O papel da informação e da comunicação em situações de emergência: a crise sanitária e humanitária no território Yanomami / The role of information and communication in emergency situations: the health and humanitarin crisis in the Yanomani territory / El papel de la información and de la comunicación en situaciones de emergencia: la crisis sanitaria y humanitaria en el territorio Yanomani

A crise humanitária no território Yanomami, agravada nos últimos anos com a invasão de atividades de garimpo, revela uma trama de fatores sociais, ambientais e políticos, que resultaram numa 'emergência' sanitária e humanitária, em seus diversos sentidos. O fluxo contínuo de levantamento de dados, a análise da situação e a comunicação de riscos é que podem revelar o contexto em que essa emergência ocorre e permitir a intervenção oportuna na crise. Nesta nota, procuramos identificar potencialidades e limitações dos dados existentes, informações e estratégias de comunicação voltadas para emergências de saúde.

The humanitarian crisis in the Yanomami territory, exacerbated in recent years by the invasion of mining activities, reveals a set of social, environmental and political factors that resulted in a health and humanita-rian 'emergency' in its various meanings. Only the continuous flow of data collection, situation analysis and risk communication can unveil the context in which this emergency occurs and allow appropriate interven-tion in the crisis. In this note, we seek to identify the potential and limitations of available data, information and communication strategies related to health emergencies.

La crisis humanitaria en el territorio Yanomami, agudizada en los últimos años por la invasión de las ac-tividades de minerías, revela un conjunto de factores sociales, ambientales y políticos, que resultan en la 'emergencia' sanitaria y humanitaria, en sus diversas acepciones. El flujo continuo de recopilación de datos, el análisis de la situación y la comunicación de riesgos es que pueden desvelar el contexto en el que se produce esta emergencia y permitir la intervención oportuna en la crisis. En esta nota, buscamos iden-tificar el potencial y las limitaciones de los datos existentes, informaciones y estrategias de comunicación relacionadas con las emergencias sanitarias.

Unidades RISC: una estrategia para evaluar riesgos de salud en la población infantil de comunidades contaminadas / CRCP units: a strategy to assess health risks in children in contaminated communities / Unidades RISC: uma estratégia para avaliar os riscos de saúde na população infantil de comunidades contaminadas

RESUMEN Las crisis humanitarias pueden presentarse en sitios afectados por amenazas químicas, físicas, biológicas y sociales, sobre todo cuando estas amenazas interaccionan entre sí y causan una sindemia. A fin de evitar las crisis, en estos sitios se hace necesario introducir medidas de mitigación que hemos enmarcado bajo el término de "escenarios humanitarios". Debido a su naturaleza, la implementación de dichas acciones de intervención requiere de la conformación de grupos operativos multidisciplinarios y de una estrategia de trabajo que permita integrarlos con la comunidad afectada. En el caso de la población infantil, el grupo operativo recibió el nombre de unidad de riesgos infantiles en sitios contaminados (RISC), es decir, en localidades impactadas por amenazas químicas, físicas o biológicas. La estrategia consta de las siguientes seis fases: i) planificación para el estudio y la visita al sitio; ii) participación de la comunidad para identificar amenazas, vulnerabilidades y rutas de exposición (el camino que deben seguir los contaminantes desde su fuente hasta la población receptora), así como para el trabajo conjunto en las siguientes fases; iii) priorización de riesgos identificados mediante el monitoreo ambiental y uso de biomarcadores de exposición y efectos; iv) prevención de riesgos a través de la creación de diversas capacidades y alternativas para la prevención ante amenazas sindémicas (CAPAS); v) promoción para implementar las CAPAS mediante la comunicación de riesgos y la capacitación local; y vi) protección con medidas que incluyen propuestas de telesalud, progreso social e innovación para mejorar la cobertura sanitaria. La estrategia ha sido aplicada en diferentes contextos, en algunos de los cuales, ha sido enriquecida con el análisis del respeto de los derechos humanos.

ABSTRACT Humanitarian crises can occur in places affected by chemical, physical, biological, and social threats, especially when these threats interact with each other and cause a syndemic. In order to avoid crises in these places, it is necessary to introduce mitigation measures that we have framed as "humanitarian scenarios". Due to their nature, implementation of these interventions requires the creation of multidisciplinary operational groups with a work strategy that integrates them into the affected community. In the case of the child population, the operational group was called the 'childhood risks in contaminated places' (CRCP) unit; contaminated places meaning localities impacted by chemical, physical, or biological threats. The strategy has six phases: (i) planning the survey and site visit; (ii) community involvement in identifying threats, vulnerabilities, and routes of exposure (the path of pollutants from their source to the receiving population), and in preparing joint work for the subsequent phases; iii) prioritization of risks identified through environmental monitoring and use of biomarkers of exposure and effects; iv) risk prevention through the creation of various 'capacities and alternatives for the prevention of syndemic threats'; (v) advocacy to implement these capacities and alternatives through risk communication and local training; and (vi) protection through measures that include telehealth, social progress, and innovation to improve health coverage. The strategy has been implemented in different contexts, and in some of them it has been enriched by analysis of respect for human rights.

