malnutritiona precursor to many other diseases. For instance, in the

Western United States, a 1930s drought caused malnutritionto develop in many children, typhoid fever quickly surfacedamong several other diseases.29 Also devastating is the damagethat can be done to crops. Though the problem was not

water but bacteria in this case, the Ireland Potato Famine inthe 1840s was responsible for over 1 million deaths and 2million emigrants that left their home country. In countriesthat rely heavily on their own crops, a drought can cut off their nutritional supply and allow the entire populations heath

to deteriorate.Earthquakes are similarly notorious for their ability to sapresources and foster disease. Like droughts, earthquakes arecapable of cutting off water and food supply. Additionallyearthquakes bring immediate destruction that can send acommunity into chaos. In a 1995 earthquake in Kobe, Japan,heavy damage was in icted upon the city, and it took monthsfor the population to even begin to recover. Over 800,000homes lost gas for two and one half months, and water andsanitation systems were inoperable in 1.27 million homes forup to four months. 30 Even worse, an earthquake can easilyhamper relief efforts. If an earthquake destroys local hospitals

and health care facilities, it may be impossible to quarantineand cure those who succumb to disease. In a denselypopulated area, the chance for an epidemic rises greatly. Withthe unsafe water and unpredictability of heath care accessdisease management is vital in the case of an earthquake.

Hurricanes introduce added health risks due to thecombination of destruction due to strong winds and oodsthat remain after the storm. One concern with hurricanes isthe aring of mosquito-spread diseases such as West Nile

virus, malaria, and eastern equine encephalitis (EEE). The


8/688


General Assembly

particular diseases that one can catch vary depending on theactual location of the disaster, but since mosquitoes ourishin standing water, they can easily cause problems in a disasterzone.31 Additionally, the oods cause the water supplies tobecome contaminated, increasing risks of diarrhea and E.Coli infections.32 Like earthquakes, communities can suddenly lose their functionality, and without proper recovery plans,

disease can cripple a population in any number of manners.Similarly to hurricanes, tsunamis cause major ash ooding,and coupled with the widespread devastation from the forceof the wave, these waves can be devastating to the health of a community. The oods are perhaps the most damaging to acommunitys health, because they can spoil the food and watersupply. Due to this, experts warn to be wary of diseases suchas cholera, hepatitis, diarrhea, and leptospirosis.33 Additionally,as it is the case with hurricanes, oodwaters leave perfectconditions for mosquito breeding, and thus West Nile Virusand malaria become immediate risks as well.34

Particular Diseases Posing RisksCholera is one of the most threatening diseases following

a natural disaster due to how it infects humans. Generally,someone develops cholera by drinking infected water or by living in lthy, unhygienic conditions, and it tends to thrive indeveloping countries.35 If left untreated, cholera can be fatal atnearly a 50% rate, though when treated the rate is under 1%. 36

The disease is even preventable, as a vaccine does exist.37 Incrowded areas, as a city may be, the period following a disasterthat forces people from homes becomes dangerous, becausecholera is communicable from person to person. 38 Althoughnot a signi cant concern for more developed countries,

cholera can cause major problems in poorer nations.

Tetanus is another disease that, though uncommon in thedeveloped world, can be extremely dangerous if not caredfor. It can be largely controlled by getting the tetanus vaccine

which involves a series of shots as a child, followed by boosteshots every 10 years or so.39 This disease does still pose a dangerhowever, especially in underdeveloped countries where manyhave not been vaccinated. The best way to prevent tetanus

is to vaccinate, however, and the United States Center forDisease Control recommends that in cases of disaster a seriesof vaccination shots be administered to all at risk.40 If leftuntreated, tetanus results in lockjaw, the paralyzing of the jawmuscles, which can make it dif cult or even impossible tobreathe. The disease is very dangerous, with an 11% fatalityrate, a total that includes those who have been vaccinated. 4

If infected or thought to be infected, a person should haveall of their wounds thoroughly cleaned and administereda tetanus immune globulin (TIG) shot, which removes thetetanus. Though it is not communicable, tetanus does thrive inunhygienic communities, so care must still be taken in densely

populated areas.42 Tetanus is dangerous, but it can easily becontrolled if it is looked for. If proper vaccinations are givenout and health services are suf cient, then it should notbecome a recurrent problem in recovery efforts.

Malaria can quickly in ltrate a population that lives ina mosquito-inhabited area. 36% of the worlds populationlives in areas with potential malaria risk, and 7% of thosehave never had any sort of malaria control.43 It is especiallydangerous after a disaster because disasters tend to increasethe risk of getting the disease. Malaria infects most oftenin areas with poor or no housing and overcrowding, anddisasters generally induce both. Additionally, a disaster could

very likely force populations to move quickly and as a masspossibly to areas with higher risk of malaria than before, suchas areas near water.44 It is also most common in tropical andsub-tropical regions, areas that are typically more at risk tocertain disasters like oods and hurricanes.45 Malaria can befought with antibiotics, but there are also many instances of antibiotic-resistant strains of the disease, making it even morecomplicated to control. 46 For instance, in 1999 refugee camps in

Tanzania, patients with malaria were treated with chloroquinethe drug used under Tanzanias national guidelines. It turnedout that the malaria that had infected the refugees was resistantto chloroquine, and a drug called sulfadoxine/pyrimethamine

was instituted for the refugees, though the national populationcould still use chloroquine.47 Such an unpredictable disease is

worrisome, and efforts should always be made to minimize itsimpact following a disaster.

Heath Dangers of Refugee CampsRefugee camps vary widely in size, location, an

standards, but all require great attention to prevent the spreadof infectious disease. In many instances, these camps have

very low living conditions. In a camp on the Thai-CambodianMosquitoes spread several infectious diseases, including West NileVirus, EEE, and malaria. When disaster strikes and mosquito man-agement halts, such diseases suddenly become major concerns.




border, for example, 70,000 refugees are crowded into a campthat offers merely 33 meters of space per person, including outside, public space, while water rations are only 20 liters perperson per day, one fth of what the WHO recommends. 48

This water not only contributes to the undernourishment of the camp, but also to the lth in it, as less water is availablefor bathing. The camp also suffers from malnutrition,because much of the food provided by the United Nations

World Food Program is bartered away due to the high levelof unemployment.49 With these levels of undernourishment,poor sanitation, and livable space, disease can spread muchmore easily than in a stable community.

