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"Gender and Offender Status Predicting Treatment Success in Refugees and Asylum Seekers with PTSD," European Journal of Psychotraumatology 5: 20803 (Jan. 2014) [open access]
"Irish Midwives' Experiences of Providing Maternity Care to Non-Irish Women Seeking Asylum," International Journal of Women's Health, vol. 6 (Jan. 2014) [open access]
"Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia," AIDS & Behavior, vol. 18, no. 2 (Feb. 2014) [open access]
"Migration and Preterm Birth in War Refugees: A Swedish Cohort Study," European Journal of Epidemiology, Latest Articles, 14 Jan. 2014 [open access]
"Il Lavoro del Centro di Studio e Ricerche G. Devereux - Bologna Transcultural Psychiatric Team (BoTPT) con i Rifugiati e i Richiedenti Asilo: Per una Memoria Utile = Work of the Bologna Transcultural Psychiatric Team (BoTPT) with Refugees and Asylum Seekers: When Remembering Helps," Journal of Psychopathology = Giornale di Psicopatologia, vol. 19, no. 3 (Sept. 2013) [full-text]
- Note: In Italian, with an English summary.
"Periodontal Status of Tibetan Refugees Residing in Shimla, Himachal Pradesh, India," European Journal of General Dentistry, vol. 3, no. 1 (2014) [open access]
- Thematic Focus: Mental Health Aspects of RSD (2 Feb. 2014)
- Thematic Focus: Health (6 Jan. 2014)
We are watching the Olympics, at least little snatches of them when we can. The graceful ice dancers twirling in unison, the bird-like flights of the petite ski jumpers, the dangerously fast luge, the brutal bounce and spins of the free-style moguls. But if I were an olympic athlete, I would enter the biathlon. That's the cross-country ski endurance race punctuated by rifle shooting. Scott and I actually did have cross country skis when we were newlyweds in Chicago. Thanks to his Norwegian roots, we inherited them from his parents and used them on the Lake Chicago trails. And as much as I deplore gun violence in America, I did grow up with guns. From my first pellet gun to 22's to gauge shot guns, I was a decent shot. Many cans jumped off the railroad track where we set them up, and clay pigeons burst into shards when we shot skeet. So the idea of being strong enough to slog through the snow on skis, and sharp enough to hold a gun steady and shoot, appeals to me.
Mom and patient in ICU A panel of Kenya's leading paediatricians as we debate improving infant survival
Our Caring Community learning Scottish Dancing for an evening activity The orthopedic surgeon from Charlotte NC who operated on my mom two weeks prior, doing a teaching/surgical trip to Kenyatta the same day I was there for neonatal survival meetings. How crazy is that?????
Because my life is a biathlon. Most days are a cross-country endurance race through slippery and hazardous conditions. Up in the dark, prayer and maybe exercise, breakfast and plans for the day, devotions with kids. Day in and out at the hospital, covering rounds, checking labs, teaching. Sorting out call schedules, meeting with my team, mentoring younger docs. Covering RVA student health, appointments, immunization policies, working with students, projects. Laundry. Emails, planning WHM conferences, answering questions, accounting. Prayer meeting times, communication. Cooking dinner, creating atmosphere and wholeness. Cheering at games, thinking, reading, learning. Meetings. The marathon continues, day after day, striding through and over, pushing back against the path of least resistance.
Birthday for Jack's classmate
Sunday morning pre-Valentine treats First-place Basketball tournament Colleagues reporting on their trip to a Paeds conference in Germany Kenyan Raspberries, which are being off-loaded at Kijabe New surgical residents-note Erik second from left, who brought his daughter here for treatment from Congo and developed relationship and trust here and is now staying for his own residency My "Banquet Ask" at our Student Health Clinic
Then the beeper goes off, and it is time to shoot. In the war against disease, in the covert effort to save the lives of children, one has to go on the offensive. No matter how weary, to take a deep breath and line up the gun, to carefully but boldly pull the trigger. This week it was baby B, another gastroschisis, plummeting down. We were so close to our fourth save; he had been doing so well. But when the pager went off at church, I went into shooting mode, intubating, changing therapies, xrays, antibiotics, move to ICU. He stabilized temporarily, but then he needed blood. Fresh blood. And I was the only handy compatible donor, so another round of shooting, this time in the lab's blood donor room. Perhaps these shots were off target. Bahati died that night. Or perhaps they were on target, the target of showing love to this family, giving these parents the assurance that they and we had done everything possible.
