In recent years, the legality and civilian casualties of the secretive American drone programme have increasingly been the subject of much discussion. But one question has gone largely unasked: What is the impact of drone warfare on humanitarian work?
"The public debate, rightly so, has focused on the transparency and targeting of drones, but for humanitarians, there are a whole set of much more specific concerns that we don't necessarily have answers on and ought to be thinking about," says Naz Modirzadeh, a senior fellow at Harvard Law School and a leading expert on the intersection between counterterrorism and humanitarian aid.
In places like Afghanistan and Pakistan, strikes by unmanned planes are increasingly affecting humanitarian operations, aid workers say, necessitating a greater discussion by humanitarians on how to deal with the impact and a greater focus by US policymakers on how to mitigate it.
The issue will be increasingly relevant in coming years, as drones, also used in Somalia, Yemen and Gaza, become an ever more popular weapon of choice in counter-terrorism operations.
The legal framework
One of the first questions of relevance for humanitarians is the legal framework under which the drone strikes operate and whether international humanitarian law (IHL), which protects humanitarian access and aid workers, applies.
Last month, NBC News made public a US Justice Department white paper making the legal case for drone strikes "outside [an] area of active hostilities", in which IHL traditionally applies.
It argued the USA was engaged in a geographically boundless non-international armed conflict with non-state armed groups - essentially claiming that it is "at war everywhere all the time", as one international lawyer put it.
In the white paper, the US argues its counter-terrorism programme will be "informed by" what it presents as four core principles of IHL - necessity, distinction, proportionality and humanity. But it is not clear whether this is a binding interpretation of the law or a flexible policy statement.
Modirzadeh argues there are unanticipated costs of waging conflict in what she calls "fuzzy international legal terms".
"A purported global non-international armed conflict, fought through weaponized unmanned vessels, whatever its status under international law, raises fundamental questions about how the humanitarian community will engage with states in order to ensure that lifesaving supplies reach the civilian population," she told IRIN.
"If strikes target a particular region (such as in Yemen or Pakistan), what state, if any, has an obligation to ensure the population has access to relief operations?
With whom do humanitarians interact to negotiate access? Can the territorial state reasonably be expected to offer meaningful and secure access? Does the targeting state have any obligations under IHL relevant to humanitarian assistance? Does human rights law [apply] as the dominant set of rules relevant to the basic needs of the population?"
In an attempt to answer some of these questions, the UN special rapporteur on human rights and counter-terrorism in January launched an inquiry into the civilian impact of the use of drones, focusing on the applicable legal framework. He will present findings and recommendations to the UN General Assembly later this year.
Perceptions of neutrality
In the meantime, aid workers are already feeling the impact on the ground.
Like other counter-terrorism methods, including other air strikes and night raids, drone strikes have in many cases created environments of suspicion and paranoia, even witch-hunts, with perceived collaborators hunted down and in some cases executed in front of video cameras.
In this environment, how do you manage perceptions of humanitarians' neutrality? To varying degrees, aid workers have been able to distance themselves from traditional military associations: checkpoints, troops, convoys. But how can you distance yourself from a drone strike?
Take the May 2008 US missile attack on al-Shabab leader Aden Hashi Ayro in Somalia as an indicator.
According to NGO security officials there, attacks by armed groups on aid workers rose from one or two per month leading up to his assassination, to 6-11 per month for the rest of the year. Aid workers were abducted and two US NGOs working in the area of the strike shut down operations as a result.
"That was kind of a turning point in al-Shabab suspicion towards humanitarian actors," said Jeremy Konyndyk, director of policy and advocacy at Mercy Corps, which was working in Somalia at the time.
"The fact that foreign NGOs were operating in the same area where the strike had occurred was enough to put them at severe risk."
Pakistan is a more recent case in point of how even the prospect of drone strikes can compound tensions.
In 2011, Pakistani investigators alleged that a doctor running a vaccination campaign in northeastern Pakistan was an undercover CIA agent trying to gather information on the whereabouts of Osama Bin Laden.
