|SCN News, Number 24 - Nutrition in the Context of Conflict and Crisis (UNSSCN, 2002, 99 p.)|
The 29th Session of the SCN was held in Berlin (Kick), Germany at the Dorint Hotel on 11-15 March 2002. The Session was hosted by the Federal Ministry for Economic Cooperation and Development (BMZ), the Government of Germany, in collaboration with the German Foundation for International Development (DSE) and Deutsche Gesellschaft fhnische Zusammenarbeit (GTZ)
This year's Symposium on Nutrition in the Context of Conflict and Crisis took place on 12-13 March. The Symposium s goal was to raise awareness of the critical importance of nutrition before, during and after crises and conflicts. It set out to do this through four specific objectives:
· to promote cooperation amongst UN agencies, NGOs and bilaterals
· to promote greater understanding and linkages in food and nutrition policies used in development and humanitarian situations.
· to provide a forum for discussion on achievements and new challenges needed to improve nutrition situations, and
· to highlight basic human rights and humanitarian principles as the basis for nutrition programming.
The Symposium focused primarily on those emergencies where there is a total breakdown in authority resulting from internal or external conflict, known also as complex emergencies. Complex emergencies pose a particular challenge for humanitarian agencies because response may be compromised by the interaction of violent conflict, internal and external political objectives and insecurity.
A statement (see back cover of this issue) was prepared for endorsement by the UN Secretary General. This statement urges better coordinated action between UN agencies, bilaterals and NGOs in emergency situations. Most importantly, it reflects the Symposium's recurring themes found below and lists recommended actions for the SCN.
The 6th Dr. Horwitz Lecture, given by Soha Moussa, provides a personal and technical account on the importance of keeping schools open during crisis and conflict. This lecture serves to remind all those involved in emergency work of the emotional and psychological effects that violence, insecurity and uncertainty can have on a child.
To summarize, the following themes emerged during the Symposium:
· There has been significant progress in a number of technical areas in emergency nutrition. However, these advances are poorly implemented
· Nutritional needs can and should be addressed through a range of interventions, including broad-based livelihood approaches, selective feeding programs, and health programs
· The humanitarian imperative is a central tenant of emergency relief interventions, but it is undermined by the politicization of aid, especially food aid. The humanitarian imperative needs to be divorced from political and foreign policy objectives
· The human rights approach promotes equitable distribution and emphasizes human dignity. This approach is a shift away from the notion that emergency relief is a charitable gift, which denies dignity
· There is a moral dilemma and an inherent tension between access to affected populations and cooperation with corrupt regimes. In situations of insecurity, while negotiating access, there is a risk of legitimizing governments or quasi-governments
· The professionalization of NGOs means they are increasingly taking on the mandate of capacity building as part of their emergency response. Yet, the appropriateness of capacity building is context specific and, as a minimum, agencies should respect the International Red Cross and Red Crescent Movement and NGO Code of Conduct and attempt to build disaster response on existing local capacity
· Refugee populations are often better off than local populations. During emergencies, the host governments are not well equipped to handle displaced populations. Solutions are still needed to reconcile the standard of living of the emergency-affected, refugee, or displaced populations, and the needs of the host government population
· Agencies risk disrupting social structures by inappropriate targeting and blanket protocols, calling for knowledge and in-depth context analysis. Blanket protocols risk being culturally insensitive and more evidence is needed to support the effectiveness in targeting certain groups. Vulnerability assessments must consider the multiple risks facing people in conflict without singling out individual criteria for targeting
· Agency specialization can lead to gaps in mandates. The conceptual framework currently in use promotes multisectoral interventions to address nutritional needs. Eventually, certain agencies find it very difficult to cover all the sectors, leading to specialization and gaps in mandate. Therefore, coordination of actions between agencies is needed to ensure that none of the emergency needs of an affected population are missed
· The term do no harm is inappropriate. There are positive and negative effects of action, therefore, the goal should be to minimize the bad and maximize the good aspects of aid and emergency relief.