RESUMO Crises humanitárias podem ocorrer em locais afetados por ameaças químicas, físicas, biológicas e sociais, principalmente quando essas ameaças interagem entre si e causam uma sindemia. Para evitar as crises, é necessário introduzir nesses locais medidas de mitigação que enquadramos no termo "cenários humanitários". Por sua natureza, a implementação de tais ações de intervenção exige a formação de grupos operacionais multidisciplinares e de uma estratégia de trabalho que permita integrá-los à comunidade afetada. No caso da população infantil, o grupo operacional recebeu o nome de Unidade de Riscos Infantis em Áreas Contaminadas (na sigla em espanhol, RISC), ou seja, em locais impactados por ameaças químicas, físicas ou biológicas. A estratégia consiste nas seis fases a seguir: i) planejamento para o estudo e visita ao local; ii) participação da comunidade para identificar ameaças, vulnerabilidades e rotas de exposição (caminho que os contaminantes devem seguir desde a sua fonte até a população receptora), bem como para o trabalho conjunto nas fases seguintes; iii) priorização dos riscos identificados por meio do monitoramento ambiental e uso de biomarcadores de exposição e efeitos; iv) prevenção de riscos por meio da criação de diversas capacidades e alternativas para a prevenção diante de ameaças sindêmicas (CAPAS); v) promoção da implantação das CAPAS por meio da comunicação de riscos e capacitação local; e vi) proteção com medidas que incluem propostas de telessaúde, progresso social e inovação para melhorar a cobertura de saúde. A estratégia foi aplicada em diferentes contextos, em alguns dos quais foi enriquecida com uma análise do respeito pelos direitos humanos.

(Sobre)viver na rua: narrativas das pessoas em situação de rua sobre a rede de apoio / (About) living on the street: narratives of homeless people about the support network / (Sobre)vivir en la calle: narrativas de personas en situación de calle sobre la red de apoyo

A população em situação de rua (PSR), em seu cotidiano, se relaciona com diferentes pessoas, grupos e/ou coletivos ligados à execução das políticas públicas, às organizações não governamentais, familiares ou a membros da sociedade civil. Pensar nessas dinâmicas de trabalho, cooperação e auxílio remete a pensar sobre uma rede de apoio que constrói estratégias com essa população. Tendo presente essas problematizações, este estudo teve como objetivo analisar as narrativas das pessoas em situação de rua sobre como é produzida sua rede de apoio. Para tanto, foi realizado um estudo qualitativo, de orientação etnográfica, sendo utilizada a observação participante, registros em diário de campo e entrevistas narrativas. Participaram seis pessoas em situação de rua que recebem alimentação ofertada por projetos sociais em uma cidade do interior do Rio Grande do Sul. Os dados produzidos foram analisados a partir da Análise Temática. As análises expressam as especificidades das narrativas das trajetórias de vida associadas à chegada às ruas e à composição de uma rede de apoio na rua. Ao conhecer como se produz e opera essa rede de apoio, a partir das narrativas das pessoas em situação de rua, problematiza-se a complexidade dessa engrenagem e o desafio de produzir ações integradas entre as diferentes instâncias da rede. Nisso, destaca-se a potencialidade de práticas que levem conta à escuta, ao diálogo e à articulação na operacionalização de políticas públicas atentas às necessidades dessa população.(AU)

The street population, in their daily lives, relates to different people, groups and/or collectives linked to the execution of public policies, to non-governmental organizations, family members, or to members of civil society. Thinking about these dynamics of work, cooperation, and assistance leads to thinking about a support network that builds strategies with this population. Having these problematizations in mind, this study aims to analyze the narratives of homeless people about how their support network is produced. To this end, a qualitative study was carried out, with ethnographic orientation, using participant observation, records in a field diary, and narrative interviews. Participated in the research six homeless people who receive food offered by social projects in a municipality in the interior of Rio Grande do Sul. The data produced were analyzed using the Thematic Analysis. The analyzes express the specifities of the narratives of life trajectories associated with the arrival on the streets and the composition of a support network on the street. By knowing how the support network is produced and operated, the complexity of this gear and the challenge of producing integrated actions between the different instances of the network are problematized. Thus, it highlights the potential of practices that consider listening, dialogue, and articulation in the operationalization of public policies that are attentive to the needs of this population.(AU)

Las personas en situación de calle en su cotidiano se relacionan con distintas personas, grupos y/o colectivos, que están vinculados a la ejecución de políticas públicas, organizaciones no gubernamentales, familiares o miembros de la sociedad civil. Pensar en estas dinámicas de trabajo, cooperación y ayuda nos lleva a una red de apoyo que construye estrategias con estas personas. Teniendo en cuenta esta problemática, este estudio tiene como objetivo analizar las narrativas de las personas en situación de calle acerca de cómo se produce su red de apoyo. Con este fin, se realizó un estudio cualitativo, etnográfico, utilizando observación participante, registros de diario de campo y entrevistas narrativas. Este estudio incluyó a seis personas en situación de calle que reciben alimentos ofrecidos por proyectos sociales en una ciudad del interior de Rio Grande do Sul (Brasil). Se utilizó el Análisis Temático. Los análisis expresan las especificidades de las narrativas de las trayectorias de vida asociadas con la llegada a las calles y la composición de una red de apoyo en la calle. Al saber cómo se produce y opera la red de apoyo, a partir de las narrativas de las personas en la calle, se problematizan la complejidad de este equipo y el desafío de producir acciones integradas entre las diferentes instancias de la red. Destaca el potencial de las prácticas que tienen en cuenta la escucha, el diálogo y la articulación en la implementación de políticas públicas que estén atentas a las necesidades de esta población.(AU)