When poor conditions in refugee camps exist, sicknessand mortality rates can rise rapidly. In a 1985 refugee campin Sudan, for example, it was infectious disease that resultedin thousands of deaths at the camp. Over the course of onemonth at the Wad Kowli camp, an average of 7.3 deaths per day (per 10,000 people) resulted from malaria, measles, diarrhea/dysentery, or chest infections. Those who were malnourished

fared even worse, as 72 of the 420 malnourished children inthe camp died within a 15-day period of February 1985.50

In fact, malnourishment was at a level so high in thesecamps that it was simply appalling. The Sudanese camps began

with a malnutrition rate (categorized as having less than 80%of ones original bodyweight) of 32%. As dangerous as that iover the course of a ve-week period, the rate in the campsactually rose to over 50%.51 This lead to much disease anddeath in the camps, where the morbidity rate was a staggering8.9 deaths per day per 10,000 people, with the rate of deathfor malnourished children at 115 per 10,000, comparedto 0.5 in normal years.52 This rate is capable of control, ascamps in Thailand lowered the rate from 9.1 to 0.7 over aone-month period. The Sudanese camps, however, remainedat a rate between 6 and 10 deaths per day for six months. 5

Though these refugees may have survived a disaster or crisisthey are certainly not out of the danger. These camps can beincredibly hazardous, and work must be done not simply to

Refugee camps such as this one are often mired by lth and inadequate resources. These poor conditions greatly increase the risk of infectiousdisease, and the high population density of the camps allows for rapid transmission of diseases and threatens dangerous epidemics..


10/6810


General Assembly

protect those in cities, but also those who have ed to refugeecamps.

What Poses the Greatest RisksDifferent disasters naturally pose different risks, and some

disasters are more likely to lead to infectious disease outbreak than others. According to Paul Shears, deaths in rapid onsetdisasters like tornados and earthquakes are much more likely to be immediate, due to injuries sustained. Conversely, whileslower to onset disasters like droughts do not cause immediatefatalities, often result in malnutrition, disease, and fatalitieslater in the recovery.54 If the disaster forces a populationinto refugee camps though, the chance for disease could

very easily rise, as described earlier. An interesting aspect isthe added risk that disasters involving water hold. Thoughsomewhat rare, tornados and oods can result in not just theimmediate deaths due to injury, but also severe illness, withsimilar timetables to those in droughts. According to somestudies, there have been rises in diarrhea following both,

which is likely attributed to polluted water.55 Why do droughts and famines pose such great risks? It

seems to be a combination of both the deterioration that themalnutrition causes and the effects of living in camps. Famineleads to both the deterioration of the body and the disruptionof society. The body deterioration also leads to higher severity of communicable diseases, and when societies are crowded inundernourished, unsanitary communities, these already weak

victims transmit diseases more easily. Over time, a disease canengulf a society, resulting in an endemic.56

Hurricane Katrina and the Importance of Fighting ExistingDisease

Much attention has been given to preventing infectiousdiseases resulting from natural disasters, but it is also incredibly important to continue providing care for those with chronic,existing conditions that need regular attention from healthservices. Following Hurricane Katrina, which struck the Gulf Coast of the United States on 29 August 2005, efforts fromthe emergency health providers focused on offering care tothe furthest regions of Louisiana and Mississippi. However,patients with conditions such as diabetes, hypertension, andasthma were left without care. Many victims needed regularmedicines or clinical visits, but without transportation, phone

lines, or electricity, these became dif cult to access. Besides,much of the existing medicine supplies in hospitals andpharmacies were lost or destroyed by the storm. 57 In mobileclinics that were set up across Mississippi following thehurricane, 12.6% of patients that came requested medicationor re lls on medication.58 It is more likely that patients wouldexist in developed countries such as the United States, wherethe highest cause of morbidity is not infections, but chronicdisease.59

Some of the most vulnerable patients that must beaccounted for after a disaster are those already in hospitals

Whether in for acute or chronic conditions, patients inhospitals are at an elevated danger during a disaster, if simplybecause their bodies are often weaker than those of healthy people. During Hurricane Katrina, over 7,000 people werein New Orleans hospitals, with 1,749 recorded as patients. 60

Though in most instances, stable and psychiatric patients weretransferred before the storm hit, many others, including thosein intensive care and newborns, could not leave the hospital. 6

For those left in the hospitals, it was truly horrifying. Hospitalrooms temperatures sweltered to over 100 degrees, broken

elevators forced patients to be carried down stairs, and patientseventually resorted to brushing their teeth with IV uid, astap water was unusable.62 In one hospital, where generatorsbroke after being ooded, it still took almost a week for theseveral hundred patients to be evacuated. 63 All of the workersinside may have been doing all that they could to provide carefor the patients, but hospitals hold some of the most fragile

victims of a disaster, and they must receive attention fromrescuers if they hope to avoid further disaster.

For those who were evacuated, the patients that werecared for had many similar issues. In a refugee clinic in

Tarrant County, Texas, family physicians were put in charge

of caring for the 3,700 refugees sent to the nearby shelter These physicians have said that while they were able tadequately care for all the different patients needs, they heardof instances in other camps where doctors- who were non-family physicians- struggled to care for patients outside theirareas of expertise.64 When cared for properly, the physiciansalso noted that most of the patients did not actually needto be hospitalized, and the extent of their care was treatingfor chronic conditions and re lling prescriptions. 65 HurricaneKatrina did occur in the United States, which, despite the large

When Hurricane Katrina struck the Gulf Coast of the United States,it proved that health concerns must also be addressed in developednations. In New Orleans, in particular, hospitals were poorly man-aged, resulting in health dangers for the chronically ill.




number that remained, was able to evacuate a large portionof the Louisiana population. Had this been in a nation withless transportation capabilities or had the disaster been moresudden, the health care priorities could conceivably differ.

Evacuations and Caring for the Chronic Ill and SpecialNeeds Patients

Disaster relief teams must be able to support all victims,and this requires them to accommodate a variety of people. Forthe chronically ill, medications are vital, but when populationsare evacuated, many leave their pills, needles, or inhalers intheir homes, placing themselves in potentially worse situations.

