This monograph is not intended to be an exhaustive and definitive assessment of child health in complex emergencies. The topic is much too vast and complex, and different individuals and institutions will have incompatible perspectives. Rather, we aim to provide a starting point for discussion and debate on how to improve the care of children in these settings.

CARE OF CHILDREN IN COMPLEX EMERGENCIES

Addressing the health needs of children in complex emergencies is critical to the success of relief efforts and requires coordinated and effective interventions. The major causes of childhood morbidity and mortality in complex emergencies are similar to nonemergency settings: diarrheal diseases, acute respiratory tract infection, measles, malaria, and malnutrition. However, the severity and magnitude of these diseases are often exacerbated by conflict or disaster, necessitating rapid assessment and treatment of large numbers of severely ill children. Disease surveillance systems must be rapidly established, particularly for diseases known to cause outbreaks with high case fatality, such as measles, cholera, shigellosis, and meningococcal disease.

Guidelines are necessary but not sufficient to ensure optimal care. Guidelines define the standard and scope of curative and preventive care, often guide training and needs assessment efforts, and are an important component of preparedness planning. In scope, guidelines can address curative aspects of disease diagnosis and treatment in ill children, preventive health interventions for the individual and community, and development and oversight of health systems. Each of these levels of care, from the individual child to the national level of health system planning, is important to the care of children in complex emergencies. However, many conditions must be in place for guidelines to be used effectively, including properly trained and supervised health care workers, adequate and appropriate drug supplies, knowledge of local epidemiology and appropriate health-seeking behavior, accessible health care facilities, functioning referral systems, and sufficient funding.

Consideration of the broader context in which guidelines are used in complex emergencies is necessary to ensure their effectiveness. The type of emergency, whether an armed conflict, famine, or natural disaster, and the phase of the emergency determine specific health risks and demand responses sufficiently flexible to adapt to these risks. The health needs of



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