An AFI Changemakers Report to the United Nations at the 68th World Health Assembly
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ACKNOWLEDGEMENTS © Ariel Foundation International 2015 July 2015 Report written by Poonam Bhar, Hannah Johnson, Ailidh Lang and Rinisha Yagarajah(Chairs), Madhubrata Gosh (Rapporteur), Frieda Matty, Thepa Mohan, Jennifer Hendry, Alison Hendry and Maria- Alexandra Radu. Report prepared and edited by Maria- Alexandra Radu Photography by Eujene Liyu AFI Changemakers World Health Alliance Summit conceived, organised and facilitated by Ariel Foundation International, Dr. Ariel Rosita King. Special Thank You to: Dr. Ariel King for dedicating so much of her life to providing young people with a platform that promotes their voices and ideas. Ambassador Ireneo Namboka AFI Changemakers 2015 Summit Co-chairs Maria- Alexandra Radu and Poonam Bhar. All participants of the AFI Changemakers Summit on “the Right to Health and Access to Medicines”and the Circle of Leaders for their participation and support.
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CONTENTS FOREWORD
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ABOUT THIS REPORT
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WORKING GROUPS
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SUMMARY OF RECOMMENDATIONS
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SECTION 1: WHO REFORM
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SECTION 2: COMMUNICABLE DISEASES
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SECTION 3: HEALTH ISSUES AND NEEDS OF YOUTH IN LONG TERM CONFLICT ZONES
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CONCLUDING REMARKS
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ABOUT THE AUTHORS
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AFI CHANGEMAKERS REPORTS
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REFERENCES
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FOREWORD “The world needs a collective defence system, and that require international cooperation and collaboration, in the name of global solidarity".i Dr Margaret Chan, WHO Director- General The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva, Switzerland. At the 68th World Health Assembly many problems concerning international public health were discussed. The themes included WHO reform, non-communicable diseases, communicable diseases, access to healthcare in conflict zones such as Palestine and Syria, and many more. This report looks in detail at issues that have been discussed at the 68th World Health Assembly and the discussions that the AFI Changemakers delegation has participated in as follows: the WHO Reform, Communicable Diseases and Health Issues and Needs of Youth in Long-Term Conflict Zones. These three areas of concern encapsulate many of the most serious and pressing issues the global community faces at the moment in health and some of them are issues that have not even been tackled in the field yet, because they are a result of 21st century social changes, for example healthcare in long-term conflict areas and the WHO reform. There are other issues that have been present and discussed in the international arena numerous times, progress having been made to tackle these problems, immunization and communicable diseases treatments. . The summit that preceeded this report was facilitated by Ariel Foundation International. We want to recognise the crucial role that young people must play in any dialogue about health and human rights and because we believe that the determination, talent and passion that youth have can solve some of the largest and most complex issues the world is facing today. The summit deliberated on actions and recommendations concerning issues within the World Health Assembly and we wish them to be taken forward to the United Nations, WHO, UN Right to Development Working Group and UNAIDS bodies.
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ABOUT THIS REPORT 0.1 This report is the result of the AFI Changemakers Summit at the 68th World Health Assembly in Geneva in May 2015. The Summit saw youth, aged between 18 and 35, from all over the world come together to discuss issues relating to the World Health Organisation and world health acess and security and proposing concrete policy recommendations that should be enacted to create lasting change to the global healthcare landscape. 0.2 This year, 2015, is a crucial year with regards to the future of global development. The transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs) presents a vital opportunity to see the realisation of the right to healthcare and access to medicine for all to be put at the forefront of the agenda. Moreover, in 2015 the World Health Organisation is also seeking to reform and in the light of the disastrous response of the organisation to the Ebola crisis there are now discussions of a much needed change in the structure and running of the organisation for the first time after its establishment. We are determined to push youth involvement and importance in consultations in the wake of these important reforms and goal setting to ensure the correct, equal and appropriate considerations of all stakeholders that will be affected by these changes and new global aims.
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WORKING GROUPS WITHING THE AFI CHANGEMAKERS SUMMIT The AFI Changemakers summits act as open forums for free dialogue between young people from all over the world. At the beginning of the Summit participants worked together to identify key issues within the World Health Assembly that they recognised should be prioritised or lack in attention from the international discourse. A number of issues were raised, including; communicable and non-communicable diseases, the WHO reform, maternal health, yout and children rights in conflict zones, the right to health as a fundamental human right and the healthcare rights of migrants and refugees. After discussion of the proposed topics and deliberation, the key issues chosen were divided between three Working Groups as follows: 1. WHO Reform Chair: Poonam Bhar Group members: Frieda Matty 2. Communicable diseases Co-chair: Rinisha Yagarajah, Hannah Johnson Group members: Jennifer Hendry, Alison Hendry 3. Health issues and needs of youth in long-term conflict zones Chair: Ailidh Lang Rapporteur: Madhubrata Gosh Group members: Thepa Mohan, Maria- Alexandra Radu
Within these groups, participants shared the knowledge gathered during the WHA as well as their own ideas, opinions and experiences with the aim of developing preliminary conclusions and recommendations; these were then presented to and discussed with the other summit participants. After the summit, participants worked extensively on the development of the preliminary discussions, collaborating and conducting research in order to produce comprehensive reports. This report compiles the work of the three Working Groups, in addition to providing an overview of the issues discussed during the highly 68th World Health Assembly.
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SUMMARY OF RECOMMENDATIONS Recommendation 1.1.1 Member states should become shareholders, so as to have them act in a more collective way and work together on cohesive goals, rather than an their own side projects and areas of regional interests. The WHO should seek out help from some nonstate actors who have strong capacities on certain issues to promote better efficiency inside the WHO. Recommendation 1.1.2 The WHO should clarify their guidance on the treatment of diseases and health more broadly as well as providing concrete details and measurable criteria. An official budget should be clearly laid out as part of all resolutions. Recommendation 1.1.3 The connection between WHO’s headquarters and regional offices must be improved. Recommendation 1.2.1 It is crucial to involve other organizations in the implementation of plans to combat communicable diseases, including NGOs, employers and young people, to reach out to communities and countries in need. Recommendation 1.2.2 Early health education should begin from home, communities to school. It is important to educate communities about the dangers and outcomes of communicable diseases. Recommendation 1.2.4 Facilitate the process for NGOs to be established in every country and to be supported by the WHO in order to assist its work and ensure access to affordable and appropriate healthcare. Recommendation 2.1.1 For the younger generations, including Infectious disease subjects into their school syllabus will be a powerful tool. They can include interesting pictures and fewer words to capture their attention. To make changes in the world or to increase knowledge on these matters, educating the younger generations is one of the most effective measures we can take. Recommendation 2.1.2 Use celebrities to endorse health awareness. This is an important advertisement technique, as it attracts an audience by suggesting that their success and talent can be in part attributed to the product they represent. Recommendation 2.2.1 New medicines should be subsidized like some countries subsidize fuel. Furthermore, funding management should change. Medical personnel should be involved in the decision making process to make all monetary aspects transparent.