Thus, in refugee camps it becomes vital that medicines foranticipated chronic conditions such as diabetes, asthma, or any ailment requiring regular medication be adequately stocked.66

Additionally, it is important to ensure that all evacuees areequally cared for. When evacuations are ordered, governmentsare responsible with ensuring that as many people that canleave the evacuation area do so. To ensure this, evacuationnotices should be distributed as soon as possible and throughall available media. Additionally, these notices should come inmultiple languages, so that minority groups are not placed ata disadvantage if they do not speak the dominant language.67

When New Orleans and the surrounding communities wereordered to evacuate as Hurricane Katrina approached, many groups of people were stranded. Among the left behind werethose without transportation, who were oftentimes in thelowest economic brackets.68 Lacking resources, these are thepeople who actually need the most help. More coordinatedand ef cient evacuations will need to be designed in the futureand they cannot neglect the poorest communities, which often

have the poorest health of all.Infections from Dead Bodies

As stated previously, the likelihood of a communicableepidemic breaking out following a disaster varies greatly depending on the particular type of disaster and its location.If a disaster leads to a large number of deaths from injury or trauma, common belief is that the corpses will lead todiseases spreading. Studies have shown, however, that this isnot the case.69 In fact, the only time that it is recommended todisinfect a dead body is if the person has died from cholera,shigellosis, or hemorrhagic fever.70 To minimize the chances

though, experts do recommend that bodies be taken care of in a speci c manner. For example, they suggest that bodies beburied and not cremated, that mass graves be avoided if at allpossible, and that corpse handlers take sanitation precautionssuch as wearing disposable gloves, using body bags, andavoiding bodily uids.71

Some do have higher level of concerns regarding bodies,however. If corpses contaminate a water supply, the diseasegastroenteritis does become a potential risk. 72 There aresome concerns for those directly handling corpses. 73 The

related diseases, however, can largely be avoided with care fosanitation and are rarely cause for genuine fear. Additionallyin burial, there is potential for the body to come in contact

with water if it is not buried properly. Many recommend thatthere be a sand and clay-mixed soil to minimize pathogentransmission and a 2.5 meter separation between bodyand water.74 As of now, however, no universal standard for

burial practices exists, and these recommendations can varydepending on other conditions. 75 According to most expertshowever, these fears are mostly based on myth, and as long asadequate precautions are taken, corpses should not becomemajor health risks, regardless of the death total.

Mental Health Though oftentimes overlooked, caring for menta

health is just as signi cant as ghting infectious diseaseFollowing a natural disaster, there is an increased risk for

victims to develop post-traumatic stress disorder (PTSD) anddepression. That risk is elevated for women, especially those

who are pregnant, as they already have an elevated risk odeveloping these disorders.76 During a study of postpartum

women immediately after Hurricane Katrina, women whohad severe hurricane experiences were statistically more likelto be suffering from symptoms of depression or PTSD. 77 Inother studies, gender has not proven to be a predictor as withUnited States studies. After a 2006 Vietnam typhoon, thepercentage of at-risk persons increased from 20.7% to 27.1%

Although health, fear of disaster, and disaster-related injuryall correlated with mental health risks, gender did not. 78 Thisdoes not suggest that gender is meaningless, but it does revealthat when discussing the mental health of a community, the

community must uniquely be evaluated, as there are differentrisk factors for all involved. In Vietnam, for instance, one variable that made a person less likely to suffer depressionor PTSD following the typhoon was religion.79 In both USand Vietnamese studies, however, fear during the disasterand injuries caused by it were both among the strongestpredictors.80 Thus, those who experience the worst of adisaster and those who need treatment from health servicesshould be watched closely in the months following a disasterfor they are at a much higher risk to develop post-disasterhealth issues.

In providing mental health care, there also exists a wide

range of problems. One is calculating just how much extratime and effort can be extended to supporting mental healthpatients. It is dif cult to gauge how long this is needed, forsome forms of depression set in over time, whereas others setin more quickly.81 Making these estimates can be dif cult as

well, due to the wide variety of services in mental healthcareFollowing a disaster, researchers believe that increases areexpected in: assessments, crisis counseling, psycho educationpsychotherapy, and pharmacotherapy. 82 The availability omental health services differs widely from country to country


12/6812


General Assembly

and it is important that in developing nations populationsare not neglected due to the lack of institutionalized mentalhealthcare service.

c urrent s ituation

Haiti: The Worlds Latest Test

Natural disasters have and will continue to occur on thisplanet, and even in the past few years the globe has beentested on its ability to cope with disease spread after them.

Today, we have more advanced medicine, communicationabilities, and technology than imaginable a half-century ago.Still, when disaster strikes, disease remains a pertinent issuethat instills fear in many.

In January 2010, a 7.0 magnitude earthquake struck theheart of Haiti, a poverty stricken nation in the Caribbean Sea.Immediately after the quake, one of the biggest concerns wasthe aring of disease in the population.83 The earthquake wasdeclared a perfect storm for disease. It cut off electricity,

utilities, and clean drinking water from a poor, homelesspopulation crowded in a warm, tropical country. Evenbefore the storm, Haiti was well known for its medical careproblems, as the hospitals often provided inadequate care fortheir patients.84 In response, the UN sent 12,500 troops forrelief efforts, along with several other nations that sent theirown relief workers. 15 food distribution points were set up,built to feed roughly 97,000 victims.85 In efforts to minimizedisease, efforts were made in Haiti to focus on providing clean

drinking water and administer vaccinations to children, which were given to almost 100,000 Haitians.86 The spread of disease was somewhat controlled, as the major outbreak of infectiousdisease was prevented. Still, there were many cases of diseasespecially infections to wounds, which caused fevers, rashesand in some cases required amputations. 87 Though thesediseases were in many cases treated, many of the infections

would not have occurred had proper care been administeredearlier. Despite the horrors of the Haiti quake, the UN andthe worlds efforts to control the spread of disease preventedmany more tragedies from occurring. More work can andshould be done, however, and the relief efforts were by nomeans a total success in Haiti.

Disease SurveillanceIn order to prevent disease from spiraling out of control,

one of the major techniques is to engage in disease surveillance The World Health Organization actively takes part in this, asit operates the Global Alert and Response (GAR) program.

