Category: Innovations

How can the “One Health” approach help change humanitarianism?

A market in Chine. ©Simon Law

Dr. Rafael Ruiz de Castañeda is a researcher and teacher at the Faculty of Medicine of the University of Geneva, in the Department of Tropical and Humanitarian Medicine, and at the Institute of Global Health. He co-directs, with Dr. Isabelle Bolon, an interdisciplinary unit which, through a “One Health” approach, addresses public and global health issues.

For Défis Humanitaires, he presents his vision of what One Health is – or should be – and shares with us the difficulties and solutions to better integrate this approach in humanitarian contexts.

Madeleine Trentesaux: Rafael Ruiz de Castañeda, we will start with an effort to define what One Health is. It is commonly considered that the One Health approach is based on the interdependence between human, animal and environmental health. For your part, you have a definition that goes somewhat further. What is it?

Rafael Ruiz de Castañeda : The work of definition is important, but before I start, I would like to point out its limitations. Defining terms and concepts often implies separating them and marking their limits. Creating silos runs counter to the very principles of One Health.

One Health is not a discipline but a public health and global health approach that is built on the fact that there is an interdependence between human, animal and environmental health. Its added value lies in the collaboration between disciplines and sectors and in its capacity to integrate communities affected by public health issues.

It is precisely here, when you add that One Health is intersectoral, that you mark a specificity of this approach.

Yes, One Health is definitely interdisciplinary from an academic point of view, but it must also involve different sectors. It must mix the academic world with that of international organizations, humanitarian actors, etc., and, above all, it must integrate human communities. It is the affected communities that know how to identify the problems at the human-animal-environment interface and often know a lot about them.

The strength of the One Health approach is to find the right actors and disciplines to respond to the identified problem. It is not necessarily an approach that can be applied to all problems, but it is of particular interest for those at the crossroads between human, animal and environmental health.

 

Breeder in Kabo, CAR – 2015, ©Vincent Tremeau

One Health is an approach that must be interdisciplinary and intersectoral. We also hear about other concepts such as Planetary Health. What is the difference between this concept and One Health? What is the added value of the cohabitation of these two concepts?

Each of these approaches has a specific history and involves different actors and schools of thought. These concepts are more or less focused on human or animal health or on the environment.

Tripartite Alliance Strategy Document, 2017, here

One Health is older than Planetary Health. It has its origins in the concept of “One Medicine” put forward in the 1960s by Prof. Calvin Schwabe. The concept of One Health was established following the increase in the number of epidemics of emerging infectious diseases of animal origin in recent decades, such as AIDS, SARS, Ebola or animal influenza.

Since the mid-2000s, three major international organizations have been leading this fight: the World Health Organization (WHO), the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO). This is known as the Tripartite Alliance.

More recently, the notion of Planetary Health is emerging thanks to a publication in The Lancet in 2014. It focuses on the processes of environmental disruption on a planetary scale that impact human health. For example, biodiversity loss, deforestation, climate change and their consequences on human health.

These differences are valid and do exist in the current environment. But, again, I would like to emphasize the importance of collaboration, not the creation of new silos. It’s about identifying and understanding the problems and needs to find the right people and entities to collaborate with to find an operational solution.

We can clearly see the interest, particularly in the academic field, of this approach, which allows for a decompartmentalization between human, animal and environmental health. It is also a concept that has gained in popularity, but whose implementation is not obvious. Is it being done at the risk of becoming a “showcase concept”? What is its integration into policy at the international, national and local levels?

This is a good question because, indeed, the One Health approach can be difficult to operationalize. At the international level, the concept is carried by the Tripartite Alliance, which we have already mentioned.

At the national level, the difficulty in adopting a One Health approach is that we have created and organized our societies in a fragmented way. There is, for example, a ministry for human health, one for agriculture and yet another for the economy[1].

We often work in silos, and changes in behavior and ways of working are long and difficult to integrate, especially if their positive impact is not demonstrated. The role of countries where, for example, many zoonoses are endemic will be key to the implementation of the One Health approach.

Is it necessary to have supra structures labeled “One Health”? Not necessarily, because although it is important to create and define areas of work, we must not risk creating new silos. What we need are collaborative mechanisms. For example, that the Department of Agriculture can easily share data with the Department of Human Health. It is important to get into the habit of discussing between human medicine, animal medicine, zoology, animal ecology… practices and needs in order to pool some resources and collaborate on the ground.

