Hello, I'm Cyrus Shahpar, Deputy Team Lead for the Global Rapid Response team at the US Centers for Disease Control and Prevention. Today, I'm going to answer a question many of you probably have. What exactly is a complex humanitarian emergency? First, complex humanitarian emergencies are a result of a combination of disasters. So, to understand them, we need to have a foundation in the types of disasters. A disaster happens when the forces of an extreme events that disrupts the lives of people. It exceeds the ability of the community to cope on its own. There are three key points to this definition to keep in mind. A disaster interrupts the normal function of a community. The affected population cannot fully cope with the effects of a disaster. And normal function cannot be resumed without external assistance. A disaster does not occur every time a community is exposed to a threat. The consequences of a disaster depend on the nature of the threat, and the vulnerability and level of disaster preparedness of the population at risk. Certain communities may have very low capacity to cope with the harmful effects of disasters and suffer the most consequences as a result. Typically, when people think of the term disaster, the image of natural disasters like tornadoes, hurricanes, or earthquakes comes to mind. However, there are a variety of types of disasters. Most people discuss five major categories of disasters. Sudden-onset disasters, slow-onset hazards, epidemics, industrial or technological events and complex emergencies. Let's go into each type in more detail. The first three types of disasters to be discussed are natural disasters. Natural disasters can include sudden onset disasters, slow onset disaster and disease epidemics. Sudden onset disasters include events like flood, earthquakes, tsunamis, tropical storms, volcanic eruptions, and landslides. They typically occur swiftly and without warning. Floods are the most frequent type of natural disaster that causes sudden migration of large populations and food shortages. While earthquakes usually cause the greatest number of deaths and structural damage. These types of disasters frequently cause thousands of deaths and casualties. Slow onset disasters include droughts, famine, environmental degradation, deforestation, which is the loss of trees and vegetation, pest infestation and desertification, which is the conversion of farmable lands to deserts. These disasters are usually a result of poor weather conditions combined with the poor use of the land. Communities in Africa have traditionally been at increased risk for this type of disaster due to poverty and social inequality and environmental degradation from poor land use and rapid population growth. Epidemics usually occur when diseases that normally do not occur in the community spread under certain conditions. Examples of epidemic diseases that threaten displace populations include cholera, measles, malaria and HIV. After a major sudden or slow onset disaster, the risk of epidemic disease increases due to overcrowding and unhygienic conditions. The next types of disasters are man-made and include industrial and technological disasters, and complex emergencies. Industrial or technological disasters result from a society's industrial and technological activities that lead to pollution, spillage, explosions, and fires. This may occur because of poor planning, construction of man-made facilities, or neglect of safety procedures. Sudden onset disasters may actually trigger secondary industrial disasters. These industrial disasters have the potential to cause large scale loss of life and structural damage. Especially in developing countries that have unregulated industrialization and in that adequate safety standards. Finally, complex emergencies are usually a result of multiple contributing factors. They usually follow wars between states, internal conflicts, and terrorist attacks. Massive population displacements may occur due to a lack of food, insecurity, and increasing death rates. Sadly, civilians that are not part of the conflict can end up being the majority of casualties, because they are targets of both sides of the violent conflict. This is the type of disaster we will focus on today. In thinking about these types of disasters, it is important to remember not all communities are at risk for every type of disaster, but every community is at risk for some particular disaster. Now on to complex humanitarian emergencies, or CHEs. The term CHE is used to used the human disaster that follows armed conflict, particularly war and civil strife. CHEs are often the result of weakening political and governmental processes, which can be due to poor leadership combined with natural disasters like the ones mentioned earlier. It is important to understand the different causes and types of disasters because 87% of the 30 largest CHEs in the past decayed were associated with natural disaster. As we discussed before, one type of natural disaster has the potential to snowball into another type resulting in more problems. CHEs are often the result of collective violence or arm conflict, particularly genocide in civil war. Since 1946, there has been an increase in the number of armed conflicts events per year. The increase in armed conflict has resulted in a dramatic increase in war-related deaths. In 25 conflicts that occur during the 20th century, it is estimated that 191 million people were killed directly or indirectly, 72 million of these deaths were conflict related. Furthermore, the proportion of war-related deaths among civilians has ranged from 35-65% in recent years. Resulting in the World Health Organization concluding that war-related injuries will become 1 of 15 causes of death by the year 2020. During CHEs, certain services like healthcare, education, or social welfare programs maybe the first to stop functioning. As the emergency progresses, increasing in security and poor access to food may force populations to migrate. Sub-optimal humanitarian action may lead to more human misery in the form on malnutrition, disease outbreaks, and violence. Society as a whole usually collapses as