PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the
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UN Civil-Military Coordination and Health Cluster
.PAN AMERICAN HEALTH ORGANIZATIONPan American Sanitary Bureau, Regional Office of theWORLD HEALTH ORGANIZATION
United Nations:Civil-Military Coordination and the Cluster SystemDr. Ciro R. UgarteEmergency Preparedness andDisaster Relief#Pan AmericanHealthOrganizationOutline:UN Humanitarian Civil-Military CoordinationUN Cluster System. Challenges & opportunities of DOD / International Organizations Coordination.#Pan AmericanHealthOrganizationUN Civil-Military CoordinationThe focal point for UN civil-military coordination is the Civil-Military Coordination Section (CMCS) of OCHA. CMCS often deploys a Coordination Officer to support field-effective mechanisms. The most common interface mechanisms are: Civil-Military Operations Centre (CMOC)Civil-Military Cooperation House (CIMIC House) Humanitarian Operation Centre (HOC)#Pan AmericanHealthOrganizationUN Civil Military CoordinationHumanitarian organizations and military forces have different mandatesHumanitarian organizations endeavour to provide assistance to affected populations based on assessed needs and on the humanitarian principles.Civil defense units are deployed in a humanitarian crisis based on the agenda of their government.Militaries are deployed with a specific security and political agenda or in support of a security and political agenda.#Pan AmericanHealthOrganization4Range of civil-military relationshipLow opportunities of CM cooperation / high risks for humanitarians of being drawn into conflict dynamics
High opportunities of CM cooperation / low risks for humanitarians of being drawn into conflict dynamicsPEACETIME#Pan AmericanHealthOrganization5El principio de soberana nacional se ha diluido por el derecho de intervencin humanitaria
El enfoque desastres complejos se aplica arbitrariamente a los desastres naturales
Principles on military-civilian relationsHumanitarian criteria to use/accept military assets.Military assets unique and only as a last resort.A humanitarian operation retains its civilian nature.Follows principles of humanitarian assistance.Avoid direct delivery of humanitarian assistance.Retains its international and multilateral character.#Pan AmericanHealthOrganizationUN Civil-Military coordination in the health sectorThe mission of the Global Health Cluster (GHC) is to build consensus on humanitarian health priorities and related best practices, and strengthen system-wide capacities to ensure an effective and predictable response.
The GHC looks at how civil-military coordination might affect humanitarian agencies ability to access affected populations and provide health assistance.
Global Health Cluster - Position Paper Civil-military coordination during humanitarian health action
#Pan AmericanHealthOrganizationBuilding a Stronger, More Predictable Humanitarian Response System
#Pan AmericanHealthOrganization8Changing Environment
Proliferation of humanitarian actorsDemands for more structured international responsesChanging role of the UN (less direct implementation, more standard-setting and facilitation, more capacity-building)Competitive funding environmentIncreased public scrutiny of humanitarian action
#Pan AmericanHealthOrganization9Whose reform?
Inter-Agency Standing Committee (IASC)
Composed of NGO consortia, Red Cross and Red Crescent Movement, IOM, World bank and UN agencies
#Pan AmericanHealthOrganization10Everyones reform
FOUR PILLARS OF REFORMCLUSTER APPROACH
Adequate capacity and predictable leadership in all sectorsHUMANITARIAN COORDINATORSEffective leadership and coordination in humanitarian emergenciesHUMANITARIAN FINANCING
Adequate, timely and flexible financingPARTNERSHIP
Strong partnerships between UN and non-UN actors#Pan AmericanHealthOrganization11 Cluster mechanismGeneral Assembly Resolution 46/182 on humanitarian assistance: IASC (Inter Agency Standing Committee)Cluster lead agencies identified, PAHO/WHO for health cluster,UNICEF for WASH cluster and nutrition clusterWFP for foodOthers
#Pan AmericanHealthOrganizationLinks with Government and national authoritiesEach State has the responsibility first and foremost to take care of the victims of natural disasters and other emergencies occurring on its territory. Hence, the affected State has the primary role in the initiation, organization, coordination, and implementation of humanitarian assistance within its territory.