"That did a tremendous amount of harm to the humanitarian community," said Sarah Holewinski, executive director of the Center for Civilians in Conflict.
According to one volunteer who has worked with government vaccination teams in Khyber Agency, one of Pakistan's lawless tribal areas: "Because of drones and the Dr. Shakil Afridi case, all health workers are looked on with suspicion."
Citing the case, in June 2012, a local Taliban commander in North Waziristan Agency, Hafiz Gul Bahadur, distributed pamphlets in the town of Miramshah banning polio vaccinations until drone strikes stopped. He alleged the campaign was a cover for US spies. Until now, vaccinations have not resumed in many parts of North Waziristan.
"The CIA is not going to sit down with humanitarian organizations and explain their operations"
The Pakistani volunteer, who requested anonymity, said hostility worsens after a drone strike. "In villages, we have been accused of being Western agents and [have had] jibes hurled at us," he told IRIN. "My relatives warn me not to do this vaccination work as my life could be at risk."
The Overseas Development Institute (ODI) Humanitarian Policy Group raised the issue in research with the Taliban last year.
"Fighters recalled retaliating against local aid workers present after drone attacks and airstrikes, assuming that they were responsible for passing on intelligence," Ashley Jackson, an ODI research fellow, told IRIN.
"Aid workers gathering information for programming or assessing needs - even basic information - become suspect for asking questions, and are often blamed [by] the Taliban in the aftermath of such strikes."
Organizations working in rural areas of Afghanistan, who use GPS coordinates as a more reliable way of tracking the people they help in remote villages, say they have had more difficulty collecting beneficiary information in the last year and a half or so.
"If you are running around with maps, or even a large watch that could be mistaken for a GPS, people are very uncomfortable," said one aid worker working with a USAID-funded programme in tribal areas of Afghanistan.
Third-party organizations doing monitoring and evaluation of NGO programmes have in some cases refused to offer the option of taking GPS coordinates because it has become too dangerous.
"It has made collecting information really difficult," the aid worker said. Even where they are able to get the information, "now we are worried about where that information goes," not only for privacy reasons, but also security reasons.
In addition, counter-terrorism legislation has required aid agencies to do more vetting than usual in areas where drone strikes occur, Modirzadeh points out. "If you are asking all sorts of questions of your partners and vendors and one week later there is a drone strike, who is going to be blamed?"
Protection of civilians
One of the main concerns humanitarians have is who to liaise with when things go wrong, to secure safe access and to advocate the protection of civilians.
"Who do you call when an intelligence agency is running strikes and there are no operations on the ground?" Modirzadeh asks.
While the protection of civilians eventually became an important pillar of the US counter-insurgency approach, because it contributed to "winning hearts and minds", the shift to counter-terrorism has placed the well-being of civilian populations on the back-burner, Holewinski says.
"The CIA is not going to sit down with humanitarian organizations and explain their operations and discuss how they can protect each other's space. It's an inherently clandestine organization."
In 2012, an aid worker with the International Committee of the Red Cross (ICRC) died of shrapnel wounds after an air strike in southern Yemen.
"This is the cost of being vague about legal obligations," Modirzadeh says.
Some say this is a new face to an old problem, but the remotely-controlled nature of the operations does add a unique challenge. Many of those who have tried to dialogue with drone strike operations have hit a brick wall.
ODI's Jackson was working with Oxfam in Afghanistan 2010 and 2011 when a drone strike caused civilian casualties near the eastern city of Jalalabad. She tried to determine who was responsible for the strike, but "it's incredibly difficult to get to anyone," she said.
The drones might fly out of the same airbase as the regular military but have a completely separate chain of command, leading to the Central Intelligence Agency (CIA) and the US military special operations forces' Joint Special Operations Command (JSOC).
Jackson's colleagues in Washington tried to arrange meetings with US officials, but "humanitarians don't formally interface with the CIA or certain parts of the Pentagon who control this." In the end, she said, "we had zero success."
