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Location: AMSA Global Health Scholars '08-'09 Discussion Forum
Discussion: Fifth reading: Assistance, protection, and governance networks
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ljanneck |
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kmckeegan |
1. Fifth reading: Assistance, protection, and governance networks
Mar 5 2009, 7:47 AM EST
I think this paper provided a great, broad-based perspective on the trends in crises and humanitarian responses that we’ve been struggling with in the last few readings: “the absence of distinctions between war, peace, and crime”, and the failure of the “assumption that the world’s military forces will find it in their collective interests to maintain a distinction between the military and civilians during war.” As in Goma, which we’ve discussed, the inability to separate civilians from combatants and to create a neutral or humanitarian space is the major stumbling block in creating an arena for humanitarian governance. If one aspect of the rationale for humanitarianism is the ideal of an innocent civilian victim, the increasing militarization of nominally civilian populations poses both a logistical and an ideological challenge. The authors of this paper argue that terrorist concerns should not undermine humanitarian ones, and I agree, but I also think that the change in paradigm that occurs with a shift in focus to terrorism may also drive the development of new and more productive responses to the loss of distinction between civilian and military. For example, in a recent interview on the Daily Show, [author, book] was discussing Gen. Petreaus’s strategy of “employing” local militias so that they would stop attacking US soldiers and civilians. Petraeus used this cash incentive to “demilitarize” civilians. This strategy has the potential for creating new space for humanitarian governance, although it remains to be seen if it will lead to a permanent peace. If Petraues’s strategy succeeds in Iraq, perhaps it should be applied to other conflicts characterized by large numbers of quasi-militarized civilians. Do you find this valuable? |
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kmckeegan |
2. Fifth reading: Assistance, protection, and governance networks
Mar 5 2009, 7:50 AM EST
**sorry, [author, book] above =Thomas Ricks, 'The Gamble'; Daily Show Feb 10.***This article also raises the issue of the “shift in responsibility and competence from state governments to local, national, regional, and worldwide governance networks”; networks that, as we’ve discussed, are ill-equipped to take on the role of the state and to provide coherent and long-term solutions to complex emergencies. The problem really unites all of the aspects of humanitarianism that we’ve been discussing this year, from DeTorrente’s article on the pitfalls in the relationship between independent humanitarians and political entities to our first reading on the competence of the humanitarian response. Such large and fundamental questions are unlikely to be answered with simply, or soon, but hopefully, overtime an awareness of these challenges will lead to conscious choices and a positive evolution in the field. Do you find this valuable? |
sezaeh |
3. RE: Fifth reading: Assistance, protection, and governance networks
Mar 5 2009, 10:06 PM EST
This article provides a nice overview of the evolution of humanitarian relief in complex emergencies, giving a closer look at some of the lessons that have been learned over the last fifty years from humanitarian engagement in various conflicts. Of particular interest to me, as I have discussed in prior responses, is the “relief to development continuum,” which came about after the Cold War. As the article mentions, the transition from relief to development is often not linear or smooth, but rather appears differently in each conflict situation.Given my interest in Sierra Leone and the impact of long term conflict, I can truly relate to the article’s discussion of the impact of complex emergencies on a country’s health infrastructure. In Salone, a debilitating eleven year Civil War destroyed the country’s medical capacity. Today, seven years after the conflict has come to its conclusion, the country continues to struggle at the bottom of the Human Development Index with some of the worst maternal and child health indicators in the world. It is sadly true that “complex emergencies involve...the deliberate creation of crises that result in the further destruction of fragile health, education, welfare, political, economic, and environmental systems.” Do you find this valuable? |
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sezaeh |
4. RE: Fifth reading: Assistance, protection, and governance networks
Mar 5 2009, 10:06 PM EST
Given the frequent destruction of health systems and “breakdown” of ministries of health, it is external international providers who provide critical health services. While such service provision is essential for the short term, it may have a longer impact than one would expect. For example, Sierra Leone’s Ministry of Social Welfare continues to largely depend on UNICEF for its child protection agenda in the country. Government priorities must be aligned with UNICEF’s priorities, which means being aligned with worldwide donor priorities. It is questionable how long this relationship will exist for, and when Sierra Leone’s government will be able to be the lead actor in directing the agenda for service provision. We must continue to work to incorporate local actors as we provide relief and move towards development. After all, it is these individuals who will make a sustainable and long lasting contribution towards their countries. Isn’t that what we’re really there for? Do you find this valuable? |