The programs role is straightforward: to act as, an integratedglobal alert and response system for epidemics and otherpublic health emergencies based on strong national publichealth systems and capacity and an effective internationalsystem for coordinated response. 88 Beginning in 2007, the

WHO has mandated that nations report all public health risksthat are of great concern, even if the cause of the threatis unknown.89 These new mandates require that countriesspeci cally report any threatening outbreaks of smallpoxpolio, a new strand of in uenza, or SARS. Additionally, man

Disease was among many concerns in Haiti following the 2010 earthquake in the Caribbean nation. In Haiti and other countries today, combinedefforts of local, national, and international forces are necessary to limit damage following natural disasters of any type and scale.




countries have decided to start surveillance for diarrhea anddengue fever.90 In cases of a disaster, recognizing an outbreak is vital, because a disease can spread much more quickly in apopulation with depleted energy and resources.

In todays world, there is highly advanced technology thatnations can now use to survey for disease. For instance, in

Jakarta, the US Naval Medical Research Unit along with the

Indonesian Ministry of Health operate the Early Warning Outbreak Recognition System, or EWORS. If a patient isfeared of having an acute infection, hospitals require thathe or she ll out a questionnaire providing demographicinformation, which is uploaded to a computer to interpretand look for trends. 91 The advantage of this advanced systemis that it can discover potential outbreaks much more quickly than pure human analysis could. Unfortunately, there arestill signi cant problems, as it is dif cult to coordinate andstandardize different hospitals procedures, and it is also acomplex ordeal to manage secondary investigations with localhealth bureaus.92

In less developed nations, more simpli ed syndromicsurveillance is often used to predict epidemics, and its level of success is somewhat surprising. Oftentimes, these countries

will simply compare the disease rates to the average, setting a threshold that rates cannot go above. In Uganda, thismethod successfully predicted two malaria outbreaks in2005 and 2006 two full weeks before the disease rates roseto their highest levels.93 This has proved more dif cult withother diseases, however. Dengue fever, for example, is notgenerally con rmed until death, and syndromic surveillanceis feared to be too slow to catch this type of disease. 94

Another factor hindering surveillance is how information isdistributed. With increases in technology, however, there arestill more efforts to speed surveillance at all levels to greaterspeeds. In 2006, one study showed that the use of cell phonesto transfer patient data signi cantly sped up surveillance.In a 2005 Iranian cholera outbreak, cell phone surveillance(CPS) recorded the peak of the outbreak earlier, and cases were received by the Center for Disease Control one to tendays faster than by Irans traditional methods. 95 Considering that even since 2005 cell phone and Internet technology hasgreatly expanded through the introduction of smart phonesand 3G software, 96 these methods could come to great usein the coming years. Technology will most certainly improvedisease surveillance, but the struggle will be to determine justhow it is most ef ciently used in all countries.

Climate Change and Risk In todays world, one of the largest environmental

concerns is global warming. Studies have suggested that asthe worlds temperature increases, so does the likelihood of tropical activity, meaning more hurricanes, typhoons, andother hydro-meteorological disasters.97 Many researchersnow fear that this change will bring a new pattern of rainfall,

where long periods of drought alternate with short bursts of torrential rain, leading to unmanageable crop seasons, oodsand famine, all of which contribute to the diseases healthexperts tend to fear. 98 The other problem that climate changebrings is raising seawaters. In the South Paci c Ocean, thereare many smaller, low lying countries or provinces on smalislands, many of which lie all or mostly below one meter above

sea level.99

If seas continue to rise as predicted, this couldgreatly increase the number of environmental refugees forneighboring countries. Further debilitating in these countrieshowever, is the risk of earthquake. Many countries such asIndia that would take some of these refugees live in earthquakeprone regions.100 The danger of this is already clear from the2004 earthquake in the Indian Ocean. On 26 December 2004,a 9.0-scaled earthquake struck in the Indian Ocean, 150 kmoff the coast of Aceh, an Indonesian province. The tsunamitriggered by the earthquake killed over 130,000 in Indonesiaand left another half million homeless.101 In this instanceother than tetanus, all other major diseases were controlled,

and no major diseases became epidemic.102 However, movingforward, researchers have suggested focusing more on mentalhealth and non-communicable disease after disasters, for they

were not suf ciently accomplished in Indonesia after thetsunami.103 Though healthcare after the tsunami was managedbetter than many expected, the likelihood of another disasterin this region is certainly elevated and it remains a primaryconcern for regions needing the most development.

P ast i nternational a ctions

In 1987 the UN declared the 1990s as the International

Decade for Natural Disaster Reduction (IDNDR). In doing so, they emphasized the need to raise awareness aboutdisasters and disaster prevention and promised to makeefforts to combat the various aspects of natural disasters,including healthcare.104 Though its goals were admirable, theIDNDR certainly struggled. Four years into the decade, manybelieved that despite the IDNDR title on various conferencesand brochures, effective actions taken to materialize itsgoals [were] few.105 Thus, the following year, a worldconference on disaster reduction was held in Yokohama,

Japan. The conference produced the Yokohama Strategy which emphasized disaster prevention and preparation.10

In the future, leaders at the Yokohama conference agreedto promote disaster education and awareness and to takeactive roles in developing community programs for disasterreduction.107 Developments were made over the nal yearsof the decade in early warning systems, but not much effortappears to have been directly aimed at improving healthcarefollowing a disaster.108

In 2004, the world was tested when an Indian Oceantsunami struck Indonesia, Sri Lanka, and several othersurrounding nations. Early reports out of the nation were


14/6814


General Assembly

grim, as some experts predicted death tolls from diseasereaching the tens of thousands. To raise concerns, there

were also serious cases of poor hygiene and unsanitary conditions, as doctors and rescue workers appeared todisregard caution due to the overwhelming body count. 109 Due to the impressive international response, however, majordiseases were essentially controlled and rebuilding efforts

began quickly after the rescue phase ended.110

Following thetsunami, the WHO released a Health Action in Crises reportthat outlined important lessons learned from the tsunami.

The Organization established that better assessments of atrisk populations needed to be taken, the Red Cross, WHO,and other involved NGOs had to establish unilateral healthcare benchmarks in recovery efforts, donor response and theaid of NGOs was invaluable and essential for a population tofully recover.111 In the World Health Assembly that followed,members af rmed these efforts and stressed the need to putforth efforts in aiding nations in crisis and developing bettermethods of delivering this support. 112 After the disaster in the

Indian Ocean, the WHO felt much stronger about how toprepare for natural disasters and what exactly needed to beimproved.

