From Disasters to Development

7/28/2019 From Disasters to Development

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From Disastersto Development

Pierre Perrin, MD, MPHChief Medical Officer

International Committee of the Red Cross


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Section A

Disasters and Development


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Crisis Recovery

DevelopmentDevelopment

Disaster

Relief

Disaster

Disaster

Continued


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Disaster

Adisasteris a disruption in the normal

pattern of life generating . . .

Suffering

Socioeconomic breakdown Modification of the environment

To such an extent that there is a need forassistance (PAHO)


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Crisis

Settlement

Transition

Stability Stability

Relief

Conflict

Armed Conflicts

Conflict


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Armed Conflicts Do NotOccur Unexpectedly

Behind the immediate factors that trigger

conflicts, analysis reveals deeper causes,such as . . .

Territorial demands Socioeconomic inequalities

Economic interests

The defense of political ideologies

Continued


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Armed Conflicts Do NotOccur Unexpectedly

Behind the immediate factors that trigger

conflicts, analysis reveals deeper causes,such as . . .

Burgeoning nationalism The struggles of ethnic minorities

Racism and arms proliferation


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Understanding Disasters

We want to understand

What causes a disaster

What the impact will be

To do this, we need to define a frame thatshows the functioning of a society


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Society

PopulationLegal

System Media

Political SystemPolice Armed Forces

TerritoryEcology

EconomicSystem

Social andCulturalSystem


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Development

The interaction between the three systems

can be called developmentwhen changes inany of them contribute to a better overallequilibrium

Continued


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Development

Development is a comprehensive economic,

social, and political process . . .

That aims at the constant improvement of

the well-being of the population and allindividuals

On the basis of their active, free, and

meaningful participation in development

Continued


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Development

Development is a comprehensive economic,

social, and political process . . .

And in the fair distribution of benefits

resulting therefrom (UN Gen. Assembly, The Right to

Development, 1986)


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Reality of Development

The reality is often far from the ideal view of

a society

Dysfunction of society leads to inequalities

among the people


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Complex Reality

Political

System

Population

TerritoryEcology

EconomicSystem


E

Armed Forces

B

C

A

X

D


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Model in a Disaster Cycle

Crisis Recovery

DevelopmentDevelopment

Disaster

Relief

Disaster


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Impact of Drought

Population

Legal

System Media

Political SystemPolice Armed Forces

TerritoryEcology

EconomicSystem



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Impact of Armed Conflict

Political

System

Population

EconomicSystem


E

Armed Forces

B

C

TerritoryEcology


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Vulnerabilities

Vulnerabilitiesthe weak points of a society

There are different levels

Ecological

Economic Social

Human

Political


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Vulnerabilities are LinkedLack ofrain

Previouserosion

Lack ofusable

water

Crop sensitive tolack of water

Reductionof food

production

Less foodproduction

Vulnerablegroups

Prices arehigher

Reduced accessto food

MigrationReduced accessto food Malnutrition

Increasedmortality


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AggressivePhenomenon

Vulnerability NegativeImpact

X

Effect of Vulnerability


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Aim of

Humanitarian Response

For humanitarian organizations, the link

between emergencies and development isclearly the reduction of vulnerabilities


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Rural Populations

Stricken by Drought

Vulnerabilities

Economic

Environmental

Social


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Environmental Vulnerabilities

Environmental measures

Improve water storage system

Reduce erosion

Reforest


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Economic Vulnerabilities

Economic measures

Diversify the means of subsistence

Institute cooperatives

Improve methods of raising livestock Encourage saving

Develop markets


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Social Vulnerabilities

Social measures

Develop local aid organizations

Respect traditional mechanisms of mutual

aid


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From Relief to Development

It is essential to analyze vulnerabilities

exposed by a disaster People have to define the systems (political,

economic, socio-cultural) that they want tobuild after the disaster so that they will beless vulnerable to future disasters

Continued


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From Relief to Development

When planning relief activities, always define

long term objectives aimed at restoring thesystems as defined by the people


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EconomicSecurity

Social andCulturalSecurity

Political

Security

HumanSecurity

Restoring Human Security


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Section B

Health, Ethics, Law, and Policiesin Armed Conflicts


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Main Causes of Armed Conflicts

Fight for territories

Scarcity of resources

Competition for natural resources

Religious antagonism Ethnic discrimination

Ideological struggle

Bad governance

Arms availability


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Civilians in Armed Conflicts

