HUMANITARIAN ASSISTANCEOCT 30, 2014 MCGILL EXECUTIVE EDUCATION

TODAY

1) -background to humanitarian principles, law -snapshot MSF

connections and contrasts Development and Humanitarianism –how we work together to fight AIDS

2) rapid small group brainstorm based on MSF Case Studies

-feedback one question to group

Break

3) Humanitarianism part 2 – activities & challenges

4) Rapid small group brainstorm 2- Ebola

-Q&A

PART 1

The concept of extending care to strangers is centuries old, has roots in major religions and writings of ancient scholars

The rules of war are perhaps as old as wars themselves, across the world

Early laws of war may not have been principally humanitarian but economic in intent but effect was humanitarian

Hippocratic oath: Medical Ethics

Taken by physicians to protect all life, to hold in highest regard one’s teachers, to recognize one’s limitations, and to renounce self-interest in the treatment of patients.

HIPPOCRATES C460 - 370BC

DURING CONFLICT: MEDICAL IMPARTIALITY 1859

Henri Dunant – founder of Red Cross (ICRC)

• Organized medical services for Austrian and French wounded

• First Geneva Convention (1864) formed ICRC – signatories agreed to impartiality and neutrality

DURING CONFLICT: MEDICAL IMPARTIALITY 1854, CRIMEAN WAR

Historical records suggest preferential treatment of ‘friends’ over ‘enemies’ during conflict

Nurses (F. Nightingale, D. Dix) • the impartiality movement

treating all equally• Roots of medical personnel seen

as neutral not taking part in war

FUNDAMENTAL PRINCIPLES OF THE INTERNATIONAL RED CROSS AND RED CRESCENT MOVEMENT

Humanity

Impartiality Neutrality

Independence Voluntary Service

Unity Universality

First put in writing in 1921. Adopted in 1965 in current format by the International Conference of the Red Cross – which includes States Parties to the Geneva Conventions.

MAIN SOURCES OF IHLHague Law (pertaining chiefly to means of war)

The Petersburg Declaration 1868

Hague Regulations of 1899 and 1907

Gas protocol of 1925

NPT (non-proliferation of nuclear weapons) 1968

Biological weapons 1972

Convention on inhuman weapons (CCW) 1980

Chemical weapons 1993

Anti Personnel Mines 1997

Convention on Cluster Munitions 2008

DURING CONFLICT: MEDICAL IMPARTIALITYFour Geneva Protocols (1864-1949) plus 2 provisions – Humanitarian law

Humane treatment for all persons (not hostile)

Medical workers not punished for providing care to all (Medical Neutrality)

Access to those in need Article 3: impartial humanitarian bodies allowed to offer services (ICRC)

Impartiality of treatment

Attacks on civilians prohibited

MAIN PRINCIPLES OF IHL

HUMANITY

Distinction

Military necessity

Proportionality

PROTECTION OF WOMEN IN HUMANITARIAN LAW 1949

GC IV, Art. 27 Women must be protected against any attack on their honour, in particular against rape, enforced prostitution, or any other form of indecent assault.

AP I, Art. 48 Parties to an armed conflict must take constant care in the conduct of military operations to spare the civilian population, civilians and civilian objects.

AP I, Art. 76 Women must be protected against rape, forced prostitution and any other form of indecent assault…parties to a conflict must endeavour to avoid the pronouncement of the death penalty on pregnant women or mothers having dependent infants for an offence related to the armed conflict..

19 JUNE 2008

SECURITY COUNCIL DEMANDS IMMEDIATE AND COMPLETE HALT TO ACTS OF SEXUAL VIOLENCE AGAINST CIVILIANS IN CONFLICT ZONES, UNANIMOUSLY ADOPTING RESOLUTION 1820 (2008)

DURING CONFLICT: MEDICAL IMPARTIALITY

Humanitarian vs. Human Rights Law

Humanitarian indicates behavior for parties during war in relation to people at mercy of the conflict

Human rights the rights of individuals to treatment by or protection from government abuses

THE ICRC CONSIDERS SILENCE DURING HOLOCAUST “GREATEST FAILURE”

•International Humanitarian Law

• Assistance to civilians in time of conflict

• Distinction between combatants and non-combatants

•Refugee law

•Principle of non-refoulementor freedoms could be threatened

HUMANITARIAN FRAMEWORK

Anti-Slavery Movement (ongoing but started 1700s)