The SCN Secretariat is most grateful to Ellen Messer, Marc Cohen and Anthony Zwi for reviewing the papers in this collection.
The German Foundation for International Development (DSE) is an institution for international dialogue and training following the policy guidelines of the Federal Government of Germany. DSE's development efforts focus on an exchange of political experience through workshops and conferences and on further professional training for specialists and executives from developing and transitional countries. The activities of the Foundation are mainly commissioned by the Federal Ministry for Economic Co-operation and Development (BMZ). The scope of its mandate, however, also allows DSE to act on behalf of other organisations. The DSE Centre for Food, Rural Development and the Environment (ZEL) contributes to rural development, food and nutrition security, management of natural resources and of development projects in partner countries.
The Deutsche Gesellschaft fhnische Zusammenarbeit (GTZ) GmbH is a government-owned corporation for international cooperation with worldwide operations. GTZ's aim is to positively shape the political, economic, ecological and social development in our partner countries, thereby improving people's living conditions. Through the services it provides, GTZ supports complex development and reform processes and contributes to global sustainable development. The GTZ was founded in 1975 as a corporation under private law. The German Federal Ministry for Economic Cooperation and Development (BMZ) is its main financing organisation. GTZ also undertakes commissions for other government departments, for governments of other countries, for international clients such as the European Commission, the United Nations or the World Bank, as well as for private-sector corporations. The GTZ operates on a public-benefit basis.
SYMPOSIUM OVERVIEW: BREAKING THE LINKS BETWEEN CONFLICT AND FOOD INSECURITY IN COMPLEX EMERGENCIES
Ellen Messer and Marc Cohen
The papers and perspectives from the Symposium on Nutrition in the Context of Crisis and Conflict reflect what is old and new in humanitarian thinking and action, both in the principles that guide and regulate the rhetoric and behaviors of donor and implementing-agency bureaucracies, and in what concepts motivate the technical interventions on the ground. In aggregate they expertly address all three dimensions of nutrition-food, health, and care-and all three aspects of food security-availability, access, and utilization.
The contributors, all policy makers and practitioners, recognize and seek new ways to overcome the sometimes fragmented rather than holistic responses to food crises, while at the same time they emphasize the need to identify more diverse and creative ways for the affected communities to mobilize resources to protect food security and prevent destitution. As illustrated by Young et al.'s community-based approaches, there are multiple and complementary avenues to reach and assist the food insecure, in particular women, for example, through preferential targeting to improve technology in what is traditionally women's work, and by increasing women's access to elevated levels of resources as their portion within traditional economies visibly dominated by men.
Similarly, Jonsson et al. demonstrate that decisions to provision vulnerable populations in the context of illegal actions by states or non-state actors can and do involve tradeoffs, but life-saving projects based on human rights principles can try to meet individual demands and needs for essential food, water, and medicine without giving full and extra support to unlawful authorities. Unfortunately, we have few examples of such actions and evaluations of their political implications, or successes and failures. In many militarized contexts, codes of conduct notwithstanding, humanitarians still find it impossible to avoid hiring armed guards and providing food, incomes, and vehicles to combatants, who fuel further conflict.
Although the more polemical papers on principles argue against a politicization of aid (which appears to be almost inevitable because both violations and defense of human rights tend to take place in the political arena), the more practical reports on livelihood-security and human rights strategies suggest ways humanitarians can work around rights-abusive governments and offer new ways to reach and engage networks of females and males struggling to gain livelihood and maintain stable lives with dignity in unsettled times.
Moussa's thoughtful contribution on the use of food for education argues creatively from hard experience that schools and school feeding, especially in contexts of political instability, are multi-functional. Such programs, by their very regularity and existence, always bring to the table extra-nutritional meanings and values, as they contribute to social and psychological welfare and a sense of connectedness that goes well beyond the immediate access to food. Education of girls has also been shown to deliver intergenerational nutritional benefits.