Experiencias de las brigadas del Contingente Henry Reeve en Ciudad de México, 2021 / Experiences of the Henry Reeve Contingent ́s Brigades in Mexico City, 2021

Durante el enfrentamiento a la pandemia de COVID-19, más de 40 países recibieron la ayuda solidaria de Cuba a través de las brigadas del Contingente Henry Reeve, ejemplo de esto fue su participación en México entre diciembre 2020 y abril de 2021. Con el objetivo de exponer las experiencias de las brigadas médicas cubanas del Contingente Henry Reeve durante el enfrentamiento de la epidemia de la COVID-19 en la Ciudad de México desde diciembre de 2020 hasta abril de 2021, se relatan algunos desafíos enfrentados por el equipo de cooperación médica internacional cubano durante tres meses de intensa labor que gracias, además, a la estrecha colaboración de las autoridades sanitarias y sociales, la Secretaría de Defensa, y la Secretaría de Marina mexicanas les permitió aumentar sus conocimientos sobre bioseguridad y de enfrentamiento a situaciones de graves epidemias en hospitales de campaña. Así alcanzó una eficiente respuesta con 1700 vidas salvadas. La labor desempeñada por las brigadas sanitarias cubanas junto al personal de salud mexicano permitió brindar atención de calidad a los enfermos de COVID-19 y fortalecer los lazos de hermandad entre ambos pueblos(AU)

During the confrontation to the COVID-19 pandemic, more than 40 countries received solidarity aid from Cuba through the brigades of the Henry Reeve Contingent, and an example of this was their presence in Mexico from December 2020 to April 2021. With the objective of showing the experiences of the Cuban medical brigades of the Henry Reeve Contingent during the confrontation of COVID-19 epidemic in Mexico City from December 2020 to April 2021, some challenges faced by the Cuban international medical cooperation team during 3 months of intense work are reported thanks to, in addition, the close collaboration of the health and social authorities, the Ministry of Defense, and the Mexican Ministry of the Navy, that allowed health workers to increase their knowledge about biosecurity and dealing with situations of serious epidemics in field hospitals. Thus, the efforts reached an efficient response with 1700 lives saved. The work carried out by the Cuban health brigades together with Mexican health personnel allowed to provide quality care to those sick with COVID-19 and strengthen the bonds of brotherhood between both peoples(AU)

Roles of local healthcare workers in the humanitarian response in South Sudan: a literature review

Introduction: Armed conflict is devastating to the health system, is a public health concern and recovery is an enormous challenge. The independence of South Sudan in 2011 brought much hope. However, eight years later, the country is still at conflict with itself. Although rich in resources, it is ranked among the poorest in the world and depends on donor funding for most service delivery, especially health. In an international context, promoting the localisation of humanitarian aid and the integration of health services, there is a lot to learn from the roles being played by healthcare workers (HCWs) throughout the conflict in South Sudan. Method: A literature review was conducted to identify the roles of local HCWs in South Sudan since 2011. Four databases were searched, grey literature sourced, and snowballing done to capture additional documents for a comprehensive analysis. Questions were adapted from the Critical Appraisal Skills Programme for qualitative and systematic reviews guided appraisals of the articles. Results were systematically coded, synthesised and summarised using a priori and emergent themes. Results: The health system in South Sudan is very fragmented with heavy dependence on humanitarian aid. There is serious shortage in health workforce with heavy reliance on unskilled workers to fill in the gaps, mainly in rural settings. Although close collaboration exists among different stakeholders to deliver integrated services, poor infrastructure, insecurity, lack of capacity and donor dependency still poses a challenge towards localisation of aid and sustainability. Conclusions: The literature reviewed for this study indicates that the road towards localisation of health care is possible but will depend highly on continued collaboration between the different contributors, integration of services, building capacity of the nationals, increased government funding and infrastructural development. Local involvement of HCWs by international agencies is paramount in ownership and sustainability of services.