Abolition of Torture 1800s

Factory Act 1833 England – humanize working conditions

Rights of women 1800s

Humanitarian law, International Committee of Red Cross 1863

Nuremberg Tribunals –WWII, Genocide Convention 1948

Criminal tribunals – Former Yugoslavia and Rwanda 1993 &1994

Ottawa Treaty (Landmines) 1997

International Criminal Court – 1998

UN Convention Against Transnational Crime (trafficking) 2003

Convention on Cluster Munitions 2008

GLOBAL COOPERATION FOR HUMANITY & RIGHTS

HUMAN RIGHTS LAW1948 UN Declaration of Human Rights

1966 Covenant on Civil & Pol Rights

1966 Convention on Economic Social & Cultural rights

1965 Convention on the Elimination of all forms racial discrimination

1984 “ on the Elimination of Discrimination against Women

1989 Convention Rights of The Child

2005 Enforced Disappearances

Regional conventions

1950 European Convention on Human Rights

1969 American Convention on Human Rights

1982 African Charter on Human and People’s rights

HUMANITARIAN LAW & HUMAN RIGHTS LAW

IHL HRL

Times of war, int’l armed conflict, non-int’l armed conflicts

All the time

Conduct of hostilities Does not deal with conduct of hostilities

States duty to implement States duty to implement

Categories of persons affected

Derogations in times of emergency

HRL IHL

Right to life

Prohibition of torture & ill treatment

Non discrimination

Respect of judicial guarantees

Protection of the wounded

Protection of civilians

Regulation of means & methods of warfare

Providing humanitarian relief

Economic, social & cultural rights

Right to education, work family life

Civil & political rights

Freedom of association

Of the press

Of conscience

% OF CIVILIAN CASUALTIES OF WAR

WWII

Vietnam

Today

UN Commission on the Status of Women: “international humanitarian law, which prohibits attacks on civilians, is systematically ignored, and human rights are violated in armed conflict, affecting especially women, children, the elderly and the disabled”

CONFLICTS, WAR, DISASTERS, NEGLECT, ABUSE

IMPACT OF CONFLICTS, WAR, DISASTERS, NEGLECT

MDGS AND HUMANITARIAN OVERLAP

LACK ACCESS TO MEDICINES1/3 worlds population Up to 50% parts of Africa & Asia

CLIMATE CHANGE

Year-long Commission The Lancet & University College London Institute for Global Health.

Climate change will have greatest impact on those already poorest in the world: deepen inequities

The Lancet, Volume 373, 16 May 2009

“is the biggest global health threat of the 21st century.”

RESPONDING TODISASTER AND ACTS OF INHUMANITY

MSF Charter:

“Médecins Sans Frontières observes, independence, neutrality and impartiality in the name of universal medical ethics

and the right to humanitarian assistance and demands full and unhindered freedom in the exercise of its functions...”

Medical aid where it is needed most. Independent. Neutral. Impartial

OVERALL PURPOSE OF MSF FOUNDED 1971 

Preserve Life

 

Alleviate Suffering

 

Protect Human Dignity

 

Restore Ability of People to Make Their Own Decisions

“Two inseparable elements are combined in MSF’s work: medical aid and witnessing (temoignage)…- Chantilly 1995

RWANDA 1996

Child vaccinated against measles, DRC. Photo: Gwenn Dubourthoumieu

DEMOCRATIC REPUBLIC OF CONGO (ZAIRE)

MSF in Ajiep, Southern Sudan 1998

SOUTHERN SUDAN (PRE-INDEPENDENCE)

MSF in East Timor in 1998 following mass violence

EAST TIMOR (JUST AFTER REFERENDUM)

PERU

Child living with HIV taking pediatric antiviral medicines – a scientific innovation also created by a local and global demand for equity and access to resources

SOUTH AFRICA 2008 AIDS PANDEMIC

ACCESS TO MEDICINES

WHO ARE THE HUMANITARIANS?

17 billion in funds and an estimated workforce of 274,000 aid workers internationally growing at 4% annually

In 2009, 178 humanitarian aid workers were killed, kidnaped or seriously injured in violent attacks, the highest number on record.

PART 2

WHAT TO DO THEY PROVIDE Water: Why is water a critical issue?

• Promotes public health, reduces patient visits to health clinics.• Reduces social burden on women and children as well as

protection risks.• Livestock, brick building, gardens

Sanitation

Medical including psychosocial

Refugees, IDP health

Food support

Fuel

Shelter

Training/mentoring

Advocacy

IDP HEALTH

The Host Government is responsible, as for refugees. However…

Under the Cluster Approach, the World Health Organization (WHO) facilitates coordination among health actors.

