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.
22 - Satchit Balsari - Forced Migrations
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En provenance du cours de University of Colorado System
Foundations for Global Health Responders
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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.
Rencontrer les enseignants
Dr. Jay Lemery, MDAssociate Professor
Emergency Medicine, University of Colorado School of Medicine
In this episode, we decided to depart from the traditional lecture and
give you a chance to join in on a conversation between two humanitarians.
Dr. Balsari talks about his most recent experiences from a Jordanian refugee camp.
And some of the challenges faced by both modern refugees undergoing forced
migration, as well as the organizations and nations trying to aid them.
He'll touch on the difficulties in providing not only basic needs, but
also providing work and integrating refugees into a new community and nation.
Saghie, you know that I haven't been to a refugee camp in a while.
>> I find that hard to believe.
[LAUGH] Yeah, I know, more the negotiations in the diplomatic side.
But parts I miss, but part, you know,
what seem like I would have to learn all over again.
Because I know things are different and you just came back from Jordan, and
tell me what did you find?
>> I'm not sure where to begin.
So Jordan is interesting, because when you see refugee camps,
all the refugees in Jordan are not in refugee camps.
The refugees currently are obviously coming over from Syria.
Some from Iraq, but mostly, mostly from Syria.
UNHCR expects about 800,000 refugees by the end of this year in Jordan.
About 10 million Syrians have been displaced in Syria and, you know,
close to a million will, will make it to Jordan.
What's amazing about Jordan is its capacity and its willingness to
absorb this community of, of refugees, these neighbors of theirs
800,000 out of a population of 6.3 million Syrians is close to 13%.
>> My God.
>> Cannot imagine, you know, another country in the west that would open up its
borders to 13% of, of its population.
So Jordan does, does absorb the Syrians coming in.
About 20% of them are currently in camps.
You know, as they come to the borders, they are greeted there by
representatives from the Government of Jordan and UNHCR and it's,
there is agencies and directed to one of largely two refugee camps.
But from there a lot of Syrians are given the option
of getting government supersized bailout,
where essentially there is a guarantee that they
submit to the government and are able to leave camps and
selt, settle in both rural and urban areas.
>> So that's totally new isn't it?
>> That is totally new and it raises such interesting questions, because, you know,
the last time we spoke you talked about these rapid needs assessments to,
to conduct as soon as a refugee camp is being set up or
as soon as a humanitarian crisis unfolds.
How do you conduct a needs assessment if you dont know where
the beneficiaries are going to be.
They're, you know, all across the countryside, they're in cities,
they're in towns, they're in villages.
So that that is, you know, the first challenge is identify that.
>> Now is that just in Jordan, or is the same thing with Lebanon,
because they've never formed any refugee camps?
It just went into the community.
>> So, so Lebanon is the other end of the spectrum where there are no refugee camps
and everyone is an urban settler.
>> Right.
>> In, in Lebanon.
In Jordan what's interesting is just looking at the pros and
cons there are clear advantages to a refugee camp and, and, and not that
that is a permanent solution to anything, but in terms of service delivery.
>> Yeah.
>> Which seems to be the most obvious advantage
of having a contained population, you can, you can count the heads.
You can flicker out how many packages of food shelter, clothing,
you're going to need.
And you can control the populations coming in and out.
It flies in the face of how human beings should be treated, their freedom of
movement, their freedom of expression, their ability to organize themselves.
Yet, for service delivery, it makes it, it a lot more manageable.
The urban settlers on the other hand have the obvious ad, advantages of
that freedom of movement they are choosing where they will live.
They, they rent out flats in Jordan they're able to move freely.
They're part of, of society.
And to not feel like they are subject to do live in camp-like settings,
especially the ones in Jordan that are very arid.
There are areas, you know, the child-friendly spaces, for example,
are very barrack life.
The tents are all uniform and there is a sense of doom and
gloom in the camp and, and no sense of hope.
>> Saghie, it was really extremely interesting to hear what's happening
as different models or possible models for the future i, in Jordan.
Eh, are, are we looking at time that we might abolish refugee camps?
Wha, wha, what, what are your thoughts on this?
>> Well as you know this is not so black and white.
The challenges in the urban settlers were very interesting.
So this large influx of refugees into Jordan cities, right, drives up prices.
So, rents are very high.
The refugees are burning through their cash savings and
from whatever cash assistance that they have, to pay for these rents, only because
those that have opted to leave the refugee camps do not want to go back to the camps.
They don't think the environment is right for them or their families.