Happily, these discussions demonstrate that linkages between conflict/conflict-prevention and food insecurity/food security in the post-Cold War era are beginning to be addressed by peace and food-security advocates both inside and outside of government and relevant international agencies, which increasingly recognize and accept the critical inputs of NGOs. The explicit commitment of the German government through its Ministry for Economic Cooperation and Development, to policies ensuring sustainable food security and prevention of conflict, along with USAID's reorganization, and renewed attention to 'interactive pillars' that include agriculture and trade in interaction with conflict prevention, humanitarian assistance, and democratization, suggest that governments are widening their scope of action to address complex food-security and conflict issues together, and also to increase integration of NGO and private actors and actions.
In addition, actions by UN agencies following up the activities of the World Food Summit, suggest that nations and the UN system as a whole at last are taking human rights seriously in implementation of humanitarian assistance.
These efforts may be slowly bridging the gap between those diplomatic agents and agencies that engage in conflict prevention and peace making, and those who seek to protect food and livelihood assistance. But the structural causes of crises and conflicts, including the politics of food, still do not enter seriously into most diplomatic discussions, which are handled by separate departments. Equally, the conflict-potentiating effects of aid, including who will control scarce resources such as irrigation water, improved seeds, or other technologies-in addition to land-require careful analysis in each situation, and are always political. While the principle that humanitarian agencies and aid should eschew politics is right in spirit, crisis situations, such as the demand for refugee feeding, are inherently political, and the politics of food, which cannot be wished away, must always enter into combined food-security/conflict-prevention strategies in order to prevent future crisis.
For the most part, these presentations were not addressing conceptual questions of whether conflicts are caused by food insecurity, or the more theoretical questions of whether people engage in violence and warfare primarily because of ethnic animosities or perceived resources deprivation. Nor were they addressing how UN agencies, governments, or NGOs might intervene in situations of impending crisis to avoid conflict. But the case studies on livestock protection do illustrate what appear to be successful strategies for preventing or mitigating the impacts of conflict, and assuring the benefits of those resource savings are widely shared across households and communities. Both relief and development policies stand to benefit from such gendered approaches, which seek to protect food security and livelihoods as a deterrent to conflict, whatever its causes.
Contact: Ellen Messer email@example.com and
Marc Cohen firstname.lastname@example.org
NUTRITION IN THE CONTEXT OF CRISIS AND CONFLICT
Director, Federal Ministry of Economic Co-operation and Development, Bonn
It does not take much to appreciate the relevance of a Symposium on Nutrition in the Context of Crisis and Conflict. We all recall the pictures of hungry children in Afghanistan and their empty and fearful eyes as they look at the cameras and into an uncertain future. We also vividly recall the stream of hungry, fearful refugees being rejected at the borders. At the same time we see pictures of areas covered with small food parcels and lorries full of foodstuffs that cannot get to affected regions because of conflict. After reading in Ssche Zeitung on 12 February 2002 that Afghan mothers are happy if their children get a place in an orphanage because they are simply unable to feed them, I know that the theme of this symposium is a right and important one.
The Trouble Spots Worldwide
Since the end of the Cold War, 103 armed conflicts have taken place, of which 88 are and were conflicts within states1. Old conflicts have broken out afresh, often intensified by ethnic and religious tension. At the end of 2000, some 24m people were dependent upon international humanitarian aid for their survival as a result of armed conflicts in developing and newly industrialized countries. Aid organizations often report rising acute malnutrition of refugees and internally displaced persons (IDP)2. The UN estimates the number of refugees and IDP to be around 35m, of which, 80% are women and children3.
Africa is where most of the conflicts rage and, at the same time, the continent where the share of hungry people is the largest. In East Africa, political conflicts and wars have exacerbated hunger in Rwanda, Burundi, Eritrea, Ethiopia, Somalia, Sudan and Kenya. In Central Africa, the people in the Democratic Re-public Congo are suffering from the expansion and intensification of the civil war. The fertile regions in the east that used to produce in abundance, can no longer feed their own population. In West Africa, Liberia and Sierra Leone remain the biggest hunger crisis spots. Sierra Leone is attempting to recover from eight years of brutal civil war and has started reconstruction, but even the UN peace-keeping forces have not yet been able to re-establish peace throughout the country4.