• Ex: Haiti Earthquake (2010)• Ex: Pakistan Floods (2010)

Other Important Clusters:

• UNICEF leads WASH and Nutrition Clusters• WFP leads the Food cluster. • UNEP leads on “Environment” as an issue cutting across all

clusters.

FUEL

Nearly half of the world’s population – about 3 billion people – cooks their food each day on polluting, inefficient stoves

Current Initiatives• Fuel & Firewood Initiative (Women’s

Commission)

Objective: Develop and disseminate guidelines concerning safe access to cooking fuels and to encourage rigorous field testing of alternatives to wood.

• Global Alliance for Clean Cookstoves

Objective: Save lives, improve livelihoods, empower women, and combat climate change by creating a thriving global market for clean, efficient cooking solutions.

Future Opportunities

• Costing/Replicating alternative energy sources

• Improving evidence base for fuel efficient stove uptake/usage

• Expanding partnerships with universities, foundations, private sector.

TRENDS & REALITIESUrbanization

Increasing displacement as a result of conflict and natural disasters.

• People affected by natural disasters increased from 150 million in 1990 to 300 million in 2008

Population growth

Insecurity, lack of access to populations of concern

Gender inequity, gender based violence

Mixed migration flows

Extreme climate events

APPROACHES TO DEVELOPMENT AND HUMANITARIAN ACTION: NGO PROFILES AND SYNTHESIS NOV 2010 Terminology broad, activities quite broad

World Vision - Christian humanitarian organization - working with children & communities in context of poverty & injustice

CARE - leading humanitarian organization fighting global poverty, improve human condition (health), social position (gender & ethnic discrimination), enabling environment (policy, governance).

MSF - impartiality and medical ethics, IHL, independent

Oxfam- Regional focus, multi-country & regional solutions, advocacy

All but MSF think of themselves as development actors but views development through specific lens: children’s wellbeing, women’s empowerment, faith, entrepreneurship, housing

REBELLIOUS HUMANITARIANISM (MSF)

Go where needed,

not where allowed

Bear witness to human rights

violations and blocked relief

“Temoignage”– commitment

to testimony, open advocacy

and denunciation when

working with endangered populations

Violating neutrality – MSF called for military intervention in Bosnia, Rwanda

SOME HUMANITARIAN ACTORS OF MANYInternational

OCHA - Office for the Coordination of Humanitarian Affairs UNHCR - Office of the United Nations High Commissioner for Refugees UNICEF- United Nations Children's Fund UNRWA- United Nations Relief and Works Agency for Palestine Refugees in the Near East UNFPA - United Nations Population Fund ICRC- The International Committee of the Red Cross IFRC - International Federation of Red Cross and Red Crescent Societies IOM - International Organization for Migration WFP - World Food Programme

NGO: IRC, MSF, MDM, Merlin, ACF, CRS, Islamic Relief Services, Care

National humanitarian organizations e.g.

-Red Crescent societies

-many local NGOS and community based organizations

SOME DEVELOPMENT ACTORS OF MANYLocal NGOS & Community organizations

INGOs- Action Aid International- CARE International- Oxfam- Welfare Association, Geneva

Gov. Agencies & other Donors - CIDA- Asian Development Bank- AUSAID- DANIDA

-DFID

- Irish Aid- World Bank - Commission of the European Union

UN Bodies

UNAIDS, Geneva, Switzerland- United Nations Environment Program [UNEP]- UN Industrial Development Organisation

INGOs- Action Aid International- CARE International- Oxfam- Welfare Association, Geneva

International Labour Organisation Research Org. and Networks- Institute of Arable Crops Research- International Institute for Environment and Development [IIED]- Natural Resources International

Private companies & consultancies

SORT OF…

Source: Humanitarian Coalition

HUMANITARIAN & DEVELOPMENT AID A CONTINUUM

Humanitarian aid designed to save lives, alleviate suffering maintain and protect human dignity

Development aid responds to ongoing structural issues that may hinder economic, institutional and social development

Source: Humanitarian Coalition

LIMITS OR PERCEPTIONS OF DEVELOPMENT LIMITSDevelopment can have political motivations

Entrenches relationship of dependence on poor countries to West

Neo-liberal critique

Dambisa Moyo denounces relationship of dependence of recipients on donors

Ineffective technical cooperation

ODA high % in servicing foreign debt repayments

Excessive transaction costs

Needs more funding and more funding for climate events

“David Rieff had been humanitarianism’s obituarist, first in his Newsweek article The Death of Humanitarianism

(1999) and then in his book A Bed for the Night: Humanitarianism in Crisis, 2002.”

