Henry Dunant, fundador de la Cruz Roja / Henry Dunant, founder of the International Red Crosse

El presente se aborda la figura de Henry Dunant, activista en favor de la causa humanitaria, fue testigo de las secuelas de la batalla de Solferino en Italia cuyo impacto le llevó a escribir sus memorias y experiencias en el libro "Un recuerdo de Solferino" en el que reclamó la creación de un cuerpo de voluntarios para socorrer a los heridos de guerra sin distinción del bando que fuera. En 1901, recibió el primer Premio Nobel de la Paz por su papel al fundar el Movimiento Internacional de la Cruz Roja (AU).

The current work is about the figure of Henry Dunant, militant in favor of the humanitarian cause. He was a witness of the sequels of Solferino´s battle, in Italy, the impact of which led him to write his memoirs and experiences in the book "A recollection of Solferino". In it he claimed for the creation of a voluntary corps to help war wounded people without distinction of the band where they fought. In 1901 he was awarded the first Nobel Peace Prize because of its role in the foundation of the International Red Crosse Movement (AU).

Henry Dunant, fundador de la Cruz Roja / Henry Dunant, founder of the International Red Crosse

El presente se aborda la figura de Henry Dunant, activista en favor de la causa humanitaria, fue testigo de las secuelas de la batalla de Solferino en Italia cuyo impacto le llevó a escribir sus memorias y experiencias en el libro "Un recuerdo de Solferino" en el que reclamó la creación de un cuerpo de voluntarios para socorrer a los heridos de guerra sin distinción del bando que fuera. En 1901, recibió el primer Premio Nobel de la Paz por su papel al fundar el Movimiento Internacional de la Cruz Roja (AU).

The current work is about the figure of Henry Dunant, militant in favor of the humanitarian cause. He was a witness of the sequels of Solferino´s battle, in Italy, the impact of which led him to write his memoirs and experiences in the book "A recollection of Solferino". In it he claimed for the creation of a voluntary corps to help war wounded people without distinction of the band where they fought. In 1901 he was awarded the first Nobel Peace Prize because of its role in the foundation of the International Red Crosse Movement (AU).

Trust in Humanitarian Aid From the Earthquake in 2017 to COVID-19 in Iran: A Policy Analysis.

The earthquake of November 2017, the great flood of April 2019, and the COVID-19 outbreak in 2020 are 3 major emergencies in Iran during the last 3 years. A common issue in all of these crises seems to be the issue of "trust." Official authorities, including the Iranian President, ministers, and the judiciary system, tried to gain people's trust by either changing policies or developing new ones. In August 2019, the new law on crisis management in Iran went into effect and the issue of public donation has been considered, too. Also, in their response to the COVID-19 outbreak, Iranian officials ordered all sectors to cooperate with the Ministry of Health and provide it with all necessary facilities. Therefore, it seems that new policies are still needed to overcome mistrust in Iran at times of emergency. Developing a policy on donation management was the first step, and there are several factors that could have contributed to the perception of the mistrust and failure in emergency missions. Mistrust can be the result of different causes, including but not limited to lack of knowledge on capabilities and efficiencies of humanitarian organizations, engagement of a wide range of organizations from different categories, extension of mistrust of an organization to other emergency organizations in the area or all of operation, lack of unity in emergency response, and poor public relations.

Towards systematic evaluation of epidemic responses during humanitarian crises: a scoping review of existing public health evaluation frameworks.

Epidemics continue to pose a significant public health threat to populations in low and middle-income countries. However, little is known about the appropriateness and performance of response interventions in such settings. We undertook a rapid scoping review of public health evaluation frameworks for emergency settings in order to judge their suitability for assessing epidemic response. Our search identified a large variety of frameworks. However, very few are suitable for framing the response to an epidemic, or its evaluation. We propose a generic epidemic framework that draws on elements of existing frameworks. We believe that this framework may potentially be of use in closing the gap between increasing global epidemic risk and the ability to respond effectively.

Simulación clínica y seguridad en urgencias y emergencias: Emergency Crisis Resource Management (E-CRM) / Clinical simulations and safety in emergencies: Emergency Crisis Resource Management

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Did internal displacement from the 2010 earthquake in Haiti lead to long-term violence against children? A matched pairs study design.

