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TEN QUESTIONS WITH DR. UNNIKRISHNAN P.V. Interview by Preeti Kaur Rajpal"Put poor people, especially women and children at the centre stage of health and humanitarian response. Three things that can make or break a relief operation are people, people and people." Dr. Unnikrishnan P.V. is a medical doctor who works on humanitarian issues. He currently works with Action AID International, an international Development agency dedicated to fight poverty worldwide. He serves with Action AID International as the Emergencies & Conflicts Advisor for Asia and on the International Emergencies and Conflict Team. He has worked in over 25 countries, with agencies such as ActionAID, Oxfam, and various U.N. organizations.  Landmines leave a long trail of mortality and morbidity - a landmine survivor in Pnom Penh, Cambodia. Photo Credit: Dr. Unnikrishnan P.V., ActionAid International. GP: Tell us about your work in global health and with Action AID International. Dr. Unnikrishnan P.V.: Most of the work has been with ordinary and poor people in crisis situations like natural disasters, conflicts, wars and health emergencies - with people for whom survival is an everyday struggle. I also had the opportunity to work with International development and humanitarian agencies like ActionAid and Oxfam, U.N. organizations and donors - many of such agencies, through their resources and politics, have a big say in defining the future of people in crises. Some of the flashpoints of my work are/were in Asia, Africa and Americas - nearly 25 countries, plus some rebel controlled areas. Health, especially responding to the not-so-visible health issues like psychosocial and physical disabilities that disasters, conflicts, wars and epidemics cause are a key component of my work. Working with the media, using the opportunities that international and local media provide to influence policies is another specific work. Currently I work as the Emergencies and Conflict Advisor for ActionAid International's (AAI) International Emergencies and Conflicts Team. The work involves running humanitarian operations, long-term disaster preparedness, policy and advocacy work and responding to conflicts and wars - mostly their impacts on children and women. This also includes responding to the HIV and AIDS pandemic, especially in conflict-related situations where violence against women and girls is a war weapon. Half my working time is spent in Asia and the other half goes for field deployments in Africa and Americas and policy and advocacy related work with international institutions. For example, I represent AAI in the UN Inter Agency Standing Committee (UN-IASC) Task Force developing the minimum standards for mental health and psychosocial support in emergency settings and as a board member of SPHERE project which is a global initiative of hundreds of NGOs and Red Cross movements worldwide that deals with humanitarian standards. I also work as a volunteer with the People's Health Movement, a grassroots movement spread across the globe and International People's Health University. All of this work is in close interaction with the media - local and international. GP: What is the focus of your work? Dr. Unnikrishnan P.V.: Humanitarian action and health. This involves facilitating (often co-ordinating) humanitarian assistance in crisis zones. The focus is about bridging the relief gaps, livelihood programmes, psychosocial care and support, assistance to people who have developed disabilities due to the disaster etc. Policy and advocacy is part of my work - such as highlighting the impact of climate change and how this leads to more people being affected by floods, devastated by typhoons or hurricanes and the drought spells and subsequent food insecurity. Needless to say, the nexus of violent conflicts and suffering of its victims is a campaign agenda - especially the plight of women and children. The impact of neo-liberal policies, especially when it comes to medicines and health care is another area. 
Women and children carry the bulk of the burden that conflicts and disasters leave. Location: Goma, Democratic Republic of Congo (DRC). Photo Credit: Dr. Unnikrishnan P.V., ActionAid International. GP: Can you tell us about your experience working in recent natural disaster zones? Dr. Unnikrishnan P.V.: In 2006, the tsunami response in five countries (India, Sri Lanka, Maldives, Thailand and Somalia), earthquake (India and Pakistan), typhoons in Vietnam and floods in Thailand and South Asia and the floods in Kenya dominated my natural disaster related work. Some of these situations (like food insecurity in Afghanistan and earthquake in South Asia) has an inter phase with conflicts. The experience in these places reminds me of the key lessons that I have learnt in other such situations as well: 1) Put poor people, especially women and children at the centre of any humanitarian assistance. 2) Ensure dignified and appropriate assistance - this alone can turn a helpless victim into an active survivor. 3) Visible damages like shelters and school buildings needs to be rebuilt. But this should not overshadow invisible, yet pressing survival needs like the psychosocial and mental health support and health care support needed for people who have developed paraplegia and other 'disabilities', say, because of the fractures of the spine and pelvis in an earthquake devastated area. Agencies often overlook these vital components. 4) Invest in disaster preparedness - it is 100 times more cost effective than post - disaster response. 5) Invest in local communities - they are the first and quickest source of support. 6) Follow humanitarian principles, respect International Humanitarian Laws and adhere to humanitarian standards. 7) International donors need to be more considerate to victims of low profile, yet killing disasters. 8) Media interest beyond relief phase is crucial in rebuilding shattered communities. GP: How does working in a natural disaster zone compare to working in other global health contexts? Dr. Unnikrishnan P.V.: Disasters devastate, leaving a long trail of mortality and morbidity. Hospital buildings collapse, case load increases, health workers get hit or busy taking care of their own neighbours and family members-it is like hell let loose. Add to that the stories of human suffering hour after hour you have to listen to-often you wish you were not there. Health is often the first casualty and unfortunately the least priority for most of the relief agencies. With fewer resources and no commitments to rebuild, health care is a Himalayan task in crisis situations. Insecurity is another angle that amplifies the crises. When I was a child, my mother used to tell me stories of angels. However, I meet angels in real life in crises situations - as health and humanitarian workers, far from the glamour of cameras and flashlights. They remind me that all the angels are not in heaven. Their selfless work inspire you to carry on, however traumatizing these missions can be. 