Although in other regions of the world the connection between conflict and hunger is not as equally pronounced and widespread, conflicts contribute to exacerbating the food situation in Palestine, Indonesia, East Timor, Colombia, and some south-east European countries.
The Vicious Circle Between Crises And Hunger
Most of these armed conflicts take place in regions heavily dependent upon agriculture. As a consequence of civil war and displacement, fields can no longer be cultivated and whole regions lie fallow. Conflicts cause hunger, but at the same time, hunger can also cause conflicts.
Armed conflicts destroy crops, cattle herds and land; they ruin a country's infrastructure and markets. Further, they destroy the ecological and social resources needed for food production. A study by the International Food Policy Research Institute found that in 14 Sub-Saharan African countries food production in years of war fell distinctly short of that during peace years5. Thus in Angola, production was reduced by almost 50%, with an average reduction in all conflict-affected countries of 12.3%. The FAO used a similar method to estimate the conflict-induced losses of agricultural yields. During 1970 to 1997 losses amounted to US$121b6. This accounts for more than 75% of the total support given by the international donor community to Sub-Saharan countries afflicted by conflicts. Figures like these reaffirm that it would be much more appropriate, and preserving of human dignity, to prevent conflicts rather than to provide emergency aid.
Agricultural losses do not stop with conflict. Land-mines are one of the cruellest tragedies hampering the path towards peace in a country. The Red Cross estimates that 24,000 civilians are either killed or brutally maimed each year by land mines7. In some countries the bulk of the arable and grazing land is mined, making food production impossible. Thus, it would be possible to expand usable farmland in Cambodia by 135% if the country were fully demined. As long as there is no drastic change in this situation, poverty and hunger will continue to be a permanent threat.
Apart from mines, food is also used as a weapon. In the wake of food sieges, food reserves and production capacities are destroyed and hunger prevails. In southern Sudan, where both government and rebel troops apply these tactics, some 2.5m people were dependent upon emergency food aid in July 1999. Hutu guerrillas from Rwanda have abused their control over the distribution of food aid in refugee camps to expand their own political power8.
FAO provides evidence for these practices in its description of the world food situation. Most of the ten countries showing the poorest food situation (Somalia, Afghanistan, Burundi, Eritrea, Haiti, DR Congo, Mozambique, PR Korea and Niger) were or still are affected by war-like conflicts and/or are faced with natural disasters6. Sufficient food for the population will remain intangible as long as wars are waging and conflicts prevail.
Crises, Conflicts And Wars As A Result Of Injustice, Poverty And Hunger
Quite often warlords or the ruling political class capitalize and abuse ethnic differences, using them deliberately to escalate violence. This mixing of different interests is described as politicized ethnicity9. By contrast, civil wars in Central America have been the outcome of protracted food crises and human rights violations. Access to land, and thus access to food, has often been the key demand of rebels. Even today, numerous landless farmers in Central and South America are fighting against an unjust distribution of land, which excludes them from securing their own food. Lack of agro reforms, or misconceived or one-sided reforms, encompass a tremendous potential for conflict. Generally speaking, tension explodes quickly into violent conflicts where economic conditions are deteriorating. People feel that there is nothing more to lose, therefore, they are willing to fight for resources, political power or even recognition.
Development policy is peace policy
Challenges, Possible Solutions And Fields Of Action
Nutrition in the context of crises and conflicts must encompass three aspects:
· managing acute emergency situations and formulating assistance in such a way that it does not intensify impact
· preventing crises and preserving human dignity; and
· combating hunger as a cause of conflict and/or consequence of conflict.
Management of acute emergency situations
A rapid, coordinated response on the basis of a division of labour by the various players-states, UN organizations (WFP, UNHCR, and others), NGOs, and bilateral donors-is a fundamental precondition for success. The WFP has been, and continues to be, a crucial player during this phase and an important partner of the German government.
