Refugee Health Emergency Nurses Association of Ontario Belleville, Ontario September 27, 2016 Medecins sans Frontieres/Doctors without Borders Current Challenges: A front-line Nurses Experience Nancy Graham, RN, BScN Associate - MSF Canada Public Health Nurse- Toronto
MSF: Current Challenges: A front-line Nurse s experience Presentation Outline A brief outline about MSF/Doctors without Borders Brief Introduction Refugee or IDP or Migrant? Brief Introduction Humanitarian Role of the Nurse contexts in a Humanitarian Project Humanitarian Contexts in which we work Agencies working with Refugees/IDP s & Services Provided What I learned from my experience in the field Major health issues with Refugees/IDP s Reflections on application to our nursing practice today More than Doctors: Who works with MSF? Are you interested? Recommended websites & who to contact 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 wellfounded 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 nongovernmental 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, 2016 Are 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