ECOSOC HOLDS PANEL ON THE EFFECTS OF HIV/AIDS AND OTHER WIDESPREAD DISEASES ON HUMANITARIAN RELIEF OPERATIONS

14.07.03

Panellists Stress that Prevention and Response to
Disease Outbreak is Everyone’s Business and
that Coordinated Relief Operations Save Lives



The Economic and Social Council (ECOSOC) this afternoon held a panel discussion on how HIV/AIDS and other widespread diseases affect humanitarian relief operations and what the appropriate response of the international community, including the United Nations and its partners, must be.
Introducing the topic, Valery P. Kuchinsky, Vice-President of ECOSOC, said the area of health was one of the crucial areas that needed to be addressed through cooperation in order to alleviate suffering in humanitarian crises. Carolyn McAskie, Deputy Emergency Relief Coordinator and moderator of the panel, said that HIV/AIDS, in combination with drought and food crises, represented a new kind of humanitarian emergency. The response needed to come from all sectors – working together – using all possible tools, to respond to the tragedy of HIV/AIDS and its impact on humanitarian emergencies.
In humanitarian crises – especially in complex emergencies – 70 per cent of people were killed by communicable diseases, said David Nabarro, Executive Director for Sustainable Development and Healthy Environments of the World Health Organization. In such situations, malaria, diarrhoeal diseases, pneumonia and tuberculosis caused high morbidity and mortality due to population displacement, temporary settlements, overcrowding, malnutrition, poor water and lack of sanitation. In addition, national and local capacity to respond was reduced due to the breakdown of public health systems, delays in detection of diseases, and a lack of access to health care.
Michel Sidibe, Director of the Country and Regional Support Department at UNAIDS, said that HIV/AIDS must be viewed as a humanitarian emergency, but one of different quality than traditional humanitarian emergencies. Five key challenges facing the United Nations and UNAIDS in their fight against HIV/AIDS were the need to bridge this artificial divide between humanitarianism and development; to attack parallel tragedies such as the large number of orphans, which required the development of community safety-net programmes; to combat the rapid feminisation of the epidemic; to protect human rights; and to improve the monitoring of the epidemic.
No organization could defeat AIDS on its own, nor would politically correct speeches and debates change the course of the epidemic, said Massimo Barra, President of the European Red Cross Network on AIDS. Instead, changes in the policy environment among the governments of affected and donor countries and a collaborative approach among implementing agencies were needed. The challenges could not be dealt with separately, but must be dealt with through a community-level response and a comprehensive package of strategies designed to curb a patchwork of problems.
Jean-Ja cques Graisse, Deputy Executive Director of the World Food Programme, said strong coordination was key in efforts to respond to the HIV/AIDS pandemic. An innovative approach to regional coordination had been created in southern Africa, improving regional programming significantly. Southern Africa might be the first case of an HIV/AIDS – related large-scale emergency, but it was unlikely to be the last. The challenge was to re-tool responses to match the vulnerability caused by the disease. He stressed that in responding to the crisis in Southern Africa, humanitarian agencies must view their programming through an “HIV/AIDS lens”.
In a subsequent question-and-answer segment, speakers raised the problems involved in inter-agency coordination; the effective use of funds and resources; the need to find new and more creative solutions; the relationship between food security and HIV/AIDS; lack of accurate data on infection rates; and HIV/AIDS and refugees.
Participating in the interactive segment were representatives of the United Kingdom, South Africa, the United States, Ukraine and Botswana. A representative of the United Nations High Commissioner for Refugees also participated in the discussion.
The Economic and Social Council will reconvene at 10 a.m. on Tuesday, 15 July, to continue its general debate on special economic, humanitarian and disaster relief assistance.

Statements
CAROLYN MCASKIE, Deputy Emergency Relief Coordinator, Office for the Coordination of Humanitarian Affairs (OCHA) and moderator of the panel, said that HIV/AIDS, in combination with drought and food crises, represented a new kind of humanitarian emergency; the South African experience demonstrated that highly affected populations were more vulnerable to external shocks. Of particular concern were the external shocks caused by conflict, which had the capacity to further the spread of HIV/AIDS through abuses of human rights, including rape and sexual abuse, and the mass migration of large groups across regions. The extent of the pandemic obliged OCHA to give due consideration to HIV/AIDS in its overall planning for emergency humanitarian relief. This response needed to come from all sectors, working together, as although OCHA was mandated as the lead agency to organize emergency responses, UNAIDS was mandated to organize those programmes related to HIV/AIDS.
