 In this session, we are going to look at complex emergencies, a major form of public health disasters in the eastern Africa region. Let us start by looking at this scenario. A certain district Y has been affected by a 10-year conflict in which over 200,000 people have been internally displaced and they live in camps. They cannot return to their homes for fear of the rebels. The living conditions and health status of people in these camps is very poor. This is an example of a complex emergency. What then is a complex emergency? A complex emergency is a deep social crisis in which large numbers of people die from war, displacement and hunger, owing to man-made disasters. This is a definition by Klugman. It is also defined as a humanitarian crisis with a breakdown in authority due to internal or external conflicts that requires international response. This definition is by the UN Office for Coordination of Humanitarian Affairs, OSHA. Characteristics of a complex emergency include violence and massive displacement of people, administrative economic and political collapse. It is long lasting and widespread. That means it affects a large number of people. This is usually exploitation and worsening of existing differences in civil society, like economic differences, social differences, political differences, religious differences and others. There is often dispute over legitimacy of authority, usually between government and other formal or informal groups like rebels, insurgents, etc. Vulnerable population is at greatest risk. Large-scale humanitarian assistance is often needed. It is usually hindrance of assistance by political or military forces, meaning that some groups that have power may prevent others from receiving assistance. Complex emergencies are usually political. They often result in catastrophic public health problems. Complex emergencies often include wars and civil strife, armed aggression, insurgency and other actions resulting in displaced persons and refugees. They usually have a political undertone. Can you name some in your region? Look at these pictures and try to understand some of the effects of complex emergencies. There are greater interventions in refugee or mass displacement of people situations. There is need for a rapid needs assessment. There is need to provide water and sanitation to affected people. There is need to provide food and nutrition to affected people. Need to provide shelter and site planning, health care, control of communicable diseases and coordination of the humanitarian response. What is involved in a rapid needs assessment? Health priorities are identified on the basis of rapid collection and analysis of data. Information is collected on background displacement, risk factors, resources required, etc. It is important to use a guideline based on standards. For instance, the sphere standards, water and sanitation. Drinking water is a top priority in complex emergencies. Both quality and quantity are important. During the first days, 20 liters of water per person per day should be the target. Huwa and inadequate water supply is associated with sanitation related diseases. Sanitation in the first days of displacement, emergency latrin should be provided for every 50 to 100 persons. But these should be improved to one latrin for 20 persons. Ideally, one latrin per family when the conflict improves or the situation improves or the humanitarian situation is addressed. Food and nutrition. Population movement is both a cause and a consequence of food shortage. Malnutrition is an important contributory cause of death during complex emergencies. Food distribution should be planned, effective and equitable. Shelter and site planning is an important aspect of complex emergencies, especially where large numbers of people are displaced. Shelter is important for protection, security, privacy. It is recommended that each person has 3.5 square meters of available space for their personal use. Appropriate shelter sites should be selected. They should be in a secure location away from the border. Availability of land and access to water and the location should be socially and culturally agreeable to the affected persons. Health care aims to reduce mortality in the emergency phase of displacement. Curative, preventive and rehabilitative care is crucial. Manios and guidelines should be available for standardization of treatment. A tier system of health care is important that is hospital, health center and outreach services. Determine human resource needs, recruit and train health workers and place them where they are needed. Control of communicable diseases is very important during complex emergencies. Intervention strategies include attacking the sources of infection like curative care, isolation of highly infectious persons, prevent transmission of illness through environmental sanitation, personal hygiene and health education. Protect the susceptible persons like miso immunization, chemoprophylaxis for selected diseases and provision of bed nets. There is need for continuous surveillance to detect epidemics and to assess effectiveness of interventions. Coordination is another vital part of management of complex emergencies. The rationale is that there are usually many actors involved in the response. The goal is to achieve the greatest impact through integration of activities. Establish clear leadership and coordination, ensure priorities are shared between the intervening partners. Rationalize services by establishing common standards and ensure good communication among stakeholders.