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Recommendation 2.2.2 Flexible amendments must be made to Trade Related Aspects of Intellectual Property Rights (TRIPS) to increase the production of essential medicines in emergency situations. One way to do this is give intellectual rights to generic companies. Recommendation 2.2.3 Adding new medicines to the EML in a timely manner could greatly improve access to essential medicines. Recommendation 3.1.1 In line with the UNHCR recommendations, refugee populations should be placed in camps without basic infrastructure only as a last resortii. Emphasis should be placed on integration within host communities, with both primary and secondary health care services used by both populations expanded and access to these ensured for the refugee population. Recommendation 3.1.3 To tackle the increased morbidity due to psychological disease amongst displaced youth, UNHCR and WHO should mandate increased mental health service provision in refugee settlements. Recommendation 3.1.4 A combined and culturally sensitive approach should be advocated for NGOs working with displaced populations. Recommendation 3.2.1 Behaviour change activities should be centralized in schools. Healthy practices must be demonstrated to these children. Basic hygiene needs to be reviewed with refugee children. Recommendation 3.2.2 Implement a health improvement program to all refugee children that involves their family. This is to encourage family’s involvement in the children’s medical care at home and to create a platform for children to discuss and acknowledge their health issues with supportive adults around them. Recommendation 3.2.3 Organize home visits by teachers and community volunteers to promote enrollment in school. By bringing in more students, they will all be able to be immunized. This improves the immunization coverage in refugee children. Eventually, their health quality becomes better. Recommendation 3.2.4 Schools should evaluate the immunization status and needs of these children. They should begin or continue the vaccination series for all immunizations required for children. These vaccines must be routinely administered as part of a schoolbased program. Recommendation 3.3.2 Use social media to spread the message regarding diseases and urging women and children to come forward to the small health facilities. Provide female doctors to avoid social stigma. Recommendation 3.3.4 Provide healthcare units that are easily accessible to the women and children instead of big hospitals or medical establishments and include youth in community service project and provide them some type of compensation for their services either by skill training, medical benefits, free vaccines or consultations or even food and water. 7|Page
SECTION 1: WHO REFORM Introduction Since the World Health Organisation was founded in 1948, political, economic and social changes have occurred beyond the imagination of the founders of the WHO. Witnessing unequal development and healthcare access globally, the challenge to ‘the attainment by all peoples of the highest possible level of health’, the WHO’s core objective, is significant.iiiWe hear that the world needs a strong WHO to direct and coordinate all entities working in global health. While many argue for greater focus, there are no voices suggesting that WHO is just one health actor among many and should seek a niche commensurate with its modest resources. Indeed, the dominant idea is that WHO should somehow be different and stand out prominently in an increasingly crowded world. However, beyond the idea of a strong WHO there is also a consensus. It is an invocation of despair, anxiety and frustration that the Organisation’s potential to fulfill the role for which it was established is no longer being realised.
So why is there a call for WHO reform now? The first case of the current epidemic of Ebola appeared in a two-year-old child in Guinea in December 2013, but was misdiagnosed. Ebola was only confirmed in that country on March 21, 2014 and in Liberia two days later, and then in Sierra Leone in late May. The WHO declared a "public health emergency of international concern"iv on August 8 - weeks after the volunteer group Doctors Without Borders said on June 21 that Ebola was "out of control" and required a "massive deployment of resources". It took 8 months of procedures and paperwork for the decision to finally be made that the deadly hemorrhagic virus outbreak was a public health emergency of international concern. The West Africa Ebola outbreak highlighted leadership failings of the WHO and prompted calls for reform, in order to prevent ‘needless’ deaths in future.Some of the main criticisms of the WHO in the last 20 years have included its lack of effectiveness, inefficiency and lack of leadership. Such criticisms have followed the WHO’s failure to overcome the new challenges that emerged with the HIV/AIDS epidemic. As a result, we saw creation of new organizations reinforced by the venture philanthropy of the Bill and Melinda Gates Foundation (BMGF). ‘New’ and ‘old’ forms of governance were juxtaposed to imply that ‘the new’ was more effective and was going to replace the state-based international organizations. The global health community was enthralled by the rapid increase in funds, organizations, and jobs. Aggregate resources flowing to global health rose from 7 billion dollars in 2000 to 27 billion dollars per year in 2009. The ‘Health Millennium Development Goals’ (MDGs) exacerbated the strategic and financial imbalance. To reach the MDGs, effort focused on adding funds for immunization and HIV/AIDS, tuberculosis, and malaria initiatives, and provided opportunities for positioning countries and heads of states.
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We, the AFI Changemakers believe that involving youth in the WHO reform can bring an entirely new perspective. 50% of the world is made up of youth, youth who are of different nationalities and different backgrounds. Youth who have mostly grown up surrounded with social media and technology. Youth who are mentally and physically capable of handling emergencies. The world’s youth have much to bring into the reformation of the WHO. In the past 30 years, there has been a paradigm shift and the WHO can only cater for the people of the world if the organisation keeps up with this shift. To keep up with this aggressive and rapid change, young people should be involved decision making and problem solving.