Let’s take the example of rabies [2]. Various studies have shown that vaccination of dogs is the most cost-effective action to prevent and control the disease in both dogs and humans. Vaccination of dogs can eliminate rabies in humans. This idea is a strong paradigm shift for those involved in human health.

6 years after the beginning of the civil war in Yemen, more than 80% of the population needs humanitarian aid. For trade, milk and meat production the association has distributed 3 goats per household. ©Solidarités International, december 2020

How can this collaboration between sectors be put into practice?

I would put forward two solutions to operationalize this approach. First, One Healh is a systems approach that attempts to identify and address problems at their source (e.g., wildlife). Thus, One Health is often focused on prevention, and that is where the effort should be made, rather than on responding or responding to events.

If we take the example of infectious diseases of animal origin (zoonoses), we must be able to identify them in animals before they reach the human population. This requires close collaboration between veterinarians, animal ecologists, field epidemiologists, etc., in terms of sharing information, data and resources. Resource sharing can take the form, for example, of joint field missions, or sharing laboratory space dedicated to human and animal research.

Communities also play a critical role because they are in contact with domestic and wild animals and can provide early warning through syndromic surveillance in animals.

Secondly, a new generation of health actors must be trained, for whom a systemic and collaborative approach is natural. These paradigm and behavioral shifts are long-term changes and education is key to these processes. However, this work must be accompanied and facilitated by the creation of institutions and structures that support this interdisciplinary and intersectoral approach.

And in the humanitarian environment, where prevention is made difficult by the context, how can this approach be put into practice?

Humanitarian settings present many difficulties in implementing action. It is an environment often characterized by urgency, instability and sometimes the high vulnerability of people in the field.

However, it is a context that would greatly benefit from better integration of the One Health approach. Indeed, human-animal-environment interactions are numerous and take various forms. Humans, in precarious contexts such as camps or migration routes, are often in contact with domestic or wild animals – livestock, dogs or wild fauna such as snakes or scorpions, mosquitoes and other disease-carrying insects.

The origins of humanitarian crises are also regularly found in the environment – natural disasters, unsafe water causing a cholera epidemic for example.

One Health approach is important to combat envenomated snakebites

In 2017, the WHO officially recognized snakebite as a neglected tropical disease. It is estimated to cause up to 138,000 deaths per year worldwide. A One Health approach to this issue allows us to consider the consequences of snakebites not only on human health but also on animal health and on the socio-economic situation of affected households. For example, snakebites on livestock can kill animals and weaken the economic situation of owners. In terms of human health, snakebites are a major cause of the health burden due to neglected tropical diseases in terms of disability-adjusted life years [3].

Bitis Arientas, a snake commonly found in refugee camps in Kenya. Source: WHO Snakebite Information and Data Platform. This platform aims to gather global data on snakebites. Accessible here

Faced with these situations, humanitarians must treat people with competent and efficient health personnel, but also respond to the crisis in a global and integrated way thanks to an interdisciplinary team. It is necessary to understand where the disease comes from (animal or environmental origin), the practices that allowed it to pass from animals to humans and/or from humans to humans, etc.

You have worked a lot on education issues. Why are they so important to you?

I think education is key to the integration and operationalization of the One Health approach. I mentioned earlier the importance of setting up mechanisms for collaboration between sectors and I think it is essential that the academic community offer spaces for reflection, collaboration and interdisciplinary research. This is what we are trying to do at the University of Geneva with our Master’s degree in Global Health, as well as with other programs and courses in tropical and humanitarian medicine at the Faculty of Medicine.

One Health, Planetary Health or Eco Health approaches must be integrated into human medicine studies. It is through these teachings and the appropriation of these approaches by future health care workers that we will be able to train the more integrated, committed and conscious generation that I hope for. Moreover, we are currently working on the development of a complete program at the Faculty of Medicine of the University of Geneva, which would integrate “One Health” teachings from the first years of medicine.

Chronic food insecurity, malnutrition, recurrent epidemics (cholera, typhoid, polio, etc.), cyclical floods and massive influxes of people linked to the growing instability of neighboring countries: Nigeriens are being severely tested. ©Solidarités International, June 2020

You have implemented and tested innovative education solutions in a variety of contexts from the University of Geneva to the Kakuma refugee camp in Kenya. What have you created with your students?

With my colleagues from the Institute of Global Health, notably Prof. Antoine Flahaut, director of the Institute, and Dr. Isabelle Bolon, we created the MOOC [4] Global Health at the Human-Animal-Ecosystem Interface which involves more than 30 experts from some 20 institutions based in Geneva and elsewhere, including many colleagues from the Institut Pasteur.

