The document discusses antibiotic resistance as a global health crisis. It describes how antibiotic resistance threatens modern medicine by undermining treatments for infections and surgeries. Global leaders are gathering at the UN General Assembly in September to commit to tackling antimicrobial resistance, which already kills hundreds of thousands each year and could kill 10 million annually by 2050 without action. The article explains the scope and severity of the crisis, noting that antibiotic resistance has the potential to dwarf deaths from other disasters if not addressed.

1. ANTIBIOTIC RESISTANCE
CONFRONTING THE GLOBAL CRISIS
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2. 22 3Resources, links, pictures, videos and much more are available for subscribers in our digital and online editions www.crisis-response.com join the CRJ LinkedIn group follow us on twitter @editorialcrj Crisis Response Journal 12:1 | September 20162 3join the CRJ LinkedIn group follow us on twitter @editorialcrj
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September 2016 | vol:12 | issue:1 CRISISRESPONSE
contents Cover story: Antimicrobial resistance
Cover illustration: Алексей Нуждин | 123rf
News����������������������������������������������������������������4
Comment
Brexit: A European opportunity?����������������������8
Prince Michael of Liechtenstein introduces our section
devoted to the UK’s vote to leave the European Union
Views from CRJ���������������������������������������������12
CRJ’s Editorial Advisory Panel thoughts on the effects
of Brexit upon security, resilience and civil protection
Brexercise and testing: Blue skies ahead?����14
The UK is a leading player in EU safety exercises and
there is no reason this should change, says Brian Dillon
Features Analysis
Spring flooding in France�������������������������������16
Four people died and 24 were injured in flooding earlier
this year, write Christophe Libeau and Pierre Joubert
Medical care for all victims of war����������������20
Serena Leone introduces Emergency, an Italian-
founded, international NGO that builds hospitals and
provides healthcare in countries savaged by conflict
Fighting the nanoparticle war �����������������������22
Nanotechnology is of immense value in a wide
variety of applications, but nanoparticles can also
be toxic for humans, especially first responders.
Our authors explain how early detection can protect
people working in hazardous environments
Antimicrobial resistance��������������������������������26
This September, global leaders gather at the UN
General Assembly to commit to fighting antimicrobial
resistance. Why is the issue so important? Marc
Mendelson and Ramanan Laxminarayan explain
Terrorism, Security, Conflict
UK counter-terrorism strategy�����������������������52
Roger Gomm says terrorists continue to target
crowded places that are less protected
Crime or terrorism: What’s in a name?���������54
It is important to avoid rushing to blame ‘terrorism’ for all
and any violent acts in society, contends Christine Jessup
Civil protection in the hyper-terrorism age����56
Alex Townsend-Drake concludes that civil protection as an
end can only be achieved through careful political change
Unlocking sustainable conflict resolution������58
Casey Brunelle argues that strategic foresight is
the pathway to sustainable conflict resolution
NATO stability policing�����������������������������������62
Vittorio Stingo describes NATO’s stability policing to
tackle the challenges of failing or collapsed nation states
Countering the insider threat�������������������������64
Andrew Brown reports on de-escalation and negotiation
techniques used when training police in Afghanistan
Working in hostile environments��������������������68
Advice on how to protect yourself in hostile or
fragile environments from Rob McAlister
Public safety
Preparing the public for terrorism�����������������72
Susan Anson and Hayley Watson describe a project on the
complexities of preparing the public for terrorist attacks
Social media: A two-way street���������������������74
Rob Shimmin explores how companies and emergency
services might improve their use of social media in a crisis
An ear to the ground or head in the sand? ����76
Jan M Gutteling and Peter W de Vries describe how
new insights into how the public responds to a crisis –
whether they seek or avoid risk-related information in
emergencies – will help shape better risk communication
Technology
Emergency incident management������������������79
CRJ talks to Joel Portice of Intermedix
RD: Robots that assemble themselves��������80
Our authors report on tiny, intricate origami
robots, which have the potential to revolutionise
response to all manner of emergency situations
RD: The potential of apps to save lives�������82
Millions of people’s lives have been changed thanks to
the ingenuity of Apple’s HealthKit and ResearchKit. There
is no telling how many lives will be saved in the future
In-depth
Hashtag hazards��������������������������������������������85
21st century incident command systems�������86
Addressing terrorist mindsets������������������������88
Prevention or liability?�����������������������������������90
Firefighting in tunnels 92
Regulars
Books ������������������������������������������������������������93
Events������������������������������������������������������������94
Looking Back��������������������������������������������������97
Frontline���������������������������������������������������������98
Emily Hough speaks to Shandra Woworuntu, who
was trafficked and ensnared in sexual slavery, about
her work to raise awareness of the gaps in identifying
and dealing with this crime, as well as the lack of
assistance currently provided to its survivors
The global reaches of antibiotic resistance���30
Saskia Popescu asks: how would first responders feel
about carrying out their roles? How would any person
feel about something as simple as shaking hands?