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1.1 Bridging the internal governance and managerial gap
The major tensions in the process of promoting reform: 1.1.1 The tension between the individual interests of member of states versus the interest in global health. The WHO is a member driven organisation and all the members of states are concerned with their own national interests. As member states pursue their own interests, they may obstruct the organisation from focusing on transnational issues of global health. Recommendation 1.1.1 Member states should become shareholders, so as to have them act in a more collective way and work together on cohesive goals, rather than an their own side projects and areas of regional interests. The WHO should seek out help from some nonstate actors who have strong capacities on certain issues to promote better efficiency inside the WHO. 1.1.2 The scope of the global health challenges versus the budget and the resources that are available to the WHO. From what is rather obvious over the years, resources are incommensurate with the scale and scope of the issues the organisation is supposed to take charge of. Recommendation 1.1.2 The WHO should clarify their guidance on the treatment of diseases and health more broadly as well as providing concrete details and measurable criteria. An official budget should be clearly laid 10 | P a g e
out as part of all resolutions for both the headquarters as well as the six regional offices . 1.1.3 Inefficient regionalisation: Each of the six regional offices has an independent administrative system. The leader of each regional office is elected by regional member states, and is in charge of fundraising for their region. Therefore the regional offices have to deal with external politics and internal pressures, which makes it more difficult for the central WHO headquarter to keep the offices linked and coordinating effectively with the headquarter. This explains why the WHO often has overlapping projects and a lack of clear internal governance hierarchy. This also leads to lack of accountability of the organisation. Recommendation 1.1.3 The connection between WHO’s headquarters and regional offices must be improved. This could be done by having staff for regional offices be appointed as a part of the headquarters’ function as opposed to the current independent political regional elections. The WHO headquarters can also send interns to one of the six regional offices as part of their internship programs. Standardise the administration and management process so there is effective cooperation between the regional hubs to avoid overlapping projects and wasted resources.
1.2 Programmatic and Priority Settings
What is a general program of work? It provides a vision and is used to guide the work of the organization during a predetermined time period. To start the WHO reform we need clear priorities: "As you have made extremely clear, priority setting should be the force that drives all reforms. Rerorms follow priority functions. Money follows agreed priorities." Dr Margaret Chan, Executive Board Special Session on WHO reform Investing in health to reduce poverty There is a need to provide basic amenities to people in need as well as implementation of policies toward alleviating poverty, such as: providing clean water and sanitation, education and health care facilities for the affected communities in each and every country. Health provision and lack of access to medicines are increasing the rates of poverty in both developed and developing countries as healthcare prices are heightened.
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CATEGORIES FOR PRIORITY SETTING AND PROGRAMMES IN WHO REFORM 1.2.1 Communicable diseases Reducing the burden of communicable diseases, including HIV/AIDS, Tuberculosis, malaria, and neglected tropical diseases. Recommendation 1.2.1 Rates of infection for communicable on the rise, however, do not reflect in the prevention and awareness in the most affected regions awareness in some parts of the world has still not been reached.v The burdens of communicable diseases are poor productivity, long term hospitalization (and loss of earnings for the sufferer/their family), stigmatization leading to discrimination and an increased risk of being made redundant. Thus, it is crucial to involve other organizations in the implementation of plans to combat communicable diseases, including NGOs, employers and young people, to reach out to communities and countries in need. 1.2.2 Noncommunicable diseases Reducing the burden of noncommunicable diseases, including heart disease, cancer, lung disease, diabetes, and mental disorders as well as disability, and injuries, through health promotion and risk reduction, prevention, treatment and monitoring of noncommunicable diseases and their risk factors. Recommendation 1.2.2 Prevention is better than cure. We believe that early education of health should begin from home, communities to school levels. It is important to educate the communities about the dangers and 12 | P a g e
outcomes of communicable diseases. Education can be delivered via outreach programs about nutrition, eating healthily and also living an active lifestyle and discouraging sedentary life styles. Encourage early routine checkups, to be made affordable and available to all especially to in middle and lower income countries. 1.2.3 Promoting life-long health good practices Reducing morbidity and mortality and improving health during pregnancy, childbirth, the neonatal period, childhood and adolescence; improving sexual and reproductive health; and promoting active and healthy ageing, taking into account the need to address determinants of health and internationally agreed development goals, in particular the health- related Millennium Development Goals. Recommendation 1.2.3 Since the target is still far from being reached especially in developing countries, there is a need of properly trained health workers and birth attendants, ready to teach, serve and help the woman and children, with health related issues. Health education with sex education especially for teenagers and young adults about reproductive health should be introduced via early teaching programs from a young school age. Youth are an invaluable tool that we can use to spread information in new and innovative ways.
1.2.4 Health Systems Support the strengthening of the organization of health systems with a focus on integrated service delivery and financing, of health systems with a particular focus on achieving universal coverage, strengthening human resources for health, health information systems, facilitating transfer of technologies, promoting access to affordable, quality, safe, and efficacious medical products, and promoting health services research. Recommendation 1.2.4 Facilitate the process for NGOs to be established in every country and to be supported by the WHO in order to assist its work and ensure access to affordable and appropriate healthcare.
Surveillance and effective response toward disease outbreaks, acute public health emergencies and the effective management of health-related aspects of humanitarian disasters to contribute to health security. Recommendation 1.2.5 Provision of material, personnel and technology to carry out surveillance in order to manage and implement health safety, so that we can prevent the spreading of infections and reduce the mortality and morbidity rate. The issue of acute public health emergencies has been handled far better in the case of early response to emergencies than the case of outbreaks, and therefore we recommend that more effort needs to be placed on the implementation of policies on outbreaks.
1.2.5 Preparedness, Surveillance and Response
1.3 Involvement of Youth in WHO reform Youth involvement in the WHO reform should be one of the main focuses. The main point we wish to emphasise is not to suggest that youth should dominate WHO reform, but for both younger and older generations to work together as a team. It is very important to work together because experiences of both older generations and the current youth would be of a great advantage to the WHO reform. When the WHO was founded, its model was suited for the period and was fit for purpose for the first 20-30 years. Since then, the world has has developed in ways which no longer fit this model. New issues have arisen that the youth are perfectly placed to understand as they, too, are directly affected.
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We are living in a world faced with huge social challenges. Last year, the world passed a historic milestone when reaching a population of seven billion people, 1.8 billion of which are youth aged 10 to 24. And of this young population, 90 percent live in developing countries. This generation, the most interconnected generation ever, continues to grow rapidly, and the challenges they face are ever more daunting. About half of all young people survive on less than two dollars a day. More than 100 million adolescents do not attend school. Every year, 16 million adolescent girls become mothers. Almost 40 percent of the 6,800 new HIV infections each day are among young people. And every three seconds, another girl is forced or coerced to marry. We, the youth are majorly affected by most of current problems the world is facing. So, to combat these problems, it is in the best interest of everyone that youth are actively engaged in problem solving.
