Humanitarian aid

Henry Dunant

The beginnings of organized international humanitarian aid can be traced to the late 19th century. Early campaigns include British aid to distressed populations on the continent and in Sweden during the Napoleonic Wars,[10][11] and the international relief campaigns during the Great Irish Famine in the 1840s.[12][13]

In 1854, when the Crimean War began[14] Florence Nightingale and her team of 38 nurses arrived to Barracks Hospital of Scutari where there were thousands of sick and wounded soldiers.[15] Nightingale and her team watched as the understaffed military hospitals struggled to maintain hygienic conditions and meet the needs of patients.[14] Ten times more soldiers were dying of disease than from battle wounds.[16] Typhus, typhoid, cholera and dysentery were common in the army hospitals.[16] Nightingale and her team established a kitchen, laundry and increased hygiene. More nurses arrived to aid in the efforts and the General Hospital at Scutari was able to care for 6,000 patients.[15] Nightingale's contributions still influence humanitarian aid efforts. This is especially true in regard to Nightingale's use of statistics and measures of mortality and morbidity. Nightingale used principles of new science and statistics to measure progress and plan for her hospital.[16] She kept records of the number and cause of deaths in order to continuously improve the conditions in hospitals.[17] Her findings were that in every 1,000 soldiers, 600 were dying of communicable and infectious diseases.[18] She worked to improve hygiene, nutrition and clean water and decreased the mortality rate from 60% to 42% to 2.2%.[18] All of these improvements are pillars of modern humanitarian intervention. Once she returned to Great Britain she campaigned for the founding of the Royal Commission on the Health of the Army.[17] She advocated for the use of statistics and coxcombs to portray the needs of those in conflict settings.[17][19]

Henry Dunant at Solferino

The most well-known origin story of formalized humanitarian aid is that of Henri Dunant, a Swiss businessman and social activist, who upon seeing the sheer destruction and inhumane abandonment of wounded soldiers from the Battle of Solferino in June 1859, canceled his plans and began a relief response.[20] Despite little to no experience as a medical physician, Dunant worked alongside local volunteers to assist the wounded soldiers from all warring parties, including Austrian, Italian and French casualties, in any way he could including the provision of food, water, and medical supplies. His graphic account of the immense suffering he witnessed, written in his book A Memory of Solferino, became a foundational text to modern humanitarianism.[21]

Cover of the original edition of A Memory of Solferino (1862)

A Memory of Solferino changed the world in a way that no one, let alone Dunant, could have foreseen nor truly appreciated at the time. To start, Dunant was able to profoundly stir the emotions of his readers by bringing the battle and suffering into their homes, equipping them to understand the current barbaric state of war and treatment of soldiers after they were injured or killed; in of themselves these accounts altered the course of history.[22] Beyond this, in his two-week experience attending to the wounded soldiers of all nationalities, Dunant inadvertently established the vital conceptual pillars of what would later become the International Committee of the Red Cross and International Humanitarian Law: impartiality and neutrality.[23] Dunant took these ideas and came up with two more ingenious concepts that would profoundly alter the practice of war; first Dunant envisioned a creation of permanent volunteer relief societies, much like the ad hoc relief group he coordinated in Solferino, to assist wounded soldiers; next Dunant began an effort to call for the adoption of a treaty which would guarantee the protection of wounded soldiers and any who attempted to come to their aid.[24]

After publishing his foundational text in 1862, progress came quickly for Dunant and his efforts to create a permanent relief society and International Humanitarian Law. The embryonic formation of the International Committee of the Red Cross had begun to take shape in 1863 when the private Geneva Society of Public Welfare created a permanent sub-committee called "The International Committee for Aid to Wounded in Situations of War". Composed of five Geneva citizens, this committee endorsed Dunant's vision to legally neutralize medical personnel responding to wounded soldiers.[25][26] The constitutive conference of this committee in October 1863 created the statutory foundation of the International Committee of the Red Cross in their resolutions regarding national societies, caring for the wounded, their symbol, and most importantly the indispensable neutrality of ambulances, hospitals, medical personnel and the wounded themselves.[27] Beyond this, in order to solidify humanitarian practice, the Geneva Society of Public Welfare hosted a convention between 8 and 22 August 1864 at the Geneva Town Hall with 16 diverse States present, including many governments of Europe, the Ottoman Empire, the United States of America (USA), Brazil and Mexico.[28] This diplomatic conference was exceptional, not due to the number or status of its attendees but rather because of its very raison d'être. Unlike many diplomatic conferences before it, this conference's purpose was not to reach a settlement after a conflict nor to mediate between opposing interests; indeed this conference was to lay down rules for the future of conflict with aims to protect medical services and those wounded in battle.[29]

