Humanitarian Missions
What
is a humanitarian mission?
The traditional roles of a nation’s military are to
defend the nation’s borders against enemies, and to prepare to wage war when
necessary. The U.S. military has
seen a dramatic increase in the number of missions that service members have
participated in, and in the number of nations to which they have been deployed.
While the use of the U.S. military is increasing, the
traditional roles of fighting wars and protecting the nation’s borders have
been augmented by what are broadly known as humanitarian
missions. Such missions are also known as
Operations Other Than War (OOTW) or Strategic and Sustainment Operations
(SASO).
Each mission is likely to have unique features, based on factors such as
geography, climate, the population being served,
and the local infrastructure.
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However, there
are features that are common to many humanitarian missions:
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Most
humanitarian missions are undertaken in response to a humanitarian
emergency.
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A
humanitarian emergency is defined as a crisis involving a large population
for whom the local government is unable to meet basic needs, either due to
disruption or displacement.
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Humanitarian
emergencies are generally brought on by one or more specific events, such as
war, famine or natural disaster.
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Natural
disasters:
These are unpredictable, sudden climatic or geologic events.
Some populations have greater vulnerability to such events due to
overpopulation and weak infrastructure.
Examples include earthquakes or hurricanes.
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Technological
Disasters: These include release of nuclear, chemical, or biological toxins.
This may be accidental (e.g., Chernobyl nuclear reactor, Bhopal India chemical
plant), or intentional, as a terrorist act (e.g., Tokyo subway release of
Sarin nerve gas, Federal building bombing in Oklahoma City).
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Complex
Emergencies:
These are the result of war or civil strife, typically involving displacement of
many people from their homes, heavy damage to infrastructure, and
continuing risks to personal safety. In recent years, more civilians have been killed and injured in war
than have soldiers. Some are
refugees, who leave their own country as a result of war, violence, or
fear of persecution. Others
are classified as displaced persons, since they stay within their own
nation’s borders, but leave their homes. An example of a complex emergency is the continuing violence in the
Balkans.
What
effects do disasters have?
Effects
can be expected to vary according to the type of disaster as well as unique
local factors such as infrastructural features. Among the effects that should be anticipated and assessed in preparing a
response are:
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Inadequate
water supply: most likely to be contaminated by floods. This is also a
problem
with large numbers of displaced persons in complex emergencies.
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Inadequate
shelter: likely to be particularly effected by earthquakes and hurricanes.
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Inadequate
sanitation: a leading contributor to the spread of disease. This is common to
complex disasters with displaced persons, as well as many natural disasters
such as hurricanes and floods.
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Inadequate
health care: This is often a problem even before a disaster in the
developing world, making efforts to respond to a disaster that much more
difficult.
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Trauma:
a superimposed problem in sudden, catastrophic natural events such as
earthquakes or tornadoes. It may complicate complex emergencies if
military or paramilitary forces terrorize a population.
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Mortality:
the unfortunate end result of many of the above factors.
Most often measured through calculation of crude mortality rates (CMRs),
which can be compared with baseline CMRs for the region to give an estimate
of the severity of the disaster as well as the success of one’s response
efforts.
What
are the most common causes of mortality in humanitarian emergencies?
These are also the most common causes of mortality in
the developing world, especially in children, even in the absence of
humanitarian emergencies:
CASE
SCENARIO
You
have been deployed to a refugee camp on the Mozambique-Kenya border where 10,000
Mozambique natives have been displaced from their homes as a result of prolonged
floods, punctuated by cyclones. You
are inundated by hundreds upon hundreds of individuals with diarrhea.
Most are children, and many appear markedly dehydrated.
What
approach should you take in treating individual cases?
Back at home, you would have started an IV and given liters of saline to
many of the children you see. However,
you have limited resources—two physicians and six corpsmen make up your team,
and your available IV supplies wouldn’t even treat 1% of the patients you see.
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The
treatment of choice is oral rehydration therapy
(ORT), which is safe, effective,
and cheap—and most important of all, it can be given by mothers or other
relatives, enabling your personnel to evaluate and institute therapy for far
greater numbers. Diarrhea can cause
more than half the deaths early in a humanitarian emergency, but dramatic
reductions in mortality have been made possible by ORT.
Several alternative formulations have been found to be effective, using
local components such as corn or rice in place of sugar.
What
should you think about on a population level?
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In this
setting, overcrowding, inadequate sanitation, inadequate nutrition, and
inadequate water supply all contribute to the problem.
Enlist your preventive medicine team in improving sanitation by
establishing a latrine area separate from any water supply, attempt to establish
a safe water supply, attempt to establish more sufficient shelter with greater
space between families. In
addition, particularly if dysentery (bloody diarrhea) is present, consider
whether there are differences between different areas of the camp, which may
give you epidemiologic clues regarding factors in the outbreak (e.g., effected
individuals are getting their drinking water downstream from where others are
defecating).
Authored by Major Michael Roy, USAF, MC
For more detailed information, read:
CDC: Famine-Affected, Refugee, and Displaced Populations: Recommendations
for Public Health Issues, MMWR - Vol. 41, No. RR-13
HA Multiservice Procedures for Humanitarian Assistance
Operations: FM 100-23-1
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