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Conclusion It was open to debate whether the WHO should in practice seek to direct work in international health, as provided for in its constitution. The idea that it was a directing authority led too frequently to a mindset within the WHO that others should conform to its way of doing things, and in several cases this has undermined its ability to forge effective partnerships with others. Nevertheless, the very same proliferation of global health institutions surely provided the opportunity for the WHO to make more of its coordinating function as specified in the constitution: providing leadership, offering guidance and promoting coherence between the many different actors. Similarly, the WHO surely had a role to play in influencing other actors within and outside the health sector – both governmental and non-governmental – to behave in ways that sought to reconcile the political, economic and commercial objectives of these actors with public health goals. In the light of all this, we, the AFI Changemakers consider that the current process of reform, involving youth, should be used as an opportunity for the WHO and its member states to think how it should reposition itself in current circumstances as a leader in global health. This needs to be based on a proper analysis of what the WHO’s role should be in relation to the health challenges facing the world now.
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SECTION 2: COMMUNICABLE DISEASES Introduction Over the centuries, physicians, public health experts and global organisations have all fought for the eradication of infectious diseases. In fact, as recently as 1967, the U.S. Surgeon General William H Stewart stated, "it is time to close the book on infectious diseases."vi Throughout the 20th century, the success of global vaccine programmes and improvements in public health encouraged many to believe that a world free from infectious agents was attainable. However, since the 1980's, approximately one to three new infectious agents have emerged each year, including outbreaks of SARS and H1N1, alongside continuing issues with previously well-established infections, such as tuberculosis. Communicable diseases are defined as illnesses attributable to specific infectious agents or their toxic products, that are capable of being directly or indirectly transmitted from the environment, zoonotically or from person to person. The recent Ebola outbreak in West Africa has emphasised the potential devastating effects of such infectious agents. Outbreaks of communicable diseases can occur anywhere in the world, at any time and therefore it is essential that governments, multilateral institutions and non-governmental organisations develop a complex network of global, interconnected systems that aim to prevent and detect outbreaks as well as coordinating efficient responses. Dr Margaret Chan, directorgeneral of the World Health Organisation, has recognised this need, stating, ."new and emerging infections keep coming back and the world needs a collective defence system, and that require international cooperation and collaboration, in the name of global solidarity".vii Although there have been many scientific and technological advances encouraging success in our battle against communicable diseases, significant challenges remain. In this report, we aim to discuss in detail and propose recommendations for two main challenges that we feel as youth are imperative to winning this global fight, education and access to medicine.
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2.1 Bridging the internal governance and managerial gap 2.1.1 Education in society Education plays a crucial role in the prevention of communicable diseases. It provides a safe foundation for everyone, as education prepares children with knowledge about this topic, including prevention measures. We believe that free education should be provided for all children and toddlers. Teaching children about communicable diseases is difficult and will face at times cultural scrutiny but for the progress of the next generation it is an absolute necessity, one only has to look at statistics showing disease reduction amongst educated youth to realise its importance. For the general public, in order for us to gain access to medical knowledge, quickly, instantly and effectively, producing eye-catching posters would be effective. The use of celebrities and famous public figures to endorse and represent in the poster would catch the attention of the masses efficiently, as the public pays more attention to media and the celebrity world, and often it is the case that the public can relate to and trust such persons. For certain regions in the world that are unable to gain access to the internet, to localise specific medical awareness catered to that region would be effective in educating the locals. Simple posters, with direct, easily absorbed information would be simple yet effective. Recommendation 2.1.1 For the younger generations, including Infectious disease subjects into their school syllabus will be a powerful tool. They can include interesting pictures and 17 | P a g e
fewer words to capture their attention. To make changes in the world or to increase knowledge on these matters, educating the younger generations is one of the most effective measures we can take. The youth are usually inquisitive and eager to learn about ways in which their actions could benefit the world. Unfortunately, there are posters of suicide bombers in countries like Iraq, Afghanistan which has affected the mind of young children. Instead, posters displaying positive and educational messages should be displayed behind a magazine cover, story books or any kind of accessible choices of media in that particular country. Recommendation 2.1.2 Use celebrities to endorse health awareness. This is an important advertisement technique, as it attracts an audience by suggesting that their success and talent can be in part attributed to the product they represent. Thus, we recommend that the WHO consider using this advertising technique to create short video clips, featuring local celebrities and public figures, which educate the public by detailing the symptoms of certain diseases and how to prevent them. For example, composing a short video of a celebrity following the correct hand hygiene technique, will highlight its importance in disease prevention.viii For an example, Ghanaian actress and Television host – Joselyn Dumas – has launched a Cholera awareness campaign called the “Xcholera campaign”. The campaign is to raise awareness for the outbreak of cholera in Ghana. The “Xcholera Campaign” has so far been endorsed by celebrities like K.O.D., Nana
Aba Anamoah, Efya, Fifi Folson, and Yvonne Nelson. Joselyn Dumas hopes that with this campaign, the number of lives being lost to cholera will be saved.ix 2.2.1 Access and research Access to essential medicines is very important in treating and containing the spread of communicable diseases. Communicable diseases are by nature beyond the control of individuals that acquire them because they are caused by external pathogens. This leaves much dependence on access to medication for effective treatment. For emerging diseases and drug resistant forms the importance of access increases even more. High mortality rates and ineffective medicine create complicated situations that must be dealt with creatively. Three main changes must be made in the present access landscape to alleviate the burden of communicable disease: decreased prices, private-public collaboration to overcome intellectual property barriers, and a streamlined process for gaining approval for the WHO Essential Medicines List (EML). Recommendation 2.2.1 New drugs are often made available through compassionate care use programs. This is typically used to test the efficacy of new medicines. However, when efficacy is ensured drugs often become inaccessible. Prices are increased and patients can no longer afford them. To combat this, new medicines should be subsidized like some countries subsidize fuel. Furthermore, funding management should change. Medical personnel should be involved in the decision making process to make all monetary aspects transparent. 18 | P a g e
Recommendation 2.2.2 Intellectual property barriers limit generic competition with mainstream drug companies. This allows a select few companies to dominate the market and control prices. Flexible amendments must be made to Trade Related Aspects of Intellectual Property Rights (TRIPS) to increase the production of essential medicines in emergency situations. One way to do this is give intellectual rights to generic companies. This should keep prices at a reasonable level by increasing supply, thereby increasing access. Governments, private companies, and the WHO should be involved in the process every step of the way to ensure the best outcomes. Recommendation 2.2.3 Adding new medicines to the EML in a timely manner could greatly improve access to essential medicines. The number of times the WHO Expert Committee on Selection and Use of Essential Medicines meets each year should be increased first and foremost to aid this process. As suggested by MSF in their "Ready, Set, Slow Down�x - brief, rapid testing of newly development drugs should also include rapid testing of essential medicines with other new drug regimens. A waiver process for certain emergencies situations is also cited as a potentially positive change.