Original Geneva Conventions

The first of the renowned Geneva Conventions was signed on 22 August 1864; never before in history has a treaty so greatly impacted how warring parties engage with one another.[30] The basic tenents of the convention outlined the neutrality of medical services, including hospitals, ambulances, and related personnel, the requirement to care for and protect the sick and wounded during the conflict and something of particular symbolic importance to the International Committee of the Red Cross: the Red Cross emblem.[31] For the first time in contemporary history, it was acknowledged by a representative selection of states that war had limits. The significance only grew with time in the revision and adaptation of the Geneva Convention in 1906, 1929 and 1949; additionally, supplementary treaties granted protection to hospital ships, prisoners of war and most importantly to civilians in wartime.[32]

The International Committee of the Red Cross exists to this day as the guardian of International Humanitarian Law and as one of the largest providers of humanitarian aid in the world.[33]

A contemporary print showing the distribution of relief in Bellary, Madras Presidency. From The Illustrated London News (1877).

Internationally organized humanitarian aid efforts continued to be launched for the rest of the century, often with ever-greater logistical acumen and experience. In 1876, after a drought led to cascading crop failures across Northern China, a famine broke out that lasted several years—during its course as many as 10 million people may have died from hunger and disease.[34] British missionary Timothy Richard first called international attention to the famine in Shandong in the summer of 1876 and appealed to the foreign community in Shanghai for money to help the victims. The Shandong Famine Relief Committee was soon established, with those participating including diplomats, businessmen, as well as Christian missionaries, Catholic and Protestant alike.[35] An international network was set up to solicit donations, ultimately bringing in 204,000 silver taels, the equivalent of $7–10 million if valued at 2012 silver prices.[36]

Simultaneously in India, another campaign was launched in response to the Great Famine of 1876–78. Retrospectively, authorities from across the administrative and colonial structures of the British Raj and princely states have been to various degrees blamed for the shocking severity of the famine, with critiques revolving around their laissez-faire attitude and the resulting lack of any adequate policy to address the mass death and suffering across the subcontinent, though meaningful relief measures began to be introduced towards the famine's end. Privately, a famine relief fund was set up in the United Kingdom, raising £426,000 within its first few months of operation.

Intertwined with and informed efforts related to the profound destruction and disruption caused by World War I, including that of the Red Cross and Red Crescent organization, the Russian famine of 1921–1922, taking place in a country already immensely burdened with systemic agriculture and logistical struggles—then ravaged by successive periods of industrial war, blockade, bad harvests, the Russian Revolution, its resulting political restructuring and social upheaval, and then the insurgency and war communism of the Russian Civil War that followed. In the nascent Russian Soviet Federative Socialist Republic, Vladimir Lenin allowed his personal friend and acclaimed thinker Maxim Gorky to pen an open letter to the international community asking for relief for the Russian people. Despite the ongoing ideological, material, and military conflicts levied by both the new socialist state and the capitalist international community towards one another, efforts to aid the starving population of Soviet Russia were intensive, deliberate, and effective. American efforts, led in large part future president Herbert Hoover, as well as those by the International Committee for Russian Relief joined extant humanitarian organizations in delivering food and medicine to Russia over the course of 1921 and 1922, at some points feeding over 10 millions Russians every day. With the United States left relatively untouched by World War I, its intensive private and public efforts in Russia constituted a clear expression of its new paramount soft power on the international stage, with power projection from European states having been either totally destroyed or severely limited in scope in the years following the conflict.