•inadequate, selective and inequitable application of humanitarian budgets across the vast spectrum of human need; •humanitarian co-option into war aims posed by belligerent funding and military encroachment into humanitarian activity which is seen as causing a dangerous blurring of belligerent and humanitarian interests and action

However this has always been the case says Hugo Slim.

Not end of humanitarianism“The long cherished dream of humanitarian coordination might best be set aside for the more effective (and more achievable) vision of strategic variation.”

CHALLENGES

TO SPEAK OR BE SILENT – CHALLENGES OF IMPARTIALITY

Biafra, southern Nigeria 1971

MSF formed by doctors and journalists who could not keep ICRC oath of silence.

NICARAGUA 1972

MSF first medical mission was to Managua, 10,000-30,000 people lost their lives.

MSF

1975 Cambodian refugees in Thailand

1976 War in Lebanon, first major intervention in war

1990s War former Yugoslavia

1994 Genocide in Rwanda, 800000 Tutsis & moderate Hutus died

2000 HIV/AIDS Pandemic, ARV therapy, advocacy

2003 US invades Iraq, MSF remains in Bagdad and criticizes American government failure to provide medical assistance to civilians.

2004 Tsunami South East Asia

2010 Haiti Earthquake

AIMS & LIMITS OF HUMANITARIANISM

“You can’t stop genocide with doctors.”

MSF called for an armed intervention in Rwanda, 17 June 1994

MSF relies on private donations to carry out its work

• More than 80% of all funds raised come from individual donors

• MSF is able to act quickly in emergencies and deliver aid to people based on need, irrespective of political, economic or religious interests

PRIVATE DO-NATIONS

OTHER

Every year, MSF sends thousands of professionals (doctors, nurses, logistical experts, engineers etc.) to respond to emergencies around the world

BUT over 90% of MSF staff are locally hired

• This ensures continuity in MSF programs• Provides training and jobs to local people• Teams share local knowledge and international

“REBELLIOUS HUMANITARIANISM”

The Nobel committee cited MSF’s commitment to “independent medical humanitarian action” and to “speaking out, which helps to form bodies of public opinion opposed to violations and abuses of power.”

MSF recognizes that there is no clear temporal distinction between humanitarian and development interventions: the organization has been in countries experiencing protracted crises for decades (e.g. Afghanistan).

As nations stabilize and develop their own health infrastructure, however, MSF gradually scales back or discontinues operations.

MSF ‘EMERGENCY’ CONTRADICTION

Sudan (present since 1979), Democratic Republic of Congo (since 1987), Myanmar/Burma (since 1992) and Somalia (since 1991)

ACCOUNTABILITY-continuously reflect on the impact of our humanitarian action

-keep the people who support us informed

-transparent and specific about costs and benefits of our operations.

-publish lengthy reports about our work e.g.Haiti six months after the devastating January 2010 earthquake and again six months later, after the nation was further stricken by a cholera outbreak.

-end of 2011, we similarly documented our work in the Horn of Africa—in Somalia, Ethiopia, and Kenya—during the malnutrition crisis that contributed to the death of tens of thousands of Somalis and the displacement of hundreds of thousands more.

-ground our decisions in our medical and humanitarian ethics, that experienced MSF teams conduct independent assessments of the needs on the ground before we open a project.

…MSF is respected, not always loved. It has a tendency to arrogance, self-righteouness and sometimes ignores or fails to understand the broad context.

Its fractious nature can lead to the establishment of 2-3 independent MSF operations in a single country. It usually arrives after an emergency starts and it pulls out as soon as it has decided its work is done.

Used for political means

THE DOVE IS NEVER FREECRITIQUES

SUMMARY OF LESSONS LEARNED

Emergency response must be based on accurate information and use a public health approach

Major causes of mortality in emergencies are preventable through well-proven, low-cost public health interventions

Protection of affected populations, maintenance of humanitarian space and safety of humanitarian workers is becoming increasingly difficult (CDC)

SUMMARY OF LESSONS LEARNED (CONT.)

Emergency response has evolved as a specialist field with its own indicators, policies, procedures, manuals, and reference materials

Agencies that developed institutional expertise in the key technical areas of humanitarian aid and invested in staff training have proven their effectiveness

Relief agencies must be accountable to agreed standards

Better outcomes with involvement of host government staff and use of local skills

Preparedness and coordination between agencies is key for effective response. CDC

HUMANITARIAN ORGANIZATIONS: WHAT DO THEY DO WELL?

