Health Response to Crisis Situations

Since its establishment, IOM’s health activities have evolved and expanded in response to the changing needs of migrants and their host communities, as well as the contexts in which migration occurs. The adoption of the 2008 World Health Assembly Resolution on the Health of Migrants (WHA 61.17) signified a shift in global policy and an increased focus by global actors on prioritizing the migration health agenda.

IOM has also contributed to humanitarian response to all major crises worldwide since the time of its founding. Within IOM’s Humanitarian Mandate, health is recognized as an essential component. Humanitarian crises produce increasingly complex and often large-scale migration flows and mobility patterns, which typically expose affected populations to significant vulnerabilities and generate serious and longer-term migration management challenges. Consequently, in 2012, IOM developed the IOM Migration Crisis Operational Framework (MCOF) at the request of its Member States. The MCOF is a practical, operational and institution-wide tool to improve and systematize the way in which the Organization supports its Member States and partners to better prepare for and respond to the migration dimension of crises. Health support is one of the 15 areas of assistance articulated under the MCOF.

Moreover, IOM is a formal partner of the World Health Organization since 1999, with areas of collaboration covering the health aspects of migration and human mobility, including humanitarian crises, public health emergencies and the implementation of the International Health Regulations (IHR 2005). As a formal partner of the WHO, a member of the Inter-Agency Standing Committee’s (IASC) Global Health Cluster (GHC), and more recently, a partner to the Global Outbreak Alert and Response Network (GOARN), IOM’s role as an important actor in delivering response to humanitarian and public health emergencies, as well as in supporting health system recovery and resilience, continues to grow.

IOM’s health response to humanitarian and public health emergencies aims to alleviate suffering, save lives and protect human dignity while also upholding IOM’s commitment to humanitarian principles and protection mainstreaming. This response encompasses the various stages and typologies of crises, throughout all the phases of the migration cycle and the mobility continuum.

Areas of IOM’s Health Response to Crisis Situations

Primary Health Care Provision and Community Health Revitalization

From the onset of a crisis through the subsequent early recovery and transition period, well-functioning primary health care (PHC) needs to be sustained. PHC provision can be done through a variety of internal, external, and/or provisional health services. This includes the provision of health services through mobile clinics, temporary health posts, transitional clinics, community health outreach, and support to existing health care facilities, depending on the context, availability of resources, and operational feasibility.

IOM’s provision of PHC is aligned with the GHC response domains, as articulated in the Health Resources Availability Mapping System (HeRAMS). These domains encompass:

1. General clinical services and essential trauma care
2. Child health, including immunization and nutrition
3. Communicable diseases 
4. Sexual and reproductive health, including STI and HIV/AIDS, maternal and newborn health, and sexual violence
5. Non-communicable diseases and mental health
6. Environmental health 

These six domains, with their respective essential services, are imperative to save lives, reduce morbidity and suffering in times of crisis. IOM’s health programming in response to crisis therefore endeavors to address all six domains comprehensively, either through direct health service provision, or in partnership with other health actors.

Furthermore, the scope of these six domains and their essential services covers the three different levels of care, allowing more effective referral and coordination of care between:

1. Community care
2. Primary care
3. Secondary and tertiary care.

Health Referrals

To facilitate linkages between the different levels of health services, and notably access of crisis-affected populations and their surrounding communities to adequate secondary and tertiary health care services during crisis and post-crisis recovery periods and to reduce undue congestion of hospitals, IOM provides an adequate environment in strengthening health referral mechanisms to and from community, primary, secondary and tertiary health care facilities. In many crisis settings, IOM supports hospital discharge with transportation, logistics and reception assistance to patients. In so doing, operational relief is provided to reduce the strain on functioning health care facilities during and after crisis events.

Medical Evacuation and Rehabilitation

In severe circumstances during emergencies or in post-emergency phases where there are overwhelming needs for urgent and complex medical care; some patients may require local, regional or international medical evacuation in order to access adequate, life-saving medical care. In these cases IOM initiates medical evacuation programmes in collaboration with interested governments and partners and contributes to in-country capacity and enhancement of national health infrastructure, skills development, and targeted initiatives that serve to address gaps in health service delivery.

Travel Health Assistance

Travel and movements of populations may pose health risks to both the individuals engaged in traveling, as well as the hosting or receiving communities. IOM has a responsibility to ensure that people traveling under the auspices of the Organization travel in a safe and dignified manner, are fit to travel, receive appropriate assistance through medical escorts to final destination when necessary, and do not become a hazard to other travelers, personnel or receiving communities.

Health, Border and Mobility Management

IOM’s approach to responding to public health emergencies, disease outbreaks and preparing for future health threats is particularly anchored upon human mobility, notably through the Health, Border and Mobility Management (HBMM) framework. The summary of the components within the HBMM framework are shown in the below figure. HBMM has the ultimate goal of improving prevention, detection and response to the spread of infectious diseases and other health threats along the mobility continuum (at origin, transit, destination and return points) and its spaces of vulnerability, with particular focus on border areas. At the core of HBMM is the understanding that mobility is a continuum that extends beyond the physical or regulated border areas, such as the official Points of Entry (or PoEs, as articulated within IHR, 2005), to include pathways and spaces of vulnerability. Grounded on this understanding, the scope of HBMM ranges from collection and analysis of information on mobility patterns, to disease surveillance and health threat response mechanisms at spaces of vulnerability along mobility pathways. HBMM, therefore, ultimately contributes to health system strengthening that is sensitive to mobility dynamics, notably at the primary health care level.

IOM’s Health Response to Crisis Situations Within other MCOF Sectors

Camp Management and Displacement Tracking

As the co-lead of the Camp Coordination and Camp Management (CCCM) Cluster, IOM strives to facilitate the effective and equitable provision of assistance and protection in camps and camp-like settings for displaced persons and migrants in transition. Recognizing IOM’s key role in camp management, it is vital that public health dimensions such as public health risk assessments and monitoring are systematically integrated into existing camp-based operational practices as well as included within the information collection process of the Displacement Tracking Matrix (DTM).

Shelter and Non Food Items (NFIs)

The incorporation of first aid kits, insecticide treated bed nets, and other health materials into IOM’s NFI packages supports existing health promotion practices and promotes self-sufficiency and self-management for the affected populations.

Water, Sanitation and Hygiene (WASH)

In addition to ensuring adequate access to clean water, sanitation and safe waste management in times of crisis, IOM has the capacity to incorporate health promotion and disease prevention activities as well as capacity building support for the affected communities within its WASH programming. IOM’s response to cholera outbreaks put equal emphasis on detection and management of cases, as well as prevention through WASH interventions.           

Transport Assistance for Affected Populations

Travel and movements of populations may pose health risks to both the people traveling and the hosting or receiving communities. IOM has a responsibility to ensure that people traveling under the auspices of the Organization travel in a safe and dignified manner, are fit to travel, receive appropriate assistance through medical escorts to final destination when necessary, and do not become a hazard to other travelers, personnel or receiving communities.

Psychosocial Assistance

IOM also directly implements mental health support and psychosocial interventions to immediately address the needs of crisis affected populations. Services include the deployment of mobile psychosocial teams to provide psychosocial counselling, the setup of referral mechanisms and the provision of basic psychosocial trainings, including psychological first aid trainings, for humanitarian workers in accordance with Do No Harm principles.