Hello, I'm Cyrus Shahpar, Deputy Team Lead for the Global Rapid Response Team at the U.S. Centers for Disease Control and Prevention. Today I will be talking to you about camp management, site planning, and public health interventions in complex humanitarian emergencies. We will examine the four key principles of emergency interventions, specific camp management interventions, including shelter and site planning, coordination strategies such as the cluster system and Sphere Project, and important logistical considerations. First, let's talk about the four main principles that guide public health interventions in complex humanitarian emergencies. One, most widely prevalent diseases are totally preventable and treatable in the setting of the CHE. Two, public health interventions should be based on accurate and reliable information. Three, coordination between camp leaders, organizations, host governments, and the local population is essential. And finally, the last principle is that the needs of the surrounding communities and the impact of public health interventions on those communities must be considered. These principles must be considered for all the different displacement scenarios complex emergencies create. In some situations the affected population may not actually be displaced from their homes or communities. Instead they may be cut off from the outside world and not able to travel or communicate outside of their own communities. This was the case in Serajevo where the city was essentially under siege and because it was unsafe to leave the city, residents continued to live in their homes. In another scenario, affected populations are displaced from their home communities and integrated into a host community. During the conflict in Liberia, many displaced persons were living in abandoned buildings throughout the capital city of Monrovia. In the third scenario, the displaced population resides in clusters such as transit centers or refugee camps, which may be self settled, or planned camps. Many refugees from Darfur have been living in camps along the eastern border of Chad. It is often the case that displaced populations can live in camps and be integrated into host communities at the same time. There are advantages and disadvantages to both scenarios. In camps, it is often easier to provide essential services. It is easier to advocate for the needs of the refugee population. And it is also easier to monitor their health status. At the same time, overcrowding in camp settings may increase the risk of disease. As shown in the table, overcrowding and poor living conditions are contributing risk factors to three of the five leading causes of death among refugee populations. Camp life can easily to dependencies since most of the population's needs are being provided and no expense. The advantages of integrating displays persons into the host community include promoting self sufficiency, providing access to work, and encouraging the use of existing services. However there are also distinct disadvantages posed by integrating displaced persons into a host community. For instance it becomes much more difficult to monitor the needs of the population and to provide them with essential services. It also places a significant burden on the host community. One that they may not be able to support without outside assistance. Several strategies have been identified for reducing the public health impact of displacement on refugee and IDP populations. The intervention priorities in the emergency phase cover ten sectors of activity. Several of these intervention priorities fall under the heading of Camp Management. These include shelter, site planning, food items, non-food items, and water and sanitation. Standards have been developed to guide the implementation of interventions in these areas. These standards are documented in the Sphere Handbook, which we will introduce later. In the camp setting, it is necessary to provide sufficient covered space to protect camp residence from adverse climate conditions and disease vectors, and to insure health, security, and privacy. Whenever possible displaced persons should build their own shelter while using local materials while taking measures to minimize the environmental impact. Whenever possible, original household units should be maintained. Ultimately, standards for adequate shelter should depend on the local climate and the size of the households in question. Shelter in a camp setting can take many forms including plastic sheeting, tents, indigenous materials such as trees or grass, and existing structures such as unused homes, collective centers, and schools. The following standards should be met in providing shelter to displaced persons. A covered area that averages 3.5 to 4.5 square meters per person. Shelter that is appropriate for the local climate. And a four by six meter sheet of plastic at the beginning of the crisis, per average household of five persons. One of the guiding principles of site planning or site selection is to provide sufficient space for living and additional services necessary for the functioning of the camp. In general, it is preferable to maintain smaller camps, a few small camps of less than 10,000 people are preferable to one large camp. Small camps are easier to manage and favor a return to self-sufficiency. Displaced persons should be involved and consulted in the planning process. Their social organization and opinion should be taken into account whenever possible. It is important to consider the impact of site selection on the host community and to utilize local resources when it is feasible. There are certain criteria to consider in regard to site selection. These are security and protection, accessibility, resources, soil conditions and organization. The settlement must be located in a safe area, greater than 50 kilometers from any border or any conflict area. Security both within and outside of the camp, must be addressed. Security of women and children should be of particular concern. The area should be physically safe, free from land mines, flooding and extremes of heat and cold. To allow for the transportation of people, water, and relief items, access to the site must be possible during all seasons. An adequate quantity of water must be available either on-site or close by year round. In addition, an adequate supply of fuel or firewood and materials for shelter construction need to be made available and readily accessible. The site must be suitable for the construction of latrines and cemeteries. It is also important that the terrain should slope in order to provide natural drainage for rainwater away from the site. Once the site has been determined, a plan should be developed that details the location of living units, roads, and other facilities. A map should be used to develop a network of roads that divides the area into sections. The preferred method is to organize the site into basic community units, constituted by a number of shelters and community facilities such as latrines, water points, and washing areas. Good access by roads to every section and facility is essential for the transport of staff and materials. Several factors should be