The Inter-Agency Standing Committee had done much to further the integration of issues related to HIV/AIDS into humanitarian responses, she noted. It had been recognized that HIV/AIDS could dramatically increase the impact of a humanitarian situation on populations affected by conflict. In this context, the Resident Coordinator/Humanitarian Coordinator system could play a crucial role in the response to HIV/AIDS. In conflict-affected areas, they could extend their role through normal processes such as negotiating access, expanding information centres and developing early warning and contingency planning in consideration of HIV/AIDS. Moreover, while the consolidated appeals process (CAP) was not the best tool – due to its short-term nature – to respond to HIV/AIDS, this process could add value in emergency situations. The important thing was that all possible tools were used, given the tragedy of HIV/AIDS and its interaction with humanitarian emergencies.
DAVID NABARRO, Executive Director for Sustainable Development and Healthy Environments at the World Health Organization, responding to the wider theme of the title of the panel, said that in crises – especially in complex emergencies - people were often killed by communicable diseases. In fact, communicable diseases caused up to 70 per cent of deaths in complex emergencies. In such situations, malaria, diarrhoeal diseases, pneumonia and tuberculosis caused high morbidity and mortality. The malaria burden was huge and 30 per cent of global malaria deaths occurred in countries affected by complex emergencies. Refugees were particularly at risk and 50 to 75 per cent of medical consultations in the Great Lakes region were suspected malaria cases. Currently there were major outbreaks among displaced populations in Burundi, Rwanda and Tanzania. The burden of tuberculosis – and its potential consequences – was also dramatic. It was fairly obvious why communities in complex emergencies were particularly vulnerable to communicable diseases. The causes were population displacement, temporary settlements, overcrowding, malnutrition, poor water and lack of sanitation. In addition national and local capacity to respond was reduced due to the breakdown of public health systems, weakened health system capacities, delays in detection of diseases, and a lack of access to health care.
The breakdown of public health services made outbreak detection and containment very difficult, he continued. There was always a potential for local and international spread into non-affected communities through refugees, relief workers, military groups, and animal movements. It was stressed that preventing, and responding to, disease outbreak, was everyone’s business and that during major outbreaks, humanitarian relief operations were crucial to save lives and stop international spread. Concerning HIV/AIDS in complex emergencies, he said that the conditions – conflict, instability, poverty and powerlessness – favoured a rapid spread of HIV. HIV/AIDS was a major issue in several current crises. Action by humanitarian agencies and organization could have a major impact on the factors that led to increased HIV incidence or rapid progression from HIV to AIDS. The objective must be to focus attention on core issues in order to generate a shared understanding of what needed priority attention in a crisis when some groups would be vulnerable to increased HIV/AIDS risk.
MICHEL SIDIBE, Director of the Country and Regional Support Department at UNAIDS, said that HIV/AIDS must indeed be viewed as a humanitarian emergency, but one of different quality than traditional humanitarian emergencies. Where those who were endangered by lack of food could be rescued through rapid reaction, in the case of HIV/AIDS there were 13 million people condemned to die. Moreover, already vulnerable populations were more susceptible to infection: in one instance, 80 per cent of blood in one African country had gone untested for the virus, of this blood 75 per cent had been distributed to children under five and 15 per cent to pregnant women. Thus, it was essential to recognize that no humanitarian paradigm could leave HIV/AIDS on the side.
Relief operations provided a key opportunity to attack HIV/AIDS, he said. In Southern African, the United Nations Population Fund (UNFPA) and UNAIDS had teamed up to help identify, distribute and monitor food and reproductive health issues. This kind of creative action that bridged the artificial divide between humanitarian and development work must become increasingly common. Among the areas of primary concern, it was important to rebuild the capacity of institutions weakened by AIDS - which meant targeting highly affected communities - and to integrate HIV/AIDS into standard humanitarian assessment tool books. UNAIDS was leading the movement to bridge this artificial split, including by engaging with regional African bodies.
The five key challenges facing the United Nations and UNAIDS in their fight against HIV/AIDS were the need to bridge this artificial divide between humanitarianism and development; to attack parallel tragedies such as the large number of orphans, which required the development of community safety-net programmes; to combat the rapid feminisation of the epidemic; to protect human rights; and to improve the monitoring of the epidemic. On this last, it was important to note that in order to meet the other challenges, better data was needed.