RAF C-130 airdropping food during 1985 famine

Early attempts were in private hands and were limited in their financial and organizational capabilities. It was only in the 1980s, that global news coverage and celebrity endorsement were mobilized to galvanize large-scale government-led famine (and other forms of) relief in response to disasters around the world. The 1983–85 famine in Ethiopia caused upwards of 1 million deaths and was documented by a BBC news crew, with Michael Buerk describing "a biblical famine in the 20th Century" and "the closest thing to hell on Earth".[37]

Live Aid, a 1985 fund-raising effort headed by Bob Geldof induced millions of people in the West to donate money and to urge their governments to participate in the relief effort in Ethiopia. Some of the proceeds also went to the famine hit areas of Eritrea.[38]

A 2004 reform initiative by Jan Egeland, resulted in the creation of the Humanitarian Cluster System, designed to improve coordination between humanitarian agencies working on the same issues.[39]

Ban Ki-moon

The first global summit on humanitarian diplomacy was held in 2016 in Istanbul, Turkey.[40] An initiative of United Nations Secretary-General Ban Ki-moon, the World Humanitarian Summit included participants from governments, civil society organizations, private organizations, and groups affected by humanitarian need. Issues that were discussed included: preventing and ending conflict, managing crises, and aid financing.

Attendees at the summit agreed a series of reforms on aid spending called the Grand Bargain,[41] including a commitment to spend 25% of aid funds directly through local and national humanitarian aid organizations.[42]

There are different kinds of medical humanitarian aid, including: providing medical supplies and equipment; sending professionals to an affected region; and, long-term training for local medical staff. Such aid emerged when international organizations stepped in to respond to the need of national governments for global support and partnership to address natural disasters, wars, and other crises that impact people's health.[45] Often, a humanitarian aid organization would clash with a government's approach to the unfolding domestic conflict. In such cases, humanitarian aid organizations have sought out autonomy to extend help regardless of political or ethnic affiliation.[45]

Humanitarian medical aid as a sector possesses several limitations. First, multiple organizations often exist to solve the same problem. Rather than collaborating to address a given situation, organizations frequently interact as competitors, which creates bottlenecks of treatment and supplies.[46] A second limitation is how humanitarian organizations are focused on a specific disaster or epidemic, without a plan for whatever might come next; international organizations frequently enter a region, provide short term aid, and then exit without ensuring local capacity to maintain or sustain this medical care.[47] Finally, humanitarian medical aid assumes a biomedical approach which does not always account for the alternative beliefs and practices about health and well-being in the affected regions.[48] This problem is rarely explored as most studies conducted are done from the lens of the donor or Westernized humanitarian organization rather than the recipient country's perspective.[49] Discovering ways of encouraging locals to embrace bio-medicine approaches while simultaneously respecting a given people's culture and beliefs remains a major challenge for humanitarian aid organizations; in particular as organizations constantly enter new regions as crises occur. However, understanding how to provide aid cohesively with existing regional approaches is necessary in securing the local peoples' acceptance of the humanitarian aid's work.

World Food Programme distributing food in Liberia

Humanitarian aid spans a wide range of activities, including providing food aid, shelter, education, healthcare or protection. The majority of aid is provided in the form of in-kind goods or assistance, with cash and vouchers constituting only 6% of total humanitarian spending.[50] However, evidence has shown how cash transfers can be better for recipients as it gives them choice and control, they can be more cost-efficient and better for local markets and economies.[50]

It is important to note that humanitarian aid is not only delivered through aid workers sent by bilateral, multilateral or intergovernmental organizations, such as the United Nations. Actors like the affected people themselves, civil society, local informal first-responders, civil society, the diaspora, businesses, local governments, military, local and international non-governmental organizations all play a crucial role in a timely delivery of humanitarian aid.[51]

How aid is delivered can affect the quality and quantity of aid. Often in disaster situations, international aid agencies work in hand with local agencies. There can be different arrangements on the role these agencies play, and such arrangement affects that quality of hard and soft aid delivered.[52]