taken into account when organizing the location and layout of facilities and shelters, such as the space required per person and for each installation, the accessibility of services, the minimum distance between facilities and shelters, the cultural habits and social organization of the refugee population, access to water points and sanitary facilities and ethnic and security factors. In many cases, the displaced population will have settled on a site before any site planning can be carried out. Usually improvements to the site can be made without moving all the shelters. Organizing facilities, improving access to all sections of the camp, and planning sessions for new arrivals will improve camp management. Sometimes it may be necessary to completely reorganize the site, although this is usually not advised. Such an undertaking is necessary when there is a legitimate threat to refugee health from overcrowding or fire danger. Problems such as lack of water, insecurity, or potential danger, may also necessitate a move to a new site. In addition to shelter and site planning considerations, camp managers need to address both food and non-food items, and water and sanitation, as well. The provision of food items within a camp setting requires a good supply chain, accurate population numbers, and an efficient distribution system. It is critical that the system is developed to distribute food aid equitably, ensuring an average of 2,100 kilocalories per person per day. Displaced persons and refugees generally take only very few of their personal belongings when leaving their homes. The provision of non-food items must take into account the climate and culture of the local area, as well as what people have carried with them from their homes. Providing local non-food items is optimal, but the impact on the local population and environment must be considered before doing so. Distributions of non-food items must be organized to provide the population with the essential goods required for daily living. These include water containers for the storage of water in households, cooking utensils, material for shelter construction, soap, tools for building latrines or waste disposal pits, blankets, and clothing. The distribution of non-food items is just as important as that of food rations. Refugees will often sell or exchange part of their food ration in order to purchase these items, unless they are freely distributed, further compromising their nutritional status. The following standards should be met with distributing non-food items. Households should have a cooking pot and utensils. Each person should be provided with 250 grams of soap each month. Households should have five kilograms of firewood or the equivalent per day. People should have access to sufficient blankets and households should have two water collecting vessels of 10 to 20 liters each, and one storage water vessel of 20 liters with a cover and a spigot. Several factors related to water and sanitation should be considered in site planning and camp management. First, sources of water may be limited by where the displaced population is located. It is important to ensure an adequate quantity of water when locating and developing a camp. Adequate sanitation may be complicated by site location and soil conditions. All these interventions involve many people, moving in many directions. For this reason coordination is one of the top ten priorities in any refugee situation. Unfortunately, it is an issue that is often neglected or poorly implemented. Coordination directly influences the effectiveness of any relief work. And it is essential in major refugee relief programs. To ensure coordination it is necessary to establish clear leadership, create a coordinating body, ensure the priorities are shared by agencies, prevent program duplication and ensure all needs covered, and rationalize services by creating common standards and using common guidelines. To improve coordination, several organizations are working together to identify and address gaps in humanitarian response. These organizations have divided into working clusters that each focus on one key aspect of emergency response. The camp management and coordination cluster is jointly led by UNHCR and the International Organization For Migration, or IOM. Another development that has increased both coordination and accountability is the Sphere Project. The Sphere Project is a voluntary initiative that includes a broad range of humanitarian actors. The goal is to improve the quality of assistance to people affected by disaster or conflict as well as the accountability of humanitarian agencies and states toward their continuants, donors and affected populations. The Sphere Project has developed minimum standards to guide how the humanitarian community responds to population affected by disaster or conflict. These standards, covering the critical humanitarian sectors as well as the principles in which they're grounded, are set out in the Sphere Handbook, Humanitarian Charter and Minimum Standards in Humanitarian Response. The handbook collects evidence-based universal minimum standards in four sectors. Water supply, sanitation and hygiene promotion, food security and nutrition, shelter, settlement, and non-food items, and health action. These standards are based on the moral and legal principles spelled out in the humanitarian charter. It also defines protection principles and core standards that should inform any humanitarian response, ensuring the quality and accountability of services provided to the affected populations. Necessary to all interventions and coordination efforts is logistics. Logistics is the branch of science and operations dealing with communication, procurement, transportation and shipping, warehousing and storage, supply chain management, material handling, inventory and distribution, cold chain management, and physical security and lodging. In addition to these activities, logisticians need to be leaders and effective communicators. Logistics in emergencies differs from other logistics fields in a handful of important ways. These differences include usually starting from scratch, working with many partners, working around political and time zone restrains, and enduring harsh living conditions. Without effective logistical planning and follow through, the best laid interventions and camp management strategies will fall short. Now that we have briefly discussed the major considerations involved in camp management, site planning, and coordination, let's recap. The underlying principles of public health intervention and CHEs are, one, the most widely prevalent diseases are treatable and preventable. Two, interventions should be based on accurate and reliable information. Three, Coordination is essential. And four, surrounding communities must be considered. Applying these principals camp managers must consider shelter, site planning food items, non-food items, and water, sanitation and hygiene. These interventions, if well planned, are coordinated with the cluster system or another approach, and follow the minimum standards outlined by the Sphere Project. Lastly, logistical planning is critical for success. Thank you.