 is Ken Iserson from the University of Arizona who's talking about the good, the bad, and the ugly ethical response to humanitarian crises. Ken, over to you. Okay, thank you. I'll try to find my slides. Thank you, Mark, for inviting me back. This is far different from the first time I gave an annual speech at the, or talk at the Claim Center. We were sandwiched, sandwiched into this little room off the main hospital lobby. One third of the people couldn't even sit down, and the ones who could, it was so uncomfortable they didn't even bother. But this is much different. Okay, great, so is this the, so front back? Ditt, ditt, ditt, ditt. Okay, this actually should have been the first talk because this is the big picture. I can only tell you that my data for this talk comes from having worked and taught on all seven continents. So, yep, seven, count them up in your head, yeah. Okay, six months in Antarctica. All right, so what's the big humanitarian crisis right now in our world? And, oh my gosh, what good timing. We have Typhoon Haiyan that's hit the Philippines, how providential this talk and a huge, but I was actually supposed to give this talk last year and got deployed right before the conference. And that was Hurricane Sandy. And the year before that it would've, and we see these all the time. Okay, so this is a catastrophe. This is what a humanitarian catastrophe is. Okay, a lot of people with needs and all kinds of interventions are needed. We're gonna talk about, very quickly, about the two classes and the really important differences. The acute crises and the chronic or cyclical disasters. Okay, natural disasters, we hear about those. The endemics that have the potential will become pandemics. Those are acute crises, war, genocide. And then the chronic ones that we don't pay that much attention to. Okay, so these are the questions I'm gonna try to answer very quickly. In each of the humanitarian crises, why do we intervene? What ethical guidelines shape our interventions? What legal guidelines? And how well do we achieve our goals? Boy, that's just a little bit to pack into this 15 minutes. Okay, I mean, basically the whole United Nations actions in 15 minutes. Natural crises, these are real pictures of, and you can identify some of them. So natural disasters, those are what lead our news. If it, the old news man's thing, if it bleeds, it leads. But actually, if it bleeds and we have great video, it leads, and so we see a lot about natural disasters. Why do we intervene? Will emotion and media and ethnic ties and politics? And let me just use the Typhoon Hiana as an example. Emotion, we're seeing bodies and bodies. This is on NBC, CBS, ABC, CNN. Bodies and bodies and bodies lined up. Little kids, no water, okay, so that's the emotion. And the media who are on site getting video, ethnic ties. I sat next to a lady on the plane coming up here and she identified herself as being a Filipino-American, obviously not first generation, but she said her mother and all her friends were together gathering different things and figuring out the best way to contribute to disaster relief. Do you know the best way to contribute to disaster relief? We'll get there at the end of the talk. Think about it, okay. Ethical guidelines, it's very straightforward. Red Cross Code, and you'll see that pop up over and over again. The Red, International Red Cross Code is how we guide our ethics for almost all, almost all disaster relief. Legal guidelines, in this case, domestic laws and sovereignty. The U.S. major aircraft carrier has steamed into the Philippines along with landing craft and destroyers and everything else. Did we do that just because we decided that was a good idea? No, the Philippines had to invite us in. They had to invite us in. It's national sovereignty, okay. And how well do we achieve our goals? Well, we're gonna have immediate success. We're gonna clean up the bodies and most of the stuff. We're gonna feed the people. And how well are we gonna do it to prevent this problem from happening in the future? Not so much. Pandemics, these are some possible future pandemics. And you've heard of some of them. Maybe you haven't heard of all of them, but they're there. Why do we bother intervening? Self-interest, we don't wanna be the victim. Why is the CDC all over the MERS coronavirus? It's only mainly in Arabia right now. Why do we care? Because we're afraid it's gonna come here. I don't think so. It's camel related. I don't think we have too many camels. But we do that. Red Cross Code, Public Health and Disclosures, the World Health Organization. Sometimes countries don't disclose as we found out with China. Healthcare ethics when we're dealing with the individual patients. And we actually do a very, very good job with this. Acute crisis wars. We haven't had a global war in quite a while. We still had over six million dead in the last, well since World War II in various different wars. And there's a lot of wars continuing as we know. And genocide, and this is what genocide is. Basically destroying national ethnic religious groups and it's happening everywhere in the world. And there's all these different ways that they can be done. Okay, so why do we intervene? Emotion. If it gets on the media, then there's emotion. And then ethnic ties. Different groups identify problems with their co-religionists, certainly in China that's happening, and other ethnic ties. And they want that stopped. Politics. Politics doesn't have anything with us intervening, right? Of course it does. Okay, those who we're tied in with, we go and help. Or that we think will be a benefit to us. Now here's a different ethical code. This is different. This is not the Red Cross Code. This is called the Sphere Project Code. Sphere Project is an international group, independent group that did a code for relief efforts during war and genocide, war particularly. And I'll show