Merrian |
5. RE: Fifth reading: Assistance, protection, and governance networks
Mar 8 2009, 3:21 PM EDT
I am going to take this opportunity to reflect on myself. I realize more each year how much I subscribe to the 'relief to development' continuum. But what role do I want to play? Do I want to be involved in short term projects that shot gun more advanced development topics like health infrastructure building and omen's equality? If I were part of the leadership for MSF would I be advocating for that group to be more development minded in their emergency responses? The paper mentions three challenges to international relief workers: 1. delivery of emergency health care; which i would describe as relief work 2. assessment of health conditions in vulnerable populations; which I would describe as both relief work and development and 3. assistance in reestablishment of national health care systems; which to me is the back-bone of health development. I think just as I am dissatisfied with work in the ER that sends all the long-term planning to the 'upstairs doc' I am equally disillusioned by the idea of short term disaster relief. This paper reminds us all that some of these disasters or so complex that one angle cannot really address even something as specialized as 'the health care sector' in a conflict setting. I believe I want to be involved in health care system development and renewal. I want to understand a place and help piece it back together. But am I as an ex-pat the right person for a job like that? Is it thoroughly overwhelming of a task like a 90 year-old with a 13 item problem list on the IM floor? Its easier to focus on saving lives and providing resources in the most basic way. You can establish objectives and time frames and reach them. Integrating a plan for health infrastructure is another task entirely, and as the paper points out there is not much integration, structure, or accountability to guide those who are tackling health development.
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Merrian |
6. RE: Fifth reading: Assistance, protection, and governance networks
Mar 8 2009, 3:21 PM EDT
Perhaps I can do short term relief work and focus on advocating for humanitarian governance in conflict setting. I can let me experiences in the short term allow me to bear witness to those who may have the power to install longer term solutions. This to me is very important because humanitarian governance is not just a western ideal imposed by those who have already done whatever exploiting they need to do to succeed (as many argue). Protecting innocents is one of the few ways to prevent long-term national instability. It shows true international solidarity. It empowers citizens to seek other means to solve crises because they are protected enough to act for their own peace.
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Paul.Johnson |
7. RE: Fifth reading: Assistance, protection, and governance networks
Mar 10 2009, 2:39 PM EDT
This, and the other articles, make me think about Global Health in broader terms- what are the goals, how do we approach it, how do we deal with the 'relief to development continuum' mentioned above? It's very interesting to me to look at the lessons learned table in this article, which begins in the 60's. Historically, I see a big shift in thought as colonialism ended post-WWII, and wealthy nations began to think about development. I think it's important to realize that international development, as a field, is still in its infant stages- only just over 40 years old. The area of Global Health and International Development seems, to me, to be developing on two fronts: 1) Logistically- how do we go about providing clean water, sanitation, run vaccination campaigns, on the ground, etc. And 2) when and where to intervene, and how much of the government's role should we assume? How closely should aid organizations associate themselves with military organizations? When should a foreign aid organization replace a poorly functioning governmental health ministry? This article, and the others we've read, seem to me to be attempts to answer the second of the dilemmas. Because the nature of these situations is both political and complex, I'm not sure that it can be nailed down to one doctrine, or set of guidelines. It would make life easier if one existed- right now development seems to be hindered by its patchwork approach- many independent organizations working on different projects and with different belief systems. I really do hope that as the field of Global Health and Development matures, we'll find some better answers to these questions.Do you find this valuable? |
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Paul.Johnson |
8. RE: Fifth reading: Assistance, protection, and governance networks
Mar 10 2009, 3:49 PM EDT
You may find this interesting:http://www.globalpulsejournal.com/blog/index.php/2009/03/09/film-review-what-are-we-doing-here/#comment-15346 http://www.whatarewedoinghere.net/cnn Do you find this valuable? |