Civilians are victims of armed conflicts

In some cases, the objective of the war isthe elimination of populations

Ethnic cleansing, genocide In other situations, uncontrolled armed

groups make their living by exploiting

populations


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On Populations

Malnutrition

High morbidity

High mortality

Health Impact of Armed

Conflicts

Continued


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On Populations

Malnutrition

High morbidity

High mortality

On Health System

Disruption of health

servicesDestruction of healthstructures


Conflicts

Continued


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On Populations

Malnutrition

High morbidity

High mortality

On Health System

Disruption of health

servicesDestruction of healthstructures

No access tohealth care


Conflicts


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Murder

IndiscriminateAttacks on HS

Torture

Harassment

Inhumane

Treatment

Rape

Forced

Displacement

Hostage

taking

Arbitrary

detention

Splitting

families

Deportation

Genocide

Ethniccleansing

People

may also

be the

victims of

human

rights

violations

Health and Human Rights


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Health and Human Rights Are

Linked

Murder

IndiscriminateAttacks on HS

Torture

Harassment

InhumaneTreatment

Rape

ForcedDisplacement

Hostagetaking

Arbitrarydetention

Splittingfamilies

Deportation

Genocide

Ethniccleansing

WoundsMeaslesPneumoniaMalnutritionMalaria


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Needs forAssistance

Needs forProtection

Assistance and Protection

In practice, assistance and protection of

victims can not be dissociated

Continued


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Assistance and Protection

At times, protection is assistance and vice

versa The ICRC provides protection

ICRC prison visits Correct torture and mistreatment

Distribute goods and medical services

Source: David Forsythe, Choices More Ethical than Legal: The ICRC and

Human Rights Ethics and International Affairs (1992)


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Assistance

Protection

Presence

Discrete

Negotiations

Absence

Campaigning

The choice between options is difficult

Humanitarian Strategy


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Assistance

Protection

Presence

Absence

DiscreteNegotiations

Campaigning

For a given institution,a choice must be madebetween exclusive

strategies

Institutional Strategy

Continued


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Independence

Development

ProtectionAssistance

Emergency

Individual

Group

Confidentiality

CampaigningCurative

care

Preventivecare

Coordination

Absence

Presence

DecisionProcess

Institutional Strategy To set a strategy, an organization must look

at all issues


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Ethical Decisions Choices must be made on a strong ethical

basis

Continued


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Ethical DecisionsA good ethical decision tends to . . .

Maximize all interests Minimize negative side effects

Respect the values of victims, societies,and institutions

Source: P. Lesage-Jarjoura, Nouveaux dfis professionnels pourle mdecin des annes 2000. Collge des mdecins du Qubec, 1998.


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Ethical Framework

Ethical

Decisions

Personal values, Sociocultural values, Technical guidelines,Standards, Professional guidelines, IHL, HR Law, Codes of

Conduct, Statutes, Mandates, Principles, Rules . . .

Continued


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Ethical Framework Let us have a look at some issues involved in

making a difficult decision in the field

R t f th V l


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Respect for the Values

of BeneficiariesStripped of reality, the identity of these

beneficiairiesbeing the objects ofhumanitarian actionundergoes a culturalistlevelling. At worst, the beliefs, practices, and

values of these victims no longer have anyimportance.

Source: Bernard Hours, Lidologie humanitaire anthropophage

de lhumanit,J ournal des anthropologues, 7778, 1999.

Th I t ti l H it i


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The International Humanitarian

Law (IHL)The existence of a large body of International Humanitarian

Law and Human Rights Law is an important part of themoral landscape in which relief agencies make their moraldecisions.

These international legal instruments often spell out what is

right and wrong under law. In their decision making, reliefagencies should be increasingly familiar with this body oflaw and be able to refer to relevant sections of itappropriately and abide by, wherever possible.

Continued

Source: Hugo Slim. Doing the Right Thing: Relief agencies,

moral dilemmas, and moral responsibility in politicalemergencies and war report, no. 6.



