Al Gasseer, N., Dresden, E., Keeney, G. B., & Warren, N. (2004). Journal of Midwifery & Women's Health, 49(4S1), 7-13.

Complex humanitarian emergencies are crises characterized by political instability, armed conflict, large population displacement, food shortages, social disruption, and the collapse of the public health infrastructure. High mortality rates in these crises are common and are mainly due to disease, malnutrition, and trauma. Health needs must be viewed in the context of historical, social, political, and economic events. In complex humanitarian emergencies, women and children are disproportionately affected, and healthcare workers may be targets of violence. Because these conflicts often occur in areas of the world that already had high rates of maternal and infant complications, the effects of complex humanitarian emergencies can be lethal. The consequences include rape, torture, and sexual slavery and preventable diseases such as malaria, diarrhea, and malnutrition. War leaves in its wake a largely female population, many of whom are widowed. It is estimated that after the Rwandan genocide, 70% of the remaining population were females.

Health issues during crisis and displacement include physical displacement, loss of extended family and community support, increases in female-headed houses, sex- and gender-based violence, rapid spread of communicable diseases, including HIV/AIDS, mental health problems, lack of access to family planning and reproductive health services, malnutrition, increased maternal morbidity and mortality, exposure to teratogenic chemical, biological, and nuclear weapons, low birthweight, decreased access to clean water and sanitation, neonatal hypothermia, and disruption of immunization. The Women's Commission for Refugee Women and Children recommend that programs be developed that emphasize essential services, including a mix of prevention and treatment strategies, and involve the participation of the affected women wherever possible. Because such events often occur in politically charged situations, assessment data need to represent a variety of methods and perspectives. Advocacy to policy makers on behalf of women and children affected by complex humanitarian emergencies is critical.

Judith A. Lewis