Agriculture as a terrorist target���������������������32
Agriculture and environmental systems are
vulnerable to attack, says Christoph Schroth
The ICDO and Swiss co-operation������������������36
The ICDO and Switzerland have a long history
of co-operation to improve civil protection
Urban resilience: People, not technocrats�����38
We cannot make our cities more resilient if we consider
this to be a technocratic issue, says Laura Kavanaugh
Mass evacuation mission������������������������������40
Jörg Szarzynski and Albrecht Beck report from a combined
IOM and UNDAC preparedness mission in Vanuatu
Victim identification���������������������������������������41
Jay Levinson and Abraham Domb provide insight into the
complexities of identifying victims after an earthquake
Working together for safety in the Antarctic��42
The remoteness of the Antarctic makes Search and
Rescue a difficult proposition, says Martin Boyle
Crisis management
Struggling with ‘dark dynamics’ ��������������������46
Today’s crisis management is not designed for unmapped
and poorly understood challenges, writes Patrick Lagadec
CM: From war room to boardroom�����������������48
Tony Jaques says every executive and director
should be concerned about preventing crises
A
s usual, this
edition spans
emergency and
disaster analysis,
prevention, protection,
preparedness, response
and resilience.
Admittedly, it is equally
morbidly fascinating and
disturbing to see how crises intersect, conflating
and exacerbating one another, spawning greater
emergencies that appear simply beyond the
scope of prevention or mitigation, sometimes
leaving agencies seemingly powerless to
respond effectively to their sheer scale and
complexity. But how bad is the global situation?
After all, it is not beyond experts’ capabilities
to predict, identify and categorise tomorrow’s
most devastating disasters. Terrorism, natural
catastrophes, conflict: This edition addresses
and provides insight into all of the above.
At this time, we don’t have definitive statistics
for 2016. But, despite the widely-held perception
that terrorist attacks are increasing, the US State
Department’s annual terrorism report notes a
13 per cent decrease in attacks in 2015, with 14
per cent fewer deaths. This year’s figures might
be higher (page 52), and modus operandi may
be shifting, but the line between criminality and
terrorism has become blurred, and we must be
wary of classifying all violent criminal acts as
terrorism, as Christine Jessup warns (page 54).
Again, we know that natural disasters are on
the rise. But Munich Re says last year saw a
fall in losses from such catastrophes in terms
of incidents, fatalities and in financial losses.
Granted, these figures are in no way cause for
complacency; we are certain to face larger and
more complex emergencies in the future. But
there is an even greater lurking disaster, which
CRJ has touched upon in past editions (Prof
Steiner, CRJ 10:1); one that we can no longer
afford to ignore. Deaths in a world without
antibiotics could dwarf all other catastrophes,
killing up to ten million people a year (page 26).
How sobering it is to reflect that, despite
all our technological advances, prevention,
co-operation and hard work in crises and
disasters, an absence of antibiotics would not
only claim more lives than climate, conflict
and terrorism combined, but augment their
effects immeasurably. Let’s hope that the high
level UN meeting on this subject in September
produces the unequivocal commitment that this
smouldering global health emergency demands.
Emily Hough
Nanotoxicity risk p22Flooding in France p16
Pierre Joubert US Navy | Photographer’s Mate 2nd Class Jim Watson Jessica Fitzpatrick 2 Scots | Andrew Brown
Safety co-operation in Antarctica p42 De-escalation negotiation p64
comment
3

3. 65 Crisis Response Journal 12:1 | September 2016
H
istorically, in conflict, insurgents have used infiltration,
impersonation, coercion and intimidation as key tactics
and this ‘Insider Threat’ is equally prevalent in Afghanistan.
This consists of insurgent infiltration and green-on-blue attacks
– when a member of the Afghan National Security Forces (ANSF)
directly and deliberately targets a member of International Security
Assistance Forces (ISAF). The threat can never be completely
removed, but it can be minimised as much as possible.
This risk can be exacerbated with ANSF members who have
allegiance to the insurgents, or are motivated by personal grievance
and animosity related to combat stress, a cultural gulf and the
behaviour and conduct of ISAF personnel in their environment.