So they choose to live in these, you know, relatively modest,
if not squalid, conditions in the cities.
But now very vulnerable to, to inflation all around them,
which is driven by their presence.
If food prices go up, rent prices go up, and
the local communities, the host communities begin to resent them from it.
>> Those that are absorbed into the communities are they able to,
to get employment?
Unemployment is part of the issues that really even started this war but you,
can you tell me a bit about what the communities are doing,
especially on employment issues?
>> So, that, that's exactly what makes the entire urban settling phenomenon,
or even the refugee crisis even more pronounced.
You know, it's one thing for Jordan to open up its boundaries,
and, and, and invite, you know, 13% of its population,
additional population, into its geographic territory.
But then to settle them, to give them jobs, also means that there's high
likelihood that this population may or may not return any time soon.
And that definitely affects the fabric of society, governance, politics locally
as has been the case of the Palestinian refugees that originally came to Jordan
and, and that haven't left and that have been absorbed into the local community.
>> And that changed the whole political landscape of Jordan, didn't it?
>> Of Jordan, yes absolutely.
And so the policy, the current ordaining policy is to not let refugees work.
Syrians can get work permits to work in Jordan, they're prohibitive,
they're about 300 Dinars a year.
But if they do that, they have to give up their refugee status which means they have
no access to any of the UNHCR services whether it is cash assistance,
food, medicine or health care.
Because then they're considered to be independent if,
if they seek employment and this, this becomes very challenging because
the amount of money that they earn is often very meager and
it does not justify the opportunity costs of losing their refugee status.
>> So, how is this different in Lebanon because there were never any refugee camps
there, were there, they were just absorbed.
Is that correct or?
>> So, in Lebanon it's, it's exactly the same situation but
now you don't even have refugee camps.
That's not even an, an option.
So the vulnerabilities are, are even more enhanced.
>> As you know,
those of us in the humanitarian community are only as good as the data that we have.
And surveillance is one of the nine priorities that
the UN has in terms of complex humanitarian emergencies.
So, and we're only as good in terms of, of our response and prevention and
preparedness in terms of the data that we have, so we know where to put things,
especially with health.
So our, is, has data been at all
compromised in this new model of, of placing the refugees in communities?
>> So it's hard.
Now because UNHCR is still providing services
to the refugees that are self-settled, they have account.
because the refugees that registered with the UNHCR, initially when they're in camp
or the exit camp, so they, they still have a good sense of what's going on.
But it's difficult to track these people once,
once they're you know, moving residences because the rents have gone up.
So simple plans campaigns, like immunization for measles for example,
becomes very challenging.
However, a subpopulation not to ignore in Jordan and
to actually throw more light on, are the Palestine refugees from Syria.
Jordan's official policy is to not allow them in Jordan,
so Syrians of Palestine or, origin are not welcome in Jordan.
Yet there are thousands of them that have crossed the border.
UNRWA, the United Nations Agency especially for the the relief of
Palestines in the Middle East has recorded about 14,000 cases
of Palestine refugees from Syria that have approached them for help in Jordan.
Data there is impossible to know, to calculate.
Providing services then, for them, it's very difficult.
And they cannot be absorbed into the refugee camps because they're not
recognized, they're not supposed to be there.
So they hide in these self-settled shelters across Jordan and
yet have no legal recourse to any domestic or
international mechanisms because they're absolutely stateless.
>> Yeah like all wars and complex emergencies, we,
the prevention, especially with preventable im,
immunization diseases like polio and measles,
and others fall apart usually within months.
And we all know that polio was seen in Syria.
Now seen in Bagdad.
And possibly other places, but what's been the local impact of that, and
how has that been handled?
>> Right absolutely.
I mean decades of, of public health strides unravel in these situations.
So there was a strong sense of anxiety,
urgency and concern on behalf of the aide workers.
But I don't think the communities grapple the impact of of these longer
term losses that up we all collectively suffer in, in cases like this and
especially going backwards with the polio campaign as such a loss to the world.
>> Yeah, terrible.
>> So you talked earlier about these changing trends both in the nature of war,
the nature of conflict the demographic of people affected,
and all of this seems to be, you know,
overlaid with extreme climate energy scarcity,
food water scarcity and, and this extreme deprivation that,
that the rapidly urbanizing world is seeing.
I think it's really time for you know, the next generation that,
that, that lends itself more easily to, to being global citizens to,
to address these issues and, and start preparing for
the world that we are going to face over the coming decades.
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