More cross-country endurance, normal life, then boom, time to lift the gun. Our friend E.N., who took care of our family almost 16 years ago when Jack was born here, was having her baby. She's a little older than the average first-time mom, after many years of working for others, finally she has her own husband, a hard-fought struggle for pregnancy with many complications. But the day had arrived for delivery, and I went in to comfort, to wait, to celebrate, to be the one to receive her baby, from Scott who was doing her C-section, no easy matter. Baby M.J. was vigorous, crying even before he was fully "out". But my heart sank as I dried him off. Down Syndrome. Almost 14 years ago I was in the same situation, at my sister's delivery for moral support. Only when her sweet Micah was delivered, I knew he was not quite alright. Just like MJ, unexpected but certain subtle signs. I found myself once again comforting the mourning loss of the expected baby, but enjoining her to be thankful and anticipate blessing in the unique and loving baby she did get.
So that is the biathlon- straining on, sweating, muscles tired, rhythms, pull, the constant background of effort. Then the beeper, the call, the all-out push to defeat, to pull off victory. Ski, ski, ski, ski, shoot. Ski some more. Never quite balanced.
When the women finish this event, they fall over into the snow, and gasp and cry. That's how I feel some weeks. Stretched by the pace of a normal day, then energized by the adrenaline-rush-demands of a dehydrated burned baby coming to life as we push fluids into an emergency needle into his bone. Or challenged to come up with a plan for a nearly-dying patient. Then back to the steady pace of normal life, thinking about what we can pull together for a meal.
Maybe one day I'll have skis and a gun again. Or maybe for now, it will be pots and pans, and a stethoscope and a needle.
World Harvest Mission short-term-trip-leader and construction-guru-with-decades-of-experience Brad Wallace is planning a construction trip to Bundibugyo May 9-25. He has four people signed up and could use 4 to 5 more to help on building projects at Christ School. This is the first time in AGES that we've had an opportunity like this for handy construction-oriented people to bless Bundibugyo.
If you are interested please contact Brad. 703.969.5309 or firstname.lastname@example.org.
Our children studied in these classrooms. Our friends are the teachers who still faithfully bring the Kingdom of God to Bundibugyo one child at a time. Our team mentors young people, coaches sports, helps with the farms, leads studies. Our Ugandan boys have found Jesus here, have received the foundations for their lives. The buildings are not just buildings, they are the the venue for real change in real peoples' lives.
Thanks for considering!
Yarmouk*Assessment of Mental Health and Psychosocial Support Services for Syrian Refugees in Lebanon (UNHCR, Dec. 2013) [text via ReliefWeb]
"Assessment of Reproductive Health and Violence against Women among Displaced Syrians in Lebanon," BMC Women's Health 14:25 (Feb. 2014) [open access]
Assessment on Livelihood and Employment Condition of Syrian Refugees and Asylum Seekers Residing in Domiz Camp (Un Ponte Per, 2014?) [text via ReliefWeb]
Finding Solutions for Syrian Refugees: Resettlement, Humanitarian Admission, and Family Reunification (UNHCR, updated Feb. 2014) [text]
No End in Sight: Syria’s Refugees and Regional Repercussions, Washington, DC, 21 Feb. 2014 [access]
- Follow link for audio.