But others feel they are getting somewhere. While the UN Assistance Mission in Afghanistan (UNAMA)'s 2012 report on the protection of civilians tracked only five drone strikes which resulted in civilian deaths and injuries, it did share its concerns with the International Security Assistance Force (ISAF) with the view that there is close cooperation between ISAF and the CIA and that the commander of ISAF has purview over any weapons used on his battle space.
"They are ultimately responsible from our point of view," said James Rodehaver, deputy director of UNAMA's human rights unit. "There is more than enough ability on the part of the forces here to track what sort of weapon is operating in their area and where the orders to order the strike came from," he told IRIN.
Because of a "decent flow of information", UNAMA does have a "direct line for advocacy and for messaging", he said, with concerns shared with ISAF presumably reaching responsible authorities outside Afghanistan, for example US military's Central Command (CENTCOM) in Tampa, Florida.
At times, the interaction works extremely well; at others, "it takes more effort", including delays while ISAF determines what it can and cannot share publicly.
But ISAF often provides UNAMA with relevant information, which helps the Mission confirm whether air operations - including drone strikes - occurred in a specific place at a specific time.
Advocacy with ISAF more broadly has been successful in getting international forces to change tactical directives, train its forces, and ensure Standard Operating Procedures are enforced so as to reduce civilian casualties.
Rodehaver urges that practical directives issued for aerial operations also be applied to drones for clearer policy guidance so that advocacy on drone strikes specifically can have a similar impact on operations.
But humanitarians are more skeptical. "The military will tell you, 'Those are not our guys. We don't know what to tell you'," one researcher said.
In places like Yemen, where there is no international military force on the ground, the challenges of finding an interlocutor are that much more acute.
One option for dealing with this challenge would be some kind of special operations interface, but logistically, this would be very difficult.
Special Forces on the ground are "wearing beards and blending in". Making their presence overt would open them up to attack and would expose the quiet consent of national governments who allow them to operate on their territory.
"But it's an important function the US government has to have," Holewinski says, "whether it is on the ground or somewhere else."
When her organization, which recently wrote a report on the unexamined costs of drones, tried to lobby US senators and members of Congress for greater oversight of the drone programme, not a single one responded to requests for meetings.
The way forward
The American use of armed drones has risen considerably in recent years. According to UNAMA, the number of weapons released by drones in Afghanistan jumped from 294 in 2011 to 506 in 2012, a 72 percent increase. But from the limited information available, it appears civilian casualties have not followed the same curve.
Several organizations, including The Bureau of Investigative Journalism and PakistanBodyCount.org, have tried tracking civilian deaths caused by drone strikes, but researchers have questioned their methodologies, which are largely based on analyzing press reports. As such, Howlenski argues, "nobody really knows" the true number of civilians killed by drones.
Still, the New America Foundation, which has among the most conservative estimates, says civilian casualties have accounted for about 14 percent of drone-related killings during Obama's tenure - down from 46 percent during the Bush administration. In 2012, that percentage was down to 1.7, though another 9.3 percent of casualties' identities were unknown, the Foundation said.
But concern over the use of drones has, if anything, increased. Researchers expect other countries to start using drones, if they have not already (Israel, for example, has reportedly used drone strikes in Gaza). With troops pulling out of Afghanistan in 2014, the trend is likely to continue.
"If you have fewer troops on the ground, and you have less transparency and [drones] is the way they increasingly fight the war, it will increasingly be an issue for civilians and as such for aid workers," Jackson said.
And while the US government is under more and more pressure to address civilian casualties of drone strikes, observers say the impact of drones on humanitarian action is almost surely not on the radar screen.
"We are... concerned that there are consequences to covert drone strikes that policymakers and the public may underestimate or fail to recognize," the Center for Civilians in Conflict wrote in its report.
It urged more disclosure on drone warfare in order to inform public debate and an inter-agency task force in the US that would evaluate, among other things, the strategic value and humanitarian impact of covert drone strikes compared to other counterterrorism approaches.
"A fundamental shift may be slowly, if haltingly, emerging," Modirzadeh said. "It is very difficult to do things in secret anymore and we are likely to see a legal and political debate about this in the years to come."
[This report does not necessarily reflect the views of the United Nations.]