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Summary - Global Health Module including lecture notes, textbooks, guidelines COMPLETE REVISION

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Complete notes for Global Health module from St George's University of London for Medical students on their intercalation year and Biomedical Science students. Global health refers to the field of study, practice, and management that focuses on improving the health and well-being of individuals, communities, and populations worldwide. It encompasses a broad range of issues and challenges related to health, including disease prevention, health promotion, healthcare delivery systems, and addressing social determinants of health. Key Aspects of Global Health: Disease Prevention and Control: Global health initiatives aim to prevent and control the spread of infectious diseases such as HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. These efforts involve immunisation campaigns, surveillance systems, and public health interventions. Health Systems Strengthening: Global health works towards improving healthcare infrastructure, workforce development, access to essential medicines and technologies, and quality healthcare delivery. It focuses on enhancing the capacity of healthcare systems in low- and middle-income countries to provide effective and equitable care. Maternal and Child Health: Global health initiatives prioritize the health and well-being of women, infants, and children. They aim to reduce maternal mortality, improve reproductive health services, promote safe childbirth practices, and address issues such as malnutrition and child mortality. Non-Communicable Diseases (NCDs): Global health efforts also target the prevention and management of non-communicable diseases, including cardiovascular diseases, cancer, diabetes, and respiratory conditions. These conditions pose a significant burden on healthcare systems worldwide and require comprehensive strategies for prevention and treatment. Health Equity and Social Determinants: Global health recognizes the impact of social, economic, and environmental factors on health outcomes. It focuses on addressing health disparities, promoting health equity, and tackling social determinants of health such as poverty, education, access to clean water and sanitation, and gender inequality. Global Health Governance: Collaborative partnerships between governments, international organizations, NGOs, and other stakeholders are essential for effective global health governance. These partnerships facilitate coordination, resource mobilization, and policy development to address global health challenges collectively. Research and Innovation: Global health encourages research and innovation to develop new interventions, technologies, and strategies to tackle emerging health threats, improve health outcomes, and strengthen healthcare systems. Global health initiatives are typically implemented through international organizations like the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the World Bank, and various non-governmental organizations (NGOs). These organizations work together to mobilize resources, provide technical support, and advocate for policies that prioritize global health. The COVID-19 pandemic has highlighted the importance of global health cooperation and preparedness. It has demonstrated the interconnectedness of health systems worldwide and the need for collaborative efforts to respond to global health emergencies effectively.

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MSF READING NOTES

PART I: REFUGEE AND DISPLACED POPULATIONS

I.I POLITICAL ASPECTS

Background history

● 1573- The term 'refugee' was used to describe Calvinists fleeing political
repression in the Spanish-controlled Netherlands to seek refuge with their co-
religionists in France
● Refugees are seen as individuals with political, religious or economic affiliations
that arouse solidarity among those that support similar interests in other
countries and a corresponding sense of responsibility towards them
● Since WWI, providing aid and protection to refugees is seen as a collective duty
of the international community
● Refugees = groups of people whose lives would be at risk if they returned to their
home countries (League of Nations)
● 1921- Appointment of the first High Commissioner for Russian Refugees by the
League of Nations
○ Response to refugees fleeing the revolution and civil war
○ Mandate was soon expanded to cover Assyrians, Turks, Greeks,
Armenians, Spaniards, Austrian and German Jews etc.
○ Oversaw travel, identification documents, employment rights and
safeguards against expulsion
● 1946- Creation of the International Refugee Organisation (IRO) by the UN
○ Focussed on repatriation or resettlement of all those who had a 'valid
reason' not to return to their countries of origin because of 'persecution, or
fear of persecution, for reasons of race, nationality or political opinion'.
● 1951- The IRO is replaced by the UNHCR
○ Encouraged countries to receive refugees, prevent them from being
forcibly returned, provide assistance and protection, and seek lasting
solutions to the problem
● 1951- the Convention Relating to the Status of Refugees
○ Ratified by 120 countries
○ A refugee is: 'any person who, owing to a well-founded fear of being
persecuted for reasons of race, religion, nationality, membership in a
particular social group or political opinion, is outside the country of his
nationality and is unable or, owing to such fear, is unwilling to avail himself
of the protection of that country; or who, not having a nationality and being