"Remarks by António Guterres, United Nations High Commissioner for Refugees," Briefing to the General Assembly (UNHCR, Feb. 2014) [text]
Syria: Welcome UN Resolution on Access to Aid (Human Rights Watch et al., Feb. 2014) [text]
Syrian Refugees in Turkey: Bracing for the Long Haul (UpFront Blog, Feb. 2014) [text]
UNHCR Urges Countries to Offer Admission to 100,000 Syrians from Next Year (UNHCR, Feb. 2014) [text]
"Yarmuk Refugee Camp and the Syrian Uprising: A View from Within," Journal of Palestine Studies, vol. XLIII, no. 1 (Autumn 2013) [full-text]
[Image credit: "UNRWA’s Commissioner General Firmly Reiterates the Need for Unhindered Humanitarian Access after Visiting Yarmouk Camp," UNRWA, 24 Feb. 2014]
- Regional Focus: Syria (18 Feb. 2014)
1. Jargon is generally accused of being 1) a sign of fuzzy thinking and 2) a tool for oppression and exclusion. Sometimes even by me. It has struck me lately, though, that jargon is also a sign of people who care so much about a particular topic that they want to get their vocabulary exactly and precisely correct. Focusing obsessively about whether people more likely to be infected with HIV are best called most at risk populations, key populations, or risk groups is another form of genuinely caring about accuracy in the work you do. Is it a useful form of caring? Beats me.
2. For reasons that are probably obvious, I’ve been thinking a lot about bureaucracy lately. I continue to believe that structures and process are what differentiate a functioning organization from a cult of personality. That being said, where’s the line between the structures that help and the structures that suffocate? Probably there are papers written about this. I see Google Scholar in my future. (This happens to me approximately a hundred times a day – I have a thought and realize someone else must have thought it better. It’s a miracle I every get anything done with all the web searches I do.)
3. I was at a trilingual meeting the other day that was attempting to interface with an international conference call. The interpreter was somewhat overwhelmed by the challenge. Some problems really can be solved by nifty new tech. On a related note, I used the translate function on chrome to spend quite a while (successfully) tracking down a corruption scandal on a local web forum.
21 years ago today Luke Aylestock Myhre made his entrance into the world, a month early (but not three months early which he had been threatening), after a difficult labor that nearly ended in a C-section, on a snowy day in Baltimore. He was beautiful and perfect but a little early and punky, so whisked off to the nursery in an incubator. 21 years later he was back in Baltimore to interview for medical school on another snowy day. He's approximately thirty times the size he started and finally sleeps a bit longer, but most things haven't changed significantly. We still revel to watch the new steps with wonder and hope, still find our hearts wrapped in his flesh, still banter our points of view, still enjoy his company more than just about any other in the world. But now we have to do that from seven thousand miles away. We sent postcards and a few fun things in the mail weeks ago. That's how we have to do Birthdays, right? I thought that was fine.
Then this morning, a bustle to get Jack out to a basketball tournament, breakfast, laundry on the line, be at rounds by 8. I started writing a note on a baby and wrote down the date: 8/2. 8th of February, hit me like a punch in the gut.
Our firstborn son is an official adult today. It's another milestone we'll miss.
He'll be fine, with friends and work and hopefully a good dinner. We'll be fine too, distracted by most of the last 8 hours in the hospital on call. But it's another little shift in our family. And while we celebrate survival, celebrate independence, celebrate the beginning of a future, we also grieve. As all parents do, who look away from the incubator to blink and find that the little person inside is riding a bike and reading, is making slingshots and climbing trees and falling out, is writing poems and scoring goals, is climbing mountains and solving equations, is flying across continents and learning new languages, is leading groups and captaining teams.
Because he is his own person. A person we are proud to know, a person whom God has gifted in a hundred unique ways, a person who will cut to the core, see the problem creatively, live to the fullest, invest in his friends, and not lose sight of the real and the important. A person we believe in, no matter how many miles or months separate us.
Image credit: Kat Selvocki, via FlickrI have just added cross-references to my 2014 posts, where relevant. This means that when you are viewing a post that has either a particular regional or thematic focus, the cross-reference will point you to the last post that covered the same region or theme. So, for example, the 2 Feb. 2014 post on detention directs readers to the related 14 Jan. 2014 post, while the 31 Jan. 2014 post on Syria directs readers to the related 23 Jan. 2014 post.
Of course, if you click on the subject labels for "detention" and "Syria," you'll accomplish the same thing. But most regional posts cover broader areas - Africa, Americas, Asia, Europe, MENA, Oceania - and some thematic posts don't always have one all-encompassing subject term to capture the topics covered (for example, "law/policy items," "general items," "gender issues," etc.). So I thought creating a trail of breadcrumbs, so to speak, might be useful for those of you who are interested in perusing these more general overviews.