The Long War Journal‘s data covers green-on-blue attacks in
Afghanistan from January 1, 2008 up to the present and, as of May 7,
2015 there have been a total of 92 attacks reported. The total number
of Coalition deaths from green-on-blue attacks for this period is
1,508, with the total number of Coalition wounded standing at 187.
In 2013 NATO identified green-on-blue attacks as the number
one strategic risk in Afghanistan and training to mitigate the
threat was the priority for members of the ISAF. The rise in
green-on-blue incidents reflects the decision of several coalition
partners, most notably of France under its new President
Francois Hollande, and of New Zealand, to withdraw their
combat troops before the previously declared deadlines.
Prior to deployment to Afghanistan, the 2nd Battalion of the
Royal Regiment of Scotland (2 Scots) a light infantry unit was
warned that its members would facilitate the police mentoring
Battlegroup for the Op Herrick 18 tour. The unit would provide
Afghan indigenous police (all tribes) mentors operating outside
secure locations with a number of training and mentoring
roles, in preparation for transition to Afghan run operations.
With knowledge that the unit required training in de-
escalation and negotiation skills it requested assistance from
the author through his role at the Scottish Police College.
In designing the training, the team piloted the programme with
commanding officers, as this helped to develop relevant and
realistic exercises, ensuring the training was fit for purpose and was
pitched at the correct level to engage the various groups. Following
this, the programme was adjusted to include the Afghan role-play
scenarios and thereafter delivered to approximately 120 troops.
Delivery of the training identified three distinct groups of
individuals within the Battalion: Naturally skilled communicators
who quickly grasped the concept; those who ‘learned’ the skill
and would be able to apply it with practise; and those who
struggled from the outset to develop existing communication
skills, apparently as a result of poor vocabulary and intellect.
Police
mentoring:
De-escalation
negotiation
Andrew B Brown, who
helped to train 2 Scots, a light
infantry unit tasked with police
mentoring in Afghanistan,
describes de-escalation and
negotiation techniques
security
An Afghan Uniformed Police Officer smiling with
pride while on parade. On occasions, however, combat
stress linked to personal grievances or animosity, the
cultural gulf and the behaviour of ISAF troops can allow
conditions in which insurgent infiltration can occur
Corporal Si Longworth RLC | Crown Copyright

4. Both factions became violent
and uncontrollable. When
knives were drawn, ISAF
mentors were withdrawn
66 67Resources, links, pictures, videos and much more are available for subscribers in our digital and online editions www.crisis-response.com join the CRJ LinkedIn group follow us on twitter @editorialcrj Crisis Response Journal 12:1 | September 2016
Taking cognisance of traditional and proven military
training methods, the training was delivered in the following
format: Theory input; instructor demonstration; live role-
play exercise in English; and live role-play exercise in
Pashtun with Afghan role-players and interpreters.
Troops were supplied with aide memoire cards to remind them of
active listening skills and the ‘Behavioural Change Staircase,’ but
more importantly, were encouraged to undertake scenario-based
exercises that allowed them to think and practice de-escalation
and negotiation techniques that reflected local incidents.
The Lashkar Gah Training Centre (LTC) is situated approximately
six kilometres north-west of the Helmand Province’s capital
Lashkar Gah and is the centre of excellence for all Helmandi-based
police training across all tribes. On a daily basis, the training
centre facilitates approximately 2,500 recruits (the majority
are of Pashtun origin with minority Dari speakers) undergoing
various stages of basic and advanced training. The Afghan staff
comprises almost 15 professional Afghan police (high ranking and
experienced officers) and 150 Ministry of Interior (MOI) police
instructors – who are not technically policemen, but teachers
with little or no police experience. To complicate matters, the
majority of the MOI instructors are from Kabul and speak Dari.
The international contingent comprised of approximately 180
UK, US and Danish military and police instructors. The team
lives in the same camp as the Afghans but has an effective Force
Protection (FP) divide during silent hours. Normal working routine
necessitates two mentors and an interpreter to teach/mentor an
Afghan group size ranging from 50 – 120 persons, geographically
separated across a large training environment. Generally the
students are not armed, but some of the MOI and Afghan police
are. During weapons and range training all the students are armed.
The Afghans have a security detail of 75 persons that provides
inherent FP to the students and staff – its members are armed and
provide 24/7 security cover. A number of other separate police
contingencies operate from the main site – although there is no
command relationship between these disparate groupings.
Case studies
Generally the mentoring and day-to-day activities went very well
with little disruption to the mission. However, during the deployment
periods, there was a number of instances when FP had to be raised
and negotiation or de-escalation training put into practice.
The pre-deployment training received by all members of the
LTC proved to be invaluable to the Afghan police mentoring teams.