Haïti: tremblement de terre. Rapport de Situation nº 1 - 22 aout 2021 / Haiti: earthquake. Situation Report n ° 1 - August 22, 2021

Après qu'un puissant séisme de magnitude 7,2 et une dépression tropicale aient frappé Haïti les 14 et 17 août derniers, ne faisant qu'aggraver la misère et le dénuement causés par une intensification des déplacements liés aux gangs, une insécurité alimentaire chronique et des chocs climatiques récurrents, les besoins humanitaires augmentent rapidement, dépassant la vitesse à laquelle les autorités nationales et les partenaires humanitaires peuvent atteindre les populations touchées. Le passage de la dépression tropicale Grace n'a fait qu'aggraver les conditions sur le terrain après le tremblement de terre, en déversant des pluies extrêmement fortes dans les mêmes régions du sud du pays qui ont subi l'impact du tremblement de terre quelques jours plus tôt et en retardant le déploiement rapide des évaluations sectorielles et l'acheminement de l'aide humanitaire vitale. Alors que le département du Sud-Est a été largement épargné par les conséquences du séisme dévastateur, les pluies diluviennes de Grace ont déclenché des inondations dans le département qui ont touché des centaines de foyers, générant des besoins concurrents issus de crises qui se superposent. Au 21 août, le bilan s'élevait à 2 207 morts, 12 268 blessés et 344 disparus. Ces chiffres augmentent d'heure en heure, car les équipes de recherche et de sauvetage ont de plus en plus de mal à trouver des survivants. Alors que le nombre de personnes gravement blessées ne cesse d'augmenter, la capacité de réaction du système de santé, déjà limitée, est de plus en plus mise à l'épreuve. Beaucoup de celles et ceux qui ont eu la chance de s'en sortir vivants se retrouvent maintenant sans abri, sans accès à l'eau potable et à l'assainissement, et plus exposés aux violences et aux abus, y compris aux violences basées sur le genre (VBG), car l'environnement de protection reste précaire. Selon la Direction générale de la protection civile (DGPC), 650 000 personnes ont besoin d'une aide humanitaire d'urgence dans les trois départements les plus touchés (Sud, Grand'Anse et Nippes). L'agriculture et les moyens de subsistance qui y sont liés ont été durement frappés dans les zones sinistrées, ce qui risque d'aggraver la sécurité alimentaire dans un pays où 4,4 millions de personnes, soit près de 40 % de la population, souffraient déjà d'insécurité alimentaire aiguë. Certaines des zones les plus touchées, comme le département des Nippes, ont déjà été confrontées aux conséquences négatives des sécheresses cycliques et de l'érosion des sols ces dernières années, ce qui a probablement poussé de nombreuses personnes à recourir à des mécanismes d'adaptation négatifs, car elles n'ont pas la capacité de faire face à la dernière crise.

Haiti: earthquake situation. Report nº 2 - 26 August 2021

Nearly two weeks after a 7.2-magnitude earthquake rocked south-western Haiti, humanitarian assistance has begun reaching some of the hardest-to-reach areas, where the most vulnerable are still unable to meet their urgent need for food, basic sanitation and hygiene and life-saving health services. In some remote rural areas, response personnel and relief supplies have yet to reach those most in need. The compounded impacts of the earthquake and Tropical Depression Grace have greatly exacerbated pre-existing needs. The UN System in Haiti estimates 650,000 people are in need of emergency humanitarian assistance, a concerning figure considering that 634,000 people across the three most affected departments ­ Grand'Anse, Nippes and Sud ­ already needed multi-sectoral humanitarian assistance before the quake. As of the latest updates issued on 25 August, the Haitian Civil Protection General Directorate (DGPC) reported 2,207 deaths,12,268 injured and 320 missing. By 22 August, search-and-rescue crews had extracted 24 missing people from the rubble, including 4 children, who were airlifted to Camp-Perrin to receive emergency medical assistance. In the Sud Department, aftershocks continue almost two weeks after the initial quake on 14 August, creating widespread panic among the affected population. Some people whose homes are still standing in affected areas are choosing to sleep in the streets in fear that the structures may collapse at any moment.

Flash appeal summary: Haiti earthquake

Humanitarian needs are rapidly growing in the aftermath of the 7.2 magnitude earthquake that struck south-west Haiti on 14 August 2021, badly affecting the departments of Grand'Anse, Nippes and Sud. The earthquake's devastating impact, while considered less catastrophic than the 2010 earthquake that left more than 220,000 people dead and 1.5 million injured, was later compounded with heavy rains from tropical depression Grace on 17 August. Overall, official reports indicate more than 2,200 deaths and more than 12,000 people injured. The consecutive impacts damaged or destroyed more than 130,000 homes, rendering thousands homeless and in urgent need of assistance.

Flash appeal Haiti: earthquake - August 2021

On 14 August at 8:30 am local time, a 7.2 magnitude earthquake struck the south-western coast of Haiti causing large-scale damage across the country's southern peninsula. The powerful 10 km deep earthquake occurred 13km southeast of Petit-Troude-Nippes, in the department of Nippes, the same region devastated by Hurricane Matthew in 2016. Only two days after the quake, Tropical Depression Grace dumped extremely heavy rains in southern Haiti, causing flooding in the same quake-affected areas. Despite being much less catastrophic than the 2010 earthquake which left more than 220,000 people dead and 1.5 million injured, the impact of the 14 August earthquake has been devastating. According to the latest reports issued by the Haitian Civil Protection on 21 August, the death toll has now surpassed 2,200 with more than 12,200 people injured. Almost 53,000 homes have been destroyed and more than 77,000 have sustained damage. About 800,000 people have been affected and an estimated 650,000 people ­ 40 per cent of the 1.6 million people living in the affected departments ­ are in need of emergency humanitarian assistance. The back-to-back disasters are exacerbating preexisting vulnerabilities. At the time of the disaster, Haiti is still reeling from the 7 July assassination of President Jovenel Moïse and still facing an escalation in gang violence since June that has affected 1.5 million people, with at least 19,000 displaced in the metropolitan area of Port-au-Prince. The compounded effects of an ongoing political crisis, socio-economic challenges, food insecurity and gang violence continue to greatly worsen an already precarious humanitarian situation. Some 4.4 million people, or nearly 46 per cent of the population, face acute food insecurity, including 1.2 million who are in emergency levels (IPC 4) and 3.2 million people at crisis levels (IPC Phase 3). An estimated 217,000 children suffer from moderateto-severe acute malnutrition.