That said, using the subject terms is still a good way to navigate the site since other types of posts - those that highlight theses or new issues of periodicals, for example - may still include references to "detention" or "Syria" which you might overlook if you just rely on the thematic and regional groupings I compile.
I take subject terms from the International Thesaurus of Refugee Terminology (ITRT) to "describe" the references listed in my posts. Having access to a standardized vocabulary is useful for indexing purposes since it means I don't have to decide which terms to use each time I prepare a post, and I have something to refer to if I forget which terms I used previously! The downside of a thesaurus is that it doesn't evolve as quickly as language does. In the ITRT's case, it hasn't been updated in a long time - and it won't be, since that was the responsibility of the UNHCR library, which closed its doors in 2009.
Happily, this blog is also searchable. The available search features have evolved over the years. Originally, I just relied on the standard search box that came with the Blogger application (in the toolbar, on the top left). But it proved to be unreliable, so I added the site search feature to the sidebar on the right. At some point, this too didn't seem to work properly! In the meantime, the search box in the top toolbar was tweaked by Blogger, and now allows results to be sorted by date as well as relevance, which I find very useful. So I recommend using it over the sidebar search (although I don't want to remove the latter since it's good to have a back-up!).
So cross-references, and multiple browse and search options are all available. And even more tips for locating information in this blog are provided in the FAQ. But if for some reason you still can't find what you are looking for, please don't hesitate to ask for help!
"Global Strategy to End the Immigration Detention of Children," Side Event at UN Human Rights Council, Geneva, 14 March 2014 [info]
Country Profiles (Global Detention Project, Feb. 2014) [access]
- Three new profiles are available on Hungary, Morocco and New Zealand.
Detention of Asylum Seekers: Analysis of Norway’s International Obligations, Domestic Law and Practice (NOAS, 2014) [text]
"Exporting Detention: Australia-funded Immigration Detention in Indonesia," Journal of Refugee Studies, vol. 26, no. 1 (2013) [free full-text]
Immigration Detention: Behind the Record Numbers (Center for Migration Studies, Feb. 2014) [text]
"Men and the Emotional World of Immigration Detention," Migration: A COMPAS Anthology (COMPAS, 2014) [text]
CONTENTION Research Project (Migration Policy Centre & Odysseus Network) [access]
- Officially kicked-off today, this project aims "to inform, analyse and compare the EU Return Directive based judicial control of pre-removal detention of third-country nationals in 11 EU Member States (AT, BG, BE, CZ, DE, FR, IT, NL, SK, SI and UK) with a view to improving it, in particular regarding the control of the length of detention." See also the most recent MPC newsletter for a call for case law contributions.
Detention Logs: Inside Australia's Immigration Detention [access]
- "We publish data, documents and investigations that reveal new perspectives on conditions and events inside immigration detention."
- Thematic Focus: Detention (6 Feb. 2014)
Tagged Events & Opportunities, Publications and Web Sites/Tools.
I got told off recently for shopping at H&M because of some sweatshop / child labour scandal (a burden I share with Beyonce who has also been criticised for her H&M links). But is a boycott really the right individual action?
Two new(ish) papers look at the impact of government bans on child labour in India:
One economics paper by Bharadwaj, Lakdawala, and Li (via Berk Ozler) looks at the impact of India’s Child Labour (Prohibition and Regulation) Act of 1986. They find that the ban led to a decrease in child wages and an increase in child labour. This is consistent with the theory that families use child labour to reach subsistence levels - so a ban which leads to a reduction in child wages, will make families make their children work more to earn the same amount and reach that subsistence level.
Second is a note by my colleagues (Ian MacAuslan, Valentina Barca, Yashodhan Ghorpade and Gitanjali Pande) based on qualitative fieldwork in India (150 interviews and focus groups with both children and adults). Their findings support the results of Bharadwaj et al - parents make rational trade-offs, child labour is driven by household poverty, and outright bans might be counter-productive - better to invest in social protection and improving the quality of schooling.
What does all of this imply for me and my new H&M jumper? I'm not really sure. I asked the question a few years ago in Juba, and further quick googling hasn't got me any closer to an answer. I suppose the theory of change is that individual boycotts could force H&M to improve their procurement and make sure no child labour is involved. But this could either lead to those children leaving the factory and going to school, or perhaps more likely and in line with these two papers, a reduction in the going wage rate for children, and an actual increase in child labour.