, outside the country of his former habitual residence as a result of such
events, is unable or, owing to such fear, is unwilling to return to it'.
○ Stresses non-refoulement
■ Refugees may not be forcibly returned to a country where they
have reason to fear persecution
○ Only covered the internal European problem, not situations on other
continents
● Western countries held ‘liberal asylum’ policies
○ Shows refugees in a positive light
○ Refugees choose freedom and easily integrate into new host countries
that share a similar cultural background to their origin country
● Early 60s- liberation wars and conflicts in Africa and Asia led to large-scale
refugee movements
● 1967- Protocol Relating to the Status of Refugees
○ Abolished the geographical and temporal restrictions on the scope of the
1951 Convention
● De facto refugees = people who flee generalized danger instead of individual
persecution and who come in large groups
● 'Convention Governing the Specific Aspects of Refugee Problems in Africa'
○ Adopted by the Organisation of African Unity (OAU)
○ Defined refugees as: ‘those who are forced to leave their native countries
based on persecution, aggression, occupation by an outside force, foreign
domination or events seriously disturbing the peace in a part or all of the
country of origin’
● 1984- Cartagena Declaration
○ Adopted by Latin America
○ Defined refugees as the OAU, plus those who are victims of 'massive
human rights violations'

Specific problems for Internally displaced populations (IDPs)
● International protection does not cover those who flee but do not leave their own
country
● Their situation is often more precarious than that of refugees
● Humanitarian assistance is often random and inadequate
● The displaced population may be inaccessible due to surrounding conflict
○ Relief agencies will have to prove impartiality, neutrality and
independence to gain access

Refugee camps
● May be set up by the host country
● Late 60s- most refugees originate from the southern hemisphere

, ● Late 70s-late 80s- most refugees originate from SE Asia, Afghanistan, Horn of
Africa, Southern Africa and Central America
○ Due to the E-W power struggle of the Cold War
● Recently- most refugees originate from countries with internal conflicts
○ Burma, Afghanistan, Georgia, Rwanda, Sudan, Somalia etc.
● Food, water, shelters, sanitary equipment etc. must be rapidly provided
● Arriving refugees are often weak and destitute
● International aid may be the hope of survival for the refugees
● NGO aid may prevent a host country forcibly returning refugees
● Refugees have stayed in camps in Thailand, Pakistan and Sudan for 10-15 years
● Closed camps are entirely reliant on outside assistance
● Those in open camps have contact with the local population and may generate
trade/income
● Refugees may live freely in villages
○ eg. Liberians in Guinea/Ivory Coast
○ Less easy for NGOs to identify needs
○ Imbalance may risk both refugees and native villagers

The role of relief agencies
● Survival and well-being of refugees depends on:
1. Water and sanitation
2. Food
3. Shelter
4. Healthcare
● UNHCR’s mandate is to coordinate assistance to refugees
○ Works closely with UN agencies, the host government and specialised
NGOs
● WFP brings in food aid but UNHCR distributes it
● Health and sanitation are provided by NGOs and line ministries of the host
government
○ Under the general coordination of UNHCR
● Must always be wary of the settlement deteriorating
● Refugees are very sensitive to malnutrition or vitamin deficiency
● Populations are very vulnerable to epidemics due to overcrowding and poor
sanitation
● Surveillance is essential
● UNHCR has a dual mandate of aid and protection

Refugee camps as humanitarian sanctuaries
● Refugee camps are a product of violence

, ● Crossing a border does not isolate refugees from the tensions and fighting of the
home country
● Refugees reconstitute their societies in the new setting
○ Divisions and power struggles are often reproduced, and may be
exacerbated by problems in the host country
● Many camps are controlled by armed groups
● Guerrilla movements may legitimise their power base in camps by:
○ Exploiting the population
○ Diverting aid distributions to themselves
○ Recruiting more fighters and porters
● “Humanitarian sanctuary” of rebel/guerrilla groups is a key factor in perpetuating
conflicts
○ eg. Pakistan, Honduras, Sudan and Thailand
○ In the 80s, some Western countries increased aid to camps that contained
“freedom fighters” with similar ideologies
● In 1994, international aid allowed perpetrators of the Rwandan genocide ro
reinforce their control
● Humanitarian aid may be fought over in a crisis situation
● NGOs have an obligation to assist victims, even if it means they will also
strengthen the aggressors
● Relief agencies should be given complete independence to assess needs and
monitor distributions to ensure maximum benefit for the victims

Permanent solutions
● Refugee camps are a chronic problem and require long-term aid
● 3 possibilities for permanent solutions:
1. Integration into the host country
■ Not often a realistic solution because host countries are often poor
and unstable and unable to accommodate thousands of refugees
■ LICs see that HICs resist refugee integration into their society
2. Resettlement in a third country
3. Repatriation to the country of origin
■ Seen as the only option by donor countries
● During the cold war, refugees had political significance, but now they are
perceived as undesirable
● This is growing confusion about the differences between a refugee and a migrant
● The West dissuades asylum seekers
● Refugeeism is now seen as a problem of migration, rather than a human rights
issue
● There has been a shift from aid/resettlement to prevention/repatriation

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