Haiti earthquake: situation report 4 - 23 August 2021

As a result of the 7.2 magnitude earthquake on August 14, 2021, according to Haiti's Civil Protection agency (DGPC), 2,207 people have died, 12,268 people were injured, and 320 are missing. In the most affected departments ­ Sud, Grand'Anse and Nippes ­ around 53,000 houses were destroyed and more than 77,000 damaged. Rapid assessments reported 59 health facilities affected in Grand'Anse, Nippes and Sud Departments: 27 severely damaged and 32 slightly damaged. In the affected departments, health sector evaluators are carrying out assessments to gather data on injured patients (hospitalizations, types of injuries and demographics) and the degree of damage to health facilities and needs. Logistics and security challenges continue limiting the delivery of supplies, deployment of personnel to affected areas and the transfer of patients to hospitals that are not overwhelmed. Health sector needs include: medical personnel, medicines, supplies and stock management, mental health and psychosocial support initiatives, implementation of preventive and control measures for communicable diseases, WASH operations in health facilities and shelters, rehabilitation of injured patients, among others

Recomendaciones para los equipos que gestionan los comedores escolares en la emergencia sanitaria de COVID-19 en Argentina / Recommendations for the teams that manage school canteens in the public health emergency of COVID-19 in Argentina

El impacto de la pandemia causada por el COVID-19 puede profundizar las situaciones de malnutrición, donde será necesario adaptar los programas alimentarios a este nuevo contexto. El objetivo de este trabajo fue presentar la metodología y los principales resultados del proceso de formulación de una guía federal basada en la evidencia científica y adaptada a la realidad de la población infanto-juvenil que asiste a los comedores escolares de las 24 jurisdicciones de Argentina. Se observó que las modalidades de implementación de CE durante la pandemia fueron: módulos alimentarios (la más frecuente); módulos alimentarios entregados en la escuela con sostenimiento del CE regular y, viandas y/o refrigerios entregados diariamente. Existió escasa evidencia a nivel global y regional sobre recomendaciones específicas aplicadas a la implementación de CE, aunque se encontraron recomendaciones sobre higiene y manipulación de alimentos. A partir de un proceso participativo entre actores claves se obtuvieron recomendaciones específicas según las dimensiones de la seguridad alimentaria y nutricional (SAN). Se concluye que resulta necesario aumentar las experiencias participativas en el diseño de recomendaciones basadas en la evidencia, adaptadas al territorio y que asuman un enfoque integral desde las dimensiones de la SAN(AU)

The impact of the pandemic caused by COVID-19 may deepen the situations of malnutrition, where it will be necessary to adapt food programs to this new context. The objective of this work was to present the methodology and the main results of the process of formulating a federal guide based on scientific evidence and adapted to the reality of the child and adolescent population that attend school canteens in the 24 jurisdictions of Argentina. It was observed that the modalities for the implementation of SC during the pandemic were: food modules (the most frequent); food modules delivered at school with regular SC support and, food and/or snacks delivered daily. There was little evidence at the global and regional level on specific recommendations applied to the implementation of SC, although recommendations on hygiene and food handling were found. Based on a participatory process among key actors, specific recommendations were obtained according to the dimensions of food and nutrition security (FNS). It is concluded that it is necessary to increase participatory experiences in the design of recommendations based on evidence, adapted to the territory and that assume a comprehensive approach from the dimensions of FNS(AU)

Discursos (sobre)viver nos territórios em risco da região metropolitana do Recife / Discourses (about) living in territories at risk of the metropolitan region of Recife / (Discursos (sobre)vivir en los territorios en riesgo de la región metropolitana de Recife

A presente pesquisa objetiva analisar e debater os discursos produzidos por usuárias(os) do Sistema Nacional de Proteção e Defesa Civil, residentes na Região Metropolitana do Recife, no que diz respeito à vida nos territórios em risco. O estudo está inserido no conjunto de pesquisas que buscam compreender os fenômenos socioculturais que envolvem a questão do risco, e suas implicações para os processos de subjetivação das pessoas nos contextos marcados por emergências e desastres. Desenvolvemos uma metodologia qualitativa, como referenciais epistêmico-metodológicos adotamos os estudos foucaultianos sobre discurso e a Psicologia Discursiva de origem inglesa. Realizamos entrevistas semiestruturadas com a participação de três homens e doze mulheres usuárias(os) da defesa civil e beneficiárias(os) do auxílio-moradia. Os discursos produzidos ressaltaram um território marcado por um sistema de gerenciamentos de riscos deficitário e pouco efetivo, sendo que a pobreza e a dificuldade de acesso a serviços públicos básicos são demandas centrais das pessoas que nele habitam. Identificamos também estratégias de resistência, que mesmo fragilizadas, buscam suprir a ausência efetiva do Estado nesses espaços. A questão social é uma temática central no contexto pesquisado, produz marcas profundas naquilo que se define como risco e, por conseguinte, na vida das pessoas que habitam os territórios permeados por ele...(AU)