In 2005, the WHO decided to amend their InternationalHealth Regulations (IHR), which had been last updated in1969. Previously dealing with the prevention and quarantineprocedures for cholera, yellow fever, and the plague, thenew IHR would work, to prevent, protect against, controland provide a public health response to the internationalspread of disease in ways that are commensurate with andrestricted to public health risks, and which avoid unnecessary interference with international traf c and trade.113 To combatthe many new diseases that have surfaced in recent years, thenew IHR do not focus on particular diseases, but insteadoutline regulations for all health risks. This was done so thatas the world continued to change, the IHR would still beapplicable and suf cient to minimize any disease outbreak.114

The Regulations mandate the implementation of diseasesurveillance and stipulate that any health risk must be reportedto the WHO within 24 hours of its discovery. 115 Though itdoes state that the WHO will help build these surveillancesystems, the IHR are vague when describing the systems, asthey never specify which types of surveillance are preferred.116 Many have, however, declared that surveillance requirementshave been strengthened by the 2005 IHR. 117 Fears have beenexpressed regarding the Regulations though. One majorconcern is that the IHR may interfere with country or regionspeci c diseases. If a region is susceptible to a disease that isan internal problem, the WHO could simply be getting in the

way if it mandates speci c procedures, allowing the diseaseto grow.118 Overall, the 2005 International Health Regulationsdo strengthen the worlds ability to track and prevent diseasesthat could become global epidemics, but they do not fully quell most fears.

More recently, the WHO began a 5-year program in 2009to strengthen their humanitarian health assistance. In part,it evaluated an earlier 3-year program for crisis relief thafocused on developing regional of ces in more countries andincreasing emergency staff in these of ces.119 When evaluatingthe current status, the WHO admitted that they neededto obtain more reliable, solidly backed data on morbidity

mortality, and other statistics used to determine health risks.12

Additionally, it expressed the need to improve its humanitarianefforts, which have been criticized as being nonoperational. 12

In the long term, the WHO has dedicated itself to furtherdeveloping its Global Health Cluster (GHC), a program thatfocuses on providing and developing acute crisis assessmentand relief.122 The Organization truly wants this program togrow, as it hopes to implement it in all nations it determinesare priorities.123 In 2010, The World Health Organizationperformed an assessment of the GHC, determining thatthough its efforts were well intentioned, more effort hadto be put in implementing the system with governments. It

stressed the need for educating others about the new system,as they still believe that it could and would save many lives

when the next crisis emerges.124 The GHC has certainly madegreat changes in the way nations view disaster relief, but it wilcertainly be tested when the next major crisis strikes.

t imeline of s ignificant e vents

1348: Black Plague emerges in Europe. With noknowledge of the disease, it spreads across almost allof Europe, with mortality rates well over 90% in many cases.125

1494: French pox (syphilis) emerges in Europe. Thoughunknown at the time, the disease was sexually transmitted and crossed the Atlantic with sailorsexploring the New World 126

1840s: bacterial infection causes the infamous IrishPotato Famine, killing over 1 million and forcing 2million to leave the country

1930s: drought causes malnutrition and typhoid feverbreakouts across Western United States

1969: First International Health Regulations are written, which outline the procedure for controlling six of the worlds most infectious diseases

1979: At a refugee camp on the Thai/Cambodian border,malnourishment and illness plague the refugees, asover 70,000 refugees are held together while receiving inadequate space, food, or water.

1980: The World Health Assembly, ending a 13-year battle to end the disease, announces Smallpoxeradication.127




1985: Refugee camps in Sudan struggle to controlinfectious disease. Malaria, measles, diarrhea/dysentery,and chest infections cause death rates to soar from .05per 10,000 people per day to over 7.

1987: United Nations Declares the 1990s as theInternational Decade for National Disaster Reduction

1990: The International Decade for National Disaster

Reduction begins.1994: The Yokohama Strategy is developed to improvenatural disaster reduction efforts.

1995: An earthquake in Kobe, Japan leaves 800,000homeless and destroys sanitation systems for up to 4months in 1.27 million homes.

1999: A drug resistant strain of malaria emerges in Tanzanian refugee camps. Although the national Tanzanian population had never dealt with this problembefore, international refugees brought along the diseasefrom their homes.

2001: Early Warning Outbreak Recognition System(EWORS) begins development in Southeast Asia,designed to increase the speed and accuracy of diseasesurveillance.128

2003: SARS outbreak in China, Taiwan, and Canada.Over 8,000 people are infected and over 800 die beforethe disease is fully controlled.

2004: An earthquake in Indian Ocean triggers a tsunamithat ravages surrounding countries, especially Indonesiaand Sri Lanka. Other than a minor tetanus outbreak infectious diseases were not an issue, but mental healthcare was criticized afterwards.

2004-2005: World Health Organization amendsInternational Health Regulations to stop the spread of infectious disease, particularly across borders.

2005: An Iranian cholera outbreak provides opportunity to test the use of cell phone surveillance, which wasaccurately able to report cholera cases 1 to 10 daysahead of traditional methods.

Many NGOs such as the Red Cross are heavily involved with disaster relief, and it is essential that they work with local and international bodiesto establish the most ef cient and successful aid systems of providing the necessary assistance in communities harmed by natural disasters.


16/6816


General Assembly

2005: Hurricane Katrina strikes the Gulf Coast of theUnited States. Despite the broad devastation, healthservices are able to prevent infectious disease frombecoming endemic. In this instance, chronic disease isactually the biggest concern for local health of cials.

2005-2006: Low-tech, simpli ed surveillance systems aretested in Uganda. During two separate outbreaks of

malaria, the low-tech systems predicted the peaks of the disease rates before the advanced systems.2006: Typhoon strikes the coast of Vietnam. One of the

major concerns following the storm is mental health,as rates of depression and PTSD rise from 20.7% to27.1% in the following months.

2007: IHR take effect, requiring that member nationsreport all major health threats to the WHO, even if theparticular cause of the ailments are unknown.

2009: WHO implements a 5-year strategy to improvecrisis relief and dedicates itself to the Global HealthClusters long-term success.

January 2010: A 7.0 magnitude earthquake hits in Haiti.Infectious disease is controlled, but health of cials dodeal with many skin conditions and infections from

wounds, highlighting the health risks that the disastercan directly cause.

P roPosed s olutions

There are countless causes to disease outbreak, making it impossible to fully assure a populations safety by simply addressing one aspect. Thus, it is essential that a solutionaddresses both long and short-term goals, aid in both disaster

prevention and reaction, and pertains to both industrializedand developing countries. To accomplish these goals, expertshave suggested creating a more comprehensive diseasesurveillance network, improving evacuation strategies tominimize those in direct paths of foreseen disasters, betterequipping refugee centers with medicine, doctors, and othernecessities, pursuing further research, and providing morefunds to developing nations to improve local disaster response.

