How can humanitarian agencies ensure that they help the most vulnerable and most in need rather than simply the easiest to reach or those in the least risky environments?
A few weeks ago, the UN Refugee Agency (UNHCR) declared that for the first time since the Second World War, the number of people forcibly displaced has exceeded 50 million.
This number is startling and has implications for governments and populations all across the world, but it also holds great meaning for humanitarian agencies. In the face of growing numbers of people in need, who should relief organisations target and how? And what should inform the decisions they make?
Shedding some light on these questions and others, Médecins Sans Frontières (MSF) recently published the report Where is Everyone? Based on interviews with 116 humanitarian workers and focussed around humanitarian responses to the crises in South Sudan, the Democratic Republic of Congo, and Jordan, the report's findings ultimately make for uncomfortable reading.
Amongst other things, for instance, MSF concludes that relief agencies' "technical capacities were not as they should be" though not because of insufficient funding; that "risk aversion was pervasive...meaning that agencies were choosing to prioritise the easiest-to-reach over the most vulnerable"; and that "the UN was at the heart of the dysfunction".
In order to shed light on the issue and answer MSF's call for debate around its findings, Think Africa Press asked a range of humanitarian experts and practitioners:
"How can humanitarian agencies ensure that their operations help the most vulnerable and most in need rather than simply the easiest to reach or those in the least risky environments?"
Raouf Mazou, Representative for UNHCR, Nairobi
The MSF report is a welcome reminder of the importance of early humanitarian action at the onset of a crisis. It is indeed at this crucial stage that the greatest amount suffering is experienced and the largest number of deaths occur. In truth however, responses to large-scale emergencies are invariably inadequate, insufficient and late. It is rare that 'acute displacement emergencies', such as the ones the world has experienced too often in recent months, are preceded by adequate measures of preparedness, regardless of how many early warning signs there might have been. As a result, once the crisis has started, humanitarian agencies are left playing catch-up.
The ability of humanitarian actors to mitigate the consequences of crisis depends primarily on access and in that regard security and logistical constraints should not be downplayed. Humanitarian actors have paid a very high price in Somalia, which as a result has meant the crisis there is among those with the highest level of 'remote management'.
Logistical constraints can partially be overcome with financial resources. In parts of South Sudan, with no roads in the rainy season, food and other relief assistance had to be airlifted at steep costs. Should more have been done?
Could the response have been better coordinated? Probably. The MSF report and other evaluations done will help draw lessons and improve future interventions.
However, the more fundamental question in my view is over how long a 'massive response' can be sustained in a context of multiple 'acute displacement emergencies' By 2013, contributions to the refugee crisis in South Sudan began to dwindle as donors prioritised other emergencies.
The assumption made in the report that as the humanitarian system grows and expands "surely its capacity to meet these challenges should also be growing" is, in my view, erroneous.
It is precisely the contrary which may be observed if the humanitarian aid system does not adapt. A model based solely on training and deploying a growing number of 'emergency response experts' will simply not work, and some of the successes of the humanitarian response in Jordan seem to be attributed to the strong role of the government.
Yet state institutions are often ignored and sidelined in humanitarian emergency responses to the detriment of the sustainability of the gains made during the crucial first days of an emergency.
Finally, pre-existing long-term programmes in the geographic area affected by the crisis should not necessarily be seen as hampering or slowing down emergency response.
The unprecedented challenges presented by the Syria crisis have re-emphasised the importance of involving development actors from the onset of humanitarian responses.
Development actors, which have greater financial means, also often bring a welcome perspective underpinning the fact that humanitarian assistance is not an end in itself and therefore a 'solution' is needed as early as possible to bring normalcy to paused lives.
Sandrine Tiller, Programmes Adviser, Humanitarian Issues, MSF (UK), co-author of Where is Everyone?
From the research we have done, we have found that the organisations that were best able to respond to the most vulnerable shared a few common traits: Firstly, they were looking for problems. In a good way! Getting out of the office, out of the hospital compound, and off the beaten track. MSF's own programmes improved as soon as good surveillance systems were set up. Then those who were too sick, tired or scared to come to the hospital could get assistance.