the affected populations are forced to spend their time and energy searching for basic human needs of food, water, and other necessities. As infrastructure collapses during a CHE, the follow may occur. Politically driven resource wars. Widespread human rights abuse and civil unrest. Culture and ethnic minority groups are risk of extinction. Disruption of essential services and supplies. Poverty and economic collapse. Forced migration of large populations from their homes. Catastrophic environmental and public health events. And acute human suffering with significant excess mortality. Populations that are forced to migrate are primarily classified as refugees or internally displaced persons, or IDPs. Refugees are people who, because of fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion, flee from their home country. And unwilling to return and seek protection across an international border. The treatment of refugees is clearly defined in the Geneva Convention and added protocols. Almost all countries have signed the Geneva Conventions and are obliged to grant asylum to any refugee that flees into their territory. While it would be illegal for these countries to return refugees to the country they are fleeing from, there is no legal way of forcing a country to offer them asylum. The United Nations High Commissioner for Refugees, UNHCR, is responsible for protecting the rights of refugees and ensuring that they are treated according to internationally recognized standards. The majority of displaced persons are referred to as IDPs. These people are forced to flee from their homes suddenly, or unexpectedly in large numbers as a result of armed conflict, internal strife, systematic violations of human rights, or natural or man-made disasters, but remain with the territory of their country. Although some IDPs are compelled by similar reasons to flee and may face similar problems as refugees, they do not enjoy the same legal status for protection and for assistance, simply because they did not cross their country's borders. Prior to 1998, no international agency had been given the responsibility of ensuring adequate care and protection for IDPs. Since then, standards have been developed by the United Nations to define the treatment of internally displaced persons. Since 2006, UNHCR has assumed more responsibility for IDPs and is now assisting more IDPs than refugees. Now that you understand the definition of a CHE, and who they impact, let's examine more of the underlying factors that cause them. CHEs are events that involve multiple factors that evolve and affect a population. These factors may be political, economic, social, or cultural. It is important to realize that past and current political factors can help predict the potential for a crisis and determine what protocol solutions is appropriate. In a CHE, as a weakened state collapses, historical, religious, political and ethnic forces deeply ingrained in population resurface. This can lead to insecurity and civil strife, which drives people to fight for independence and nationhood. This is one underlying cause for the emergence of a CHE. For example, after years of relative stability during the communist years of Yugoslavia, tensions that existed between ethnic groups in the past resurfaced and caused tremendous civil conflict. Social factors can also contribute to the development of a humanitarian emergency. During a CHE, the social factors of a society often disintegrate. Displacement causes people to spend a lot of time looking for food, water, shelter, and security. Families often break up and separations prevent the formation of the long-term relationships that hold groups together. This breaks down the social fabric of a community. During a CHE, cultural factors may act to worsen the problem. Discrimination may result in certain groups being denied access to essential services. Additionally, ethnic hostilities make it difficult to place communities together in a camp. Since ethnic hostilities have often been the basis for warfare in the past, such hostilities makes settling displaced peoples difficult. Finally, economic factors are a contributing factors to the development of a CHE. Overpopulation can increase pressure on the land and further environmental degradation. Competition for valuable resources is a major contributor to a global increase in conflicts and complex emergencies. There's an increasing disparity between the rich and the poor due to urbanization. The poor have been isolated and are exposed to more hazards. As a result, this can increase in ethic and communal tensions, as CHDs develop, economic hardships and food deficits may result from the disruption. The function of public health professionals in these situations is to reduce excess mortality, which is the number of deaths, and morbidity, which is the incidents of disease. During emergencies, we work to define health risks, suggest ways to reduce these risks and monitor the capacity and reconstruction of the public health system. Public health emergency response focuses on reducing excess mortality morbidity through the implementation of ten essential public health interventions. They are, rapid assessment. Measles immunization. Improving water and sanitation. Ensuring adequate food and nutrition. Shelter and site planning. Health care during the emergency phase. Control of communicable diseases and epidemics. Public health surveillance. Human resources and training. And coordination. Okay, let's summarize what we learned in this lesson. A CHE is the human disaster that follows armed conflict like war and civil strife. Often, CHEs result in great political instability, which is the result of many underlying causes, including political, economic, social or cultural factors. CHE has often caused forced migration, creating refugees and IDPs. As a result, emergency response programs typically seek to address ten essential public health interventions. In another presentation, we will discuss those who are the major actors in emergency response and what roles they may play. Including donors, agencies, local ministries and non-governmental organizations. Thank you.