Disease Surveillance Though many systems are already in place, some have

called to create a carefully planned world disease surveillancesystem. When discussing the International Health Regulationsin 2001, of cials from the United States General Accounting Of ce noted that, The

Regulations do not provide an international framework for addressing threatening epidemics at their sourcewithincountries. 129 In response, many have called for a more activerole at provincial and local levels, giving departments morefunds and freedom to actively survey and battle diseases.Some argue that disease surveillance with certain diseases is

wasteful, because it does not accomplish the ultimate goalof disease eradication. In the past, the WHO has focused its

efforts on cholera surveillance, but of cials later determinedthat although surveillance lowered death tolls from the diseaseit did not diminish the number of cases. 130 The number of actual cases is even up for debate. In 1999, when there were9,200 con rmed cases of cholera fatalities, one WHO expertestimated that up to 120,000 deaths could have actually beencaused by the disease.131 Though disease surveillance is a

necessary tool that should be developed and perfected as ourtechnology improves, it must be done so intelligently and without wasting energies.

Improving Disaster Preparations and Strategies There are many who believe that the largest cause of

disease and death in disasters results from poor planningand management. One of their ideas includes developingevacuation strategies. During Hurricane Katrina, this wasone of the most common complaints critics had of thedisaster plan. As one writer noted, The movement of traf cout of the city can be pictured as sand moving through anhourglass.132 For regions that are particularly vulnerable topredictable disasters such as hurricanes and typhoons, it couldbe bene cial to develop new evacuation plans for such citiesIf these are thoughtfully created and the public is educatedabout the disaster plan for their home, then it could removethousands of humans from a disaster area before it the eventoccurs. Thus, communities would signi cantly lower the riskof disease transmission within their areas, as they will be lespopulated once a storm has hit. Simultaneously, howeverimprovements can also be made for rescue plans for manycities. There are still many cases where poor disaster planningresults in additional loss of life. For instance, the 2009 Typhoon

Morakot was one of the worst storms in decades, killing overa dozen people in neighboring countries. In Taiwan though,the situation was much worse due to poor rescue planning and execution. There were cases of victims waiting outsidein the rain for over three days before rescuers made it totheir villages, and those who were evacuated were housed incrowded public spaces like soccer elds.133 The Taiwanesegovernment faced much criticism following the storm, asit surfaced that they originally refused international aid.13

Moving forward, nations should develop more comprehensiveplans for disaster relief ahead of time, avoiding the strugglesthat countless governments have made when time becomes

crucial. Over 500 people died during Typhoon Morakot, butof cials should be grateful that their hesitancy and lack ofcoordination did not result in many more. 135

Improving Refugee Camp StandardsRefugee camps are notorious for their oftentimes-cramped

quarters, lack of resources, and poor health and sanitationpractices. Though the minimum recommended shelter spacein camps is 3.5 square meters in warm climates and 5.5 squaremeters in cold climates, emergencies often force of cials to




cram refugees into areas.136 Experts have also establishedthat refugees need at least 2,100 calories per day, as well asan adequate water supply.137 These values are oftentimesoverlooked though, and it could be bene cial to developan enforceable set of standards that camps are expected toprovide. The UNHCR and NGOs such as the Sphere Projecthave already done great work in promoting similar ideas,

but many still call for stronger action.138

To directly controldisease and illness, others have called for strengthening of medical care in camps. These camps worry about thepotential breakout of infectious disease, but they must alsocare for chronic illness. In less equipped communities, thishealthcare can be lacking, so it becomes, in part, the WHOsresponsibility to step in and provide assistance. If regionalstations can be stocked with medicines, for both acute andchronic conditions, then conditions could drastically improvein many refugee camps.

Chronic Disease There are still many who believe that not infectious,

but chronic disease is the biggest threat following a disaster. Though such diseases are often self managed, many health care

experts note that this becomes impossible following a disasteras those held in shelters are often lacking vital medicines.13

When this occurs, it can not only lead to complications withtheir conditions, but it can add to their levels of stress andanxiety, leaving them susceptible to other dangers. 140 Onepossible solution is for countries to keep more detailed recordsof the common chronic diseases that their populations suffer,

from which would allow for them to prepare disaster campsbetter by equipping them with the necessary medicines andprescriptions that patients may need. They may not be able tocure these diseases, but if they can be managed properly manycamps would run much more smoothly.

b loc P ositions

United States The United States Center for Disease Control (US CDC)

already has many of the surveillance capabilities and disasteprevention methods that other nations lack, and it would be

at the forefront of promoting many of these technologies,especially if it meant that they would be bene ting nanciall

In countries such as the United States, monitoring elderly patients with conditions such as diabetes is crucial during and following disasters.


18/6818


General Assembly

from aiding other countries developments. Following scaresfrom diseases such as SARS, the United States would alsosupport more openness regarding potential disease outbreaks.SARS was particularly damaging to the United States becauseit hurt them nancially.141 When diseases escalate to the point

where they interfere with travel and trade, the United Statesis hurt signi cantly, and it hopes to do all it can to prevent

infections from spreading to that level whenever possible. When concerning preparing for disasters, the United Statesagain has much experience, as it deals with hurricanes in theGulf of Mexico and the Atlantic Ocean yearly. Following Hurricane Katrina, public pressure has risen for the US tostep up these measures at home, as the relentless criticismforced FEMA head Michael Brown to resign following thedisaster.142 Thus, it would not be surprising to see them pushforward efforts to improve preparation on international levelsas well.

European UnionIn a 2008 council on disaster strategy, the European Union

stressed a balanced approach to disaster preparation, vowing to cover all aspects. It stresses the need for solidarity betweenits member states and the need for cohesion. 143 Provided thatother nations are willing to comply, the EU would supportinformation sharing and providing assistance to countries inneed. The EU has historically been strict on its policies withasylum and refugee seekers, however, so it is unsure if how

willing they would be to opening themselves up too much when it comes to providing assistance to other nations withcamps.144 With surveillance, the EU is historically open whendiscussing disease rates and infectious disease, as they make

most of their ndings open to the public.145

Considering their already strong position, they would most likely supportstrengthening international agreements on these matters as

well.