Conclusion In conclusion, the stress that infectious diseases continue to affect on national, regional and global systems necessitate WHO action in disease prevention, management and treatment. Research and administration of effective treatments against communicable diseases is essential for safeguarding our future. The overuse of antibiotics and the protracted, costly process of drug discovery, augments the potential threat of common infections to decimate populations. The 68th World Health Assembly addressed the devastation wrecked by the Ebola outbreak in West Africa. This emphasised the need for swift detection methods and decisive multilateral action in the face of the interconnected health threats of a globalised world. At the 68th World Health Assembly, Dr Margaret Chan demanded that we be on ‘high alert’, further stating that global health ‘threats’ endanger ‘people, their health, their livelihoods’xi- the question is how can we reduce individual vulnerabilities to communicable diseases? As Changemakers, we recommend the WHO focuses on two key areas to combat the challenges posed by existing and emerging communicable diseases: To contain the Ebola outbreak, the WHO identified ‘community engagement’ as an essential regulatory mechanism which relied on a ‘package of interventions’ such as safe burials, social mobilisation and education. We recommend the use of increased advertisements (celebrity endorsed campaigns) and using media appropriate to the six regions of the WHO to filter important information and ensure its outreach to a wide range of communities. Access to essential medication- We recommend the need for decreased drug prices, improved private-public coordination to overcome intellectual property barriers and a streamlined process for gaining approval for the WHO Essential Medicines List (EML). The WHO asserts their objective to be the ‘attainment by all peoples of the highest possible level of health’xii,yet communicable diseases, even those with effective existing treatments (e.g. HIV/AIDS), continue to threaten the livelihood of peoples across the globe.Thus, as youth, passionate about improving health conditions for future generations, we recommend that the WHO focuses on combating communicable diseases by improving education and facilitating easier access to medicine.
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SECTION 3: HEALTH ISSUES AND NEEDS OF YOUTH IN LONG TERM CONFLICT ZONES Introduction Health issues and the needs of youth and children in humanitarian crises can be particularly diverse and varied and can sometimes be overlooked because of the magnitude of the conflict, but these ignored age groups will become the next “lost generations� which will then be unable to rebuild the countries after the crises because of the lack of skills, infrastructure, knowledge or resources. Therefore, the health needs of youth and children should be given priority on the global agenda when tackling zones affected by conflict and in crisis. Public health threats and internal conflicts, as well as conflicts triggered and conducted between countries or groups can severely affect the conditions and capabilities of the healthcare providers and access to healthcare in these areas. An even bigger concern is represented by the damage that limited or the lack thereof to healthcare and to accessing support impacts children and youth that are in crises or in areas of conflict, or have fled these areas and now are in the impossibility of fulfilling their health needs. In the present report section, we will examine and produce policy recommendations in three main areas. The first one is the case of children and youth asylum seekers, with examples from Palestine. Next on, we will look at the impact that long term conflict has on the previously mentioned age groups, with cases from Pakistan and Afghanistan. Lastly, it will examine and assess how education can be use to improve health practices and development, using examples from Myanmar.
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3.1 Health Needs of Young People Displaced Due to Long Term Conflict The world is facing the worst refugee crisis since the Second World War, with over a million refugees in need of resettlement across the world, fleeing multiple crises in regions including Syria and Iraq, Central Africa and Myanmarxiii. Health issues facing displaced populations, including thousands of young people, are vast and unique. A failure to act effectively in providing healthcare to refugees leaves the world in danger of condemning a generation of young people to poor health and limiting their capabilities to contribute to global society. 3.1.1 Infrastructure Lack of infrastructure including sanitation and healthcare facilities can cause outbreaks of communicable disease, breakdown of existing health initiatives including vaccination programmes and disrupt access to medicines required to treat noncommunicable disease. In complex emergencies, such as the displacement of people due to conflict, it has been shown that the death rate can increase by 60 times in refugee and displaced populations, three quarters of which is caused by communicable diseasexiv. Disproportionately affected by the increase in deaths due to communicable disease are youth. A large number of these deaths are preventable, however many efforts at prevention are hampered by poor infrastructure. The huge task of maintaining the health of a population without basic infrastructure is daunting, however utilising existing infrastructure and facilitating integration within established communities should be encouraged. Recommendation 3.1.1 In line with the UNHCR recommendations, refugee populations should be placed in camps 21 | P a g e
without basic infrastructure only as a last resort xv . Emphasis should be placed on integration within host communities, with both primary and secondary health care services used by both populations expanded and access to these ensured for the refugee population. By improving access and the standard of healthcare available to those from refugee or displaced populations, proven preventative and treatment measures can be implicated to halt the spread of disease. This integration will require not only resilient health systems, as advocated for by the WHO at the 68th World Health Assembly, but also international cooperation and support led by the World Health Organisation. Recommendation 3.1.2 The crowded and unsanitary conditions many displaced populations live in mean that communicable disease outbreaks can have devastating effects, especially on the young who are especially vulnerable if not immunised. An integrated effort among NGOs and public health officials should occur to initiate mass campaigns focussed on both health education and action to protect children from vaccine preventable disease. Sustainable intervention, as outlined in a previous report conducted by the AFI Changemakers, is key to ensuring lasting positive health effectsxvi. 3.1.2 Psychological Health Young people fleeing conflict may have suffered considerable psychological trauma, including separation from family members of friends, exposure to considerable violence and high levels of stress and pressure. There is increased psychological morbidity amongst displaced children, including PTSD, anxiety disorders and depression. The WHO
definition of health includes physical and mental well-being, and focus needs to be on psychological health as well as physical. Recommendation 3.1.3 To tackle the increased morbidity due to psychological disease amongst displaced youth, UNHCR and WHO should mandate increased mental health service provision in refugee settlements. The screening of all refugee children should occur through the primary health care and education systems. There is scope for the development of a standardised mental health screening tool for children displaced due to conflict by the WHO, which would acknowledge the many contributing factors towards poor mental health among this group. This screening tool could be made available to doctors working on the ground in conflict zones, and translated into local languages to ensure maximum impact. The completion of the World Mental Health Survey, and the experience gained using the
composite diagnostic interview, could inform this processxvii. Recommendation 3.1.4 A combined and culturally sensitive approach should be advocated for NGOs working with displaced populations. Culturally, mental illness seen through the eyes of modern medical practitioners may be perceived very differently than among populations fleeing conflict. Cultural sensitivity and awareness of the perceived benefit of traditional health practice should allow them to be utilised alongside modern techniques for dealing with psychological trauma, where complementation is possible without negative effects to the patient. In particular, psychological trauma resulting from sexual violence must be treated with extreme sensitivity in many cultures, and NGOs and other organisations must work together in the sharing of best practices when treating these victims.