Designing emergency assistance in an appropriate manner poses a substantial challenge. Mary Anderson, in her 1999 study 'Do No Harm', has given examples of how aid itself can exacerbate conflicts10. Donors must take measures to prevent this misuse of food aid from the onset of their planning and implementation. This requires an in-depth understanding of the origins of the conflict and a precise analysis of the participating conflict parties and their willingness to resolve the conflict. Aid should not be given without accountability. Furthermore, planning must take into account the risk of well-intentioned food aid prolonging conflicts.
It is well known that food aid can have a counterproductive effect on market and nutrition practices. Local markets can be destroyed, making livelihoods almost impossible for small farmers, and increasing dependency. Over the past 20 years, donors have contributed massive food aid supplies to the Ethiopian government, neglecting the necessary reforms in the agricultural sector and proliferating dependency amongst farmers. Food aid must be demand-driven. It is not right to take advantage of people's misery through marketing surplus production and using attractive incentives. Food aid should be procured in regional or local markets. The German government has shifted toward this direction: approximately 95% of German food aid is procured in developing countries. Furthermore, German food aid is untied, meaning countries can freely decide what type of procurement is best suited for themselves. In the meantime, this approach is being copied in almost all EU countries and we appeal to other donors to follow suit.
Preventing conflicts from becoming violent
Preventing crises from turning into violent conflicts is something that concerns us all. On 11 September 2001 we were given a terrifying example of what it means to live in one world. No part of the world is safe, no part can cut itself off and protect itself from what is happening elsewhere. The G-8 states account for more than 70% of the world-wide gross national product, but for only about 10% of the world population. While Western menus offers specialities from every corner of the world, 24,000 human beings die from hunger and malnutrition every day11. Southern countries must be enabled to share in world-wide developments. They must be able to live their life in freedom and with human dignity. Peace cannot prevail as long as social marginalization and injustice continues. Development is the most important weapon in the fight against terror, crises and conflicts worldwide.
The German government has declared the prevention and overcoming of violent conflicts to be one of the core objectives of its international policy, and it has been given broad support by society. The basis of the German government's concept of crisis prevention and conflict settlement is an extended security concept comprising of political, economic, ecological and social stability. In this concept, development policy plays the important role of contributing to a reduction of the structural causes of conflict, as well as, to the promotion of mechanisms for a non-violent settlement of conflicts in crisis-prone partner countries through improving the economic, social, political and ecological situation. Development policy is peace policy.
What Can We Do?
Poverty reduction is needed to reduce the structural causes of conflict. Worldwide, more than 1.5b people must live on less than US$1 per day12. Their poverty is a hotbed for instability and conflict. At the UN Millennium Summit in September 2000 the heads of states and governments agreed to reduce by half the share of extremely poor people in the world population by the year 2015. The German government fully endorses this goal and has developed a Programme of Action 2015 to outline the steps Germany is undertaking to contribute towards realizing this goal.
Good governance (i.e. sound, development-oriented government action) has been an elementary principle of our co-operation. We intend to continue focusing on this in our future work. For example, we will increasingly support those countries that promote a peaceful co-existence of different ethnic groups and religions within their societies, thus establishing mechanisms of non-violent conflict resolution. Likewise, we support the strengthening of rule of law institutions. The German government has strengthened this approach as part of the struggle against international terror and has made available special funds for this purpose.
· establishing the Civil Peace Service as a new development cooperation instrument. Trained experts act as mediators to prevent violent conflicts or, once these have ended, to build lasting peace
· supporting co-operation in the areas where potential conflicts could occur over scarce resources, for example, in the field of fresh-water resource management, and
· supporting reconciliation and communication measures, for example, a project in Chad helps settle conflicts between cattle-holders and farmers by means of a committee of understanding.
What Does The German Government Do To Combat Hunger?
At the global level the German ministry advocates, within the framework of the WTO negotiations, dismantling of agricultural subsidies and especially export subsidies to avoid an adverse impact on food security (e.g. as a result of the destruction of local markets or subsidized exports). It is important to improve developing countries' access to markets to bolster foreign exchange earnings. Hence, the EU has granted the least developed countries duty-free market access for almost all goods, except arms. The German government is examining further possibilities of improving market access, and we invite other donors to join the EU's initiative 'Everything but Arms'.
