A GUIDANCE DOCUMENT FOR MEDICAL TEAMS RESPONDING TO HEALTH EMERGENCIES IN ARMED CONFLICTS AND OTHER INSECURE ENVIRONMENTS 1 A guidance document for medical teams responding to health emergencies in armed conflict and other insecure environments A GUIDANCE DOCUMENT FOR MEDICAL TEAMS RESPONDING TO HEALTH EMERGENCIES IN ARMED CONFLICTS (1)1 AND OTHER INSECURE ENVIRONMENTS2 1 This general expression covers confrontations between: two or more states; state and a body other than a state; a state and a dissident faction; two or more organized armed groups within a state (https://www.icrc.org/en/doc/assets/files/other/opinion-paper-armed-conflict.pdf) 2 Defined as areas/regions with a heightened level of risk to personnel, facilities, patients, and operations from various types of violence. 2 3 A guidance document for medical teams responding to health emergencies in armed conflict and other insecure environments Contents A guidance document for medical teams responding to health emergencies in armed conflicts and other insecure I. FOREWORD xi environments II. ACKNOWLEDGEMENTS xii ISBN 978-92-4-002935-4 (electronic version) III. ABBREVIATIONS xiii ISBN 978-92-4-002936-1 (print version) IV. TABLES, FIGURES, AND EXAMPLES xv V. STRUCTURE OF THE RED BOOK 1 © World Health Organization 2021 VI. IMPORTANT NOTE ON THE BLUE BOOK AND RED BOOK 2 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- VII. HOW TO USE THE RED BOOK 3 ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). A. WHY, WHAT, WHERE, WHO, WHEN, AND HOW? 5 Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, 1. Why? 5 provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion 2. What? 6 that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If 3. Where? 6 you create a translation of this work, you should add the following disclaimer along with the suggested citation: 4. Who? 8 “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content 5. When? 8 or accuracy of this translation. The original English edition shall be the binding and authentic edition”. 6. How? 9 Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation 7. Team classification for armed conflict and other insecure environments 9 rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/). B. WHO ROLE AND FUNCTIONS 10 Suggested citation. A guidance document for medical teams responding to health emergencies in armed conflicts and other insecure environments. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. I. INTRODUCTION AND GUIDING PRINCIPLES 12 Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. A. GUIDING PRINCIPLES FOR BLUE AND RED BOOKS 13 B. CATEGORIES OF MEDICAL TEAMS 15 Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. C. LIMITATIONS 16 D. WHAT THE RED BOOK DOES NOT DO 17 Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party- II. THE FUTURE OF HUMANITARIAN ASSISTANCE 18 owned component in the work rests solely with the user. 1 INTERNATIONAL HUMANITARIAN LAW (IHL) AND CORE General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, HUMANITARIAN PRINCIPLES IN ACTION 23 territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted 1.1 FIRST, DO NO HARM! 25 and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. 1.2 IHL AND CORE HUMANITARIAN PRINCIPLES 27 The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed 1.2.1 IHL 28 or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and 1.2.2 Core humanitarian principles 31 omissions excepted, the names of proprietary products are distinguished by initial capital letters. 1.2.3 Can the principles be decoupled? 35 All reasonable precautions have been taken by WHO to verify the information contained in this publication. 1.3 WHO CAN USE THE EMBLEM 37 However, the published material is being distributed without warranty of any kind, either expressed or implied. 1.4 SCENARIOS AND PRACTICE 40 The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. 