MASSIMO BARRA, President of the European Red Cross Network on AIDS, said that no organization could defeat AIDS on its own, nor would politically correct speeches and debates change the course of the epidemic. Instead, changes in the policy environment among the governments of affected and donor countries and a collaborative approach among implementing agencies were needed. The unfolding disaster in Southern Africa was an example of community erosion – the slow but inexorable destruction of the region’s social fabric. HIV/AIDS was driving this process; poor access to health care, the accelerated spread of tuberculosis, malaria and other diseases, lack of safe water and sanitation and ineffective agricultural production were its aggravating factors.
The challenges posed by HIV/AIDS could not be dealt with separately, he said, but must be dealt with through a community-level response and a comprehensive package of strategies designed to curb a patchwork of problems. The International Federation of Red Cross and Red Crescent Societies had taken a new and long-term approach to the crisis in Southern Africa, which included a no exit strategy at the end of a one-year term. Instead, the Federation was committed to a strategy that combined food security with integrated community care involving HIV/AIDS prevention, care and treatment, the provision of safe water and sanitation, health services and the promotion of economic self-reliance.
Furthermore, he noted that the impact of HIV/AIDS was not limited to Africa, but had highlighted the inhumane treatment accorded to intravenous drug users in Europe. In many places, people needing treatment were forced to the margin by government policies that forced them into situations where the transmission of HIV was most likely. Yet, it was scientifically proven that only harm reduction strategies worked against the spread of HIV/AIDS. Needle and syringe exchanges, drug substitution and condom provision were vital components of the response to HIV/AIDS.
JEAN-JACQUES GRAISSE, Deputy Executive Director of the World Food Programme (WFP), said that WFP had only recently begun its work on food aid in relation to communicable diseases. It had been noted that caloric intake affected the success of patients beginning and continuing their treatment. WFP was now devoting a sizeable amount of its attention to the relationship between food security and HIV/AIDS. The international community was witnessing a large-scale emergency fuelled by HIV/AIDS. It was well known that the disease had a devastating impact on societies, disproportionately affected working age adults and placing a heavy burden of care on women and girls. However, the Southern African crisis was a new kind of complex emergency – a deadly convergence of HIV/AIDS, chronic poverty, poor policy environments and food shortages that had left millions of people in need of urgent assistance. HIV/AIDS was both a cause and consequence of food insecurity and shortages – households that had lost breadwinners and caregivers to AIDS were poorer and more vulnerable to food insecurity. At the same time, those who were hungry were more likely to engage in risky behaviour. HIV/AIDS and malnutrition often operated in tandem, as nutrition deficits increased both the risk to HIV and the vulnerability to opportunistic infections, such as tuberculosis.
The HIV/AIDS pandemic had grown from a serious public health threat into a massive and complex crisis, forcing humanitarian and development agencies to adapt their programmes to respond to the devastation it was causing. This involved the need for immediate action to meet current emergency needs and longer-term objectives. Food aid must be combined with other essential multi-sectoral services, involving joint planning and programming between agencies and governments, with close collaboration with non-governmental organizations. The needs and concerns of women and vulnerable children, including orphans, must be the top priority of any intervention. An important first step was to better identify vulnerable people and communities in order to improve the ability to effectively and efficiently target various responses. Countries, and communities within countries, were not uniformly impacted, he said and stressed the need to clearly identify “high-impact hotspots” and their underlying causalities.
Strong coordination was key in all these efforts, he continued. An innovative approach to regional coordination had been created in Southern Africa that had improved regional programming significantly. Southern Africa might be the first case of an HIV/AIDS – related large-scale emergency, but it was unlikely to be the last. The challenge before the international community was to re-tool responses to match the vulnerability caused by the disease. In responding to the current humanitarian crisis in Southern Africa, humanitarian agencies must view their programming through an “HIV/AIDS lens”.

Interactive Segment
In a subsequent interactive discussion, the representative of the United Kingdom picked up on the question of coordination and the use of resources for the benefit of the client. If coordination was to become more that rhetoric, more efforts were needed to try to do things differently. She believed there was not complete agreement on what needed to be done and that there was inter-agency competition on this issue. How should the international community move forward in a more coordinated and cost-effective manner, she asked.
A representative of South Africa stressed that an integrated approach in fighting HIV/AIDS was necessary and should involve health, justice, education and transport departments too. It was disturbing to note that many of the promises made by governments about the Global Fund had not been followed-up. The effect of HIV/AIDS on agriculture and food security was also stressed since it prevented the passing down of knowledge through generations.
A representative of the United Nations High Commissioner for Refugees highlighted the effect of HIV/AIDS on refugees. UNHCR had developed a strategic plan for the last two years which monitored refugees and rates of HIV/AIDS. The study had concluded that refugees did not necessarily bring HIV/AIDS into other countries. Panellists were asked to elaborate on the fact that refugees had not been included in many national HIV/AIDS strategies. If host countries only looked at their own populations, the effect of combating the epidemic would not be as strong.