UN General Assembly Resolution 46/182#Pan AmericanHealthOrganization13AIMHigh standards of predictability, accountability and partnership in all sectors or areas of activity
More strategic responses
Better prioritization of available resources#Pan AmericanHealthOrganization14United Nations Cluster Approach
#Pan AmericanHealthOrganizationNew global cluster leadsTechnical areasNutrition UNICEFWater/Sanitation UNICEFHealth WHOEmergency Shelter:Conflict IDPsUNHCRDisastersIFRC Convenor
Cross-cutting areasCamp Coord/Mgmt:Conflict IDPsUNHCRDisastersIOMProtection: Conflict IDPs UNHCRDisasters & civiliansin conflict (non-IDPs)HCR/OHCHR/UNICEFEarly Recovery UNDP
Common service areasLogistics WFPTelecommunications OCHA/UNICEF/WFP
#Pan AmericanHealthOrganization16Emergency education cluster: UNICEF and SaveResponsibilities of global cluster leadsStandard setting Standard setting and consolidation of best practice
Building response capacityTraining and system development at local, regional and international levelsSurge capacity and standby rostersMaterial stockpiles
Providing operational supportEmergency preparednessAdvocacy and resource mobilization
#Pan AmericanHealthOrganization17Designating sector/cluster leads at the country levelThe UN consults the host government and national/international humanitarian actors to determine priority sectors.The UN ensures lead agencies are designated for all the key sectors. Where possible, lead agencies at the country level should mirror those at the global level.Sector/cluster leads are the provider of last resort, subject to access, security and funding.#Pan AmericanHealthOrganization18
United Nations Cluster System#Pan AmericanHealthOrganization19Cluster Approach in Haiti:Specific Challenges in Haiti: Too many peopleCivil-military cooperationOver coordination (10 meetings a day)Weakness of national authoritiesNo legal or formal authority of the cluster coordinator to triage.
#Pan AmericanHealthOrganizationExternal actors in Haiti,an unregulated industryUrban SAR teams: from 30 countries (1,800 rescuers)UN agenciesRed Cross societiesInternational NGOsBilateral non state institutions (universities)Religious associationsAd-hoc initiativesTotal of 43,000 Internationals#Pan AmericanHealthOrganizationHealth Cluster in Haiti
Coordination: the Health Cluster in HaitiThe Cluster began operating 3 days after the earthquake and a full time HC Coordinator. By February 16, 390 agencies registered with the HC.Sub-working : primary care, hospital care referral system medical supplies rehabilitation.#Pan AmericanHealthOrganizationHealth Cluster in Haiti
HospitalsDay 10: 8 foreign field hospitals/40 health facilitiesDay 13: 12 foreign field hospitals( 2 ships)/ 48 health facilitiesDay 15: first military hospital leaving, others schedule their departureDay 21: two more hospital ships arrivedDay 24: 21 foreign field hospitals/91 health facilities
Russian Field Hospital#Pan AmericanHealthOrganizationLand based Foreign Field Hospitals: 21MSF (Doctors without borders): 5 field hospitals,16 Operating theatres and 1,237 bed capacity, 800 internationals and over 3,000 nationals, 5,707 surgical interventions (first month 2,386; second 1,902 and third 1,419). No patients were rejected.
Israel military Hospital: arrived on day 41,100 treated patients. 242 surgical procedures under anesthesia were performed on 205 patients. Patients with brain injuries; paraplegia, low Glasgow coma score not accepted.
#Pan AmericanHealthOrganizationOther disastersBam: 11 FFH 550 beds /Ukrainian firstBanda Aceh: 9 FFH /Singapore first/beds?Pakistan: 10 FFH/Turkish first/ 38 Cuban FFH???Costs/bed/day: +/- 2,000 USDNo FFH arrives early enough for trauma care
Source: Karolinska/Sweden PDM vol 23.no 2, 2008#Pan AmericanHealthOrganization
#Pan AmericanHealthOrganizationChallenges:Field hospitals concentrate on what they do best.Rapid turnover of patients to achieve efficient use of theatres.No post op care. the least sophisticated facilities were the most overworked.No referral system between facilities.No internationally accepted standards but professional groups (military, Red Cross, MSF) developed their own guidelines.#Pan AmericanHealthOrganizationThe problemsUnacceptable practices.Questions about clinical competencies.Accountability and coordination.Complementarity of deployed medical teams (trauma, plastic surgery, crush syndrome, post op, rehab.)Better match btw supply and demand (time of arrival).#Pan AmericanHealthOrganizationOpportunities: establishing an international registry of FMT (Foreign Medical Teams)Faster deployment (if governments can rapidly identify and approve FMT).Better complementarities.Reduction of duplications or overlap.Better transparency and coordination with national authorities/clusterDonors encouraged to support a registered FMT.#Pan AmericanHealthOrganizationThinking big
#Pan AmericanHealthOrganization32Other initiativesRegistration: database of foreign medical teams, no validation required.Certification: technical evaluation, implies liability for the certifying agency (INSARAG classification).Accreditat