BACKGROUND: Empirical evidence is limited and contradictory on violence against children after internal displacement from natural disasters. Understanding how internal displacement affects violence is key in structuring effective prevention and response. OBJECTIVE: We examined the effect of internal displacement from the 2010 Haitian earthquake on long-term physical, emotional, and sexual violence against children and outlined a methodological framework to improve future evidence quality. PARTICIPANTS AND SETTING: We analyzed violence against adolescent girls and boys within the nationally representative, Haiti Violence Against Children Survey. METHODS: We pre-processed data by matching on pre-earthquake characteristics for displaced and non-displaced children and applied 95 % confidence intervals from McNemar's exact test, with sensitivity analyses, to evaluate differences in violence outcomes between matched pairs after the earthquake. RESULTS: Internal displacement was not associated with past 12-month physical, emotional, and sexual violence two years after the earthquake for girls and boys. Most violence outcomes were robust to potential unmeasured confounding. Odds ratios for any form of violence against girls were 0.84 (95 % CI: 0.52-1.33, p = 0.500) and against boys were 1.03 (95 % CI: 0.61-1.73, p = 1.000). CONCLUSIONS: Internal displacement was not a driver of long-term violence against children in Haiti. Current global protocols in disaster settings may initiate services after the optimal window of time to protect children from violence, and the post-displacement setting may be central in determining violence outcomes. The combination of specific data structures and matching methodologies is promising to increase evidence quality after rapid-onset natural disasters, especially in low-resource settings.

Breastfeeding Protection, Promotion, and Support in Humanitarian Emergencies: A Systematic Review of Literature.

BACKGROUND: Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied. RESEARCH AIMS: (1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature. METHODS: PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits (N = 10). Articles that did not include the interventions and related outcomes were excluded (n = 1,391). RESULTS: Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence. CONCLUSION: In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.

When International Humanitarian or Medical Missions Go Wrong: An Ethical Analysis.

Recent decades have seen a significant increase in physicians participating in international short-term missions to regions with limited or no access to health care by virtue of natural disaster or lack of resources. Recent publications in the ethics literature have explored the potential of these missions for unintentional harm to the intended beneficiaries. Less has been discussed about how to respond when harm actually occurs. The authors review the ethical issues raised by short-term medical and humanitarian missions and the literature on responding to unintended error to provide guidelines for avoiding harm to the intended beneficiaries of missions and an appropriate response when harm occurs. Two cases demonstrating an analysis and response to unintended harm are presented.

Data Collection Tools for Maternal and Child Health in Humanitarian Emergencies: An Updated Systematic Review.

The worst rates of preventable mortality and morbidity among women and children occur in humanitarian settings. Reliable, easy-to-use, standardized, and efficient tools for data collection are needed to enable different organizations to plan and act in the most effective way. In 2015, the World Health Organization (WHO) commissioned a review of tools for data collection on the health of women and children in humanitarian emergencies. An update of this review was conducted to investigate whether the recommendations made were taken forward and to identify newly developed tools. Fifty-three studies and 5 new tools were identified. Only 1 study used 1 of the tools identified in our search. Little has been done in terms of the previous recommendations. Authors may not be aware of the availability of such tools and of the importance of documenting their data using the same methods as other researchers. Currently used tools may not be suitable for use in humanitarian settings or may not include the domains of the authors' interests. The development of standardized instruments should be done with all key workers in the area and could be coordinated by the WHO.

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare.

Importance: Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. Objective: To describe a consensus framework for surgical care designed to respond to this emerging need. Design, Setting, and Participants: An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. Main Outcomes and Measures: The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Results: Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Conclusions and Relevance: Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.

Literature Review: Strategies for Addressing Language Barriers During Humanitarian Relief Operations.

Humanitarian relief operations (HUMRO) represent a nexus between military diplomacy and global health engagement, and may play an increasing role in military operations in the near future. Language barriers between providers and the individuals being assisted are a significant constraint on HUMRO. A literature review was conducted to identify recommendations to address patient-provider language discordance in the international HUMRO context. This was supplemented by a North Atlantic Treaty Organization and US Department of Defense doctrinal review to identify existing best practices for addressing language barriers. Four general themes were identified: (1) print-based aids, (2) information technology, (3) bilingual responders, and (4) the effective use of medical interpreters in the HUMRO setting. Each strategy is reviewed. Informed by expert opinion, we provide concrete leadership and training recommendations for how HUMRO providers might more effectively communicate with patients in a deployed language-discordant context.

