Beyond emergency care: challenges to health planning in complex emergencies.

Beyond trading insults in international humanitarian aid

Prioritising health care in complex emergencies

Reviewed by: Frontline Diplomacy: Humanitarian Aid and Conflict in Africa Terrence Lyons Frontline Diplomacy: Humanitarian Aid and Conflict in Africa. By John Prendergast. Boulder, Colorado: Lynne Rienner, 1996. 164 pp. $12.95 paper. This volume by John Prendergast is part of a growing literature by activists in the humanitarian community who have been conducting a process of critical self-examination. Prendergast and others, including Larry Minear and Thomas Weiss, Ken Menkhaus, Alex de Waal, Mark Duffield, and the interagency review of the humanitarian response to the genocide in Rwanda have raised a series of important and difficult issues. Each is struggling with the set of issues presented by Prendergast in this volume as to how emergency aid can exacerbate conflict and how to both minimize these unintended consequences of humanitarianism and to use assistance to contribute to peace building. [End Page 234] These questions have come to prominence in the literature on humanitarianism as a result of the role famine assistance played in sustaining both the military government and insurgent forces in Ethiopia in the 1980s, the factional leaders in Somalia in the early 1990s, and most tragically the 1994 genocide and continuing conflict in Rwanda and its neighbors. These horrors have forced the humanitarian community to question the simple principle that a hungry child knows no politics. Instead, the relief community has come to recognize that it cannot ignore politics and that, in many cases, emergency assistance is the principal source of resources that may be used to either reinforce peace or strengthen the forces of destruction. Apolitical humanitarianism is impossible in the context of complex emergencies and state collapse, as the disasters in Somalia, Rwanda, Burundi, and Sudan in Africa along with Afghanistan, Bosnia, and other cases around the world have made clear. Prendergast focuses his attention on a region he knows extraordinarily well, the so-called “Greater Horn of Africa” that includes not only Sudan, Ethiopia, Eritrea, and Somalia but also Rwanda, Burundi, Uganda, and the Democratic Republic of Congo (former Zaire). One of the most important contributions of this book is the insights Prendergast makes on the basis of his long involvement in the region. Much of the data for this study comes from personal observations and interviews with humanitarian officials in the field rather than at headquarters. Despite a subtitle that suggests a continental focus, Prendergast barely mentions other cases where similar dynamics took place, most notably Liberia, Sierra Leone, Mozambique, and Angola. Prendergast justifies this focus by correctly pointing out that the Greater Horn has been a “laboratory for innovative crisis response,” although humanitarian agencies in Liberia also demonstrated a broad understanding of their relationships with political and military actors on the ground. The book is organized around a series of basic aphorisms, including the Seven Deadly Sins of humanitarianism in complex emergencies and the Ten Commandments for providing aid without sustaining conflict. Each seems thoroughly sensible, particularly when supported by Prendergast’s carefully selected examples from the field. What is lacking, however, is a set of specific judgments or criteria to guide decision makers within [End Page 235] humanitarian organizations and the donor community. The distinctiveness of each case and the author’s deep appreciation for context perhaps makes such generalizations difficult. In the end, Prendergast calls for a greater awareness of the political context humanitarian organizations work within when responding to complex emergencies and to experiment, consult widely and openly, and constantly evaluate one’s actions. The author’s most specific recommendations relate to the need to use humanitarian assistance to support local community structures and initiatives. Prendergast concludes by noting the centrality of humanitarian actors in complex emergencies: In most complex political emergencies, humanitarian aid is the most important avenue of contact among the international community, the conflicting parties, and civilians in the war zone. Ignoring the wider impacts and potential of humanitarian aid removes one of the most important policy instruments for preventing the escalation of conflict and promoting long-term peace building. Prendergast’s insights from the Horn of Africa should help humanitarian actors become more conscious of their roles and better able to use emergency relief to promote conflict management. Terrence Lyons Fellow, Foreign Policy Studies Program The...

Surgery and conflict

We review the effects of war on HIV and STI transmission and critically appraise short- and medium-term approaches to prevention. Our intent is to stimulate thinking about the potential for increased HIV/STI transmission in current and future armed conflicts with particular reference to Afghanistan and to encourage timely interventions to prevent a worsening HIV epidemic in Central and South Asia. (excerpt)

The trauma of genocide

How important is neutrality to humanitarian aid agencies?

Egil Kristian Tynæs

Since 1971 Medecins Sans Frontieres (MSF) has been providing emergency medical assistance to populations in crisis. In 2011 MSF has projects in more than 60 countries, and is one of the most widely known independent humanitarian non-governmental organizations (NGOs). While the core remit of the organisation is to provide emergency aid, MSF's work also encompasses provision of basic health care in places where this is insufficient or nonexistent, training of local medical personnel, bearing witness to and raising awareness of populations in danger Material aid is delivered concomitant to medical aid, and when necessary MSF teams are able to repair or develop medical and sanitation facilities. While there is information available online, we considered that an interview with MSF would be of interest, in particular to GP trainees and GPs who are considering taking time out to work overseas. Two specific themes thought to be important to discuss were what opportunities exist for GP trainees to contribute towards MSF's work, together with accountability and sustainability aspects of MSF's projects. On 12 March 2010, Nell Gray, Field HR Officer at MSF UK was interviewed by Dr Luisa Pettigrew and Dr Ha-Neul Seo. > Ha-Neul Seo (HS): Firstly, we would be grateful for an overview of the application process for UK GP trainees and GPs within 5 years of qualification (First5). More specifically, are there any waivers to your essential criteria, and are there any additional assets that you would look for in a doctor specialising in general practice? > > Nell Gray (NG): UK GP trainees would apply using the standardised process for all applicants, after FY2 plus at least 1 year of clinical work (MSF website). > > There are no waivers to the essential criteria. UK GP training forms a good basis for an application as much MSF work is based in primary care. …

Humanitarian response inadequate in Horn of Africa crisis

Protecting health-care workers in the firing line

Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan-Afghanistan and Thailand-Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control.

Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan-Afghanistan and Thailand-Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control.

Education and debate p 342 Acute disasters attract international media and political attention — and often funds to support a response. However, if hundreds of thousands of people, or even...

Tuberculosis (TB) is a major public health problem in complex emergencies. Humanitarian agencies usually postpone the decision to offer TB treatment and opportunities to treat TB patients are often missed. This paper looks at the problem of tuberculosis treatment in these emergencies and questions whether treatment guidelines could be more flexible than international recommendations. A mathematical model is used to calculate the risks and benefits of different treatment scenarios with increasing default rates. Model outcomes are compared to a situation without treatment. An economic analysis further discusses the findings in a trade-off between the extra costs of treating relapses and failures and the savings in future treatment costs. In complex emergencies, if a TB programme could offer 4-month treatment for 75% of its patients, it could still be considered beneficial in terms of public health. In addition, the proportion of patients following at least 4 months of treatment can be used as an indicator to help evaluate the public health harm and benefit of the TB programme.