Key instruments at the local level are projects enabling people to improve their own food situation on a sustainable basis. These include projects promoting rural development, additional income and the informal sector. BMZ prioritizes the development of rural areas, which is more than just agricultural promotion. Rural areas offer space for up to 80% of the people in developing countries and for some 75% of people living in absolute poverty.
Prospects: Future challenges
Development policy as peace policy must be expanded further. Only by strengthening crisis- and conflict-preventing elements in development cooperation can we put into place long-term structures that ensure the peaceful coexistence of people on a sustained basis. Germany will continue to take an active part in the reconstruction of countries affected by the aftermath of crises and conflicts.
Fighting hunger belongs at the top of the political agenda. This is not only a moral duty, but a necessity if we all wish to live in peace and security. Hence, the German Parliament has asked the German government to play a pioneering role in the combat against hunger. Germany shall:
· maintain our priority to food security and agriculture/fishery
· endorse efforts for an international embodiment of the right to food
· continue our endeavours for a continuous improvement and adjustment of the food aid instrument, and
· endorse the orientation of relevant WTO agreements towards the needs of sustainable food security in the developing countries.
Poverty reduction is also key and must be considered a priority. Germany shall:
· consistently implement our Programme of Action 2015 to reduce poverty
· increase our attention to Africa continue and further develop the debt remission initiative, and
· give active support to improving development financing.
Food security for all will remain a dream so long as conflicts exist. Food security can dissolve tension and clearly contribute to safeguarding peace. Crisis prevention and the combat against hunger are future tasks meriting our full participation. They contribute to world-wide security and are in the interest of all of us.
1. Larson I (1999) Four Million Killed in Post-Cold War Conflicts, Prospects for Peace Increase, Even in Poorest Countries, with Investments in Agricultural Research and Technology. http://www.futureharvest.org/news/02161999.shtml
2. Somalia: UNCT Somalia Monitor 23 December - 13 January (1999) http://www.sas.upenn.edu/African_Studies/Hornet/irin_11499.html.
3. Sherman D (2002) State of the World's Mothers 2002: Mothers & Children in War & Conflict. Save the Children, The David and Lucile Packard Foundation, IKEA.
4. UNU/WIDER (1998) Humanitarian emergencies and warlord economies in Liberia and Sierra Leone. Paper presented at the conference on War, Hunger and Displacement: the Economics and Politics of the Prevention of Humanitarian Emergencies, 15-16 June 1998, Stockholm.
5. IFPRI (1998) Food from Peace, Breaking the Links between Conflict and Hunger: Food, Agriculture, and the Environment Discussion Paper 24. IFPRI: Washington DC.
6. FAO (2000) The State of Food and Agriculture. FAO: Rome.
7. ICRC (1997) Landmines must be stopped. Special brochure. ICRC: England.
8. Commission of the human rights of the US-Delegation (2002) http://www.humanrights-usa.net/reports/droc.html.
9. Murithi T (1998) Alternative Electoral Systems; 'Electoral Systems and the Management of Ethnic Conflict in Africa. Keele University. http://www.psa.ac.uk/cps/1998/murithi.pdf.
10. Anderson M (1999) Do no Harm: How aid can support peace - or war. Lynne Rienner Publishers: London.
11. WFP (2002) http://www.wfp.org.
12. FAO (2000) World Food Day 2000, Information
Contact: Karsten Hinrich
WHAT ARE THE CHALLENGES TO IMPROVED HUMANITARIAN ACTION IN FOOD CRISES?
General Director, Mcins sans Frontis
Food is a daily need. In crisis situations where markets, economies and lives are totally disrupted, finding enough food to eat is a central struggle. The physical need to eat is obvious, but the humiliation and pain of hunger and being unable to feed one's family is often poorly appreciated. Food and nutrition intervention has become the central element of humanitarian crisis response. As the role of crisis intervention has expanded in terms of publicity and political relevance, nutrition in crisis situations has become an important issue for public solidarity and for aid policy. Therefore, it is an important theme for this year's SCN Symposium.