Usually have excellent advocacy or lobbying capacity

Can fill gaps-specialised skills/capacity

Usually mobilise quickly

Often well connected at local level

WHAT DON’T THEY DO WELL?

Duplicate services

Turf wars can erupt

May step outside their areas of specialty

Often overcommit/overextend capacities

May not be so good at sustainability

May be a Political tool

A GOOD CHALLENGE BUT IN MEANTIME…

(DIFD) Department for international Development has witnessed a change in stressing the importance of preventing conflict, more than providing humanitarian aid.

DIFD expanded it activities towards prevention initiatives to include new areas, such as removing land mines, changing military assets, reducing undersized arms, as well as being involved in analyzing war by conducting an impact evaluation.

Useful to address underlying vulnerabilities vs only shock-driven response

WHO MONITORS NGOS? Little External Monitoring

Self-Regulation: NGO Standards

• Red Cross Code of Conduct• Sphere Minimum Standards in Disaster Response

SPHERE PROJECT

www.sphereproject.org

1997

Humanitarian NGOs and related organizations, including Red Cross and Red Crescent movements

• Collaboration• Expression of commitment to

quality and accountability

Minimum standards in disaster response

CRITIQUES SPHERE

Griekspoor (WHO) stresses the need for a localised, contextualised response instead of a standardised approach that can crumble in high-pressure, complex scenarios

MSF Jacqui Tong

myth of ‘homogeneous humanitarians’

“entertains idea humanitarian aid is only about providing water, food, shelter and health services”

linking quality and accountability to technical standards.

This can be exemplified by the hackneyed example — ‘there are a sufficient number of wells but women are raped when go to collect water’

MDGS & HUMANITARIAN RESPONSE

Head of International Rescue Committee David Miliband argued goals of humanitarian action need to be reassessed and humanitarian goals – "HuGos" – need to be set.

Drive to create a humanitarian counterpart to the millennium development goals …

But..

“Try explaining to an armed opposition member that the purpose of your humanitarian aid is to build the capacity of the institutions of the state that he has taken up arms against.” (Jonathan Wittall)

COORDINATION

military

every body else

Aid workers consider military to be bureaucratic and unsuitable. Military workers view aid employees as unorganized, insecure and without discipline

wrong

CIVIL-MILITARY COOPERATION

• The need for civil-military cooperation may be the exception rather than the rule

• The two should not be mixed when avoidable

However the logistic support provided by larger NGOs or the military in support of smaller NGOs can be invaluable

EXAMPLES OF CIVIL-MILITARY CO-OPERATION SERVICES REQUESTED BY NGOS

Security Services

Landmine Locations

Security Briefings

Convoy Support

Guidance on Local Security

Technical Assistance

Access to Remote Areas, Ports, and Airfields

“Post conflict development defies the exact boundaries of traditional forms of assistance: it is neither sustainable development nor is it humanitarian response.”

Mark Malloch Brown, VP, External Affairs, World Bank. (Conflict Prevention and Post-Conflict Reconstruction: Perspectives and Prospects, 1998)

OUR COMMON FUTUREDevelopment

In 1987 Brundtland report defined sustainable development as “development that ‘meets the needs of the present generation without compromising the ability of future generations to meet their needs’ (WCED 1987).

Humanitarian assistance:

Based on need

Restore Ability of People to Make Their Own Decisions

Most vulnerable people must be core of both:

The most vulnerable people living in countries with protracted and recurrent crises have been left behind in the MDG process. And too many humanitarian organizations stay away from where need is most…Somalia for example.

COOPERATION & HEALTHY TENSION

Independence, neutrality: distance may be necessary especially in conflict situations

In contexts such as natural disasters and epidemics, development groups, humanitarians and state actors should certainly work together for long-term benefits

MSF UK Programs Unit, André Heller Pérache

FOOD FOR THOUGHT

The impacts are interlinked: protracted humanitarian crises act as a barrier to sustainable development by undermining long-term recovery and resilience, and conversely, a lack of development can trigger a relapse and magnify the impact of crises on vulnerable people

Humanitarian assistance can be an investment in development

Give Law teeth: avoid need for post-mortem justice

Sierra Leone, Sylvain Cherkaoui/Cosmos for MSF 2014

SMALL GROUPS: EBOLA BRAINSTORM