3.2 Education Use in Improving Health and Development in Children and Youth in Conflict Zones Refugee children and youth have difficulties developing psycho-social skills leading them to psychosocial distress, other mental health problems, poor social and emotional development. Education is a valuable tool for improving health and mental development of these refugee children and youth. By going to school, they can have social interactions with other students and to feel a sense of community that is lacking for them. Children feel safe in a school environment. It ensures them to trust people around them and to learn various skills and knowledge. It breaks the barriers these children and youth have built in them due to the psychosocial distress they went through. It overall helps to improve 22 | P a g e
their mental health. Over the years, they will be able to cope up with the society and develop themselves. Through schooling, they will be able to function better, and it improves their mental well-being. 3.2.1 Health Awareness Refugee students may not be familiar with Western medicine. Their families may be using herbal therapies, prayer, or leaders in their community to treat illnesses that require more formal medical intervention. They are not aware of the harmful substances may be used for treatments in some cultures. It will further worsen any existing health issues.
Besides that, these children may be unwilling to share information about their problems or emotional distress with adults. Related ailments such as bruises can be visible, but some problems may not be as apparent, such as stomach aches and headaches, high absenteeism, or loss of appetite. They eventually fail to get proper medical attention due to this. These children who live in primitive conditions do not practice good personal hygiene care too. Recommendation 3.2.1 Behaviour change activities should be centralized in schools. Healthy practices must be demonstrated to these children. Basic hygiene needs to be reviewed with refugee children. Activities related to water, sanitation, and personal hygiene care should be carried out in school. Awareness on washing hands and all parts of the body, wearing clean clothes and healthy eating habits should be instilled. This is to prevent diseases that could be spread due to poor sanitation and to eradicate further outbreak of diseases. Recommendation 3.2.2 Implement a health improvement program to all refugee children that involves their family. This is to encourage family’s involvement in the children’s medical care at home and to create a platform for children to discuss and acknowledge their health issues with supportive adults around them. It also helps in increasing knowledge and awareness of health issues. Children that have been identified experiencing psychosocial distress and other health problems must be notified to their parents. Importance of conventional medications and treatment must be advocated for these children and caretakers. Health development through education in children and youth will only occur when their family is involved as a whole. Both parents and children should be taught to work together in this program.
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3.2.2 Immunization in Refugee Children Many refugee children leave their country yearly. Some of these children do not have an immunization record. Some documents could be missing or incomplete. Most of these children might not be even vaccinated in the first place due to the conditions in the home country. Upon arrival, they will be immunized but mostly they miss the opportunity for catch-up vaccinations later due to the unfavourable living conditions in certain countries. This imposes health dangers to both, the children and those around them. These children and their parents are often unaware of the importance of getting themselves vaccinated. Recommendation 3.2.3 Organize home visits by teachers and community volunteers to promote enrollment in school. By bringing in more students, they will all be able to be immunized. This improves the immunization coverage in refugee children. Eventually, their health quality becomes better. Recommendation 3.2.4 Schools should evaluate the immunization status and needs of these children. They should begin or continue the vaccination series for all immunizations required for children. These vaccines must be routinely administered as part of a school-based program.
3.3 Health provision in long-term conflict: Pakistan and Afghanistan Women in south east Asian countries suffer from major pangs of depression and also are constantly abused in all ways.as many countries in south east Asia are a male dominated society and women suffer problems on a daily basis for basic human necessities. Pakistan and Afghanistan are no exception. Some of the most common and priority diseases in Pakistan are acute respiratory such as infections, viral hepatitis, malaria, diarrhoea, dysentery. Controllable diseases include cholera, dengue fever, measles, meningococcal meningitis.
The tragedy of the health emergency is that the most pervasive problems in Afghanistan have largely been controlled in other countries: chronic malnutrition and preventable diseases like diarrhea, respiratory infections, and measles. On top of these basic health threats Afghanistan is also saddled with an extensive network of landmines that kill or maim more civilians than in any other country.
As part of the post-2015 development agenda, following a consultative process with a consortium of civil service organisations, development experts and marginalised people, a Post-2015 Development Framework Report on Pakistan was developed for submission to the UN. The report was developed by Global Call to Action Against Poverty (GCAP) and Beyond 2015 to look at specific priorities for the country in the years following the MDGs. Access to health care facilities in Pakistan is highlighted in the report as being of particular concern, it is suggested that efforts are needed to improve availability of health care, in particular maternal and neonatal facilities, in rural areas. Preventive healthcare measures should also be addressed, with particular attention paid to providing clean water and adequate sanitation facilities.
Afghanistan is one of the world's most heavily mined nations. It has one of the highest proportions of disabled people, and this is largely due to the landmines planted extensively throughout the country . Only two of Afghanistan's twenty-nine provinces are believed to be free of unexploded battlefield detritus. Most mines were laid during the period of Soviet occupation and the subsequent communist regime between 1980-92, but they were used strategically even during recent strife between the Northern Alliance and the Taliban.
Afghanistan today suffers from one of the worst health crises in the world. Years of war and civil strife have left behind enormous poverty, a crumbling infrastructure, and a widespread landmine crisis. The country is among leading nations on every global index of suffering. Life expectancy at birth is estimated at around 46 years, and one out of four children die before their fifth birthday. 24 | P a g e
3.3.1 Landmines and Their Explosive History in Afghanistan.
More than 90% of all those injured by landmines in Afghanistan are civilians. According to a survey done by the International Committee of the Red Cross, children represent half of all injuries and deaths from landmines in Afghanistan. They are the most vulnerable victims, affected while playing, tending animals, or scavenging. Growing numbers of returning populations are also at risk as they resettle across the country. Minefields continue to be discovered in Afghanistan at a rate of 12-14 million sq. meters per year. The new government of Afghanistan, however, recently acceded to
the 1997 Mine Ban Treaty, previously opposed by the Taliban and Northern Alliance. The signing of the treaty gives hope that the production, trade and use of landmines in Afghanistan will stop, that stockpiles will be destroyed, and that decades of clearing efforts can finally begin to make an impact for Afghan civilians.
than eighty percent have now received some polio vaccine.
