Refugee Health

Emergency Nurses Association of Ontario

Belleville, OntarioSeptember 27, 2016

Medecins sans Frontieres/Doctors without BordersCurrent Challenges: A front-line Nurses Experience

Nancy Graham, RN, BScNAssociate - MSF Canada

Public Health Nurse- Toronto

MSF: Current Challenges:

A front-line Nurse’s experience

Presentation Outline

Brief Introduction

Brief IntroductionRole of the Nurse in a Humanitarian Project

Humanitarian Contexts in which we work

What I learned from my experience in the field

Reflections on application to our nursing practice today

Recommended websites & who to contact

•A brief outline about MSF/Doctors without Borders

•Refugee or IDP or Migrant?

•Humanitarian contexts

•Agencies working with Refugees/IDP’s & Services Provided

•Major health issues with Refugees/IDP’s

•More than Doctors: Who works with MSF? Are you interested?

•Humanitarian space security: Not a Target Social media campaign

•Recommended websites. Questions, Comments?

Disclosure No conflicts of interest to declare

Photos are from the field or international photo database

Sensitive photos: patients gave consent for use in teaching

A brief overview of Medecins Sans

Frontieres/Doctors without Borders

Founded in 1971 by doctors and medical journalists in France.

Now the world’s leading independent international medical relief organization, with 5 operational centers in Europe and 19 partner sections worldwide.

International coordination office is in Geneva.

International website is www.msf.org.

Actions are guided by medical ethics and the principles of independence, neutrality and impartiality: based only on need and irrespective of race, religion, gender or political affiliation.

Now maintaining projects in around 70 countries around the world.

More than 80% of its funds are spent on Social Mission, that is: medical operations and témoignage. The total incoming resources (Globally) in 2014 (latest figures): 1.28 billion Euros. Private donations account for more than 86% of all income

• http://cdn.msf.org/sites/msf.org/files/msf_finance_summary_2014.pdf

MSF: Current Challenges: A front-line

Nurse’s experience

MSF: Current Challenges: A front-line

Nurse’s experience

MSF: Current Challenges: A front-line

Nurse’s experience

Emmanuel C.O. providing malaria treatment to a little boy. Mother flagged us down at the roadside

MSF: Current Challenges: A front-line

Nurse’s experience

MSF: Current Challenges: A front-line

Nurse’s experience

MSF: Current Challenges: A front-line

Nurse’s experience

IDP or Refugee? On the Run in Their Own Land

Internally displaced people, or IDPs, are often wrongly called refugees. Unlike refugees, IDPs have not crossed an international border to find sanctuary but have remained inside their home countries. Even if they have fled for similar reasons as refugees (armed conflict, generalized violence, human rights violations)

UNHCR´s original mandate does not specifically cover IDPs, but because of the agency´s expertise on displacement, it has for many years been assisting millions of them, more recently through the "cluster approach."

In 2014 19.5 Million Refugees (UNHCR mandate)

5.1 Palestinian Refugees (UNRWA mandate)

38.2 IDP’s

1.8 Million Asylum seekers

Source: www.unhcr.org/pages/4aO2afce6.html. (accessed on March 7, 2016)

MSF: Current Challenges: A front-line

Nurse’s experience

Refugee or IDP?Flowing Across Borders

The 1951 Refugee Convention establishing UNHCR spells out that a refugee is someone who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country.“

By mid-June 2015 ... A report released today by UNHCR shows that the total population of concern to UNHCR stood at unprecedented 58.0 Million ... It is now (February 2016) believed to have surpassed 60 million.

Source: www.unhcr.org/pages/4aO2afce6.html. (accessed on March 7, 2016)

MSF: Current Challenges: A front-line

Nurse’s experience

Humanitarian Crises:

Conflict & Post-conflict regions

Epidemics

Nutritional crises

Natural Disasters

Human Migrations * *(insecurity due to conflict, environmental & economic conditions)

MSF: Current Challenges: A front-line

Nurse’s experience

Agencies involved with service provision to Refugees or IDP’s

Operational Partner:

Governmental, i n t e r- governmental and non-governmental organizations and UN agencies that work in partnership with UNHCR to protect and assist refugees, leading to the achievement of durable solutions.

Implementing Partner: operational

Partner that signs an implementing agreement and receives funding from UNHCR.

MSF: Current Challenges: A front-line

Nurse’s experience

What services are provided to beneficiaries?