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DHaisch |
9. For anybody still reading this board....
Apr 2 2009, 11:08 AM EDT
In many cases, it seems that those of us who are concerned with humanitarian aid are still thinking within the framework of the Geneva Conventions, assuming that military and civilian forces will be completely separated and that there will be a clear distinction between those innocent civilians in need of aid and those who are perpetuating the violence. Thus, I appreciated that this article grappled with the changing face of humanitarian involvement in conflicts where there is deliberate war against civilians and deliberate creation of crises, an “absence of distinctions between war, peace, and crime,” and a blurring of identities between victim and perpetrator. This shift in the nature of complex emergencies calls for a different approach. As “terrorist concerns” replace humanitarian ones, we need to think carefully about the obligations and limits of humanitarian governance. We should consider ways to convince groups that it is their best interest to respect these sorts of laws and rights. But we should also consider what framework might replace the current one if groups continue to blur distinctions, warring against civilians and involving them in the violence. I am not convinced that this change is not representative of the future of complex emergencies, and we need to adapt. But how? Can we adapt to serving within systems that are violent, that blur identities, that bar access to some civilians? Where the perpetrators move between roles of civilian and combatant? How do we maintain the principles of humanitarian assistance within this new environment? Do you find this valuable? |
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DHaisch |
10. For anybody still reading this board....
Apr 2 2009, 11:08 AM EDT
And when the conflict ends, how should we be involved? Lautze and her colleagues touch on the idea of a “relief to development continuum” that would promote human rights standards, lay foundations for development, help resolve the conflict, and contain the crisis. Complex emergencies in particular call for an approach that is robust and prepared to help rehabilitate communities devastated by violence but that does not take away from immediate efforts to save lives and reduce suffering. I think this is the second major challenge as we move forward. We need to rethink how to be most effectively involved in this last step. As it becomes more necessary to help rebuild, should humanitarian agencies ask for government involvement to promote these goals? If so, how do humanitarian agencies ensure neutrality, or should that matter at this point in the process? Or should humanitarian organizations themselves divide their attention between relief and development? As usual, I don’t have any answers, but I think that struggling to answer these questions is useful in thinking well about these issues. Do you find this valuable? |
pafrancis |
11. Another perspective
Apr 6 2009, 12:03 PM EDT
My gut reaction to this article is that during times of civil war or in active complex emergencies, the foremost priority of relief workers should be the delivery of absolutely essential healthcare to the most victimized populations. This sounds obvious, but according to the authors of this paper, it appears that many humanitarian assistance operations are unduly complicated by the interests of foreign aid workers to perform almost impossible feats of ideological change during times of raw crisis and instability. A genocide is not a time for addressing women’s equality or improving dietary behaviors; this kind of crisis is the manifestation of a population that has lost all reason and has resorted to hysterical measures to achieve an irrational aim. Health workers, therefore, should focus on simply providing the most essential kinds of care, like emergency first aid, clean water, adequate food and shelter, and fulfilling the Sphere guidelines until the mood of the nation has changed (perhaps as a result of the presence of international military coercion). Other kinds of humanitarian efforts, including those of radical social reform, should be left to the political scientist and the nation builder, who are more likely than physicians or public health experts to know how to reconstruct a society that is not meeting international standards.
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pafrancis |
12. RE: Another perspective
Apr 6 2009, 12:03 PM EDT
This premise is reflected in the “vertical” approach to combating problems that arise during a complex emergency, the idea being that all efforts – in terms of finances and personnel – of an organization should be focused on resolving one well-defined conflict before (or instead of) taking on others. A comprehensive (or “horizontal”) strategy will ultimately procure desired change in many areas, but is not an approach that is suitable during times of turmoil: without the complete support from a national government, how can a foreign institution hope to enter a country and make integrative, sweeping changes that will last beyond their temporary occupation? This is not to say that I don’t see a role for undertaking public health improvement measures during times of war -- I believe it is absolutely crucial to begin rebuilding health infrastructures immediately upon achieving some success towards creating community stability in order to establish a country’s capacity to care for its own. But the goal for relief workers during a complex emergency should be to ensure that the nuts and bolts of a healthcare system are in place before expanding their aims to include projects that may involve objectives outside of the restoration of basic human welfare.
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pafrancis |
13. RE: Another perspective
Apr 6 2009, 12:04 PM EDT
Although I believe taking a vertical approach makes more sense during a complex emergency, the debate over which approach is more efficacious in the primary care field is currently underway in politically stable countries that are plagued by the three “scourges” of HIV/AIDS, tuberculosis and malaria. Some health organizations have ongoing projects that deal with one but not the other diseases, while others campaign and finance for the eradication of all three. The vertical approach has shown improvements in TB control and malaria prevention, but it doesn’t account for the fact that the three diseases are intricately related: the latter two diseases become opportunistic if the former isn’t prevented. However, the horizontal approach spreads health care workers and funds so thin that programs are not proving to be effective in meeting district-level needs and cultures. Just some thoughts to ponder.
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