Recommendation 3.3.1 Provide demining trening to the Afghan teams so they can defuse mines safely and provide the support needed for clearing efforts to be carried out., as well as aftercare support for injured victims.
Recommendation 3.3.3 Provide free health education across the masses using visual and audio aids for better understanding. Provide free education for girls till the age of 14.
3.3.2 Children's Health in Afghanistan
Under the Taliban's rule, women's physical and mental health suffered greatly. Women's access to health care decreased dramatically due to societal restrictions on gender relations and behavior. As a result, statistics on women's health are hard to determine.
It is estimated that about one out of four children in Afghanistan die before their fifth birthday. These child mortality rates are among the worst in the world, surpassed only by Sierra Leone, Niger and Angola. As the most vulnerable of the Afghan population, children are disproportionately affected by all the major health hazards in their environment. They are particularly susceptible to landmine injuries because they often lack the experience to recognize mines as a danger. Rampant malnutrition acutely affects children's growth. According to the World Health Organization, about half of Afghan children under the age of five are stunted due to chronic malnutrition. More than 60% of all childhood deaths and disabilities are due to respiratory infections, diarrhea, and vaccine preventable deaths, especially measles. Diarrhea in particular kills an estimated 85,000 children a year in Afghanistan and is considered to be one of the country's major health risks. Immunization rates, while very low, are improving considerably. Less than half of Afghan children have been immunized for measles, but the figure is rising thanks to recent emergency vaccination efforts. More 25 | P a g e
Recommendation 3.3.2 Use social media to spread the message regarding diseases and urging women and children to come forward to the small health facilities. Provide female doctors to avoid social stigma.
3.3.3 Women and Maternal Healthcare Access
When Physicians for Human Rights conducted a survey of women's health in 724 households in 2001, it found a high prevalence of poor mental health, suicidal ideation (65-77%) and suicide attempts (916%) among study participants. More than 70% of women exposed to Taliban policy made diagnostic criteria for current major depression. The majority of respondents (6387%) described their physical health as "fair" or "poor." It was found that cultural practices with regard to women had an effect on women's access to health care. Lack of female medical facilities and not having a male family member escort were listed as some of the most common reasons limiting health care access. Mental health services in Afghanistan were reported as "not available" by a majority of women exposed to Taliban policies. Fortyfour percent of respondents in the nonTaliban-controlled area reported that mental health services were not available.
The maternal mortality rate in Afghanistan is generally calculated as one of the highest in the world; for every 1,000 live births, 17 mothers die. This number takes on significance when we consider that in the United States, less than .1 maternal deaths are reported for every 1,000 live births. In Afghanistan, a great number of these deaths are preventable. Over 90% of deliveries take place at home, most without a skilled attendant present. Only about a third of the
country's 330 districts has a maternal or child health clinic. Recommendation 3.3.4 Provide healthcare units that are easily accessible to the women and children instead of big hospitals or medical establishments and include youth in community service project and provide them some type of compensation for their services either by skill training, medical benefits, free vaccines or consultations or even food and water.
Conclusion In conclusion, the issues surrounding the needs of youth and children in humanitarian crises are very complex, and necessitate a holistic approach in solving them. That is why we recommend that support and access to education, healthcare and socio-political life is made available to the youth in question. Furthermore, there should be efforts made by the WHO to involve and promote the issues of youth in the redesigning of its structure. The use of social media, community relations and voluntary support are great additions to the framework of the WHO in tackling the numerous problems facing the youth and children in places of crisis and conflict, but also in their other areas of action. Nevertheless, the side agencies should only complement and not replace the important actors, such as hospitals, clinics, the WHO and other responsible parties.
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CONCLUDING REMARKS The 68th World Health Assembly (WHA) that the AFI CHangemakers attended in Geneva, Switzerland was also attended by delegations from 194 Member States as well as recognized international NGOs and other partners, as the WHA is the annual gathering of the highest decisionmaking body of WHO and it should ensure the youth’s engagement in global health governance and diplomacy and allow youth to take an active role in contributing to its work. Priority topics from the World Health Assembly included the WHO Reform, Post 2015 development agenda, Universal Health Coverage and Health in all policies, the progress on Youth Health Risks in Conflict zones and Adolescent health, Communicable Diseases and Access to Essential Medicine.
Maria-Alexandra Radu
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ABOUT THE AUTHORS Alexandra Radu, Romania/ UK, 22 Alexandra is currently reading Business Management and Media Publishing in the UK where she is currently based. Her passion for international development and social entrepreneurship has led her to work in various countries and for multiple projects in India, Zambia, UK, Romania, Belgium to name a few. She is dedicated to connecting and sharing ideas with people from all corners of the world and wants to continue to work in empowering women and allowing them to access STEM fields. Maria-Alexandra was Co-Chair of the AFI Changemakers WHA Summit in 2015.
Poonam Bhar, Malaysia, 24 Poonam is currently enrolled at medical school in Moscow, graduating in June 2015. She is involved in a variety of influential medical projects within Russia, including providing medical help to small towns and delivering much needed support to rural orphanages. Poonam was Co-Chair of the AFI Changemakers WHA Summit in 2015.
Madhubrata Ghosh, Russia, 22 I am passionate about changing the world and the course of mankind. If even one person follows my lead and takes my passion and follows their heart then I will consider it a success. I want to reach out to as many people as I can so that they can change the course of the world.
Alison Hendry, Scotland, 20 I currently study International Relations at University of St Andrews. I have thoroughly enjoyed my first year and it has encouraged me to seek opportunities to engage with global issues. Charity work is something I hold close to my heart and my desire to help others correlates with many of the aspirations of the UN organs, in particular the WHO. This year has been important for the WHO, from its response to Ebola, natural disasters (Cyclone Pam) and encouraging vaccination programmesthe prospect of involvement in formulating a solution to the health problems we face today is inspiring. Jennifer Hendry, Scotland, 21 I currently study medicine at the University of Edinburgh and will graduate in 2017. Last year I completed a degree in medical biology which discerned an interest in considering the impact of health and disease at a global level. I have experienced public health, through my work in an orphanage abroad, alongside my local volunteer placements. These experiences have heightened my awareness of the disparities between different health systems. Armed with new knowledge, I hope to utilise this for the benefit of others.
