The Green Series - Article 4 Part 4
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The role of military assistance in responding to natural and environmental disasters, including incidents related to chemical, radioactive and nuclear accidents or deliberate events, has been long established. While there is a long standing history of military involvement in humanitarian interventions related to natural disasters, the engagement of national militaries in preparing for and responding to disease outbreaks in the domestic context is relatively recent.
The militaries might not immediately associate health epidemics or pandemics with their mandate (for various reasons, including legal, historical, political, cultural and socioeconomic factors specific to the country context), national military health services have a range of specialist resources that can be brought to bear in managing public health events, including disease outbreaks.
While the military has historically not been regarded as a primary partner in responding to disease outbreaks, the engagement of the military in the response to the COVID-19 pandemic, the scale and complexity of the pandemic has reinforced that partnership and demonstrated that collaboration with other sectors beyond the health sector is essential when preparing for and responding to public health threats and risks.[1]
Emergency preparedness plays a crucial role in building and sustaining the national, regional and global capacities required to keep the world safe from health emergencies. Improving collaboration between public health and military health services has been identified by WHO as an area with the potential to realize substantial gains in health emergency preparedness, emphasizing the need to identify synergies for future collaboration.
In November 2020, World Health resolution WHA73.8 – “Strengthening preparedness for health emergencies: implementation of the International Health Regulations (2005)” – stressed the importance of adopting an all hazards, multisectoral, coordinated approach in preparedness for health emergencies. Emergency response benefits from building and strengthening alliances and partnerships between the public health sector and nontraditional health stakeholders, such as the military health services, well before the need for a response to a public health emergency arises. Thus, instead of aiming for multisectoral engagement only at the time when a response to a public health emergency is necessary, effective public health emergency management requires preparing together for a better response through multisectoral coordination for emergency preparedness and health security.
WHO recognizes that countries would benefit from guidance on how to involve military services in supporting health interventions across the continuum from developing the capacities needed to implement prevention and preparedness to the response to and recovery from health emergencies. National military health services are often well equipped to play a supportive and complementary role in this endeavour. Many examples exist of military health assistance that helped to mitigate and ease the impact of natural 2 disasters such as earthquakes, cyclones, droughts, floods, and chemical, biological, radiological and nuclear (CBRN) emergencies.
Even more prominently, the COVID-19 pandemic has shed light on the role that national military services can play in public health emergencies, including disease outbreaks. The efforts of the national military typically focus on the following activities: [3]
a. Support for physical infrastructure
b. Logistics and supply chain management;
c. Providing military health workforce surge capacity for civilian hospitals;
d. Isolation and quarantine and border control;
e. Testing and contact tracing f. Distribution of protective equipment and; g. Managing cases.
The efforts of the national military and public health activities typically arrange as under:
National Disaster Management: Helps as under:
a. A national disaster management agency or authority is often the national government body that is responsible for coordinating disaster or emergency management policy and practice and overseeing the management and coordination of disaster risk management activities for large-scale emergencies and disasters due to most hazards. Other lead agencies and authorities may be assigned specific types of hazardous events, such as outbreaks or CBRN events. b. Military organizations are often key resources in a national disaster management plan because of their human resources, logistical capacities and technical response abilities. The military engagement for public health purposes may either be arranged through the national disaster management agency or authority or may involve a separate coordination cell for health emergencies.
Public Health Emergency Operations Centre (PHEOC)-It works as under:
a. The PHEOC integrates traditional public health services into an emergency management model. The PHEOC coordinates the information and resources for the response to health emergencies. It supports and is a component of the existing national disaster management agency or authority. PHEOCs can respond to public health emergencies that require coordination with other sectors, and support multiple national, regional or international responses simultaneously while coordinating the whole-of-government response.
b. Military health services have been recognized as a crucial partner for PHEOCs due to the sector’s key roles in national disaster management, providing key human resources, logistical capacities, and technical response abilities.
c. Emergency response plans and public health concepts of operations typically describe how and when military health services may be engaged and coordinated through the PHEOC.
Emergency Medical Teams (EMTs)-There roles are as under:
a. The EMT is a group of health professionals providing direct clinical care to populations affected by disasters or disease outbreaks as surge capacity to support the local health system. EMTs assist countries to build capacity and strengthen national health systems by setting up and coordinating the deployment of quality-assured medical teams in health emergencies.
b. EMTs that involve military health personnel – that is, comprising military health personnel or combined civil–military health personnel – provide a best-practice example for civil–military health collaboration and coordination mechanisms between public health and military health authorities.
Conclusion
Successful civil–military health collaboration for health emergency preparedness is characterized by institutionalized coordination and systemic exchange. The process needs to consider the strengths and challenges of both the public health sector and the military health services to develop and advance capacities to prevent, detect and respond to public health emergencies. A formal agreement defining key objectives, core capacities and operational modalities is crucial for enabling cross-sectoral collaboration between the two sectors.
References
1. Health emergency and disaster risk management framework. Geneva: World Health Organization; 2019 (https:// apps. who. int/iris/ handle /10665/326106
2. Managing future global public health risks by strengthening collaboration between civilian and military health services: meeting report, Jakarta, Indonesia, 24-26 October 2017
3. Inter-Agency-Standing Committee, Global Health Cluster. Position paper: civil-military coordination during humanitarian health action. Geneva: World Health Organization; 2011
4. Kamradt-Scott A, Smith F. Military assistance during health emergencies. In: McInnes C, Lee K, Youde J, editors. The Oxford handbook of global health politics. Oxford University Press: 2018