Any ideas? References? Once again, I'm left wishing that there existed some rigorous impartial GiveWell-style analysis for consumption decisions so I could outsource some more everyday moral dilemmas and not have to do the thinking myself.
When was the last time you noticed the air you are breathing ? Do you know how it affects you and your health?
Egypt leads the list of the most polluted cities in the world, in terms of particulate matter. Moreover, according to the latest report by the WHO, every Cairo resident’s daily share of air pollution is equivalent to smoking a pack of cigarettes a day.
This motivated the makers from icealex hub in Alexandria Egypt to work on solving this global problem.
Their solution: Build an air quality monitoring kit
The kit uses Arduino, gas, humidity and temperature sensors, RGB LEDs and an LCD screen to detect and measure air pollution. The Afrimakers team wishes to understand and map pollutants in their local environment and identify main pollution sources and best strategies of individual protection.
The idea was inspired by the Air Quality Egg project, which is based on Arduino, allowing anybody on the world to monitor CO2 and NO2 levels around his house, and share the results online, to be compared with the rest of the world records.
What distinguishes the prototype designed by the Afrimakers team from the AirQuality Egg’s, is the reduced cost and the outreach to local schools, communities of makers and learning centers for children. The same components of the kit can be used for many other projects which also reduces the investment for schools.
The team has a detailed documentation for this project and aims to create several learning modules for this project that could be used in schools and video tutorials.
This week, the project developers are visiting the makers in Nairobi and organizing a series of workshops in collaboration with Fablab Nairobi and iHub in order to improve their prototype and reflect about how it can be locally-driven.
If you would like to build your own air pollution monitor you can follow the instructions made by the icealex team. In case you don’t have access to the same sensors or materials we encourage you to “fork” their project here and and adapt it to your local resources.
A main goal of the team and their project is to encourage makers and local communities to dream, make and share meaningful projects that are solving big problems and are extremely affordable.
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Afrimakers is an initiative to empower African makers to develop sustainable projects and provide solution for local challenges by training more than 100 mentors in 10 African countries on running science & tech workshops for private and public schools students.
Shoghik is from Dalarik in the Armavir region (Armenia). She lives with her husband, their two children (3 and 7 years old), her parents-in-law and brother-in-law.
Shoghik works as a teacher at the village local school, where her mother-in-law also teaches. Her husband is a policeman. However, their salaries are too low to sustain their living expenses. So, Shoghik and her family are also involved in cattle breeding, in breeding pigs and piglets, and in the cultivation of alfalfa, peaches and apricots. The family sells the agricultural products in the local market, which is an important source of their income.
To continue running the agribusiness in a sustainable way, Shoghik needed a loan of 3,000 USD to purchase five steers, to buy forage for the livestock, and to purchase fertilizers.
Our loan to Shoghik was one of the 42 micro-finance loans we issued this week, to women and women’s groups in Vietnam, Armenia, Kyrgyzstan, El Salvador, Tajikistan, Kenya, Cambodia, Uganda, Peru, Ecuador and Costa Rica.
As food security is the basis for all well-being and any development for all regions, all loans went to women working in agriculture:
The background of this project, you find in the kick-off post
Water and Sanitation is link to extreme poverty. You can't break the cycle without providing access to water and sanitation.
Shockingly, there are 2.5 billion people today who don’t have access to a safe means of disposing human feces, which contain pathogens that cause diarrheal disease. Access to sanitation is one of the most off-track of the Millennium Development Goals. Over 1 billion people defecate in the open, contaminating the area where children play, the agricultural fields where people gather food and the rivers used for drinking water.
Thousands of children die every day from related diarrheal disease. In infants it can cause malnutrition, which can lead to stunted growth and impaired cognitive development with negative consequences for school performance as well as poor health outcomes later in life. A recent World Bank report finds that open defecation can account for much or all of the excess stunting in India.
Rising inequality translates to rising extreme poverty. The numbers and percent of population living in extreme poverty is going up.