Subacute Phase After an Earthquake: An Even More Important Period.

An earthquake is a very common natural disaster. Numerous studies have focused on the acute phase, but studies concerning the subacute phase after an earthquake were very limited. This aroused more attention being paid to medical relief in the subacute phase, and this study elaborated on the division of the medical relief period and the definition of medical relief targets. More importantly, major types of disease were analyzed by reviewing the relevant published studies, which were identified by searching electronic databases. Findings suggested that the clear division of medical relief stage is vital for determining the priority of medical aid and allocating medical resources scientifically, and all concerned populations should be targeted for medical assistance. The focus of acute phase is injury (64.2%), and the subacute phase is disease (27.8% respiratory disease, 22.9% common disease, 12.5% wound/injury, 10.5% skin disease, 8.7% gynecological and pediatric disease, 8.5% digestive disease). However, due to the limited available studies, the included articles perhaps did not reflect the actual proportion of each type of disease. More studies are needed to better understand the proportion of different diseases in each phase of an earthquake.

Saúde Mental e Apoio Psicossocial em Emergências Humanitárias: uma análise crítica entre políticas e práticas atuais de assistência / The Political Economy of Mental Health and Psychosocial Support in Humanitarian Emergencies a critical analysis of current practices

Existe uma tensão extraordinária no sistema humanitário: crises e emergências atingem cada vez mais povos, duram mais e são gradativamente mais complexas. As consequências dos conflitos armados e desastres socioambientais para a saúde mental e bem-estar psicossocial de indivíduos e povos, bem como para a ecologia social e os recursos comunitários significativos, já são reconhecidas e continuamente pesquisadas. Esta tese, a seu turno, explora as práticas e políticas do setor de Saúde Mental em emergências humanitárias e toma como ponto de partida analítico o desenvolvimento das Diretrizes do Comitê Permanente Interagências (IASC) em Saúde Mental e Apoio Psicossocial (SMAPS) em emergências humanitárias, lançadas no ano de 2007, assim como sua subsequente disseminação e configuração de governança, além de sua influência sobre projetos e instituições. As diretrizes IASC representam um marco lógico de importante contribuição para o setor de ajuda humanitária, no entanto, ainda constituem um campo de várias disputas e paradoxos, não só na área das referências teóricas e práticas em SMAPS em emergências humanitárias, como também relativamente à sua inserção em uma economia-política do setor de ajuda humanitária paradoxal nos princípios humanitários e éticos. Essa inserção molda as características particulares do funcionamento das Diretrizes e influencia a maneira como se produzem práticas e políticas. Fundamentando-se na pesquisa-ação, nas experiências do autor, o qual atuou como psicólogo na linha de frente em crises humanitárias na Líbia, Gaza, Síria, Timor-Leste e outros contextos, e em entrevistas com atores internacionalmente renomados e responsáveis pela elaboração e gestão de políticas internacionais do setor global de SMAPS, esta tese examina esse processo em detalhe, considerando o desenvolvimento e evolução das Diretrizes IASC de SMAPS e como, atualmente, a área de SMAPS se configura no interior da economia-política do setor humanitário. Mais explicitamente, analisam-se as maneiras como o discurso e a prática do setor de SMAPS são transformados pela estrutura humanitária que ele engendra. Desse modo, e por meio da discussão de todos esses elementos, este trabalho objetiva realizar uma revisão de elementos que influenciam e permitem o desenvolvimento de assistência humanitária seja cooptada em formas particulares que se articulam a interesses não humanitários, moldando substancial e prejudicialmente os projetos de SMAPS em emergências humanitárias ao redor do mundo

There is extraordinary strain placed on the humanitarian system. Crises and emergencies are occurring more often, affecting more people, and in contexts of increasingly complexity. The impacts of conflict and disaster on mental health as well as on the social ecology and community resources needed for coping and recovery are very well documented. This research explores the politics of mental health and psychosocial programmes in humanitarian settings, and its analytical starting point is the development of the Interagency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS) in Emergencies settings launched in the year of 2007. The research explores how the field was developed, its structural governance, trying to explore the political economy configuration of humanitarian organizations providing MHPSS in its discourses, practices and impact. It is demonstrated the MHPSS IASC guidelines unprecedent contribution to the field, however it shows how it is affected by the political economy of aid that it is fundamentally part of. This structural political economy shapes the field and influences the way SMAPS is provided. Using action research, the author\'s own experiences responding to several humanitarian crises for more than 14 years, and interviews with well-known global MHPSS policy makers, this thesis examines this process in detail, considering how the development of the guidelines has developed and evolved, and how the area currently shapes in the political economy of aid. More explicitly, it analyzes the ways in which the discourse and practice of the MHPSS field are transformed by the humanitarian structure it engenders. Despite the field achievements, action research illustrates that this process allows the development of MHPSS response to be co-opted in particular ways that articulate non-humanitarian interests, substantially and harmfully influencing the MHPSS responses

Maternal and Child Health During Forced Displacement.