Secondly, the most successful brought with them some assistance (just in case) and a flexible assessment methodology.
The UN's Rapid Response to Population Movements mechanism in DRC, for instance, impressed us with its capacity to identify a wide variety of needs and provide short-term, flexible responses. The ability to assist immediately is really valued, particularly by hard-to-reach populations who may not have seen any assistance in a while.
Finally, the most effective efforts tried to expect the unexpected. Being able to respond quickly to a changing situation is the key to a good response, and current funding systems and institutional arrangements really mitigate against that. Donors should be demanding flexibility, as it is proof that a response is really adapted to the needs.
David Rieff, author of A Bed for the Night: Humanitarianism in Crisis
I have always thought that MSF's understanding of humanitarian action, and most particularly MSF/France's understanding of it, was both operationally more focused and intellectually more modest (this despite its reputation for arrogance) than its peers within what Alex de Waal has called the 'humanitarian international'.
MSF resisted attempting to rebrand itself as a human rights agency - a decision that in my view brought such grief to CARE. Unlike Oxfam, MSF has accepted its limitations and not flattered itself it can do everything from relief through development to global campaigning on virtually every subject that affects the poor and still maintain its core humanitarian competencies.
And in contrast to the International Rescue Committee (IRC), MSF has nowhere near the same degree of indenture to national governments and corporate funders.
Having said all that, I think Where Is Everybody? is a deeply unsatisfactory and, in important ways, a hubristic, naïve, self-referential, and self-flattering report.
Let me proceed in reverse order and take the self-flattering first. The report is of course right to point out that the external constraints relief agencies operate under "are not always insuperable."
But they are not always 'superable' either and there is something churlish as well as somewhat inaccurate in the report's implication that MSF goes where others fear to tread. In some cases, it is MSF that has left and other agencies have remained, as Bob Kitchen of the IRC pointed out with understandable exasperation was the case in Somalia.
Moving on to the self-referential, the report asserts that: "The core criterion for judging the success or failure of a humanitarian operation should be impact: in particular how many lives were saved."
But while this should indeed be the criterion of a medical relief agency, it is by no means clear that it should be applied to other agencies with different mandates. In most emergencies, the 'acute' phase when many of those in need of assistance are at risk of dying is relatively short.
On MSF's logic, the organisation should then withdraw. The fact that MSF, quite correctly, rarely if ever does any such thing illustrates the incoherence of such a blanket claim. To give a specific example, in the report's Jordan case study, MSF calls for relief agencies to focus more with urban refugees and displaced persons. But few of them were or are at risk of imminent death.
The naïvety of the report is to me the most shocking. MSF denounces the UN in general and UNHCR in particular for incompetence both in terms of the (counter-productive) rules under which it operates and the poor quality of its personnel. But this is not news.
The UN has from its founding had failure all but inscribed in its DNA. Its performance is no worse on humanitarian issues than on peacekeeping or the other core concerns of the world body.
And the UNHCR has been a broken organisation for more than a decade. To denounce it in 2014 on these grounds is simply silly. It would have been far more useful for MSF to suggest ways to work around the UN than to demand improvement from so irredeemable an institution.
More naïve still is the report's emphasis on the report's emphasis on the growth in terms of budgets of the humanitarian 'industry'. To begin with, the humanitarian international is to private industry what an antiquarian bookseller is to Amazon.
And naïvety segues into hubris when the report starts by making the point that a shortage of funds is often not the key determinant to the success or failure of a humanitarian operation (and wasn't in the three cases studied), but then largely glosses over the reality that humanitarian agencies are too small to deal with the multiplication of crises that has occurred since the turn of the century.
Even more hubristic is the report's failure to acknowledge the degree to which relief agencies' options for operating differently have been increasingly hamstrung by the fact that over the past two decades they have increasingly found themselves in a much weaker position vis-à-vis the governments or insurgent groups at whose sufferance they work.