Securing access to humanitarian aid in post-disasters, conflicts, and complex emergencies is a major concern for humanitarian actors. To win assent for interventions, aid agencies often espouse the principles of humanitarian impartiality and neutrality. However, gaining secure access often involves negotiation and the practice of humanitarian diplomacy.[53] In the arena of negotiations, humanitarian diplomacy is ostensibly used by humanitarian actors to try to persuade decision makers and leaders to act, at all times and in all circumstances, in the interest of vulnerable people and with full respect for fundamental humanitarian principles.[54] However, humanitarian diplomacy is also used by state actors as part of their foreign policy.[54]

The UN implements a multifaceted approach to assist migrants and refugees throughout their relocation process.[55] This includes children's integration into the local education system, food security, and access to health services.[56] The approach also encompasses humanitarian transportation, the goal of which is to ensure migrants and refugees retain access to basic goods and services and the labour market.[55] Basic needs, including access to shelter, clean water, and child protection, are supplemented by the UN's efforts to facilitate social integration and legal regularization for displaced individuals.[56]

Scholars debate the differences between human rights and humanitarian rights and their implications. In the context of refugees, it describes the organizations’ responsibility to provide for their needs by considering both “fundamental human rights and humanitarian norms”.[68][69] Humanitarian rights are sometimes used by refugees as means to pursue their political rights.[70] Hence, "humanitarian language, materials and practice can offer a space for politics to hide".[71] As such, according to some scholars, the most evident tool offered by humanitarianism is the 'language of suffering' used by refugees in order to demand a compassionate action that will relieve their suffering.[71]

Bangladeshi citizens offload food rations from a US Marine CH-46E helicopter of 11th Marine Expeditionary Unit after Tropical Cyclone Sidr in 2007.

The total number of humanitarian aid workers around the world has been calculated by ALNAP, a network of agencies working in the Humanitarian System, as 210,800 in 2008. This is made up of roughly 50% from NGOs, 25% from the Red Cross/Red Crescent Movement and 25% from the UN system.[76] In 2010, it was reported that the humanitarian fieldworker population increased by approximately 6% per year over the previous 10 years.[77]

Aid workers are exposed to tough conditions and have to be flexible, resilient, and responsible in an environment that humans are not psychologically supposed to deal with, in such severe conditions that trauma is common. In recent years, a number of concerns have been raised about the mental health of aid workers.[78][79]

The most prevalent issue faced by humanitarian aid workers is post-traumatic stress disorder (PTSD). Adjustment to normal life again can be a problem, with feelings such as guilt being caused by the simple knowledge that international aid workers can leave a crisis zone, whilst nationals cannot.

A 2015 survey conducted by The Guardian, with aid workers of the Global Development Professionals Network, revealed that 79 percent experienced mental health issues.[80]

Reports of sexual exploitation in sexual exploitation and abuse in humanitarian response have been reported following humanitarian interventions in Liberia, Guinea and Sierra Leone in 2002,[81] in Central African Republic[82] and in the Democratic Republic of the Congo.[83]

2021 reporting on a Racial Equity Index report indicated that just under two-thirds of aid workers have experienced racism and 98% of survey respondents witnessed racism.[84]

The Sphere Project handbook, Humanitarian Charter and Minimum Standards in Disaster Response, which was produced by a coalition of leading non-governmental humanitarian agencies, lists the following principles of humanitarian action:

• The right to life with dignity
• The distinction between combatant and non-combatants
• The principle of non-refoulement

Logo of the Core Humanitarian Standard

Another humanitarian standard used is the Core Humanitarian Standard on Quality and Accountability (CHS). It was approved by the CHS Technical Advisory Group in 2014, and has since been endorsed by many humanitarian actors such as "the Boards of the Humanitarian Accountability Partnership (HAP), People in Aid and the Sphere Project".[86] It comprises nine core standards, which are complemented by detailed guidelines and indicators.

While some critics were questioning whether the sector will truly benefit from the implementation of yet another humanitarian standard, others have praised it for its simplicity.[87] Most notably, it has replaced the core standards of the Sphere Handbook[88] and it is regularly referred to and supported by officials from the United Nations, the EU, various NGOs and institutes.[89]

• Rieff, David; Myers, Joanne J. "A Bed for the Night: Humanitarianism in Crisis". Archived from the original on 30 March 2007.