Peoples Republic of China The Peoples Republic of China tends to keep much more

of its information internal than Western countries. Whenthe SARS endemic struck in 2003, reports reasoned that thedisease originated in China. Critics claimed that the disease

was allowed to spiral out of control because the governmentoriginally suppressed much of the data and was uncooperative

in providing the WHO with reports.146

China does care aboutthe health of its people, however, and is willing to enact strong measures to ensure their safety. Following the H1N1 in uenzaoutbreak in 2009, China was noted for being extraordinarily tough on Mexican and Canadian tourists and imports, wherethe disease was most prevalent at the time. 147 The governmentdoes not ignore the health of other nations either, as they sent Mexico US$1 million and supplies soon after the H1N1outbreak.148 Based on its actions, China can be expected tosupport preventive measures during disease threats and for

strong outside support for countries in need. They still hopeto keep their information close to them, but China cannotafford to allow another disease break out under their watch,and they will do all that they can to assure this.

IndonesiaIn recent years, Indonesia has become very signi cant in

the healthcare debate. Though there are signi cant investmentsin the Indonesian hospital system from neighboring countriessuch as Singapore and Malaysia, the hospitals are concentratedin cities, so much that there are only 25.6 beds available per100,000 citizens in the province of Lampung, compared to161.2 beds per 100,000 in Jakarta.149 During disaster, Indonesia will certainly need outside assistance, as the 2004 tsunamproduced many concerns for the government. Despite thein ux of both governmental and NGO help, there was greatdisorder in the country, partly due to a lack of coordination. 15

Indonesia does not fear a lack of response in time of need,but it desires coordination between NGOs and governments.It would support stronger efforts for disaster planning and

would stretch that planning to not just countries looking forthemselves, but for countries reaching to nations that wouldbe ready to support it. The nation is still struggling with manydiseases communicable in disasters like cholera and diarrhea.15

Providing necessary care to refugee camps will be extremelyimportant during the next disaster that strikes Indonesia, andconsidering how disaster prone the South Paci c and IndianOceans can be, Indonesia must make sure that it is betterprepared when the time comes.

AfricaMany of the developing nations in Africa need the

most support in developing disaster and disease preventionstructures, but much must change before most nations willbe capable of making progress. The WHO has estimated thatthere is a shortage of up to 800,000 health workers on thecontinent, and in some areas there is an average of only 1doctor per 100,000 people.152 African nations certainly agreethat their infrastructures in disease surveillance and disastershould be updated, but they simply do not have the resourcesnow. To make matters worse, many African nations arestruggling to control current epidemics such as AIDS, furtherdebilitating their health infrastructure.153 If assistance is

provided, these countries will support legislation to toughenprocedures, but without this assurance they can promise littlechange. Some of these nations are more at risk than any othershould a disaster ever strike though, so they certainly wil

work to better themselves.

r elevant P artners

The most relevant NGOs are those that will workalongside the UN and governments providing disaster reliefOrganizations such as the Red Cross often set up relief




centers in the same communities as governments, and it isessential that these groups work on the same goals. One of thelargest of these organizations is Direct Relief International.

According to their platform, they work to provide, Medicalassistance to improve the quality of life for people victimizedby poverty, disaster, and civil unrest at home and throughoutthe world.154 The actual number of these organizations

is staggering, however. Over 80 NGOs registered with the WHO to provide aid in Sumatra following the tsunami, andthere were countless other organizations that went withoutof cially informing anyone.155 The WHO must work tomake these NGOs help in disaster situations, but remaincoordinated and in control.

In the eld of disease surveillance, there are many organizations whose expertise could be bene cial. TheInternational Society for Disease Surveillance (ISDS), forinstance, works to promote and advance this eld acrossthe globe, involving both health care providers working in communities and statisticians that may develop more

advanced systems that governments can use. Additionally,there are countless organizations that research infectiousdiseases, especially in developing countries. These couldprovide invaluable information when determining the levelof concern for certain diseases in particular places and canbe looked into.

Q uestions a r esolution m ust a nswer

What efforts can the WHO make to improve diseasesurveillance in its member states, and how is thisinformation best applied, both in countries where

research is done and in the international community? What can the WHO do to improve preparations for

disasters, in terms of evacuation plans, emergency transportation, health care preparations, etc.?

What can be done to improve health and sanitation inrefugee camps and shelters, and how is the spread of disease best minimized in them?

How can countries better manage chronic ailmentsduring natural disasters, and how can these nationsbest accommodate those with specialized needs such asprescriptions, syringes, and inhalers?

How can the WHO better coordinate the efforts of NGOsduring a disaster to maximize their aid and minimize

wasteful time and spending?

What can be done to help developing nations bettertheir healthcare systems to minimize the outbreak of infectious disease, both in times of natural disaster andeveryday life?

s uggestions for f urtHer r esearcH

Considering that many of the relevant events for this topichave occurred in recent years, looking at news websites suchas the New York Times, CNN, and MSNBC can be extremely useful. Also, be sure to visit the WHOs website, as it hasupdates from many of the relevant events discussed in hereas well as many of the important documents discussed. Takethe time to read the 2005 International Health Regulations,available from the WHO website. The WHO has drasticallychanged the way that the international health system workssince the IHRs inception, and as many articles you comeacross may be had been written before they became effectivein 2007, it will be important to know what has changed. TheUS Center for Disease Control and Prevention also has someuseful descriptions of diseases relevant to our topic, as well asa section on disaster and disease prevention.

One of the most useful databases you can use is PubMedCentral. This website has a plethora of articles relating to

the medical eld that you can search, many of which deadirectly with disaster relief. In many of these articles, thebibliographies contain links to other articles in their databasemaking the volume of useful information at your grasp simplyastounding.

TOPIC B: INTERNATIONAL DRUGRESEARCH ETHICS

H istory and d iscussion of tHe P roblem

The Reality Though ethical standards have evolved over time, they

often come at the price of research subjects. Many of themost important moments in the history of ethics were notmonumental pieces of legislation passed, but infamous lapsesin ethical judgment and procedure. Though many of theseevents have spawned growth and positive change, the tragediescannot be overlooked. So, in discussing the development of research ethics over the course of history, detailing theseregrettable events is absolutely necessary. They provideimportant lessons that teach both researchers and subjectstoday and are instrumental tools to modern policymakers andlegislators.

