Books and reviews : "Handbook on War and Public Health"
31-10-1996 Article, International Review of the Red Cross, No. 314, by Gilbert Burnham
International Committee of the Red Cross (Dr Pierre Perrin, ed), Handbook on War and Public Health , ICRC, Geneva, 1996 [1 ]
Dr Gilbert Burnham , Department of International Health, The Johns Hopkins School of Hygiene and Public Health, Baltimore, USA
As the world's population increases so do the numbers of people vulnerable to natural or manmade disasters. Armed conflicts continue to displace thousands from their homes every day. Meeting the health needs of these displaced people is of major concern. Both for diseases forgotten by the developed world and for emerging pathogens, methods of providing care have often lagged behind, as events in Zaire in 1994 graphically reminded the world. In this era of instant communications, the expectations of the international community and of displaced populations themselves for a speedy and effective response are not always met. Addressing these needs in an effective and efficient manner is an increasingly important area for international health workers. Not only are conventional public health skills required, such as epidemiology and health systems management, but the practitioner must now understand principles of development, know the causes and courses of armed conflicts, be well grounded in international humanitarian law, and be able to navigate through delicate ethical problems in the field.
The Handbook on war and public health by Pierre Perrin deals with these issues and more in a detailed and comprehensive manner. Th e text is based on the extensive experience of the ICRC in providing health services to populations affected by war and other disasters. A practical field-based approach runs like a thread throughout its pages. The principles and methods discussed have obviously been forged and honed in the field during countless disasters. At the same time it is not a series of checklists or algorithms. Its strength is its ability to unite practical field concerns with the theoretical and conceptual underpinnings of the Red Cross/Red Crescent Movement. In this it provides a unique resource. Presented in other forms, some of the information has served as reference material for personnel attending the ICRC's ever popular H.E.L.P. and S.O.S. courses, and its availability now in book form will prove a valuable asset to international health workers in the field as well as graduate students.
The handbook starts with an outline of the planning process. Beginning with an assessment of needs, it follows the process through the determining of priorities, design of a programme, setting of objectives and selection of indicators, and ends with the evaluation. The chapter on food and nutrition is built around an understanding of the food chain and the impact on a population of various types of disruptions to the food system. Methods of nutritional assessment and potential pitfalls in carrying these out are also discussed. The sections on types of intervention and methods of distribution provide a good background for the public health practitioner.
Water and environmental health are presented in a way which does not overwhelm the non-engineer. Key facts for determining water needs and potential sources as well as treatment methods are clearly explained so as to allow health personnel to conduct a preliminary assessment and ask for technical assistance in an informed manner. Sanitation, which is badly neglected in most books on the health of displaced populations, is well covered. Options for f aeces disposal are clearly set out with advice on the selection of the appropriate methods. The chapter on communicable diseases presents a comprehensive public-health approach while avoiding tiresome repetition of incubation periods and clinical symptoms. Examples from recent field situations effectively illustrate methods of containing outbreaks during emergencies. The practitioner going to the field might well supplement this chapter with an infectious disease handbook such as Benenson's Control of communicable diseases in man.
Chapter five on medical and surgical care deals with resources and organization for clinical care, both at the health-centre level and the hospital level. The section on planning surgical services in disaster situations draws on the unparalleled experience of the ICRC in war surgery. This chapter could arguably have followed the later chapter on setting up the health-care system, thereby balancing the facility orientation of chapter five with the basics of primary health care and its application among displaced populations. Chapter six, dealing with epidemiology, is a good review of general principles, but someone without a basic knowledge might be best advised to start with an introductory text such as Barker's Practical epidemiology . The section on epidemiological programmes is particularly good.
The concepts on which the Movement is built, although running through the whole book, come into focus in the last three chapters. " Disasters and Development " provides an important counterweight to the tendency of some relief agencies to lose interest in humanitarian emergencies after the crisis stage passes. The section on the origins of disasters and measures to reduce vulnerability is excellent. The chapter on protecting the victims of armed conflicts is a useful primer on international humanitarian law and human rig hts law for health-care personnel. Even better is the section on application, which obviously draws on the wealth of ICRC experience. In the complex world of the 1990s, the final chapter, an introduction to humanitarian ethics, is indispensable to anyone in the field of international health. The application of fundamental principles in specific situations is considered in detail. This is perhaps one of the most important parts of the book.
The Handbook on war and public health is a very readable book, which deserves to be the companion of all health personnel providing humanitarian assistance. It manages to capture a wealth of experience, and to present it in a way which is useful both as a ready field reference, and for health workers preparing for an overseas assignment. This book is a must for public-health personnel working with displaced populations in developing countries.
1. Available also in French: Comité international de la Croix-Rouge (Dr Pierre Perrin, éd.), Guerre et santé publique, Manuel pour l'aide aux prises de décisions , CICR, Genève, 1995.