As of this writing, the exchange rate is 30 Baht=US $1. So a normal delivery package at Bumgrungrad is US $1,196, while a C-section birth is US $3100. I was quite impressed with my experience at Samitivej hospital for Tristan’s birth in 2011. I imagine the facilities in Bumrungrad, which is considered a higher-class (5star) facility, must be better.
In comparison, when I had Saoirse in March this year in St Luke’s Hospital (Bonifacio Global City, Taguig, Manila) the quote for a C-section delivery is PHP155,000-185,000 (US $3789-$4512) for 4-5 days’ hospitalization including delivery, recovery and nursery room charges, medicines and supplies used in the delivery room, hospitalization expenses (private room) and professional fees (OB-gyne, Pedia, Anesthesiologist). St Luke’s BGC is a similarly-billed 5star medical tourist hospital in Manila.
It feels like we’ve been touring hospitals this year. Six months ago we spent a lot of time in St Luke’s Hospital in Manila (also considered a 5star medical tourist hospital). I had the baby there while Keith had a series of cardiac checkups and screenings. We all had dental work done too. Now, Keith was evacuated to Bangkok’s Bumrungrad because of Dengue Hemorrhagic Fever. What a year. Well.. here is Bumrungrad in pictures.
I love these popsicles once in a while. They’re one of the few interesting ice cream brands I’ve seen in Cambodia. By interesting I mean the flavors are local, not the typical imported vanilla chocolate strawberry. They carry red bean, sweet yellow corn, durian, taro (this is the least tasty flavor unfortunately), and black glutinous rice. I’ve only ever seen them in the bigger TELA gas station mini-marts or at the Paragon grocery store (behind the Royal Palace in Phnom Penh).
One iced tea costs 25 Baht (~US $0.83) from a street vendor just outside Bumrungrad Hospital in Bangkok.
People who are raised in the industrial world and who get enthused about systems thinking are likely to make a terrible mistake. They are likely to assume that here, in systems analysis, in interconnection and complication, in the power of the computer, here at last, is the key to prediction and control. This mistake is likely because the mind-set of the industrial world assumes that there is a key to prediction and control.
- Donella H. Meadows (2008), Thinking in Systems: A Primer
The humanitarian system will collapse; if that sounds catastrophic, then perhaps you’re looking at it the wrong way. Humanitarian organisations aren’t inherently worthy, any more than any type of organisation is inherently worthy. Organisations are only delivery mechanisms for goods, and it’s the goods themselves that have value, and the success of the organisation in delivering those goods determines their own value. This is true whether the goods in question are health services, power tools – or humanitarian principles.
“Humanitarianism” isn’t a good in the way that health services or power tools, however. It might be more useful to think of humanitarianism as a disease, one that we want to spread so that it infects all of human society. A lot of progress has been made in this way regarding (for example) human rights – think of the near-universal state-level condemnation of slavery or torture (although there are frequently exceptions to prove the rule). This progress is always contingent, since diseases can go into remission, and the factors which make their progress possible change over time.
Humanitarian organisations are valuable only in so far as they act as vectors for the transmission of humanitarian principles. The physical goods and services that humanitarian organisations provide can be and frequently are provided by other types of organisations. There’s nothing inherently wrong with that, and that trend will continue to grow; and that’s one of the things that we need to take into account when we think about the future of humanitarianism (and think about it a lot more deeply than we do at present).
You could argue that humanitarian principles are how humanitarian organisations distinguish themselves in the marketplace; but that would be to accept the logic of late-stage capitalism, which I suggest you don’t. In fact, we might argue that late-stage capitalism is a rival infection, one which has been more successful than humanitarianism; successful enough that nobody now blinks an eyelid when Bill Gates declares that development “now is more like a business”.
The reason that argument fails is because it puts the cart before the horse. Humanitarian principles aren’t a product of humanitarian organisations; humanitarian organisations are the product of humanitarian principles. If the “goods” that humanitarian organisations were set up to deliver are humanitarian principles, and it seems likely that those organisations will wither and die over time, then what we need to develop is not are alternative delivery mechanisms, new vectors for the transmission of humanitarian principles.
This focus on principles is an old, old song – but this is a brand new tune. This isn’t about an MSF-style back-to-basics approach to humanitarian principles; I appreciate their focus, but it’s essentially backward-looking, and therefore doomed to failure given the changes in our external circumstances. This is about a wholly new approach to humanitarianism, one which does not locate its principles in the attitudes and actions of institutional stakeholders, but in the wider culture.