This study analyzes the discussions produced by users of the National System for Civil Protection and Defense by residents of Recife's Metropolitan Region regarding survival in territories at risk. It is part of a set of projects which seek to understand socio-cultural phenomena where the matter of risk is involved and its implications for processes of how people interiorize emergencies and disasters in their respective contexts. A qualitative methodological approach was adopted. We used Foucault's study on discourse and the English school of Discursive Psychology as epistemic-methodological frameworks. Semi-structured interviews were conducted with the participation of 12 women and 3 men who were end-users of civil defense and beneficiaries of housing assistance. The generated discussions indicated a territory marked by a system of risk management which was deficient and very ineffective, as poverty and difficult access to basic public services are demands pertaining to people who live there. We also identified strategies for resistance which, even when they became fragile, sought to overcome the state's lack of presence in these scenarios. Social issues constitute a central subject for the context analyzed, as they have a profound impact upon what is defined as risk and for the people who live in territories permeated by this risk...(AU)

La presente investigación objetiva analizar y debatir los discursos producidos por usuarias/os del Sistema Nacional de Protección y Defensa Civil, residentes en la Región Metropolitana de Recife, en lo que se refiere a la vida de las personas en territorios en riesgo. El estudio está insertado en un conjunto de investigaciones que buscan comprender los fenómenos socioculturales que involucran las cuestiones de riesgo, y sus implicaciones para los procesos de subjetivación de las personas en los contextos marcados por emergencias y desastres. Desarrollamos una metodología cualitativa, como referencias epistémico-metodológicas, y adoptamos los estudios foucaultianos sobre discurso y la Psicología Discursiva de origen inglesa. Realizamos entrevistas semiestructuradas con la participación de tres hombres y doces mujeres usuarios/as de defensa civil y beneficiarios/as del programa auxilio vivienda. Los discursos producidos apuntan un territorio marcado por un sistema de gerenciamientos de riesgos deficiente y poco efectivo, siendo que la pobreza y la dificultad al acceso de servicios públicos básicos son las demandas centrales de las personas donde habitan. Identificamos también estrategias de resistencia, que aun fragilizadas buscan suprimir la ausencia efectiva del Estado en esos lugares. La cuestión social es una temática central del contexto encuestado, produciendo marcas profundas en lo que se define como riesgo y, por consiguiente, en la vida de las personas que habitan en los territorios impregnados por estos riesgos...(AU)

Gestión de riesgos y condicionalidad política de la cooperación internacional en tiempos de Coronavirus en Venezuela / Risk management and political conditionality of international cooperation in Venezuela during COVID-19

Este artículo examina la implementación en Venezuela del modelo de gestión de riesgo conocido como la Estrategia Internacional para la Reducción de Desastres de las Naciones Unidas (UNISDR,2015), o Marco de Sendai, ante la pandemia del COVID-19, así como la condicionalidad política por parte de donantes de Ayuda Oficial para el Desarrollo (AOD) en este contexto. Explora las decisiones políticas y medidas tomadas por el gobierno de la República Bolivariana de Venezuela, cuando apenas se confirmaban los primeros casos de contagio en la ciudad China de Wuhan, ratificados posteriormente el 3 de enero del 2020 por comunicado Oficial de la Organización Mundial de la Salud (OMS), a partir de lo cual se evalúa el ciclo de vida de la gestión del riesgo ante desastres, las políticas, decisiones y practicas adoptadas en Venezuela. Por otro lado, se aborda la intencionalidad política de la Cooperación Internacional, a través de la Ayuda Oficial para el Desarrollo (AOD), revelando patrones que inspiran el accionar de los donantes ante las necesidades y alineamientos ideológicos que asumen las naciones receptoras. Se concluye que la continua subordinación de los derechos humanos y la democracia a otras preocupaciones de política interior y exterior, en particular el interés económico, demuestra que ante la grave situación endémica que hoy atraviesa el planeta y con ello, la nación venezolana, las decisiones adoptadas en materia de AOD no solo socavan la credibilidad y la legitimidad de algunos gobernantes, sino que también limitan el impacto y la efectividad de la gestión de riesgos, ante lo que ya se puede catalogar como de desastre(AU)

