Download - PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the

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Pan AmericanHealthOrganization

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•PAN AMERICAN HEALTH ORGANIZATION

•Pan American Sanitary Bureau, Regional Office of the

•WORLD HEALTH ORGANIZATION

United Nations:Civil-Military Coordination

and the Cluster System

Dr. Ciro R. UgarteEmergency Preparedness and

Disaster Relief

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Outline:

• UN Humanitarian Civil-Military Coordination

• UN Cluster System.

• Challenges & opportunities of DOD / International Organizations Coordination.

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UN Civil-Military Coordination• The 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)

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UN Civil – Military Coordination

Humanitarian organizations and military forces have different mandates

• Humanitarian 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.

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Range of civil-military relationship

Low opportunities of CM cooperation / high risks for

humanitarians of being drawn into conflict dynamics

COMBAT

High opportunities of CM cooperation / low risks for

humanitarians of being drawn into conflict dynamics

PEACETIME

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Principles on military-civilian relations

• Humanitarian 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.

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UN Civil-Military coordination in the health sector

• The 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

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Building a Stronger, More Predictable Humanitarian Response System

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Changing Environment Proliferation of humanitarian

actors Demands for more structured

international responses Changing role of the UN (less

direct implementation, more standard-setting and facilitation, more capacity-building)

Competitive funding environment

Increased public scrutiny of humanitarian action

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Whose reform?

Inter-Agency Standing Committee (IASC)

Composed of NGO consortia, Red Cross and Red Crescent Movement, IOM, World bank and UN agencies

Inter-Agency Standing Committee Full Members and Standing Invitees

Full Members

Food and Agricultural

Organisation (FAO)

Office for the Coordination of

Humanitarian Affairs (OCHA)

United Nations Development

Programme (UNDP)

United Nations Population Fund

(UNFPA)

United Nations High Comissioner

for Refugees (UNHCR)

United Nations Children’s Fund

(UNICEF)

World Food Programme (WFP)

World Health Organisation

(WHO)

Standing Invitees

International Committee of the

Red Cross (ICRC)

International Council of Voluntary

Agencies (ICVA)

International Federation of Red

Cross and Red Crescent

Societies (IFRC)

American Council for Voluntary

International Action (InterAction)

International Organisation for

Migration (IOM)

Office of the High Commissioner

for Human Rights (OHCHR)

Office of the Special

Representative of the Secretary

General on the Human Rights of

Internally Displaced Persons

(RSG on HR of IDPs)

Steering Committee for

Humanitarian Response (SCHR)

World Bank (World Bank)

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FOUR PILLARS OF REFORM

CLUSTER APPROACHAdequate capacity and predictable leadership in all sectors

HUMANITARIAN COORDINATORSEffective leadership and coordination in humanitarian emergencies

HUMANITARIAN FINANCINGAdequate, timely and flexible financing

PARTNERSHIP

Strong partnerships between UN and non-UN actors

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Cluster mechanism

General 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

cluster– WFP for food– Others…

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Links with Government and national authorities

“Each 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

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AIM

• High standards of predictability, accountability and partnership in all sectors or areas of activity

• More strategic responses

• Better prioritization of available resources

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United Nations Cluster Approach

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New global cluster leadsTechnical areasNutrition UNICEFWater/Sanitation UNICEFHealth WHOEmergency Shelter: Conflict IDPs UNHCR

Disasters IFRC ‘Convenor’

Cross-cutting areasCamp Coord/Mgmt: Conflict IDPs UNHCR

Disasters IOMProtection: Conflict IDPs UNHCR

Disasters & civiliansin conflict (non-IDPs)

HCR/OHCHR/UNICEFEarly Recovery UNDP

Common service areasLogistics WFPTelecommunications OCHA/UNICEF/WFP

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Responsibilities of global cluster leads

• Standard setting - Standard setting and consolidation of

‘best practice’

• Building response capacity- Training and system development at

local, regional and international levels- Surge capacity and standby rosters- Material stockpiles

• Providing operational support• Emergency preparedness• Advocacy and resource mobilization

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Designating sector/cluster leads at the country level

• The 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.

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United Nations Cluster System

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Cluster Approach in Haiti:

Specific Challenges in Haiti: – Too many people– Civil-military cooperation– Over coordination (10 meetings a day)– Weakness of national authorities– No legal or formal authority of the cluster

coordinator to triage….

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External actors in Haiti,an unregulated industry

• Urban SAR teams: from 30 countries (1,800 rescuers)

• UN agencies• Red Cross societies• International NGOs• Bilateral non state institutions (universities)• Religious associations• Ad-hoc initiatives• Total of 43,000 Internationals

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Health Cluster in Haiti

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Coordination: the Health Cluster in Haiti• The 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.

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Health Cluster in Haiti

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Hospitals• Day 10: 8 foreign field

hospitals/40 health facilities• Day 13: 12 foreign field

hospitals( 2 ships)/ 48 health facilities

• Day 15: first military hospital leaving, others schedule their departure

• Day 21: two more hospital ships arrived

• Day 24: 21 foreign field hospitals/91 health facilities

Russian Field Hospital

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Land based Foreign Field Hospitals: 21

• MSF (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.

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Other disasters

• Bam: 11 FFH 550 beds /Ukrainian first• Banda Aceh: 9 FFH /Singapore first/beds?• Pakistan: 10 FFH/Turkish first/ 38 Cuban

FFH???• Costs/bed/day: +/- 2,000 USD• No FFH arrives early enough for trauma care

Source: Karolinska/Sweden PDM vol 23.no 2, 2008

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Challenges:• 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.

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The problems• Unacceptable 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).

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Opportunities: 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/cluster• Donors encouraged to support a registered FMT.

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Thinking big…

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Other initiatives• Registration: database of foreign medical

teams, no validation required.• Certification: technical evaluation, implies

liability for the certifying agency (INSARAG classification).

• Accreditation: formal compliance with predetermined standards: is usually voluntary.

• Licensure: Government permission( UK, Spain).• Emergency surgery coalition( ESC).

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The three wishes of the humanitarian organizations

“We know what to do”, the military should provide:

– Security … without inconvenience

– Transport … at no cost– Communications... without controls

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In normal times . . .

¡ I NEED A DOCTOR !

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In disaster situations. . .

I NEEDONE

DOCTOR!

DISASTERZONE

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Lessons Learned from Tsunami Recovery

Key Propositions for Building Back Better

Beneficiaries deserve the kind of agency partnerships that move beyond rivalry and unhealthy competition.

A Report by the UN Secretary-General’s Special Envoy for Tsunami Recovery,

William J. Clinton. December 2006

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The real challenge: Coordination

IFRC

ICRCOXFAMCARESCR

Local NGO

WFP

ACNURPAHO WHO

FNUAP

UNICEFCDERA

ECHO

ORAS CONHUCEPREDENAC

OASCIDA USAID

UK

Netherlands

Donor countries

CAPRADE

UNDAC

National Emergency Agency

Red Cross

Ministry of health

ChurchPRESS

Universities

Hospitals

MSF

MC

INTERPOL

CARITASSecurity

Private health centers

Japan France

HHSCDC

Health Canada

DOD

South Com

Lessson…learned?

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.

•PAN AMERICAN HEALTH ORGANIZATION

•Pan American Sanitary Bureau, Regional Office of the

•WORLD HEALTH ORGANIZATION

United Nations:Civil-Military Coordination

and the Cluster System

Dr. Ciro R. UgarteEmergency Preparedness and

Disaster Relief