PURPOSE: To discuss the effects of forced displacement on maternal and child health, highlight the major pitfalls in delivering humanitarian services to this vulnerable group, and underscore the need for multilayered interventions to improve health, protect rights, and reduce vulnerabilities during forced displacements. METHODS: A comprehensive literature search was undertaken from databases including Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, Google Scholar, Scopus, and ProQuest. No restrictions were placed on geographical region, type, and year of publication. The key words used were displacement, children, women, health, challenges, disaster response, emergency medicine, terrorism, maladjustment, morbidity, disaster response, cultural sensitivity, and interventions. CONCLUSIONS: Forced displacement negatively affects maternal and child health. The key challenges during forced displacement include food insecurity, lack of shelter, unavailability of clean water and sanitation, poor infrastructure of healthcare services, unavailability of birth attendants and healthcare professionals to manage medical emergencies, inaccessibility to educational and training facilities, and lack of cultural sensitivity of humanitarian workers. The ultimate outcome of forced displacement is a sudden rise in maternal and child mortality and morbidity, maladjustment, psychological issues, altered familial roles, displaced parenting, and vulnerability to exploitation. In view of Bronfenbrenner's socio-ecological framework, multilayered interventions are proposed to improve maternal and child health during forced displacements. CLINICAL RELEVANCE: In view of the effects of forced displacement on maternal and child health and considering the major pitfalls in the delivery of humanitarian services to this vulnerable group, the proposed multilayered interventions can improve health, protect rights, and reduce vulnerabilities surrounding maternal and child health during forced displacements.

Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value.

BACKGROUND: Médecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings. METHODS: We studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013. RESULTS: During the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases. CONCLUSIONS: The quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.

Safeguarding older adults with dementia, depression, and delirium in a temporary disaster shelter.

Natural disasters impact people of every age in the communities where they occur, with older adults being a vulnerable subset of the population. Most disaster shelter volunteer nurses are experienced in addressing common health needs of older adult clients such as diabetes, hypertension, and pulmonary disease. These nurses also have the requisite training to respond to more acute medical events, including the symptoms of a heart attack or stroke. They provide care and comfort to those suffering from the distress, anxiety, and fear caused by disasters. However, they may be less adept at triaging and caring for older adults with mental health conditions such as delirium, depression, or dementia. The trauma associated with a disaster and relocation will challenge cognitive abilities in those with dementia, may exacerbate existing depression, or lead to the onset of delirium, which is a medical emergency. Older adults experiencing these conditions are at risk for harm and deterioration with serious short and long-term consequences. Since disaster shelter volunteer health care staff may not be well-versed in distinguishing between dementia, depression, or delirium, behavior observation, and safety considerations are critical determinants of whether it is possible to support the older adult in the shelter environment or it is necessary to transition to a higher level of care.

Difficulties faced by Korean disaster relief workers while providing humanitarian aid: A descriptive study.

The aim of the present study was to identify difficulties experienced by Korean disaster relief workers during humanitarian aid deployment. A convenience sample of disaster relief workers aged >18 years, who had been dispatched to an overseas disaster site, were recruited; 107 relief workers completed the Humanitarian Aid Difficulty Scale that consists of 23 items comprising five factors. The average difficulty rating was 2.64 on a five point scale. By item, participants gave the highest scores for bathroom use and the lowest scores for cooperation among team members. By factor, infrastructure was rated as the greatest difficulty, followed by health conditions, goods and equipment, culture and customs, and cooperation. Considering sociodemographic characteristics, there were significant age differences in the culture and customs factor, as well as significant occupation differences in the cooperation, culture and customs, and goods and equipment factors. These findings highlight the need to improve the welfare of workers. It is recommended that further research be conducted according to occupation and with repeated measurement prior to, in the middle of, and after deployment of relief workers.