A complex humanitarian emergency (CHE) is a “complex, multiparty, intra-state conflict” resulting in a humanitarian disaster, according to scholar of global health Richard Skolnik. CHEs are multifaceted and pose enormous regional and international threats to security. They are inextricably intertwined with war, political turbulence, lack of food and human displacement, all of which result in high rates of mortality.
In 1975–85, there were about five CHEs annually. By the end of the last century, the average number rose to 40 CHEs per year. This is concerning because CHEs are crises and despite this, they remain overlooked. The current situation in Yemen, for example, is considered the worst humanitarian crisis since 1945, according to the United Nations.
Let me contextualize the situation in Yemen to emphasize the health ramifications of CHEs. As of 2019, over 14 million people in Yemen were at risk for death and starvation secondary to diarrheal diseases such as cholera. Approximately 17,700 civilians have been murdered or wounded during the armed conflict. About 3 million women and girls were more susceptible to violence. Often, human rights violations are employed during CHEs with intent to control populations. Rape, sexual abuse and torture are commonplace.
CHEs are typically long-lasting, spanning years or even decades, which perpetuates long-term disease transmission among populations. Offering aid in these arenas of political turmoil (e.g. civil wars) is often dangerous, and even when relief workers are dispatched, they are often targeted or banned from entry. Healthcare infrastructure is often purposely destroyed during CHEs, which also makes it incredibly difficult for victims to get help and reduce epidemics.
When institutions necessary for human survival fail, many are forced to flee. You probably know what a refugee is, but you may have never heard the term Internally Displaced Person (IDP). This refers to a person who has fled but has not crossed an international border. Unlike refugees, the legal status of IDPs is not defined and therefore they are not eligible for amnesty in other nations.
Addressing CHEs is incredibly important because it has profound impacts on victims. Disaster plans are the cornerstone for preparedness. For example, there are usually some predictors that indicate a lack of political stability, and using this information to create contingency plans is crucial. Placing materials such as first aid supplies, food surpluses and medication near areas susceptible to CHEs can be useful. Surveillance of health and humans is also necessary to monitor epidemics of disease.
Other necessary steps include providing adequate amounts of water, proper sanitation (one toilet for every 20 people within 50 feet), which also includes providing menstrual hygiene products, increasing access to soap and ensuring access to shelter. Providing a safe home will also help protect women from violence. Nutritional supplementation to prevent malnutrition and offering tangible means to control the spread of infectious disease are also vital.
CHEs are more common than you might think. They are happening as you read this, and their ramifications are catastrophic.