Having the knowledge and ability to practise the skills sets through
well managed role-playing and incident scenarios prepared the
team. The invariable exposure to difficult situations without this
basic but fundamental training could have resulted in a more kinetic
and deadlier response. The functionality of effective negotiation and
de-escalation drills set the conditions for an effective mission and
has been recommended to 2 Scots successors as best practice.
The following case studies reflect incidents and reactions
within the Lashkar Gah Training Centre (LTC) only.
■■ Case study 1 – Effective Negotiations: The new training
initiative saw the development of Afghan local police (a type of
reservist policeman providing security to villages) training at the LTC.
The first few courses went well with no concerns. Problems occurred
when a course was held with two village groups training concurrently
at the centre. After the first few days a commotion was reported by
one of the US Special Forces team that worked within the LTC.
It was alleged that members of one group had sexually abused
members of another. To complicate matters it transpired that some
of the students involved were not of the minimum age to join the
police (16 years old). The US instructors’ response was dynamic
and decisive, but escalated matters very quickly. Both factions
were separated but, when referred to the Afghan Command, no
action was taken as it was not deemed a credible complaint.
Within an hour, both factions became violent and uncontrollable.
When knives were drawn, the ISAF mentors were withdrawn
from the area. This then necessitated a series of emergency
shuras (meetings), which were hostile and heated.
In the first meeting the Afghan Commander, who should
have been leading, drew his weapon and threatened to shoot
one of the protagonists – not the best approach. This set
tempers flying again and required immediate de-escalation
without letting the Afghan Commander lose face – a critical
part of Afghan negotiations. At this stage I employed a number
of the young officers to mediate the separate groups and
try to develop a working relationship to resolve crisis.
The US mentors were fully focused on arresting the alleged
perpetrators and seeing their version of Western justice applied to the
alleged offenders (three in total). This outlook complicated matters
further. Under direct command, they were stood down and agreement
secured that the Scots would resolve the situation, with the Afghan
Commander directed to take a proactive, impartial and calm lead.
The main issues were identified from both perspectives and
it transpired that the alleged sexual abuse was not the centre
of concerns – the arguments were more related to money and
attendance of young candidates; in other words, the issues
revolved around economic impact and loss of respect in both
villages. The fraternisation with boys – a normal activity on
Thursdays before Juma (prayer day) – is a cultural norm that was
only a small component piece to the problem; the US response
and misunderstanding of the cultural aspects created the
friction and potential loss of face that generated the violence.
The Lashkar Gah police Imam (religious lead) and the heads of the
Helmandi villages were summoned to the LTC the next day to attend
a shura focused upon peaceful resolution. This was achieved after an
hour’s calm and deliberate discussions between the local leaders.
The agreed result was that the alleged offenders were removed
from the training programme (under full pay). The candidates that
were under 16 years of age (hard to determine) were also returned
to their villages (under full pay). Village leaders agreed that justice
had been seen to be done fairly, although the US team leader
was not happy that criminal action had not been enforced – this
was deemed to be ‘village business’ and would be sorted under
Sharia law if charges were to be brought by the youths’ parents.
■■ Case study 2 – Know what to do: The Afghan officers
who carry sidearms are all senior and very experienced police
officers; many have fought the Mujahideen during the Russian
era. The carriage of weapons is a status symbol and is regularly
used as such to emphasise position, dedication or anger.
During a meeting of international police advisors, an Afghan trainer
was caught up in an argument with a competing training officer from
a different tribe. As the debate continued, tempers became heated
and the international observers started to feel uneasy. The observers
were escorted by guardian angels from 2 Scots who, at this point,
had been on tour for almost four months and knew the personalities
well. They were well briefed on the situation, knew the general
context of the arguments and character of the main protagonist.
After almost 30 minutes, one of the two competing officers
increased the tempo and volume of the argument, at which point
the other stood up and drew his pistol. The international observers
panicked and sought cover – during this time one of the guardian
angels had already made his way to the police officer with the pistol
and had calmly taken the weapon from his grasp and sat him down.
The ISAF officer escorting the observers composedly stopped
proceedings, directed the other guardian angels to separate the
two arguing officers and began to reassure the internationals
that all was well and nothing untoward had occurred.
Once this had been completed, the ISAF officer went to get
the assistance of the Afghan training commander (second in
command) who, once he was made aware of what had happened,
immediately dealt with the two offending officers and joined
the meeting; this ensured that both officers apologised and
continued with what was a productive meeting and outcome.