Over 10 years ago in the Martin Forman Lecture, Alan Berg called for more nutrition engineers1. Mr. Berg argued that while there is always room for more rigorous scientific knowledge, the main failure was not in terms of the coherence of our scientific knowledge, but in the application of this knowledge. The most recent edition of New and Noteworthy in Nutrition reveals that many of the same problems exist today2.
Food crisis and the ineffectiveness of the humanitarian 'system'
Food crisis is a major threat in crisis situations. Food crisis is a major cause of instability, ill-health and increased mortality. It contributes to the collapse of economies, livelihoods and increases inequities in already inequitable situations. It is also well appreciated that intervention in crisis situations is dominated by the use of food aid as the major intervention strategy, both in monetary value and volume. Food aid is the organizational logic driving emergency intervention thinking and capacity. Yet, it is well recognized that food aid is probably the most corruptible form of emergency intervention and in terms of providing nutritional well-being-it is a blunt tool.
The dangers are well known to people's immediate and long-term well-being when forced to migrate out of distress and collapse of entitlement. Relief camps may be organizationally reassuring, but they are not healthy or secure places to live. Today, much is known about crisis situations, which is meant to improve relief response. Such advances in knowledge include:
· a need for broad based food, nutrition, health and water interventions, preferably to support livelihoods, but sometimes specifically to reduce morbidity and mortality
· information now available on complex food economies and survival strategies of individuals, households and economic groups
· need to expand food quantities in food baskets and food diversity and quality, and
· quality of interventions may be compromised when coverage is extended.
In addition, it seems there has never been more money given to crisis interventions and never so much public support for humanitarian action than today. At no other time have governments supported humanitarian action in crises and wars, both financially and politically, in such a comprehensive fashion3. Humanitarianism has become mainstreamed.
Correspondingly, there has been a growth of specialist humanitarian funding channels and the development of technical implementation capacity. The much-vaunted humanitarian 'system' that has emerged has developed enormously in its capacity to talk and to meet and to have papers written on important subjects such as protection. Yet, there is still terrible hunger, chronic pipeline problems and major shortages in food basket quantities and qualities. There are still major inequities in the distribution of foodstuffs and services, with resources concentrated in certain politically sensitive areas, while other populations are abandoned. There is still inarticulate migration, shelter, livelihood, nutrition, food and health interventions. In short, the humanitarian 'system' does not seem to be able to significantly reformulate itself to be able to implement lessons learned. It does not seem to have advanced in protecting people and meeting their critical needs while preserving their dignity.
One should be careful with suggesting that the mere existence of hungry people is the failure of the humanitarian system alone hunger is primarily a political issue and humanitarian actors have limited political power. But humanitarian actors have set themselves the task of accessing the hungry and abused and meeting their needs and demanding their protection. So why is the humanitarian 'system' so ineffective?
There is one paradigm that says the 'system' is poorly funded, poorly managed and poorly coordinated. What we need would seem to be greater coherence and leadership of the 'system', through streamlined donor funding, effective coordinating mechanisms, improved information sharing and a common set of technical standards. All the different agencies can be cogs in a single well-oiled machine if someone would only put it together and oil it. This is the prevalent analysis among donors, NGOs and the UN agencies today and for the past ten years. The fact of continued and progressive failure of the 'system' does not seem to provoke a collective challenge to this paradigm. Why have the tremendous advancements in the quantity and quality of resources allotted to humanitarian action not made appreciable differences in our ability to access and protect people in crisis? More resources can always be obtained, better management decisions made, but more of the same would be produced. There needs to be a completely different frame of analysis for the problem and possible actions.
The much-vaunted humanitarian system that has merged has developed enormously in its capacity to talk and to meet and to have papers written... Yet, there is still terrible hunger, chronic pipeline problems and major shortages in food basket quantities and qualities...
