Global threats to health and health security are growing. Fragile and failed states, armed groups, ungoverned spaces, outbreaks and potential unknown "Disease X" threats, antimicrobial resistance (AMR), hybrid and gray zone conflict all exacerbate complex medical emergencies. These growing threats increase preventable morbidity and mortality of the most vulnerable populations. In an effort to promote best practices, standardize responses, and prevent excess death and disability in these contexts, The Kofi Annan International Peacekeeping Training Centre (KAIPTC), with support from multiple international partners and a volunteer facilitator faculty, administered the pilot course for military and civilian health officers involved in U.N. peacekeeping missions entitled, "Comprehensive Medical Support in Complex Emergencies (CMSCE 19)." This brief review paper provides a description of the process in designing and delivering an interdisciplinary course for providers and decision makers responding to complex emergencies. We conclude with best practices and next steps for course evolution.

1st Faculty of Medicine Institute of Hygiene and Epidemiology Prague Center for Global Health Dhabalia Global Health Intern Charles University Prague Czechia

FRICS Western Health and Social Care Trust Altnagelvin Hospital Londonderr y United BT47 6SB Londonderry UK

German Armed Forces Course Director Kofi Annan International Peacekeeping Training Centre Teshie Ghana

German Institute for Defence and Strategic Studies Research Coordinator Health Security Interface and CMSCE Chief Facilitator Hamburg Germany

Ghana Red Cross Society Ghana Accra Ghana

Health and Military Medicine Conflict and Health Research Group School of Security Studies King's College London K4L 10 Kings Building WC2R 2LS London UK

Institute for Research in International Assistance Akkon University for Human Sciences Berlin Germany

M2 Medical Intelligence Inc Accra Ghana

Military Hospital Accra Ghana Accra Ghana

Prague Center for Global Health Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University Prague Czechia

Security and Global Health Project Belfer Center Harvard Kennedy School of Government Instructor Department of Global Health and Social Change Harvard Medical School Boston USA

United Nations Division of Healthcare Management And Occupational Safety and Health New York USA

See more in PubMed

DeFraites RF, Hickey P, Sharp TW, Beadling CW.  The Health Care Response to Disasters, Complex Emergencies, and Population Displacement. In Hunter’s Tropical Medicine and Emerging Infectious Diseases. 2020 p219-227.

Beehner L. Fragile states and the territory conundrum to countering violent nonstate actors. Democracy Security. 2018;14(2):101–27. doi: 10.1080/17419166.2017.1408009. DOI

Lemay-Hébert N. Governance and political adaptation in fragile states. Cham: Palgrave Macmillan; 2019. From Saving Failed States to Managing Risks: Reinterpreting Fragility Through Resilience; pp. 75–101.

Fazal TM, Poast P. War Is Not over. Foreign Aff. 2019;98:74.

Bellamy AJ, McLoughlin S. Human Protection and the Politics of Armed Intervention: With Responsibility Comes Accountability. Global Responsibility to Protect. 2019;11(3):333–61. doi: 10.1163/1875984X-01103005. DOI

Busser M. Ethics, Obligation, and the Responsibility to Protect: Contesting the Global Power Relations of Accountability. Routledge; 2019.

Lafta RK, Falah N. Violence against health-care workers in a conflict affected city. Medicine Conflict Survival. 2019;35(1):65–79. doi: 10.1080/13623699.2018.1540095. PubMed DOI

Patel P, Gibson-Fall F, Sullivan R, Irwin R. Documenting attacks on health workers and facilities in armed conflicts. Bull World Health Organ. 2017;95(1):79. doi: 10.2471/BLT.15.168328. PubMed DOI PMC

Spiegel PB. “Differences in World Responses to Natural Disasters and Complex Emergencies, JAMA 2005;293, No. 15. PubMed

Salama P, Spiegle lP, Talley L, Waldman R. “Lessons learned from complex emergencies over past decade.” Lancet. 2004; 364: 1801-1813. PubMed

Archer SE. Civilian and military cooperation in complex humanitarian operations. Kansas: Army Combined Arms Center Fort Leavenworth; 2003.

The United Nations High Commissioner for Refugees (UNHCR). (2001) “Coordination in Complex Emergencies,” 01 September 2001 (viewed 11 December 2019 and available at: https://www.unhcr.org/partners/partners/3ba88e7c6/coordination-complex-emergencies.html).

Yuste P, Campbell J, Canyon D, Childers M, Ryan BJ. Synchronized Humanitarian, Military and Commercial Logistics: An Evolving Synergistic Partnership. Safety. 2019;5(4):67. doi: 10.3390/safety5040067. DOI

Grundy J, Biggs BA. The impact of conflict on immunisation coverage in 16 countries. Int J Health Policy Manag. 2019;8(4):211. doi: 10.15171/ijhpm.2018.127. PubMed DOI PMC

Debate V. Measles, war, and health-care reforms in Ukraine. Lancet. 2018;390:347–48. PubMed

Lechat MF. “The epidemiology of health effects of disasters.” Epidemiol Rev.1990; 12:192-198. PubMed

Noji EK. “The Public Health Consequences of Disasters.” New York: Oxford University Press; 1997.

Genser J, Irwin Cotler H. MP. The responsibility to protect. Oxford University Press; 2011.

Bischoff PH, Aning K, Acharya A, editors. Africa in Global International Relations: Emerging approaches to theory and practice. Routledge; 2015.

Khorram-Manesh A, Lönroth H, Rotter P, Wilhelmsson M, Aremyr J, Berner A, Carlström E. Non-medical aspects of civilian–military collaboration in management of major incidents. Eur J Trauma Emergency Surg. 2017;43(5):595–603. doi: 10.1007/s00068-017-0778-6. PubMed DOI PMC

The SPHERE. Project, sphere handbook, https://www.spherestandards.org/ (Viewed: Nov 29, 2019).