During a follow-up (near miss) reflection, it was determined
that either of the guardian angels could have legitimately engaged
the Afghan with the pistol given the circumstance. However, the
Scots protection knew the individuals, had worked alongside them
before and experienced similar outbursts – although not to this
degree. They knew exactly what to do and how to de-escalate. In
scenarios practised during the pre-training, it was identified that
individuals facing such incidents could quickly and effectively
disarm and defuse the situation by taking the weapon from the
individual without developing a more dangerous stand-off.
Additionally, the guardian angels all knew that the weapons were
not loaded – we did not allow the Afghans ammunition in camp.
Turning to lessons learnt, it is a balance between thinking
tactically while communicating calmly and openly to reduce
tensions in an otherwise hostile environment. Approximately 65
per cent of communication consists of non-verbal behaviours. Of
the remaining 35 per cent, inflection, pitch, and loudness account
for more than 25 per cent. However, less than seven per cent of
communication has to do with what is actually said. The following
factors were identified by the LTC staff during the mission de-brief.
Be self-assured: appear calm, focused and confident in your
surroundings. Your anxiety can make the client/audience feel
anxious and unsafe which can escalate aggression. Maintain
limited eye contact; loss of eye contact may be interpreted as
an expression of fear, lack of interest or regard, or rejection.
Excessive eye contact may be interpreted as a threat or challenge.
Keep a relaxed and alert posture. Stand up straight with
feet about shoulder width apart and weight evenly balanced
non-aggressive stance. Maintain a neutral facial expression.
A calm, attentive expression reduces hostility.
Minimise body movements such as excessive gesturing,
pacing, fidgeting or weight shifting. These are all indications of
anxiety and will tend to increase agitation; Position yourself for
safety. Angle your body and do not turn your back in relation to
the group, maintain a safe distance and place your hands in front
of your body in a non-threatening open and relaxed position.
Position yourself close to the room entrance and behind a
barrier such as a sofa or desk. Do not point or shake your finger.
Always be at the same eye level. Encourage the client to be
seated, but if he/she needs to stand, you should stand up too.
Once non-verbal tactics are in place, verbal de-escalation
can be a logical next step. Reasoning with an enraged person is
not possible. The first and only objective in de-escalation is to
reduce the level of arousal, so that discussion becomes possible.
The following are general guidelines for verbal de-escalation:
●● The primary task is to bring down the level of
arousal to a safer place in a calm manner;
●● Use a modulated, low monotonous tone of voice
rather than a high-pitched, tight voice;
●● Do not become loud or try to shout over a screaming person;
●● Do not be defensive, even if comments
or insults are directed at you;
●● Be very respectful even when firmly setting limits
or calling for help. Agitated stakeholders are very
sensitive to feeling shamed and disrespected;
●● Be honest – lying to calm someone down
may lead to future escalation;
●● Explain limits and rules in an authoritative,
firm, but respectful tone;
●● Empathise with feelings, but not with the behaviour;
●● Suggest alternative behaviours where
appropriate – a break, water or coffee;
●● Do not try to argue or convince; and
●● Trust your instincts. If de-escalation is not working, stop! Tell the
person to leave, escort him/her to the door and call for help.
In conclusion, I am indebted to Major Jock McGowan of 2
Scots for his notes taken in the field and for allowing me to
debrief the training when the troops returned to Scotland.
It is testament to the military that it adapts and learns new skills to
deal with what is effectively a complex and challenging threat during
a period of stabilisation and hand over to Afghan control. There is no
doubt that, in the words of Commanding Officer, Lieutenant Colonel
Robin Lindsay, pre-deployment training is: “First rate and equipped
our soldiers not only with a valuable skill set, but also with a way of
thinking, that might well be life saving.”
Author
Chief Inspector
Andrew B Brown is
an internationally
recognised negotiator with
specialist knowledge and
experience in dealing with
hostage/crisis incidents
particularly within a maritime
environment and in designing
conflict de-escalation skills for
military operations. He is a
Member of CRJ’s Editorial
Advisory Panel
security
Sources
■■ The Long War Journal,
Green-on-blue Attacks in
Afghanistan – The Data;
www.longwarjournal.org;
■■ McMains, MJ and
Mullins, WC (2014): Crisis
Negotiations – Managing
Critical Incidents and Hostage
Situations; Law Enforcement
and Corrections, Fifth Edition;
Waltham: Anderson Publishing;
■■ Arenas, DA (2013):
Afghanistan: Green-on-
blue Attacks, Degree in
Master of Military Studies
Thesis; United States Marine
Corps, Quantico, USA.
Proper use of interpreters
is essential to maintain
effective communication
and, importantly, open
body language towards
the person you are talking
to; this reduces tension