This course is followed in parallel by three groups of students: those from the University of Geneva, others living in the Kakuma refugee camp and a group of students from the University of Nairobi in Kenya. The teaching combines classes and project creation. It aims to bring out the public health problems in the Kakuma camp by the students living there, as well as the practical solutions to address them.

The students are then asked to create projects, implemented with the help of InZone[5], adopting a One Health approach to address the issues identified.

This curriculum has multiple benefits. First, the collaboration between students from the University of Geneva, Nairobi and Kakuma camp makes this program viable in the sensitive humanitarian context of the refugee camp. The students help each other and communicate regularly with each other.

It also provides a space for exchange between students from different backgrounds and between multiple sectors – the NGOs and international organizations that organize life in Kakuma, the academic community and the health sector. This mix is of interest to individuals, but also provides professional opportunities for students in Kakuma, Geneva and Nairobi.

Example of collaboration between students from the University of Geneva and Kakuma. Excerpt from the article by Isabelle Bolon et al, 2020.

Finally, this program is a model for teaching a One Health approach in refugee camps and, given its success, would benefit from replication in areas other than public health [6].

You are involved in the One Sustainable Health Forum, carried by Benoît Miribel and the Fondation Une Santé Durable pour Tous. This initiative aims to make the One Health approach operational. What do you expect from this approach?

I congratulate this approach. The international working groups that have been set up will draft recommendations to better integrate One Health into research and operational projects in the field. They will also make recommendations on ethics, advocacy and education. This will be a key input in the process of operationalizing One Health.

In my opinion, the interest of such an approach will be to show the added value of collaborations between disciplines and sectors and to highlight the most effective ones according to the targeted problems. It will be necessary to highlight the positive impacts of these collaborations – financial impact thanks to the pooling of resources between human and animal medicine, or representing a saving of time thanks to an integrated surveillance system for zoonoses, for example.

 

Interviewed and transcribed by Madeleine Trentesaux

 

Dr. Rafael Ruiz de Castañeda

Dr. Rafael Ruiz de Castañeda leads the One Health Unit at the Faculty of Medicine of the University of Geneva, where he works as a senior lecturer and researcher. He has a broad interest in public and global health issues at the interface of human, animal and environmental health, ranging from ongoing projects on emerging zoonoses, pandemics and the role of One Health in Health Diplomacy, One Health approach to snakebite envenoming in endemic countries, innovative approaches to One Health education and capacity building in humanitarian settings etc. Rafael also serves as a consultant for the World Health Organisation and currently supports the implementation of several projects around Neglected Tropical Diseases.

Madeleine Trentesaux

Interested in humanitarian and public health issues, Madeleine Trentesaux is currently doing a master’s degree in Health Anthropology at the University of Aix-Marseille. Previously, she completed a bachelor’s degree in anthropology at the University of Paris Nanterre and a master’s degree in “Human Rights and Humanitarian Action” at Sciences Po Paris. She has completed numerous internships, notably at Fondation Mérieux and the Fondation Une Santé Durable pour Tous. She also participated in international solidarity and development projects in France, Armenia and India. As an intern for Défis Humanitaires in 2020, she wrote an article on anthropology and humanitarian.

Madeleine Trentesaux on LinkedIn : https://www.linkedin.com/in/madeleine-trentesaux-1257a8185/

[1] L’organisation des ministères varie selon les pays, mais nous retrouvons globalement une structure cloisonnée entre secteurs.

[2] Voir, par exemple, Zinsstag, J., 2017, “Vaccination of dogs in an African city interrupts rabies transmission and reduces human exposure”, Science Translational Medicine, 9(421), https://www.science.org/doi/10.1126/scitranslmed.aaf6984

[3] Babo Martins, Sara, et al., 2019 “Snakebite and its impact in rural communities: the need for a One Health approach”, PLOS Neglected Tropical Disease, Vol. 13, Issue 9, accessible sur : https://archive-ouverte.unige.ch/unige:123745.

[4] Massive Open Online Course

[5] “InZone est un programme de l’Université de Genève qui met en place des approches innovantes en matière d’enseignement supérieur dans les communautés touchées par les conflits et les crises humanitaires. L’objectif ultime est d’autonomiser les personnes en mouvement bloquées dans les pays de transit.” – https://www.unige.ch/inzone/

[6] Pour plus d’information sur le déroulé de ce programme : Bolon et al., 2020, « One Health education in Kakuma refugee camp (Kenya): From a MOOC to projects on real world challenges”, One Health, 10, https://www.sciencedirect.com/science/article/pii/S2352771420302597?via%3Dihub

 

 

Bringing humanitarianism to life… A challenge that is taken up again and again…

The function creates the organ… and the humanitarian only exists through its function… action. But like athletes, humanitarians “think” in real time about their action. And we need an organ to think better… in order to act better. So a site like Défis Humanitaires had to be created. Thanks to Alain Boinet, its founder and also founder of the humanitarian NGO SOLIDARITES INTERNATIONAL, it was done in February 2018.

