Rehabilitation in humanitarian emergencies (FS-16)

Focused symposium

Skelton P1,2Chakraborty R3Da Silva A4Henderson P5Wappenstein D6 
1Humanity and Inclusion (formerly Handicap International), London, United Kingdom, 2UK Emergency Medical Team, London, United Kingdom, 3Humanity and Inclusion (formerly Handicap International), Dhaka, Bangladesh, 4Médecins Sans Frontières (MSF), Paris, France, 5International Committee of the Red Cross (ICRC), Mosul, Iraq, 6Sociedad Ecuatoriana de Fisioterapia, Quito, Ecuador

Learning objective 1: Drawing on real examples from recent emergencies, participants will understand the emerging role of early rehabilitation in humanitarian responses.
Learning objective 2: Participants will understand International Humanitarian Law and Humanitarian Principles and their implications for physiotherapists
Learning objective 3: Participants will be able to use up to date global humanitarian guidance and materials to advocate for and support the early inclusion of physiotherapists in emergency responses.
Description: Conflicts and disasters result in a growing imbalance between supply and demand for acute rehabilitation services (Sheppard 2016, NEPTA 2016). Recent global guidance such as "The Management of Limb Injuries in Disaster and Conflict" (ICRC, 2017) "Minimum Standards for Rehabilitation in Emergency Medical Teams" (WHO, 2016) and WCPTs own report on “The Role of Physical Therapists in Disaster Management” (WCPT, 2016) have all emphasised that early rehabilitation has a role in the response to humanitarian emergencies. While research into its role in this context is still needed (Smith et al 2015) it's efficacy has been demonstrated by Gohy et al (2016). Too often though, despite the excellent work of individuals and organisations, rehabilitation remains an afterthought (WCPT 2016, Spiegal et al 2018). Recent emergencies have highlighted the positive impact that physiotherapists can have and some of the challenges they continue to face. 
Following the 2016 Ecuador earthquake, a lack of involvement in national disaster plans and limited access to rehabilitation in the disaster area was addressed by the Ecuadorian Physiotherapy Association, who used the disaster to strengthen the role of physiotherapists in disaster response. In Iraq, during the 2017 Mosul assault, security constraints, low prioritisation and a lack of awareness of the EMT Minimum Standards for Rehabilitation (WHO 2016) meant the majority of acute medical teams did not include rehabilitation. ICRC (along with HI and MSF) took steps to try to address this. In Bangladesh, when faced with the Rohingya refugee crisis, and an outbreak that could cause significant disability, a lack of awareness of the need for rehabilitation led to delays by medical actors considering the need for follow up care and rehabilitation. HI and MSF then put in place vital follow up services. In complex, ongoing emergencies like Syria and Yemen, insecurity and the deliberate targeting of humanitarian agencies, health facilities and health workers, in direct contravention of the Geneva Conventions (Lancet editorial, 2015) has also forced the closure of rehabilitation projects, leaving humanitarian agencies with enormous challenges trying to provide urgently needed rehabilitation care for those with injury or disability. Finally, across all responses, responses are often hindered by shortages of local physiotherapists who are trained to provide early (acute) rehabilitation in emergencies. A 2019 training resource on rehabilitation in emergencies, will be launched in the symposium as a means to begin to address this need.
Implications / Conclusions: Global guidance has positioned physiotherapy at the heart of humanitarian emergency medical responses, but a lack of awareness and prioritisation, coupled with a degradation of humanitarian law and limited numbers of appropriately trained local physiotherapists means that significant challenges remain before physiotherapy can be seen as being fully integrated into these responses. With an increased awareness of the role of physiotherapy, and supported by global guidelines and resources and a basic understanding of humanitarian principles, physiotherapists can play a role in ensuring that rehabilitation is a core part of emergency humanitarian responses. 
Key-words: 1. Humanitarian 2. Rehabilitation 3. Emergency
Funding acknowledgements: No funding has been received in support of this submission.
Relevance to physical therapy globally: Early rehabilitation is an emerging but essential component of responses to global health emergencies, with increasing needs in disasters, conflicts, refugee settings and even outbreaks. At the same time, International Humanitarian Law and Humanitarian principles, with their origins in the Geneva Conventions, are increasingly under threat. Physiotherapists need to be aware of global guidance around both these issues to advocate for the inclusion of physiotherapy as an essential part of emergency medical humanitarian responses.
Target audience: Physiotherapists living in countries at risk of disaster, outbreak or conflict, as well as those with an interest in working internationally in this field.