This This article examines the implementation in Ven-ezuela of the risk management model known as the United Nations International Strategy for Disaster Reduction (UNIS-DR,2015), or Sendai Framework to the COVID-19 pandemic, as well as political conditionality by Official Development Aid (OAD) donors in this context. It explores the political decisions and measures taken by the government of the Bolivarian Republic of Venezuela, when the first cases of contagion were barely confirmed in the Chinese city of Wuhan, subsequently ratified on January 3rd, 2020, by Official Com-muniqué of the World Health Organization (WHO), from which life cycle of disaster risk management, policies, deci-sions and practices adopted in Venezuela, are assessed. On the other hand, the political intentionality of International Cooperation is addressed through the Official Development Aid (OAD), revealing patterns that inspire donor action in the face of the ideological needs and alignments that recipient nations assume. It is concluded that the continued subordination of human rights and democracy to other domestic and foreign policy concerns, in particular economic interest, make it clear that in the face of the serious endemic situation that is currently going through the planet as well as in the Venezuelan nation, decisions taken on OAD not only undermine the credibility and legitimacy of some leaders, but also limit the impact and effectiveness of risk management, in the face of what can already be classified as a disaster(AU)

Caso Venezuela: Reflexiones desde la bioética / Venezuela Case: Reflections from Bioethics / O caso da Venezuela: reflexões da bioética

Resumen: En este artículo se presenta el caso de Venezuela, país que, luego de haber tenido el mayor potencial de desarrollo de Latinoamérica, sufre una debacle política, económica y social que lo ha llevado a convertirse en el más pobre de la región, con la inflación más elevada, y a ser calificado en "emergencia humanitaria compleja". También se describen las graves violaciones a los derechos humanos: civiles, políticos, económicos, sociales, culturales y ambientales que ocurren allí sobre la base de la Declaración Universal sobre Bioética y Derechos Humanos, de la Unesco (2005). Además, se proporciona información sobre el desarrollo y la enseñanza de la bioética en Venezuela. El artículo concluye con el análisis de la situación del país desde otras perspectivas bioéticas enfocadas en Latinoamérica: bioética social y bioética de intervención; las repercusiones del problema en la región y la descripción de los esfuerzos realizados a nivel nacional e internacional para solventar la emergencia humanitaria y recuperar el país.

Abstract: This article presents the case of Venezuela, a country that, after having had the greatest development potential in Latin America, suffers a political, economic and social debacle that led it to become the poorest in the region, with the highest inflation, and to be qualified as a country in a "complex humanitarian emergency". It also describes the serious violations to human rights -civil, political, economic, social, cultural and environmental - that occur there based on the Universal Declaration on Bioethics and Human Rights by Unesco (2005). Additionally, information on the development and teaching of bioethics in Venezuela is provided. The article ends with an analysis of the country situation from other bioethical perspectives focused on Latin-America: social bioethics and intervention bioethics; the repercussions of the problem in the region and the description of the efforts made at national and international level to solve the humanitarian emergency and to recover the country.

Resumo: Este artigo apresenta o caso da Venezuela que, depois de ter o maior potencial de desenvolvimento da América Latina, sofre um desastre político, económico e social que a levou a se tornar o país mais pobre da região, além de apresentar a mais alta taxa de inflação e estar sob "emergência humanitária complexa". Também há relatos de graves violações dos direitos humanos (civil, político, económico, social, cultural e ambiental), com base na Declaração Universal de Bioética e Direitos Humanos, da Unesco (2005). Além disso, algumas informações sobre o desenvolvimento e ensino da bioética na Venezuela são fornecidas. O artigo é concluído com a análise da situação desse país, a partir de outras perspectivas bioéticas que estão enfocadas na América Latina, como a bioética social e a bioética de intervenção, as repercussões do problema na região e a descrição dos esforços realizados, em nível nacional e internacional, para solucionar a emergência humanitária e recuperar esse país.

Técnica del debranching híbrido tipo I del arco aórtico sin circulación extracorpórea / Type I hybrid aortic arch debranching without cardiopulmonary bypass

Los aneurismas del cayado aórtico representan un desafío, ya que el involucramiento de sus grandes ramas exige una técnica quirúrgica compleja. A partir de la aparición del tratamiento endovascular, una alternativa desarrollada en los últimos años para abordar el cayado aórtico consistió en el tratamiento híbrido de esta patología, mediante la derivación quirúrgica de los vasos del cuello y la posterior exclusión del aneurisma con una endoprótesis. Este método híbrido es conocido con el nombre de debranching, y en forma simplificada consiste en realizar, sin circulación extracorpórea, una serie de puentes entre la aorta ascendente y el tronco braquiocefálico, la arteria carótida izquierda y eventualmente la arteria subclavia izquierda, para permitir avanzar una endoprótesis que cubra toda la luz del aneurisma. Se describe la técnica quirúrgica del debranching híbrido tipo I, sin el auxilio de la circulación extracorpórea e implante anterógrado de la endoprótesis, para los aneurismas del cayado aórtico.

Aortic arch aneurysms represent a major challenge as the involvement of the supra-aortic vessels demands a complex surgical technique. Since the advent of endovascular aortic repair, hybrid treatment of aortic arch disease has emerged in recent years. The procedure consists of surgical bypass of the supra-aortic vessels followed by exclusion of the aneurysm with an endograft. This hybrid method is known as debranching and, briefly, consists in performing bypasses between the ascending aorta and the brachiocephalic artery, the left carotid artery and possibly the left subclavian artery without cardiopulmonary bypass, in order to advance an endograft to cover the entire lumen of the aneurysm. The aim of this paper is to describe the surgical technique of type I hybrid debranching without cardiopulmonary bypass and antegrade endograft delivery to treat aortic arch aneurysms.

