Links to the Humanitarian Charter and international law
The minimum standards in health actionare a practical expression of the shared beliefs and commitments of humanitarian agencies and the common principles governing humanitarian action that are set out in the Humanitarian Charter. Founded on the principle of humanity, and reflected in international law, these principles include the right to life with dignity, the right to protection and security, and the right to receive humanitarian assistance on the basis of need. A list of key legal and policy documents that inform the Humanitarian Charter is available for reference in Annex 1, with explanatory comments for humanitarian workers.
Although states are the main duty-bearers with respect to the rights set out above, humanitarian agencies have a responsibility to work with disaster-affected populations in a way that is consistent with these rights. From these general rights flow a number of more specific entitlements. These include the rights to participation, information and non-discrimination, as well the specific rights to water, food, shelter and health that underpin these and the other minimum standards in this Handbook.
Everyone has the right to health, as enshrined in a number of international legal instruments. The right to health can be assured only if the population is protected, if the professionals responsible for the health system are well trained and committed to universal ethical principles and professional standards, if the system in which they work is designed to meet minimum standards of need, and if the state is willing and able to establish and secure these conditions of safety and stability. In times of armed conflict, civilian hospitals and medical facilities may in no circumstances be the object of attack, and health and medical staff have the right to be protected. The carrying-out of acts or activities that jeopardise the neutrality of health facilities, such as carrying arms, is prohibited.
The minimum standards in this chapter are not a full expression of the right to health. However, the Sphere standards reflect the core content of the right to health, especially during emergencies, and contribute to the progressive realisation of this right globally.
The importance of health action in disasters
Access to healthcare is a critical determinant for survival in the initial stages of disaster. Disasters almost always have significant impacts on the public health and well-being of affected populations. The public health impacts may be described as direct (e.g. death from violence and injury) or indirect (e.g. increased rates of infectious diseases and/or malnutrition). These indirect health impacts are usually related to factors such as inadequate quantity and quality of water, breakdowns in sanitation, disruption of or reduced access to health services and deterioration of food security. Lack of security, movement constraints, population displacement and worsened living conditions (overcrowding and inadequate shelter) can also pose public health threats. Climate change is potentially increasing vulnerability and risk.
The primary goals of humanitarian response to humanitarian crises are to prevent and reduce excess mortality and morbidity. The main aim is to maintain the crude mortality rate (CMR) and under-5 mortality rate (U5MR) at, or reduce to, less than double the baseline rate documented for the population prior to the disaster (see table on baseline reference mortality data by region). Different types of disaster are associated with differing scales and patterns of mortality and morbidity (see table on public health impact of selected disasters), and the health needs of an affected population will therefore vary according to the type and extent of the disaster.
The contribution from the health sector is to provide essential health services, including preventive and promotive interventions that are effective in reducing health risks. Essential health services are priority health interventions that are effective in addressing the major causes of excess mortality and morbidity. The implementation of essential health services must be supported by actions to strengthen the health system. The way health interventions are planned, organised and delivered in response to a disaster can either enhance or undermine the existing health systems and their future recovery and development.
An analysis of the existing health system is needed to determine the system’s level of performance and to identify the major constraints to the delivery of, and access to, health services. In the early stages of a disaster, information may be incomplete and important public health decisions may have to be made without all of the relevant data being available. A multi-sectoral assessment should be conducted as soon as possible (see Core Standard 3).
Better response is achieved through better preparedness. Preparedness is based on an analysis of risks and is well linked to early warning systems. Preparedness includes contingency planning, stockpiling of equipment and supplies, establishment and/or maintenance of emergency services and stand-by arrangements, communications, information management and coordination arrangements, personnel training, community-level planning, drills and exercises. The enforcement of building codes can dramatically reduce the number of deaths and serious injuries associated with earthquakes and/or ensure that health facilities remain functional after disasters.
Public health impact of selected disasters
NB: Even for specific types of disaster, the patterns of morbidity and mortality vary significantly from context to context.
Links to other chapters
Because of the impacts of the different determinants of health on health status, many of the standards in the other chapters are relevant to this chapter. Progress in achieving standards in one area often influences and even determines progress in other areas. For a disaster response to be effective, close coordination and collaboration are required with other sectors. Coordination with local authorities, other responding agencies and community-based organisations is also necessary to ensure that needs are met, that efforts are not duplicated and that the use of resources is optimised and the quality of health services is adequate. Reference to specific standards or guidance notes in other technical chapters is made where relevant. Reference is also made to companion and complementary standards.
Links to the Protection Principles and Core Standards
In order to meet the standards of this Handbook, all humanitarian agencies should be guided by the Protection Principles, even if they do not have a distinct protec- tion mandate or specialist capacity in protection. The Principles are not ‘absolute’: it is recognised that circumstances may limit the extent to which agencies are able to fulfil them. Nevertheless, the Principles reflect universal humanitarian concerns which should guide action at all times.
The Core Standards are essential process and personnel standards shared by all sectors. The six Core Standards cover people-centred humanitarian response; coordination and collaboration; assessment; design and response; performance, transparency and learning; and aid worker performance. They provide a single reference point for approaches that underpin all other standards in the Handbook. Each technical chapter, therefore, requires the companion use of the Core Standards to help attain its own standards. In particular, to ensure the appropriateness and quality of any response, the participation of disaster-affected people – including the groups and individuals most frequently at risk in disasters – should be maximised.
Vulnerabilities and capacities of disaster-affected populations
This section is designed to be read in conjunction with, and to reinforce, the Core Standards.
It is important to understand that to be young or old, a woman, or a person with a disability or HIV, does not, of itself, make a person vulnerable or at increased risk. Rather it is the interplay of factors that does so: for example, someone who is over 70 years of age, lives alone and has poor health is likely to be more vulnerable than someone of a similar age and health status living within an extended family and with sufficient income. Similarly, a 3-year-old girl is much more vulnerable if she is unaccompanied than if she were living in the care of responsible parents.
As the health action standards and key actions are implemented, a vulnerability andcapacity analysis helps to ensure that a disaster response effort supports those who have a right to assistance in a non-discriminatory manner and who need it most. This requires a thorough understanding of the local context and of how a particular disaster impacts on particular groups of people in different ways due to their pre-existing vulnerabilities (e.g. being very poor or discriminated against), their exposure to various protection threats (e.g. gender-based violence including sexual exploitation), disease incidence or prevalence (e.g. HIV or tuberculosis) and possibilities of epidemics (e.g. measles or cholera). Disasters can make pre-existing inequalities worse. However, support for people’s coping strategies, resilience and recovery capacities is essential. Their knowledge, skills and strategies need to be supported and their access to social, legal, financial and psychosocial support advocated for. The various physical, cultural, economic and social barriers they may face in accessing these services in an equitable manner also need to be addressed.
The following highlight some of the key areas that will ensure that the rights and capacities of all vulnerable people are considered:
Optimise people’s participation, ensuring that all representative groups are included, especially those who are less visible (e.g. persons who have communication or mobility difficulties, those living in institutions, stigmatised youth and other under- or unrepresented groups).
Disaggregate data by sexand age (0–80+ years) during assessment as an important element in ensuring that the health sector adequately considers the diversity of populations.
- Ensure that the right to information on entitlements is communicated in a way that is inclusive and accessible to all members of the population.