This has to be the future of humanitarianism: not a tower guarded jealously by a self-selected set of organisations, but a “people’s humanitarianism” that guards the world. This requires a massive shift not just in the way in which the existing humanitarian system organises itself, but a change in the way in which we think about humanitarianism. It also needs a massive communications effort to ensure that those principles survive in what is often rocky ground.
I don’t think the humanitarian community is capable of implementing these changes (for reasons outlined in this post), and the alternatives on offer are frankly limited. As a starting point, my prescription is to move from organisations to networks as the most effective vectors for those principles. Even if not all the nodes in those networks will themselves be humanitarian organisations, we need to ensure that humanitarian principles infect as many nodes as possible, creating a humanitarian pandemic. I think I’ve exhausted that metaphor, and so I’ll end this post here.
In the view of the humanitarian community, what distinguishes our work from other actors providing similar goods and services (such as the military) is the basis on which it is provided. One way of framing this is the difference between humanitarian assistance from the provision of relief: the latter can be done by anybody for any reason, while the former can only be carried out by specific types of organisation based on clearly articulated principles.
Unfortunately the recipients of aid do not share this view. The available evidence suggests “that while in some settings local people differentiate among international actors, they are generally more concerned with what is being provided than who are the chosen agents of assistance and protection” (Donini et al. 2005, Mapping the Security Environment). This suggests that, regardless of whether aid recipients are justified in their views, humanitarian principles exist largely to provide a philosophical framework that enable traditional humanitarian actors to justify their actions.
Aid provided by avowedly non-humanitarian actors – such as the extensive social security provision by Hezbollah in Lebanon – causes great discomfort because it establishes an overtly clientilist relationship. Even with the best intentions, however, it is inevitable that some degree of clientilism is generated by such relationships. The Listening Project’s recent report “describe[s] how assistance begins as a boost to people’s spirits and energies, but over time, becomes entrenched as an increasingly complicated system of reciprocated dependence.” (Anderson et al. 2013, Time to Listen, p2)(PDF)
While agencies are not unaware of this, the standard response is that “there is a tendency to criticise relief for failing to improve the situation and enable a movement towards recovery or development, when humanitarian aid was never claiming to have that as an objective, or is a wholly inappropriate instrument for that purpose. The problem lies not with relief and its failings, but with the lack of other forms of international engagement.” (Harvey and Lind 2005, Dependency and humanitarian relief, p17)(PDF) This may well be the case, but it is largely irrelevant to the recipients of aid.
It is increasingly clear to humanitarian actors that the needs of those recipients are frequently not the same as those met by the supply-driven aid system. Affected communities frequently point out that amongst their most pressing requirements are employment opportunities or general security, neither of which humanitarian aid can deliver. More imaginative responses are now being implemented, such as cash transfers, but these have been held back by the humanitarian community’s limited understanding of the wider social, political and economic forces acting on affected communities.
The Listening Project report goes on to say that a number of aid recipients “say that they believe aid providers depend on the recipients’ “needs” because responding to these needs justifies the providers’ existence and work.” The point is not that aid generates clients, or that humanitarian principles have been undermined by western military policy, or that humanitarian organisations are viewed with ambivalence by other stakeholders; these are trivially true, and have been discussed at length elsewhere.
What is critical is that these developments demonstrate that the narrative which the humanitarian community has created for itself does not match the narrative created by those outside the community, particularly aid recipients. Increasingly the humanitarian community is not in control of the narrative around humanitarian action, specifically because of the advent of the information age, which gives rise to two related crises:
In the last decade, the competing narrative has been driven by the public in early-industrialised countries (facilitated by failure-focused media coverage): aid is ineffective, and the solution is mechanisms which improve effectiveness, e.g. managerialist projects such as the UN’s humanitarian reform efforts. In the next decade, however, that narrative will be overtaken by the voices of aid recipients. Thanks to the research cited above, we are beginning to have a better understanding of what those voices are saying; but the only thing we can be certain of is that they will tell a completely different story: “effectiveness” is not their god, but participation is.