Primary health care in complex humanitarian emergencies: Rwanda and Kosovo experiences and their implications for public health training

Abstract

In a complex humanitarian emergency, a catastrophic breakdown of political, economic, and social systems, often accompanied by violence, contributes to a long-lasting dependency of the affected communities on external service. Relief systems, such as the Emergency Response Units of the International Federation of Red Cross and Red Crescent Societies, have served as a sound foundation for fieldwork in humanitarian emergencies. The experience in emergencies gained in Rwanda in 1994 and Kosovo in 1999 clearly points to the need for individual adjustments of therapeutic standards to preexisting morbidity and health care levels within the affected population. In complex emergencies, public health activities have been shown to promote peace, prevent violence, and reconcile enemies. A truly democratic and multi-professional approach in all public health training for domestic or foreign service serves as good pattern for fieldwork. Beyond the technical and scientific skills required in the profession, political, ethical, and communicative competencies are critical in humanitarian assistance. Because of the manifold imperatives of further public health education for emergency assistance, a humanitarian assistance competence training center should be established. Competence training centers focus on the core competencies required to meet future needs, are client-oriented, connect regional and international networks, rely on their own system of quality control, and maintain a cooperative management of knowledge. Public health focusing on complex humanitarian emergencies will have to act in prevention not only of diseases and impairments but also of political tension and hatred.