A second-generation agent orange survivor in Vietnam. Photo Credit: Dr. Unnikrishnan P.V., ActionAid International. GP: What are some of your accomplishments in the area of global health? Dr. Unnikrishnan P.V.: Not so easy to capture in a graph or chart. For example, in Sri Lanka, just after tsunami we came across a woman who lost everything. She was devastated, crying all the time and getting traumatised with each passing day. I remember how my team (from ActionAid) started working with her, especially responding to her state of 'helplessness' and psychosocial needs. Today, she is one of our team members (a formal staff) leading psychosocial work in that village, often narrating her own story of survival, to inspire other survivors to break their trauma. I think putting a smile on this survivor's face is a key achievement. This is not a story in isolation. I can recall a few such live examples from other emergencies - like those with multiple fractures of the hip, lower limbs and spine in earthquake hit areas of Gujarat (during my work with Oxfam) and in the Islamic Republic of Iran (during my work with ActionAid) who have been put 'back on their feet'. It is important to remember that putting a smile on traumatized war victim or putting an earthquake victim back on their feet is a team work and done always with the active engagement of the community- difficult for any individual to take sole credit! At a macro level, I continue to champion the cause of health issues in crises situations- especially the issues related to invisible damages like psychosocial and physical disability needs. In most of such crisis situations, I have worked shoulder to shoulder with the media- international, national and local. This helped to build a good network of friends and colleagues in the media world. GP: What are the biggest challenges for you working in global health, especially in the field of natural disasters? Dr. Unnikrishnan P.V.: The frequency, ferocity and the spread of the disasters are increasing - like typhoons, hurricanes, floods and drought. This makes the demand on us ever increasing. Add to this the shrinking humanitarian space and deteriorating security situation and targeting of health and humanitarian workers in war and conflict zones. Well, the political insensitivity of governments not investing enough in disaster preparedness and conflict reduction work and not placing poor people and women at the centre of the health and humanitarian response are other key obstacles and challenges. GP: What led you to get involved with global health? Dr. Unnikrishnan P.V.: Listening to stories of suffering made me to realize the need. Listening to stories to how you can change the course of life through health and humanitarian work convinced me that we can make a difference. I see positive results of the work I do on a daily basis. Let it be a make shift school where hundreds of earthquake hit and traumatised children are taking refuge where we are organizing play sessions to bring the smile back on their face or let it be running a relief camp where a relief programme for pregnant women is currently underway-results are measurable on a daily basis in such situation. However limited these results are, it makes humanitarian workers like me to go on... GP: What were some of the steps you took to become professionally active in global health and the field of natural disasters? Dr. Unnikrishnan P.V.: The key step is listening to people and listening to others who have made a positive change in their lives - difficult to find these in text books! Yes, you can get technical knowledge and information from books and other sources, but ordinary people can teach you lot. I undertook several training programmes and remain a student. Some of the training programmes include (apart from a formal degree in medicine) a Masters in Humanitarian Action (at the Central Medical University in Geneva), International Diploma in Humanitarian Assistance, Working with Conflicts (Selly Oak Colleges, UK), etc. Well, these are the places I have studied in, but I learnt a lot from disaster and conflict survivors, fellow health and humanitarian workers. Sensitivity is key to work in such situations - one has to develop a humane sensitivity to care for others and empathize and a political sensitivity to empower them. Commitment is necessary - commitment to the given set of people and communities and need not necessarily to the rulers and those who govern a geographical territory. Respect for humanitarian principles like neutrality and impartiality (based on religion, geographical territories and ethnicity of survivors) needs be seen as a responsibility. 
A care and support center for women in Goma, DRC. Every day, the horror of the conflict is evident from the writing on the board. Location: Goma, DRC. Photo Credit: Dr. Unnikrishnan P.V., ActionAid International. GP: What advice would you give to health professional students looking to get involved in global health issues? Dr. Unnikrishnan P.V.: Listen to people and be on the ground- as close as to the communities- ivory towers can rust you. Be a good team member and develop the attitude to 'agree to disagree' in the peak of a heated argument. Remember, there are many ways to look at any given situation! Above all, don't compromise principles and safety - no mission is worth it. Never ignore the power of media. GP: In what direction would you like to see the field of global health and natural disaster work move in the future? Dr. Unnikrishnan P.V.: A world where more health workers and doctors are directly engaged with community work in crises zones, especially in low profile disasters and conflicts. Governments making better commitments and ensuring such commitments are translated into action- in simple terms, more budgetary allocation for health and humanitarian work, for disaster risk reduction and conflict response work. This would be possible only by cutting defense expenditure and reprioritization of resources. Above all a world willing to give health and peace a chance! Many thanks to Dr. Unnikrishnan P.V. for sharing his work with us. To learn more about Action AID International, check out www.actionaid.org. |
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