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Law (IHL) The main rules of the IHL are contained in

the following: The Geneva Convention of 1949

The Additional Protocols to the GenevaConvention of 1977

The Law of War

S l f li bili f h


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PI,Art.55: Protection of the natural

PII,Art15: Protection of works and

forces

PI,Art.54: Protection of objects

civilian population

POW

PII,Art .11: Protection of medical units

medical duties

participating in relief actions

CIV, Art .23: Consignment of medical

CIII, Art .26: Food for the POW

environment

installations containing dangerous

indispensable to the survival of the

CIII, Art.30: Medical attention for the

CIV,Art .18: Protection of hospitals

and transport

PII,Art10: General protection of

PI,Art.71: Protection of personnel

suppl ies, food and clothing

Health System

Some Examples of Applicability of the IHL to

Protection of Victims and the Health System

Continued

S E l f A li bilit f th IHL t


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Some Examples of Applicability of the IHL to

Protection of Victims and the Health System

PII,Art.5: Protection of persons whose liberties

have been restricted

Art.3 common to the four Geneva Conventions

PII,Art.13: Protection of the civilian population

PII,Art .7: Protection and care for the wounded,

sick and shipwrecked

PI,Art.51: Protection of the civi lian populationPII,Art.4: Fundamental guarantees

Victims


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The Human Rights Law International instruments of the Human

Rights Law The Universal Declaration of Human

Rights (1948)

The International Covenant on Economic,Social, and Cultural Rights (1966)

Continued


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The Human Rights Law International instruments of the Human

Rights Law The International Covenant on Civil and

Political Rights (1966)

The Convention relating to the Status ofRefugees (1951)


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Codes in Armed Conflicts Examples of codes relevant in armed

conflicts The code of conduct for International Red

Cross and Red Crescent Movement and

Non-Governmental Organizations inDisaster Relief

Continued


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Codes in Armed Conflicts Examples of codes relevant in armed

conflicts People in Aid

Sphere project

RC/RC Principles

The Red Cross and


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VICTIM

Humanity

The Red Cross and

Red Crescent Principles

Continued

The Red Cross and


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VICTIM

VICTIMSHumanity

Impartiality

The Red Cross and


Continued

The Red Cross and


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VICTIM

VICTIMS

VICTIMS

Humanity

Impartiality

Neutrality

The Red Cross and


Continued

The Red Cross and


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VICTIM

VICTIMS

VICTIMS

VICTIMS

Humanity

Impartiality

Neutrality

Independence

The Red Cross and


Professional Codes


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Professional Codes

and Resolutions The Declarations of the World Medical

Association The Helsinki Declaration (1964) related to

bioethics and biomedical research

The Statement on medical ethics in theevent of disasters (Stockholm, 1994)

The Resolutions of the International Councilof Nurses

Mandate and Statutes of


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Humanitarian Organizations Know the mandate and strategies of action

of different humanitarian organizations tounderstand their complementarity

Continued



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Humanitarian Organizations For example, the principle ofconfidentiality

espoused by the ICRC should not be placedin opposition to the principles ofdenunciation adopted by other human rights

agencies The two approaches are complementary, and

both are necessary


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Values IHL

Professional

Norms

(WMA)

HR

Codes

Ethical

Decisions

Policies

andStrategies

Decision Making

Continued


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Decision Making Quality assuranceis a tool for improving the

quality of the decision-making process Therefore, to prepare health care workers

to make ethical decisions


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Actions

Quality Assurance

Continued


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EVIDENCE BASED

APPROACH

Quality Assurance

Actions

Continued


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Quality AssurancePOLICY

DEVELOPMENT

Actions

EVIDENCE BASED

APPROACH

Continued


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DISSEMINATION

NETWORKING

Actions

EVIDENCE BASED

APPROACHPOLICY

DEVELOPMENT

Quality Assurance

Continued


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TRAINING

Actions

EVIDENCE BASED

APPROACHPOLICY

DEVELOPMENT

DISSEMINATION

NETWORKING

Quality Assurance

Ethics and Research


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in an EmergencyAn Evidence-Based Approach(EBA) may lead

to research

Continued

Ethics and Research


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in an Emergency Ethical considerations

Risk-benefit Informed consent

Confidentiality

Source: Adapted from J. Ovretveit. Evaluating Health Treatments Services

and Policies. he Nordic School of Public Health, Goteborg.


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Summary The bases for ethical decisions are as follows:

Learning from experiences Respecting the values of people

Adhering to fundamental principles of action

Looking critically at codes, norms, etc.

Looking at choices systematically

Justifying options rationally

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From Disasters to Development