Dakar — The gradual expansion by a small number of humanitarian agencies beyond their traditional remits of war and natural disaster towards tackling the consequences of large-scale criminal violence in urban settings raises questions about the legal framework and working methods of such interventions.
The tricky question for humanitarian NGOs is whether or how to intervene - for how long, on what legal basis and under what strategy. While drug cartels and other criminals often claim lives, the theatres of violence they generate are not covered by the Geneva Conventions, which have for more than 60 years guided humanitarian interventions in wars.
"If there is no declared conflict but there are all the hallmarks of warfare in terms of the intensity of violence and the organization of armed groups, there are questions about what norms and rules apply," said Robert Muggah, professor at the Institute of International Relations at the Catholic University of Rio de Janeiro and research director at Igarapé Institute, a Brazilian think tank focusing on violence prevention and reduction.
"What laws apply when an international organization negotiates access to civilian populations with the dons of drug cartels or illegal self-defence units?
What kinds of immunity are personnel granted? What are the expected procedures for dealing with militaries and police? In most cases, humanitarian agencies simply get on with the difficult work of providing assistance and minimizing harm with little time to reflect on these and other tricky questions," he told IRIN.
In 2008 the International Committee of the Red Cross (ICRC) launched a five-year pilot project to negotiate access for humanitarians in some of Brazil's Rio de Janeiro slums, while MSF has sent mobile clinics throughout some of the most violent neighbourhoods in the Honduran capital of Tegucigalpa, where drug and gang-related violence have rendered emergency medical care almost non-existent.
"Organizations such as ICRC and MSF have made clear policy statements about their intention to engage [in] urban centres that are in conflict or so-called 'other situations of violence'. They are only relatively recently starting to reckon with what this might mean in practical terms," said Muggah, who is also coordinating HASOW, Humanitarian Action in Situations Other Than War.
Created in 2011 as a two-year international initiative, HASOW probes the legal implications of humanitarian action in such settings, the changes they are spurring in international agencies, and the impact of intervention.
He and other analysts say dealing with violence in urban centres is forcing humanitarians to re-examine their "in-and-out" modus operandi, given the intricacies - and time - demanded by conflict meditation and prevention.
So-called "grey zone" conflicts pitting the state against, for example, urban drug gangs exacts a growing humanitarian cost. The death toll since 2006 in Mexico's war against the cartels is estimated to stand at between 50,000 to 110,000 - many of them ordinary people, unrelated to the gangs or the security forces.
While cities are not necessarily more deadly than the countryside, noted the World Bank in 2010, "many of today's cities - especially those that are growing very quickly - experience a convergence of factors that increase the risk for destabilizing levels of violence if they are not appropriately addressed."
"It shouldn't matter whether an IHL [international humanitarian law] framework is applicable or not; it's the consequences of this violence that aid groups are responding to, regardless of the nature of violence," said Elena Lucchi, humanitarian consultant and a former Médecins Sans Frontières (MSF) operational adviser on urban issues. "Decisions should not derive from dilemmas over legal frameworks."
The risk is that governments may spurn humanitarians' involvement in order to protect their reputation and sovereignty in these so called "situations other than war", Lucchi added.
"Situations other than war"
There are different sources of urban violence (chronic or short-term) - political violence, organized crime, drug wars - and only some scenarios lend themselves easily to humanitarian intervention, said François Grünewald, executive director of the France-based research, training and evaluation group, Urgence, Réhabilitation et Développement (Groupe URD).
In gang violence driven by organized crime, humanitarian agencies are quite limited, GrÃ¼newald told IRIN. For one, humanitarian principles (neutrality, doing no harm, etc.) - even if they applied - do not cut much ice with gangs.
"The actors in that kind of urban violence don't care at all about humanitarian issues," he said. "In most war settings groups have a goal - to control territory or to gain political recognition and political power. And if you have that goal you can't do just anything. Those actors have political motivation, they look for recognition; they might be inclined to enter into a dialogue with humanitarian actors. The drug cartels in Mexico - they just don't care. They just kill."
The few organizations with an "entry point" into the second scenario, Grünewald said, include MSF with its medical mandate and ICRC because of its special engagement with authorities and "non-state" actors, like gangs.
In addition, Doctors of the World (Médecins du Monde) has sent exploratory missions to Bolivia and Mexico to examine the impact of urban violence on health.
Violence is just one aspect of a broader challenge - how to operate effectively in urban settings - said Nicolas Moyer, executive director of the Canada-based Humanitarian Coalition. Aid experts say humanitarians' response to the 2010 earthquake in Haiti, which killed more than 220,000 and left more than 350,000 people still displaced three years later, exposed the aid community's shortcomings in urban areas.
Seeking new tools
Largely missing from the aid workers' toolbox is how to measure progress and needs in urban areas.
MSF recently conducted assessments of health care access and availability in parts of Guatemala, Honduras, and Mexico, and found that violence in some urban areas has disrupted essential services to the point that for much of the population acute needs go unmet.
"In the most violent areas - such as on the outskirts of big cities in Mexico and Honduras - health professionals are not keen to work there because they fear for their own security," said Gustavo Fernandez, MSF programme manager for Guatemala, Honduras, Iraq, Lebanon, Sudan, and South Sudan. "This creates a vacuum; the existing health structures just cannot absorb the demand."
In addition to running mobile clinics in Honduras, MSF partnered with the Health Ministry to work alongside health centre staff - at times very few of them - providing medical care, medicines and staff training. "We are always working with [Health Ministry] staff so when MSF leaves, they can continue primary care at the health centres," said MSF's head of mission in Honduras, Laurence Gaubert.
MSF also works closely with local firefighters as they are the ones capable of responding to medical emergencies in urban conflict zones.
Humanitarian agencies must adjust how they measure progress in such settings, said consultant Lucchi.
"For medical aid organizations, which commonly have worked in closed environments like refugee settings, one of the indicators of success would be a reduction of mortality," she said. "In protracted situations in [sprawling urban] settings... this sort of emergency threshold is not really appropriate. So it's essential to look for alternative ways of measuring and monitoring."
Needs assessments capable of separating acute needs from chronic ones in urban areas where there is extreme poverty, weak health systems and poor governance are still rudimentary, making it difficult for humanitarians to measure impact in a context of widespread, longstanding need.
Aid experts say urban violence exposes the gradually narrowing disconnect between humanitarian and development operations.
While in "traditional" conflict settings, the two are starting to coordinate better, Muggah said, urban violence poses new dilemmas.
In an urban environment, a humanitarian agency cannot use the same modus operandi as during, for example, inter-communal fighting, said MSF's programme coordinator, Fernandez. "In [urban] settings, the [existing local infrastructure] - though disrupted and though unable to address some critical needs - still exists; the actors are still there. For the sake of continuity and a comprehensive approach, humanitarian agencies must coordinate with all other actors."
In rural refugee camps aid groups contend with few authorities or agencies; in cities their legitimacy depends largely on being able to work long-term with multiple levels of authority (city, municipal, district, local) as well as NGOs and public workers, said Muggah.
"For some development agencies reinforcing community structures comes naturally. But for many humanitarian organizations this is rather more difficult - there tends to be inclination towards substitution as opposed to reinforcing and capacity-building, and the latter is a real need in these urban settings."
Humanitarian Coalition's Moyer said urban interventions have sparked, and will continue to spark, debate over fundamental principles. "A pure humanitarian mandate is in-and-out lifesaving, while responding to urban violence requires more integrated approaches, longer-term approaches ... I don't think there's resistance to it; I think there's curiosity about what's involved and what the possible outcomes might be."
[This report does not necessarily reflect the views of the United Nations.]