Complex Humanitarian Emergencies

A complex humanitarian emergency (CHE) is a type of disaster event that is caused by and results in a very complicated set of circumstances usually leading to great human suffering and death. CHEs have become increasingly common due to a variety of factors including war, poverty, environmental destruction and change, growing population density, and an increasing frequency of massive natural disasters.

The United Nations (UN) definition of complex emergency is a major humanitarian crisis of a multi-causal nature that requires a systemwide response. Commonly, a long-term combination of political, conflict, and peacekeeping factors is also involved. The hallmark of disasters and complex emergencies is the need for external assistance and aid.

The man-made or natural events that cause complex emergencies introduce hazards into populations that are both vulnerable and susceptible to those particular hazards. The event then exceeds the capacity of the society to respond and, therefore, demands regional or international assistance. Most often, CHEs result from dramatic events leading to a synergy of hazards including infectious diseases; limited access to food, water and housing; violence; and failing health infrastructure. access to clean water, adequate food, shelter, and immunization. Children between 0 and 5 years of age are at particularly high risk in these situations. Relatively minor acute events in the setting of chronic violence, political unrest, poor health, and educational infrastructure can result in significant morbidity and mortality. Over 75 percent of world epidemics occur in developing countries at war, where public health practices and infrastructure are not available.

Complex humanitarian emergencies may cause deaths not just through injury, but also when chronic diseases go untreated.

In industrialized countries, CHEs usually result from massive natural disasters (e.g., Hurricane Katrina) or from the effects of advanced weaponry on human and physical infrastructure (e.g., former Yugoslavia). These societies usually have high baseline levels of health and education but are overwhelmed by the disaster event. Initially, morbidity and mortality is usually a result of injuries sustained during the acute event. Later, a state of overcapacity or breakdown of the health infrastructure leads to suffering and death from the complications of untreated chronic diseases such as diabetes, heart disease, high blood pressure, and undernutrition. Psychological trauma is a major component of the recovery phase from these events.

CHEs demand a complex multimodal response. Responding UN agencies, governments, and nongovernmental organizations must work to rapidly assess the needs of the affected population and meet those specific needs. Several organizations and UN agencies maintain Web sites and staff to assess needs and coordinate these multifaceted efforts.

[Page 438]In CHEs, infrastructural and logistical coordination are no less important than financial, material, and human resource support. Approaches to CHEs should simultaneously address the immediate effects and the underlying causes of the humanitarian emergency. Many organizations also include development and sustainability in their goals for disaster response. The resilience of a population to the effects of a complex humanitarian emergency has many social and cultural determinants. The key to reducing the impact of CHEs is to address underlying insecurity in the determinants of health before an acute event. Mitigation of morbidity and mortality can be achieved by a robust emergency infrastructure, detailed emergency planning, and strong leadership.

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