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Hannah Johnson, USA, 24 Hannah Johnson is a third year General Science major at Portland State University in Portland, Oregon. Hannah will apply to medical school to become a doctor. In support of global health equity Hannah has been researching physician knowledge about Millennium Development Goal Six and the Global Plan to Stop TB. Her methodology has been executed via a shipboard program called Semester At Sea. The program has allowed her to interview Drug-Resistant TB experts in Japan, China, Vietnam, India, and South Africa. She will finish writing her Honors Senior Thesis this summer and hopes her work will improve awareness around the challenges of Drug-Resistant TB. Ailidh Lang, Scotland, 22 I am Ailidh Lang, age 22 and currently studying Medicine, with an intercalated degree in Global Health, at the University of Glasgow. I was born and raised in Scotland, and have lived in Glasgow, Scotland's biggest city, for the last 4 years. Glasgow is a wonderful city with amazing people, however it is blighted by the curse of socioeconomic inequality. Sadly, this is a trend seen around the world, and the effect it has on health is seen dramatically in Glasgow where life expectancy can vary by 25 years depending on what area of the city you live in.
Frieda Faith Matty, 32, Namibia Born in a small village in Northern Namibia. Final year medical student at 1st Moscow state medical university. Married and mother of 3 children. I believe I am different. Born to make a difference. I am a strong being. To be a blessing and to bless the world in a different way, that no one else has influenced before.
Thepa Mohan, Malaysia, 25 Thepa Mohan is from Malaysia, a multiracial country still accorgind to her the discrimination is quite visible. At the moment, she is associated with several NGO's that sets out in helping people from conditions like cerebral palsy to less fortunate people, including children who are orphaned. I have helped in conducting education fairs for the school leavers,provide counselling for them,setting out the right path and show them the options that are available.Besides that, I also help out with a centre that helps those from the underprivileged society in getting the right psychological help for free. Rinisha Yagarajah, Russia, 24 I am a final year medical student in I.M.SECHENOV First Moscow State Medical University, Moscow, Russia. In hope of becoming a cardiac surgeon and hopefully venture myself in Oncology too. I'm passionate about human rights. Respect and the basic human rights are the least anyone could get and the way the world is today, every inch of it is being abused. As long as you are part of this world, i will fight for you.
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AFI CHANGEMAKERS REPORTS AFI Changemakers at the United Nations: Report on Mental Health 2015 can be accessed at: http://www.changemakers-un.org/wp-content/uploads/2015/06/AFIChangemakers-Mental-Health-Report-June-2015.pdf
AFI Changemakers Summit 2015 report on the Right to Health and Access to Medicine can be accessed at: http://www.changemakers-un.org/wpcontent/uploads/2015/05/2015-Social-Forum-Short-Report.pdf Copies of stand-alone reports on the Right to Health and Access to Medicine can be accessed at:
Mental Health: http://www.arielfoundation.org/documents2015MentalHealthreport.pdf Courruption in Healthcare: http://www.arielfoundation.org/documents2015CorruptioninHealthcarereport.pdf Sustainability in Healthcare: http://www.arielfoundation.org/documents2015Sustainabilityhealthcarepoliciesreport. pdf
AFI Changemakers December 2014 Summit on the Right to Development report can be accessed at: http://www.arielfoundation.org/images/changereport.pdf Copies of stand-alone reports on Discrimination and Slavery and Trafficking, from the Right to Development Summit 2014 can be accessed at:
Discrimination: http://www.arielfoundation.org/documents/2015discriminationreport.pdf Slavery and Trafficking : http://www.arielfoundation.org/documents/2015slaveryreport.pdf
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REFERENCES i
CNN International Interview with Dr. Margaret Chan, April 16, 2007 available at http://edition.cnn.com/2007/WORLD/asiapcf/04/13/talkasia.chan.script/ ii
UNHCR Diagnostic Tool for Alternatives to Camps http://www.unhcr.org/5548c33b6.html
iii
WHO, CONSTITUTION OF THE WORLD HEALTH http://apps.who.int/gb/DGNP/pdf_files/constitution-en.pdf
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Medical Observer, Reform Needed After Ebola Failure: Experts, May 8, 2015 available at http://medicalobserverph.com/international-who-reform-needed-after-ebola-failure-experts/ v
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Nelson R. Antibiotic development pipeline runs dry.Lancet. 2003;362; 1723-1727
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CNN International Interview with Dr. Margaret Chan, April 16, 2007 available at http://edition.cnn.com/2007/WORLD/asiapcf/04/13/talkasia.chan.script/ viii
Kajol: India's Hand Washing Icon available at http://www.youtube.com/watch?v=fiDZe7ND2g4
ix
For example, Ghanaian actress and Television host – Joselyn Dumas – has launched a Cholera awareness campaign called the “Xcholera campaign”. The campaign is to raise awareness for the outbreak of cholera in Ghana. The “Xcholera Campaign” has so far been endorsed by celebrities like K.O.D., Nana Aba Anamoah, Efya, Fifi Folson, and Yvonne Nelson. Joselyn Dumas hopes that with this campaign, the number of lives being lost to cholera will be saved. x
MSF Issue Brief: Ready, set, slow down available at http://www.msfaccess.org/content/ready-setslow-down-new-and-promising-dr-tb-drugs-are-grabbing-headlines-not-reaching xi
WHO Director-General's speech at the Sixty-eighth World Health Assembly by Dr Margaret Chan on 18 May 2015 available at http://www.who.int/dg/speeches/2015/68th-wha/en xii
CONSTITUTION OF THE WORLD HEALTH http://www.who.int/governance/eb/who_constitution_en.pdf
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xiii World leaders’ neglect of refugees condemns millions to death and despair, 15 June 2015 available at https://www.amnesty.org/en/articles/news/2015/06/world-leaders-neglect-of-refugeescondemns-millions-to-death-and-despair/ xiv Communicable diseases in complex emergencies: impact and challenges, Lancet 2004; 364: 1974–83 available at http://www.who.int/malaria/publications/atoz/lancet2004ce_1.pdf xv
UNHCR Diagnostic Tool for Alternatives to Camps http://www.unhcr.org/5548c33b6.html
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xvi
AFI Changemakers Report on Sustainability and Access http://www.changemakers-un.org/official-changemakers-publications/ xvii
to
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