A representative of the United States said his Government encouraged OCHA and the Inter-Agency Standing Committee to continue their work on HIV/AIDS. The 15 billion dollar presidential fund for HIV/AIDS demonstrated the commitment of the United States to the fight against HIV/AIDS.
One aspect of the spread of HIV/AIDS was that in times of conflict there was no reliable data on rates of infection, said a representative of Ukraine. It was vital to improve the data collection mechanism, she said and asked whether any progress had been made in this field.
Responding, Mr. Sidibe said the challenge was to improve the coordinated response at a country level, allowing the pulling of technical and financial resources to address the pandemic. It was also necessary to enforce the accountability levels on the regional director levels. One of the major problems was not absorption of funds, but the lack of a proper financial architecture in recipient countries, preventing the transfer of resources in an accountable manner. Using the situation in Angola as an example, he said it was true that it was difficult to manage and monitor infection rates of HIV/AIDS in situations of conflict.
Mr. Graisse added that when the Executive Director of the World Food Programme had been appointed as Special Envoy to Southern Africa, he had worked in cooperation with other United Nations agencies. When teachers died, education was undermined and when farmers died, the agricultural sector was undermined. Creative thinking on behalf of all agencies was required.
Asking questions about the statistics on whether war led to HIV/AIDS or not seemed a little academic, said Mr. Barra. The real point was that the international community had not adequately responded to the HIV/AIDS pandemic. Everyone needed access to health care and treatment, not only people in rich countries, he said. Finally, he said that an aggressive strategy could help cut back the spread of HIV/AIDS by 50 per cent. The international community knew what to do; it was a matter of actually doing it. Policies needed to be changed, he said, particularly to do with drug addiction and HIV/AIDS.
Dr. Nabarro said that collectively it had not been easy to recognize that disease among millions of people was in itself an economic and humanitarian crisis. Wars had been recognized as crises, however it seemed more difficult for the international community to recognize that seven jumbo jets of people died each day from malaria represented a crisis. The international community had woken up very late to disease related crises; however, it was not yet too late. It had only just been learned that input like clean water, food, and sanitation were crucial. Every person in the room needed to take HIV/AIDS seriously and to recognize the total inadequate nature of the response of the international community. Strategically, the international community was like a swarm of bees trying to get to an elephant. However, by working together in a more coordinated way, there was still hope. The challenge at the moment was to be bigger and stronger, and more effective than a swarm of bees.
Commenting on the question posed by his countryman from Ukraine, the Vice-President of the Economic and Social Council, Valery P. Kuchinsky, noted that Ukraine was among the European countries hardest hit by HIV/AIDS. The extent of infection in Ukraine had led to HIV/AIDS being addressed not as a question of national health, but of national security. Thus, the linkage between war and HIV/AIDS was not academic. For one thing, Ukraine was an important contributor to peacekeeping troops, and this as a source of infection must be investigated. Thus, it was good to see that all United Nations documents meant to prepare troops for peacekeeping included sections on preparing for and precautions against HIV/AIDS.
In a second round of questions, a representative of Botswana said that his country had a serious problem with HIV/AIDS, but added that he was worried that the focus on HIV/AIDS in humanitarian operations would detract from recognizing the world-wide spread of HIV/AIDS. For example, Botswana had never suffered from serious conflict or economic problems.
In immediate response, Ms. McAskie reassured the representative of Botswana that today’s discussion was meant to be conducted in parallel with the wider dialogue on HIV/AIDS, not to replace it. More generally, she said in relation to today’s panel that local governments in particular needed to be incorporated into the international fight against HIV/AIDS. In her personal experience, many countries with high infection rates did not seem to be on war footing, yet when 20 to 30 per cent of the population was infected, the situation was more serious than war. It was also terribly important to have coordination mechanisms set up for the funding of the fight against HIV/AIDS, so that funds could be quickly channelled into appropriate programmes. In fact, the entire fight against HIV/AIDS needed to be conducted on an emergency basis.
The power balance between men and women in highly infected countries also needed to be changed, Ms. McAskie continued, as women’s lack of power in many countries was now their death sentence. Rape, sexual abuse and philandering by their partners, massive genital mutilation and traditions over initiation also posed serious threats – death sentences – to women’s health. Finally, the pattern of conflict in certain parts of the world needed to be changed, so as to curb the spread of HIV/AIDS.



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