In an April 2018 video, Alain Boinet outlines its objectives. Because humanitarianism is facing immense challenges (increasing refugees, complex and lasting crises, climate change, biodiversity collapse, demographic explosion), it is a matter of “Being lucid to be able to act”, to develop “A greater intelligence of challenges, actors, contexts, capacities and actions”. Three reasons for being at DH: to make humanitarian work known and recognized, to identify the major challenges, and to place these challenges in a humanitarian and geopolitical context. A few months later, Alain Boinet summed up the site’s ambition: “to bring humanitarianism to life”. To do this, each issue of the DH “newsletter” is sent to several thousand “decision-makers” among NGOs, journalists, French, European and international institutions, researchers and academics, water actors and friends.

American soldiers joined by the Afghan National Army during Operation Shir Pasha in the Spira Mountains (21.11.2008) ©DAVID FURST / AFP

Has the challenge of bringing humanitarianism to life been met, almost four years later? Before risking a diagnosis, let’s try an X-ray of the site, as if it were a person… If we look at the Humanitarian Challenges entry themes (excluding archives) as they are listed on the home page (knowing that many articles are linked to several entry themes), what do we find?

  • 80 entries on the theme “Tribunes and interviews”.
  • 70 entries on the theme “Humanitarian crises”, including since 2020 quite a few COVID 19 topics…
  • 69 entries on the theme “NGOs / humanitarian issues”.
  • 58 entries on the theme “Geopolitics”. Access to water as a “geopolitical topic” is quite present, among others…
  • 53 entries on the theme “Reflections”.
  • 41 editorials, very often anchored in a geographical reality (Sahel, Syria, Afghanistan, Armenia-Artsakh…), always focused on a concrete issue.
  • 36 entries on the theme of “Water and Sanitation”, including the annual water barometer published by SOLIDARITES INTERNATIONAL.
  • 29 entries on the theme COVID 19… The impact of the COVID 19 crisis on the editorial orientation of the site is visible, as well as on the orientation of the reflection and the humanitarian action since the beginning of 2020.
  • 22 entries on the “Innovations” theme.
  • 21 entries on the theme “Studies”, including the annual “Global humanitarian assistance report” and in 2019 a remarkable DH study “French humanitarian NGOs abroad”.
  • 20 entries on the theme “Humanitarian meetings”.
  • 13 entries on the theme of “Philanthropy”.

So, how to sum up the “personality” of the DH website? Well, if this site were a person, we would say that this person, lucid and realistic by nature, has a pronounced taste for exchange and the expression of convictions, that he or she follows the evolution of crises with acute attention and questioning, that he or she likes to share or produce studies that nourish reflection, starting from the facts, from reality. This person cultivates a geopolitical tropism, and pursues a long term fight for access to water. She is concerned about not neglecting the means of better action that are innovation and resources and, as the example of the COVID 19 crisis, knows how to adapt her guideline to the irruption of a major and unforeseen event…

 

The emblematic example is the exclusive and unprecedented DH study “French humanitarian NGOs abroad”, which X-rayed and dissected the evolution over 10 years (from 2006 to 2016) of the 11 main French NGOs, with a summary presentation for each one, and whose second edition will be published in early 2022.

It seems that DH’s “personality” speaks to subscribers. The results of a questionnaire sent in 2018 to the site’s readers indicated “a very marked interest in geopolitics, for innovation with requests on multi-actor strategies, humanitarian crises and the evolution of aid on the side of field operators.”

The diversity of themes and treatments allows specialists on technical subjects such as WASH (Water, Hygiene and Sanitation), humanitarian impact, the “triple nexus”, fundraising or the pooling of resources, to exchange and publish their progress. As such, for these specialists as well as for researchers and students, DH almost assumes the function of a “scientific journal”.