Nazi Experiments and the Nuremberg CodeIn 1933, President Paul von Hindenburg appointed Adolf

Hitler as Chancellor of Germany. 156 With this, the Nazi party which had steadily increased its representation in governmentover previous elections, suddenly held great power over theEuropean nation. Hitler morphed Germany into a police state,forcing enemies such as communists and labor leaders intoconcentration camps. 157 One particular group singled out bythe Nazi party was the Jewish population. Hitler encouraged


20/6820


General Assembly

the boycott of Jewish goods and stores, and the governmentclassi ed Jews as a separate race in 1935.158 Though many understood what was occurring, the Nazis had total controlover the nation by 1933, when Hitler urged Hindenburg tosign the Decree for the Protection of People and State, whichgave the government the authority to have essentially absolutepower in times of emergency.159 With this power, the Naziregime could ignore all ethical codes in place, because there

was no one in the country capable of checking their power.

During the mid-twentieth century in Europe, Naziresearchers held countless medical experiments, many of which shocked the world when they were revealed. Upontaking control of Germany in 1935, the Nazi party initiateda series of steps meant to Nazify the German medicalsystem. First, the German government passed laws banning

Aryan doctors from wedding non-Aryans, and the Nazisquickly intensi ed their restrictions. By 1938 the governmenthad rescinded all Jewish doctor licenses in the nation. 160 Soon after, a push for sterilization studies emerged, as Nazi

doctors wished to use the process to end cases of conditionssuch as schizophrenia, epilepsy, severe mental defect, andalcoholism.161 This applied to different ethnic groups as wellas Nazi doctors sterilized 385 mixed-race children in 1937. Inall, it has been estimated that the Nazis forcibly sterilized upto 340,000 people in Austria and Germany. 162 Nazi programs

were not limited to sterilization studies. Investigators foundthat the Nazis also conducted racial-based immune studies,euthanasia and brain research, and military wound research

on civilians and captured military, almost all without properconsent.163 These programs continued until the very end of World War II, and it was not long after that they were revealedto the world.

From 1945-1946, the International Military Tribunalconducted the Nuremberg Medical Trial, placing the mostimportant Nazi medical of cials under global scrutiny. Thetribunal convicted 16 of the 25 defendants for their war crimes

with 7 being sentenced to death and hanged. 164 Following thetrial, the Nuremburg Code was established. Among other

Nazi researchers victimized prisoners of various ethnic and religious groups during World War II. Experiments included sterilization and euthana-sia studies, and when the concentration camps were uncovered, several of the leading researchers were brought to trial in Nuremburg.




things, the Code mandated that researchers fully inform theirsubjects of potential health risks and the rationale behind any study and stipulated that research participants have the rightto halt any experiment they choose to leave.165 Many of theseparticular cases remain relevant today. For instance, many German research facilities have been criticized for holding onto information of Holocaust and euthanasia victims in

concentration camps, as critics argue they have not made fullefforts to identify these victims.166 Despite these problems,the Nuremburg Code is remembered as an instrumental stepforward in bioethics, and the course of the history of thesubject was very much directed by the document.

Streptomycin Research and Ethical Developments Though rates of tuberculosis had steadily decreased

in the late nineteenth century, the disease was still a majorconcern for the globe. Treatments in the early twentiethcentury included using the gold compound sanocrysin, bedrest, and even a procedure that involved collapsing a lung soit could not function, giving it time to heal without working.167 In the 1940s, however, the drug streptomycin emerged in theUnited States as a potential answer to the disease. After studiesinvolving guinea pigs and small-scale tests in the United States,the British government obtained a small sample of the drug fortesting.168 When the trial was designed, doctors created a new strategy of randomly assigning patients to experimental andcontrol groups. 169 In doing so, the randomization preventeddoctors from giving the actual drug to healthier patients inorder to get their drug accepted. 170 Some criticized the trialfor withholding the drug from the patients in the controlgroup, as 26% of the control patients did die. 171 According to

the researchers though, this manner was necessary due to thelimited supply of the drug, thus meeting ethical standards.172 Though some questions still remain regarding the ethicsof this study, it was instrumental in developing a drug thatbrought many results. In 1952, Selman Waksman won theNobel Prize for discovering streptomycin, though its effecton the world must also be attributed to the British researchers

who studied the drug in its early years of existence.173 More signi cant than the actual drug, however, were

the effects the Medical Research Committees (MCR) study had on research design. Researchers gave lectures following its publication, focusing not on the test results, but the new

methods implemented in their study. These radical ideasincluded blinding the physicians caring for the patients,meaning they concealed the patients medicine histories inefforts of hiding the group that each patient belonged to. 174

There were still many critics of the design, however. In thetime following the British Medical Journal s publication of thestudy, many worried that the results were still faulty, becausethe researchers kept many details of the study secret, causing many in Britain to fear that streptomycin caused major braindamage.175 Though research in the United States had already

quelled these fears, the level of secrecy caused unnecessaryanxiety in Britain, and after the MCR study researchers surelyhave learned how damaging it can be.

Randomly Controlled TrialsSince its rst breakthrough in the streptomycin studies

randomization of trials has quickly become a vital part of anethical trial. It is essential to assure an unbiased test, as it literallyplaces each subject randomly into control and experimentalgroups. This ensures that one group is not purposely madeof a certain demographic to skew test results. 176 Today, it iscommon for tests to also be double blinded, meaning thatboth researchers and subjects are unaware of which groupthey are placed in.177 This often means that a placebo, a pillidentical in looks but not containing the actual treatment,

will be given to the control group, fooling both doctors andpatients.178 An alternative to placebo-controlled trials calledactive-controlled trials exists. For control groups in thesestudies, patients are given an already existing drug insteadof an ineffective placebo, and results are compared to whathas already been created and tested rather than to the lack of treatment.179 The advantage of using active trials is that alsubjects will still receive treatment, but the styles shortcomingis that it cannot measure how bene cial a treatment is todoing nothing, but merely how close the treatment measuresto existing treatment. 180 Though one would assume that doingnothing would have an effect of zero change, it is actuallynot the general case. Many studies have shown that placebosappear to have a mental effect on patients, possibly due tooptimism and attitude changes that study participants have. 18

In a fully controlled experiment, all factors must be isolated

so that the only in uences being measured are the drugs andtreatments. Though correlated with receiving treatment, theseattitude changes

Hnmun 2011 Who Study Guide

Documents

Transcript of Hnmun 2011 Who Study Guide