you the website for that. But that is what guides it. And then human rights law, and for those lawyers in the room, you know that there is a specific set of human rights law. And we're finally getting to the word humanitarian, which is kind of an oxymoron. Humanitarian law is the law of war. It's not the law of disaster relief. Go figure, they're lawyers, so what can I say? And how well do we achieve our goal? It depends on how fast we do it. And what roles we have. When we send in the UN, or we send in troops, or we send in others, what role do they have? Are they peacekeepers? Are they peacemakers, enforcers, fighters? Or peace builders? And oftentimes, unfortunately, they're confused about the role. Our responses are usually slow and we don't know what role we want to send them in for. And so our responses are not that good. Chronic crisis, we'll try to get those all together. And they, okay, the refugees and IDPs internally displace persons, water insecurity, food insecurity, endemic diseases. And we don't pay that much attention. Peter's group is making an attempt. The Gates Foundation is making an attempt. You know, various groups are making attempts. But in general, these are not very sexy topics. Okay, because they go on and on for, you know, and we can't do anything, okay. So international pressure eventually builds up for some of these things, and we act. Emotion, media, has anybody in here not had an email with one of the starving children on it? Okay, by the way, if you talk about photos that shouldn't be used inappropriately, that's the epitome. You know, those terrible ads to get you to spend money on their administration, the NGO administrations. Millennium Development Goals, we'll talk about that. And these are, that's just a picture of the Millennium Development Goals. If you haven't heard about them, they're almost about to run out in 2015. And this is what we were supposed to make better throughout the world by 2015. And we've done that, of course. Are you awake? Of course we haven't. But we haven't made progress. And I'll show, these are the things, by the way, we do. Oh, I have to go back, I have to show you. See that picture down in the lower right? You may have seen something like that. There was a movie with Dustin Hoffman and all, and they went into an African country and had Ebola and that's EIS, that's the CDC. And that was my dream growing up, but I just didn't, I wasn't in the right position, but I've gotten other people to get into it. And that's like the SEAL Team 6 of medicine. Very cool, very cool. And they do good work. Okay, this is what we do to support acute and chronic crises. We supply these things and we try to get long-term support for sanitation and water supply, food, nutrition. Who is we? I said we, very specifically, who is we? The country is in whatever color you see, blue is what I see, I'm colorblind. But if that's blue to you, you get the idea. So it's basically the developed countries, the well-developed countries. Notice that the former Soviet Union has no part in any of this, which I think is a little surprising. This didn't come out too well, but in general, the Millennium Development Goals. And this is how we did up to 2012. That's the official report. And the things in red we really didn't do at all and it's by different areas of the world. So here are the future hopes. Better coalitions and coordination among the disaster, acute disaster and chronic disaster groups. There is almost no coordination and they work at odds with each other and they don't even in most cases know what they're doing. Literally, okay. Best response, I'll get to that again. Know what our criteria should be and how we should intervene militarily if we're going to send in troops to prevent genocides and prevent war. Help support the recipients, let's say for example, Philippines own disaster relief efforts. And guess what? We actually are doing that. But in part, because the Philippines is not a third world country, they know what they want, they know what they need. A lot of them have been trained in the West. And in fact, to go back to talk I gave a couple years ago about this, the deputy director of their health department for the Philippines sent out a message to all these international groups and said unless you can send me teams that are experienced and self-supporting, don't bother, we don't want you because you'll only be a drain on our resources. And that's exactly what they should have done and they did it and they're getting it. Okay. Anybody know who said this? Yeah? Yeah, that's unfortunate, but it is true. Okay, the Red Cross Code, the Sphere Project Handbook Code, you can get these at these addresses. What is the best way to support these international disasters or even domestic large-scale disasters? Money. Absolutely money. Unfortunately, this lady who sat next to me on the plane said her mother and this group had been on CNN because they were collecting food and medicines and I have a picture, I didn't put in here of these boxes and boxes after the typhoon in Asia and they were filling warehouses and there was nothing they could do with them because they didn't need the stuff or they couldn't find what, send money. Send money, that's it. And charity navigator repeatedly has been said, at least on the web, is the best source for you to find charities that are legit. But in the case of the Philippines or identifiable places, send money directly to their Red Cross, the Philippine Red Cross. Almost no overhead, they're on the ground, they know the system, they're in place and they're doing the work. In the US, send it to the Red Cross designated for that disaster. By the way, these people asked me to take this picture so I'll tell you. And this is from remote Ghana where I was working and we always make it work, we're emergency physicians and global health providers so thank you very much.