21 - Skip Burkle - Internally Displaced Persons

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Foundations for Global Health Responders

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University of Colorado System

Foundations for Global Health Responders

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Around the world, we are increasingly socially and economically interdependent. Health on one side of the globe affects people on the other. Global health, once merely an ethical consideration, now dominates discussions and policies of global security. A diverse team of experts in this emerging field has come together to help you contextualize your experiences as a new or seasoned global health responder. By the end of this course, you will be enlightened about the changing world you live in, and have a much better understanding of the machinations on how organizations and governments are striving to improve health worldwide. You'll also learn how to keep yourself safe and be a savvy participant in the global health arena. You'll be prepared to travel and to take your skills to chronic/emergent situations and help respond to the pressing needs while participating in global health activities throughout the world. Week one will serve as an introduction to global health concepts with a look at changing trends in the 21st century; urbanization, environmental stress and resource scarcity. During week two, we will dive into global health security: food, water, energy, and the threats of a changing climate. Week three will cover the global burden of disease, infectious disease, the rise of non-communicable diseases, mental health, and access to care. During week four, we will learn about the stakeholders in global health: NGOs, governments, non-state actors; understanding where the money comes from, how it is allocated and the challenges of measuring results; human rights: what are they and how are they protected? During week five, we move onto complex humanitarian emergencies: forced migrations, wars, response standards, and the legal basis for interventions. Finally, during week six, we will end our course by learning how to be an effective participant--caring for yourself: pre-travel preparation, understanding risks when traveling outside your home country, and physiologic vulnerability. This course also serves as a prerequisite to the hands-on 'Global Health Responder' certification from the University of Colorado School of Medicine. If you're interested in taking this 3-day hands on course-- offered throughout the world-- please go to coloradoWM.org or email our administrator: marisa.burton@ucdenver.edu.

À partir de la leçon

War & Complex Humanitarian Emergencies

Last week you learned about the stakeholders in global health, and the guidelines for humanitarian responders. This week is disaster week! Whether man-made or natural -- or a combination of both, we look at how the global health community responds to large scale humanitarian crises. Dr. Skip Burkle and Dr. Satchit Balsari will look to recent crises in the middle east and share insights into forced migrations, refugees and internal displacements. Dr. Omeed Saghafi will then interview Dr. Skip Burkle on his take on the recent Fukushima nuclear power plant failure.

Jay Lemery - Weekly Overview0:33

21 - Skip Burkle - Internally Displaced Persons6:13

22 - Satchit Balsari - Forced Migrations12:57

23 - Skip Burkle - Nuclear Threats8:30

Rencontrer les enseignants

Dr. Jay Lemery, MD
Associate Professor
Emergency Medicine, University of Colorado School of Medicine

Many NGO's in international communities focus their efforts on aiding refugees.

However, in this lecture, we will see that as the face of conflict and

disaster has changed, more people are being displaced from their homes and

communities, while still remaining in their countries of origin.

These people are not technically refugees, but are internally displaced persons.

IDPs are not only separated from their homes and families, but

they also suffer many health risks,

since they're not covered by many of the international covenants afforded refugees.

>> Among the new taxonomies is

how we're defining people that are exposed to conflict.

And as I told you in the last slide, pretty much we were dealing

just three decades ago with about 53 million refugees.

The, today we have the lowest number of refugees.

And this particular slide shows about close to 5 million.

But, we have now in dealing with mostly internally displaced persons

something that we've never even tallied before because they were such low numbers.

[COUGH] but now we have the highest number of internally displaced people.

So those are people who, who stay within the country of origin.

They do not cross an international border.

But among all populations, which we now call conflict-affected residents,

about a 148 million people throughout the world.

So these are people who are stressed in lots of different ways.

But if you ask them individually, do you feel secure?

Are, do you feel threatened?

Yes, they would answer yes to that.

So, where are these conflict affected residents?

Well, the largest number of are in Pakistan and Nigeria, but

the countries that have the largest numbers who are conflict-affected

within their countries are Libya and Somalia.

Probably something that you're not surprised at.

But if we look at that internally-displaced

populations within the, within all the countries, the IDP children

are twice as likely to die than refugees due to disease,

starvation poor immunization rates and little access to health.

So, it's refugees that are actually covered and

protected under the United Nations High Commissioner Refugees that had

the lowest death and malnutrition rates.

The highest level of immunizations against measles because once they cross a border,

an international border and

become a refugee, they're protected under international law.

This quite honestly dictated

in the initial 1945 post World War II era.

This slide depicts something that you need to be aware of, and

that is that when wars start.

And i'm talking about, oh,

the war in Somalia that caused about one and a half million deaths.

The war between Eritrea and Erithea which caused over a million deaths.

War in Sudan, the initial war that caused certainly over a million deaths.

But it's important to know that in those wars and all wars that we've had,

that [COUGH], the number of people who die from

deliberate violence, so the war itself, rarely go above 11 to 14 %.

And even striking to know that one, ones that I just mentioned, Somalia,

Sudan and Eritrea, the people who die from violence are around 2 to 3%, so

what are these other people dying from?

They're dying from the fact that war does one thing very well,

and that is that it destroys the public health infrastructure and

the social protections that we provide our populations when there's governance.

So it's water, sanitation, shelter.

It's food.

It's energy.

It's also maternal and child health programs.

It's immunization programs.

It's food programs and things like that.

One of the reasons why we, we study war,

certainly the reason I have all the decades in my career,

is to really try to mitigate those, what we call, indirect consequences.

So, the direct consequences of the deliberate violence caused by weaponry and

conflict.

The indirect consequences are these public health consequences.

But what you see here is that, of the total mortality,

if you look at the second line, it's up to 60 to 90% of those

who die that are actually dying from public health causes.

And it's the lower level, even though it's sexy, it comes on the TV,

that's what's reported, but we don't appreciate the majority

of people that are dying, are dying from public health reasons.

Current challenges [COUGH] as I mentioned the non-declared,

unconventional wars have become the norm, especially since the turn of the century.

The social media driven nation-state revolts,

as you've been watching, occurred in, in Egypt, for example.

The rise of non-state actors, like the Al Qaeda and the affiliates.

Private groups and militaries, many of them claiming to be humanitarians.

But [COUGH] with this we've never had not only in individual countries but

in regions, but globally more

problems with disappearing public health infrastructure and social protections.

Part of it is economic, part of it is the fact that after we do have conflict,

it's rare that the public health protections and

the infrastructure come back to the baseline earlier than a decade, okay.

So it takes a long time after the war is finished.

Nongovernmental organizations leave, the UN and others leave, but

that doesn't mean that the public health protections are restored or recovered.

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