Justin Armstrong, Research Associate, King's Policy Unit, King's College London
Those who are truly the most vulnerable are likely to be beyond the reach of any external aid organisation - MSF included - in many crises, particularly conflicts.
They will be those who can't access whatever services might exist and cannot easily be found to have their needs measured and efficiently addressed.
These limitations inherent in any attempted humanitarian response within a complex and volatile crisis should not be taken as justification for being content to simply respond to the most readily apparent and accessible needs.
Humanitarian organisations should always be unsatisfied with that. Even attempting to meaningfully respond to the needs of the most vulnerable would rather mean relentlessly pushing for access to those beyond the last feeding centre or water point, and beyond the limitations of the existing humanitarian infrastructure.
If nominally humanitarian organisations are to actually operate according to their stated principles of impartially and independence, they must face such grim choices. They would have to base their choices on the extent and urgency of needs, leaving aside their own broader goals, as well as those of local officials, the UN, or donors.
They - and crucially their donors, public and private - would need to be willing to accept programmes with higher start-up and logistical costs, erratic timetables, uncertain outcomes, and sometimes unmeasurable impacts.
They could offer responses, not predetermined outputs and outcomes, and they certainly could not offer all of what the rote and inflated rhetoric of modern aid claims to offer.
Perhaps even more difficult would be the necessary clear and candid discussion of the difficult choices such an approach would require. Making a choice to prioritise the most vulnerable over more accessible low-risk needs where more cost-effective and likely successful interventions are possible will never be easy, and the humility that such approach would require is too often in short supply within humanitarian circles.
Hugh Macleman, Head of Humanitarian Policy, British Red Cross
The British Red Cross is part of the International Red Cross and Red Crescent Movement, the world's largest independent humanitarian network, and we have operations in some of the most insecure regions of the world.
Our Fundamental Principles of humanity, neutrality, impartiality and independence, along with our network of around 30 million community-based volunteers, grants us unique access to many hard-to-reach areas, including across frontlines in conflict. We believe it is not just our presence but our proximity to communities in need that ensures that we can fulfil our humanitarian mission.
This is not always easy and our staff and volunteers still often take extraordinary risks to reach those worst affected by conflict or disaster.
The Syrian Arab Red Crescent, for example, together with the International Red Cross and Red Crescent Movement reaches close to 3 million people inside Syria with aid each month (including food parcels, water supplies and health services). This is despite the loss of 44 staff and volunteers who have died since the beginning of the conflict while trying to provide aid to people from all affected communities.
With assistance from the British Red Cross, the International Committee of the Red Cross and South Sudan Red Cross are also working across South Sudan, where there have also been reports of civilians being attacked, including patients in hospitals.
When aid workers are targeted, it becomes very difficult for humanitarian agencies to continue working. There are some basic security measures that can be taken, but sometimes it does become necessary to suspend operations.
When this does happen we urge all parties to the conflict to regard the International Red Cross and Red Crescent Red Cross Movement as an impartial entity which provides assistance to all in need. Last year we launched a Joint Call on Syria calling on all parties to respect our humanitarian mission.
Safer access to those in need must be a collective responsibility, honoured by all, especially States. There is significant capacity to deliver assistance directly, quickly and effectively, but this cannot be done if aid workers are not granted safe, quick and unimpeded access to those in need.
About the Authors
James Wan is the Senior Editor for Think Africa Press. He is a British-born Mauritian and has particular interests in China-Africa relations, human rights and social theory.
In 2013, he was shortlisted for The Guardian's International Development Journalism Competition. You can contact him at email@example.com and follow him on Twitter at @jamesjwan.
STORY_BIO: Shoaib Rokadiya is a freelance journalist and researcher with a particular focus on identity politics, post-colonial thought and human rights. His work has been published in The Scotsman and in an anthology of contemporary creative writing. You can contact him at firstname.lastname@example.org.