A promoção da saúde no Haiti por meio das organizações humanitárias / Promotion through humanitarian organizations

Introdução: O estudo analisou de que forma as principais organizações humanitárias atuam na Promoção da Saúde no Haiti. A pesquisa esteve focada em três instituições de grande porte, selecionadas a partir do relatório da Global Genebra (2015), consultoria filantrópica reconhecida mundialmente na avaliação de organizações de ajuda humanitária, que são, segundo o documento, (1) Comitê Internacional da Cruz Vermelha, (2) Médicos sem Fronteiras e (3) Partners in Health. Buscou-se compreender de que forma essas entidades estão inseridas no contexto da globalização neoliberal, que remonta à mercantilização da saúde e ao enfraquecimento do Estado, e de que maneira se relacionam com a pluralidade de atores sociais em saúde. Objetivos: O objetivo geral desta pesquisa consistiu em analisar de que forma as maiores organizações de ajuda humanitária atuam na Promoção da Saúde do Haiti, pela perspectiva dos princípios da Equidade, da Intersetorialidade, da Participação Social e da Sustentabilidade. Ademais, investigou-se se há evidências de posturas imperialistas nas ações das entidades humanitárias, unificadas sob o conceito de neoneocolonialismo neste estudo. Além disso, averiguou-se se é possível identificar transformações em longo prazo na comunidade haitiana, a partir da intervenção das três organizações selecionadas como representantes da atuação humanitária. Método: A tese assumiu base qualitativa e a coleta de dados foi realizada por revisão da literatura acadêmica, análise documental dos materiais fornecidos pelas próprias instituições, pelo governo haitiano e por organizações intermediárias, além de entrevistas com 15 colaboradores, incluindo dirigentes, das organizações. Resultados: Ao se considerar o aparato teórico e as entrevistas, constatou-se que as organizações aplicam os princípios da Promoção da Saúde de maneira incipiente e fragmentada, carecendo de um modelo estruturado e capaz de modificar o cenário haitiano em longo prazo. Em meio a lacunas e contradições, contudo, as organizações também trazem benefícios à comunidade haitiana e são reconhecidas pela população, principalmente ao se considerar as limitações do sistema de saúde haitiano.

The present study aimed to analyze how the main humanitarian organizations develops Health Promotion in Haiti, considering the current context of globalization and neoliberalism. The research was focused on three large institutions, selected from the Global Geneva Report (2015), worldwide philanthropic consultancy recognized in the evaluation of humanitarian aid organizations, which are (1) International Committee of the Red Cross (ICRC), (2) Doctors Without Borders (MSF) and (3) Partners in Health (PIH). The method used was a qualitative basis and the data collection was done by reviewing the academic literature. Documents were provided by the institutions, by the Haitian government and by intermediary organizations, especially on the internet. Furthermore, interviews were conducted with leaders and workers of the organizations. Therefore, from the perspective of Equity, Intersectoriality, Social Participation and Sustainability - which are among the principles of Health Promotion -, the main objective of the study was to analyze the existence of imperialist aspects in the actions of humanitarian organizations (pratice denominated neoneocolonialism in the study) and if there is a real transformation in the Haitian scenario, especially in long term, ideia aligned with the idea of Health Promotion. Considering the theoretical scope and interviews, it was verified that, although the organizations bring positive results to the Haitian community and its importance be recognized by the population, there are still essential gaps to guarantee permanence of actions in the country and to mitigate imperialism in Haiti.

Towards a safer Bajhang

The pages that follow present an earthquake scenario for the district of Bajhang, Nepal. It tells the story of three people, and what happens to them and their families during a plausible but hypothetical earthquake. This is not a prediction. This story, and the study upon which it is based, are intended as an example of what may happen if a major earthquake strikes Bajhang in the near future. Bajhang will always face a risk of earthquakes. The Main Himalayan Thrust fault, which underlies much of Nepal, is the source for potentially very damaging earthquakes. The last very large earthquake in this region occurred in BS 1562 / 1505 AD. 1 Another earthquake could occur any time, because strain has been increasing on the fault ever since. This scenario shows the consequences of such an event, and the knowledge can be used to plan for safer outcomes. The story incorporates insights from professionals around the world who study earthquake effects, research on historic earthquakes, and documented experiences from the 2015 Gorkha earthquake. The consequences are based on standard methods that engineers and scientists use to estimate the shaking, damage and human impact a given earthquake may cause. The scenario earthquake strikes on a weekday in May at 1:35 PM. Across the district, adults are working, and children are on recess at school. Measuring magnitude 7.8, the earthquake originates approximately 100 kilometers northwest of Jayaprithivi on the Main Himalayan Thrust fault. It is not the worst earthquake that could happen, but it causes serious losses and suffering. Shaking throughout Bajhang and most of Sudurpashchim Pradesh is very strong, causing the consequences explained in this narrative: casualties, damaged buildings, landslides, fire, isolation, loss of power and water, and economic hardship.