1.4.1 Scenario 1: A generic conflict scenario – mapping actors and populations 40 Editor: James Hutchison. Design and layout: Valerie Assmann 4 5v A guidance document for medical teams responding to health emergencies in armed conflict and other insecure environments 1.4.2 Scenario 2: In the emergency room (ER) 43 3.2 PREDEPLOYMENT CONSIDERATIONS 93 1.4.4 Scenario 3: Managing armed intrusion into a medical facility 44 3.3 TYPES OF COORDINATION MECHANISMS 94 1.4.4 Scenario 4: Deployment into internal conflict 44 3.3.1 Host governments 94 1.5 CONSEQUENCES AND IMPLICATIONS WHEN DEVIATING 3.3.2 Host ministry of health 95 FROM PRINCIPLED ACTION 49 3.3.3 National disaster agency/national humanitarian coordination 95 1.6 HUMANITARIAN NEGOTIATIONS 53 3.3.4 Military to military coordination 95 1.6.1 Humanitarian negotiations 53 3.3.5 Nonstate armed groups 96 1.6.2 Community engagement 55 3.3.6 UN at the global level 96 1.7 GUIDANCE NOTES 59 3.3.7 UN at the national level 96 3.3.8 UN cluster system 97 2 SAFETY AND SECURITY RISK MANAGEMENT 63 3.3.9 EMT Coordination Cell (EMTCC) 99 2.1 INTRODUCTION 63 3.3.10 United Nations Humanitarian Civil-Military Coordination (UN-CMCoord) 100 2.2 SPECIFIC SECURITY THREATS 66 3.3.11 ICRC and the international Red Cross Red Crescent Movement 114 2.3 SPECIFIC SECURITY MEASURES 67 3.4 IMPLICATIONS FOR CATEGORIES OF DEPLOYING TEAMS 106 2.4 PATIENT SAFETY 72 3.4.1 National and international military EMTs 108 2.5 MEDICAL EVACUATION FOR TEAM MEMBERS 74 3.4.2 Government/ministry of health EMTs 110 2.6 MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT (MHPSS) 3.4.3 Local NGOs/local actors 110 FOR THE TEAM 75 3.4.4 Private contractors 111 2.6.1 Staff health and well-being 77 3.4.5 International NGO (INGO) medical teams 111 Pre-deployment 77 3.4.6 Red Cross Red Crescent teams 112 During deployment 77 3.5 GUIDANCE NOTES 112 Post deployment 78 2.7 CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR 4. SEXUAL AND GENDER-BASED VIOLENCE (SGBV) AND THREATS (CBRN) 80 PROTECTION 115 2.8 GUIDANCE NOTES 85 4.1 WHAT MEDICAL TEAMS NEED TO KNOW BEFORE PROVIDING SERVICES 116 3 COORDINATION PLATFORMS AND MODALITIES89 4.1.1 Relevant laws and policies 116 3.1 OBJECTIVES OF HUMANITARIAN COORDINATION IN 4.1.2 Available resources and medical services 117 CONFLICT SETTINGS 90 4.1.3 Staff training 118 3.1.1 Robust, principled framework for action 91 4.1.4 Coordination with other service providers 118 3.1.2 Collective impartiality and neutrality 91 4.2 COMPONENTS OF A MEDICAL RESPONSE TO SGBV 119 3.1.3 Impartial access and care 91 4.2.1 Survivor-centred care and first-line support 119 3.1.4 Collective security 92 4.2.2 Clinical management of rape 120 3.1.5 Protection 92 4.2.3 Special considerations when dealing with intimate partner 3.1.6 Advocacy 93 violence 123 vi6 vii7 A guidance document for medical teams responding to health emergencies in armed conflict and other insecure environments 4.2.4 Special considerations for children 123 6 SELECTED TOPICS IN RESPONSE OPERATIONS 161 4.2.5 Self-care for medical teams dealing with SGBV 123 6.1 PRE-DEPLOYMENT 164 4.3 PROTECTION, RISK MITIGATION AND ADVOCACY 124 6.1.1 Training 164 4.3.1 Security risks to SGBV survivors 124 6.1.2 Staff readiness 165 4.3.2 Risk mitigation and SGBV 125 6.1.3 Operating expenses 166 4.3.3 Advocacy 126 6.1.4 Locally hired staff 166 4.4 MEDIA AND SGBV 121 127 6.1.5 Exit planning 167 4.5 LEGAL AND SECURITY FRAMEWORKS 128 6.2 DEPLOYMENT 168 4.5.1 Tips for SGBV documentation 129 6.2.1 Patient records, continuity of care and monitoring of 4.6 GUIDANCE NOTES 130 aggregated data 168 6.2.2 Implementing exit and handover strategies 169 5 ESSENTIAL EMERGENCY CLINICAL CARE AND 6.3 POST DEPLOYMENT 170 REHABILITATION 133 6.3.1 Deployment legacy 170 5.1 INTRODUCTION AND SETTING 133 6.3.2 Lessons and learning 171 5.2 TYPE OF HEALTH-CARE NEEDS MEDICAL TEAMS SHOULD BE 6.4 GUIDANCE NOTES 171 ABLE TO MANAGE 136 5.3 SPECIAL OPERATIONAL ISSUES 139 7.