Shelter (UN -HCR)

Food distribution (UN -WFP)

Water Access, Treatment & Distribution

Sanitation and waste management

Public Health Surveillance, CD/IC, analysis

Stationary, mobile health & vaccination clinics

Nutrition treatment centre (TFC’s)

Field Hospital (incl. Lab, pharmacy, OT, L & D)

Security, Registration & documentation (UN-HCR)

Education, Advocacy (UN-ICEF)

MSF: Current Challenges: A front-line

Nurse’s experience

Major Health Issues with Refugees/IDP’s

Medical management

Communicable diseases

Emergency public health

Child health

HIV and STIs

Malaria.

Mental health

Nutrition

Reproductive & maternal health

Tuberculosis

More than Doctors: Who works with

Refugees?

Consultants: Lab Technologists, Pharmacists, Radiology Techs, Engineers, Construction- Project Managers

Nurses: *clinical, community, management

Mental Health Officers (MSW, Psychologists, RN)

Sexual Health Educators (BEd, RN, MSW)

Epidemiologists (MPH, MHSc, PhD)

Medical Doctors: GP’s, Surgeons, Specialists

Communications Experts: Journalists, Public Relations, MEd

IT, HR, Finance & Administration Professionals

Water & Sanitation Experts (PEng, Diploma)

Logisticians: supply, building, security, comms* not just acute needs but chronic illnesses/non-communicable

Humanitarian Context: What does MSF

provide?

Acute & chronic health care, including medical, surgical, obstetrical, pediatrics, mental health

Therapeutic and supplementary nutrition

Outbreak Management & Mass vaccination campaigns

Water and sanitation systems

Distribution of drugs and supplies

Training and health education of staff

Rehabilitation of health structures

Water

Key to prevent diarrhea (major cause of morbidity & mortality.

85% of deaths in Goma, DRC (1994) Cholera & Shigella

Lg. amounts needed in public health emergency/disasters

Surface H2O, Wells, Bore-holes, Springs

15L/day/pp Water containers 40L/family

Taste & appearance must be acceptable

Chlorination is most rapid effective strategy

Public awareness of basic hygiene essential –IEC led locally

Water

Canadians currently use an average of 329 litres of water per person, per day — second only to the United States in the developed world, and more than twice as much as Europeans. Mar 18, 2009

New study calls average water use by Canadians 'alarming'www.nationalpost.com/life/study+calls+average+water+Canadians.../story.htm

Water Bladder System – Rural Clinic , DRC

Sierra Leone District Health Unit - Prenatal Care Poster –

At time of delivery bring 2 clean lappas, a blade, spirits

and thread…

Recommended Websites Inter-Agency Standing Committee (IASC) www.humanitarianinfo.org/iasc

Humanitarian Early Warning Service (HEWS) www.hewsweb.org

The Sphere Project www.sphereproject.org

Canadian Medical Assistance Teams www.canadianmedicalteams.org

WHO www.who.int/hac/techguidance/pht/mental_health_refugees/en

www.who.int/hac/techguidance/pht/interagency_emergency_healthkit/en

UNHCR www.unhcr

MSF/Doctors without Borders www.msf.ca/en/recruitment-events-msf

Thank you MSF Canada – PR & Communications Unit

Want more information?

MSF Doctors without Borders HR Info Event – Oct. 27, 2016

October 27, 2016Are you interested in learning more about Doctors Without Borders/Médecins Sans Frontières (MSF)?

Join us for an information session and learn more about our projects, our humanitarian work and our field workers.The information session will be lead by a recently returned MSF field worker. Come and meet experienced MSF field workers from the Toronto area and listen to their stories of life "in the field.“

Location: Centre for Social Innovation – Annex Toronto

www.msf.ca/en/recruitment-events-msf

MSF: Current Challenges: Not A Target

A Social Media Action in Solidarity Against the Targeted Killing of Civilians and Humanitarians

Doctors Without Borders/Médecins Sans Frontières (MSF) has launched a social media act of solidarity to stand up for the protection of civilians and civilian infrastructure, patients, medical staff and hospitals in conflicts.

On average, an MSF-supported health structure was bombed or shelled every single week in 2015 in Syria and in the first six weeks of 2016. MSF's health workers and health structures have also been targeted in Yemen, South Sudan and Afghanistan, among other countries, causing intolerable suffering, death and destruction. And this is only the tip of the iceberg of reported attacks.

These horrific attacks contravene International Humanitarian Law and have a catastrophic impact on people already made vulnerable by war and violence. When hospitals are bombed, civilians are often severely maimed or killed, and those who survive lose access to the medical help they desperately need.

www.msf.ca/en/notatarget

Thank you for your kind attention