Drilling and hand pump to supply water to the jerry cans of the villagers of Djibo, in Burkina Faso ©Solidarités International

More specifically, water stakeholders can, in DH, develop the why, how, where and when of their commitment to access to this vital resource for all. Upstream and downstream of major meetings on this issue, such as the World Water Forum, whose 9th edition will be held in March 2022 in Dakar, Senegal, preparatory work, data and summaries are disseminated, sometimes in the form of interviews with decision-makers. Actors will also regularly find the latest initiatives, technical progress or the state of research in this field. A good example is the publication, each year, of the water barometer published by SOLIDARITES INTERNATIONAL, unique in its kind.

Elsewhere, journalists or institutions involved in the humanitarian sector can seek or express analyses, positions or issues, both specific and more broadly strategic. Whether they are looking for precise data, the expression of convictions or in-depth analysis of global or specific issues, each issue contains at least one theme/article out of the four published that is of interest to them.

DH’s editorial line is clearly aimed at readers who are already “initiated” in humanitarian or geostrategic issues. It is not a site for the general public, but a place for exchange and deepening of knowledge between people or institutions already “concerned” with these subjects, and above all between humanitarian actors in the broad sense. One wonders if, after reading some of the more specialized articles, a layperson would be able to grasp the richness of the site. Moreover, a regularly updated glossary of international humanitarian terms could be included as an appendix to the site.

Pont aérien du Réseau Logistique Humanitaire pour faire face aux contraintes logistiques de la pandémie de Covid-19. ©Réseau Logistique Humanitaire.

In summary, DH has clearly found a role that no other specialized site has played until now. This positive observation does not mean that there is no need to enrich the proposed content. On a personal level, I would see three axes to be reinforced:

  • Develop a “dialogue” and perspective on crises that have marked the evolution of humanitarianism: what does the Rwanda crisis have to say about the practice of humanitarianism in CAR or South Sudan today, how did the Bosnian page influence the evolution of humanitarianism or its implementation in Syria today? Also Afghanistan and the Sahel (partly covered in DH), Somalia and Yemen, the Tsunami in Southeast Asia and its consequences on the World Humanitarian Summit in Istanbul in May 2016, etc.
  • To publish more testimonies that feed our reflection, like the last editorial that was both “field” and very documented (“Thirsty Northeast Syria”).
  • To regularly make room for the word coming from “the other side of the mirror”, that of the people who are the beneficiaries of humanitarian aid, and who are the only justification for the existence of the global humanitarian system, a raw word, without reformulating it in our technical-professional jargon, in order to provide a counterpoint to the expertise developed in these pages.

Beyond these avenues of optimization (and others), and with regard to the objectives declared at the birth of DH, the challenge of bringing humanitarianism to life is always taken up…

Pierre Brunet, writer and humanitarian :

Born in 1961 in Paris to a French father and a Spanish mother, Pierre Brunet found his first vocation as a freelance journalist. In 1994, he crossed paths with humanitarian aid and volunteered in Rwanda, which had been devastated by genocide. In early 1995, he left on a humanitarian mission in Bosnia-Herzegovina, then torn by civil war. There he took on the responsibilities of program coordinator in Sarajevo, then head of mission.

Upon his return to France at the end of 1996, he joined the headquarters of the French NGO SOLIDARITES INTERNATIONAL, for which he had gone on mission. He will be in charge of communication and fundraising, while returning to the field, as in Afghanistan in 2003, and starting to write… In 2011, while remaining involved in humanitarian work, he commits himself totally to writing, and devotes an essential part of his time to his vocation of writer.

Pierre Brunet is Vice-President of the association SOLIDARITES INTERNATIONAL. He has been in the field in the North-East of Syria, in the “jungle” of Calais in November 2015, and in Greece and Macedonia with migrants in April 2016.

Pierre Brunet’s novels are published by Calmann-Lévy:

  • January 2006: publication of his first novel “Barnum” by Calmann-Lévy, a story born from his humanitarian experience.
  • September 2008 : publication of his second novel ” JAB “, the story of a little Spanish orphan girl who grew up in Morocco and who will become a professional boxer as an adult.
  • March 2014: release of his third novel “Fenicia”, inspired by the life of his mother, a little Spanish orphan during the civil war, refugee in France, later an anarchist activist, seductress, who died in a psychiatric institute at 31 years old.
  • End of August 2017: release of his fourth novel “The Triangle of Uncertainty”, in which the author “returns” again, as in “Barnum” to Rwanda in 1994, to evoke the trauma of a French officer during Operation Turquoise.

In parallel to his work as a writer, Pierre Brunet works as a co-writer of synopses for television series or feature films, in partnership with various production companies. He also collaborates with various magazines by publishing columns or articles, notably on international news.