The meaning of Humanitarian Action
There is a danger in assuming all intervention in emergency or crisis situations is automatically humanitarian. Fifteen years ago, the word 'humanitarian' was hardly used. Most agencies defined their actions in emergency situations as relief operations. But, relief operations were the poor cousin of proper development work. They were the necessary evil before getting back to the serious business of development. In other words, relief was the band aid.
UN agencies were largely absent from the heart of crisis situations. The UN was far more bound by re-did not have the analytic frame, logistic and security apparatus, or staffing to stay in crisis situations. Donors had a difficult time applying their disaster funding mechanisms to the challenges of manmade disaster response. Following increases in available funds and media exposure in the early 90s, different institutions have developed a humanitarian infrastructure and a humanitarian identify. Almost all agencies that seek to do good things today define themselves as 'humanitarian'. As a word it has lost currency, moral intent and political meaning.
Yet, humanitarian ideas and conceptual frames are important for working in man-made crises. They have been developed precisely to do this, so understanding humanitarianism is important in understanding the nature of emergency interventions. The task is to develop better access to ordinary people caught up in the middle of acute crises, in order to assist and protect them, and to help expand their horizon of choice so that they may start to re-establish control and agency over their own lives.
Armed conflict is recognized as an affair of society-a political system trying to win power and influence over another political system. Armed conflict is intolerable as an experience and so the balance between the freedoms of the individual and the requirements placed on the individual by his or her membership in society become strained. Hence, there has been an explicit recognition of the place and rights of 'Man' in society and the need to protect and assist men and women in the midst of war.
States recognize that there may be contradictions by allowing the recognition of 'Man' in war. However, they also recognize it is sufficiently important to sustain an appreciation for human life and human dignity and allow such compromise if they are reasonable. Therefore, they have created the laws of war. If 'Man's' political history is characterized by the use of violence, one of the reasons society has been successful is that men and women have usually been able to generate an ethic of restraint in the use of violence4.
If humanitarian action is genuinely aimed at impartially serving those in greatest need (impartiality), if it is humane in its impulse (humanity), if it is provided with independence from any other agenda, be it political or religious (independence), and if it is non-partisan in the social struggle in which it is operational (neutral), then it has the greatest chance of being allowed5. It is difficult to negotiate the terms and conditions of access on a case by case basis. Therefore, each case of denial effects the chances of humanitarian action in other contexts.
Humanitarianism is a moral philosophy not a political ideology; personal political preferences do not have any impact on a commitment to humanitarian action. On the other hand, developmentalism is caught up in the right-left debate on the validity of the concept of social justice and the means to societal development. Humanitarian action should be politically irrelevant and unquestionable in motive (historically) to have maximum opportunity for access and assistance.
Peace and development on the other hand are intensely political issues. For peace to be desirable it must be just and must reasonably allow for the balance between the needs of the men and women in society. This delicate understanding of working in conflict is crucial. Current policies linking aid to development, peace and respect for human rights are overly-simplistic and disrespectful of the complexity of affairs in other people's societies. Would the international community dare to impose a rather mediocre package of social services on the people of Ireland or Israel today and call it conflict resolution and peace-building? Despite the very good will of aid officials and their genuine ambitions, the articulation of current aid and political strategies in Africa and Afghanistan today shows a deep lack of respect for the very real and pressing political and social realities of their conflicts and wars.
What this argument proposes is that humanitarian action is grounded in a set of principles designed to promote maximum access to people in crisis and the prioritization of a particular set of objectives relating to alleviation of acute human need and the preservation of dignity. If this argument is accepted, then it is logical that humanitarian action becomes a small and limited ideology grounded in an ethic of self-restraint and not the normal utopian and progressive ideologies found today.
Humanitarian action does not aim to provoke social change; it aims to assist and protect victims and inspire discipline and restraint in the use of force for social change (this does not mean it is unimportant or unpowerful). Humanitarian action is practical and politically realistic. It must be action oriented, it must be non-coercive, it must be provided solely for the benefit of those we seek to assist. Humanitarian action is targeted to humans and not society and, therefore, humanitarian actors must take responsibility for the delivery of their assistance all the way to the beneficiary level. The basic conditions that humanitarian actors require are to have the freedom to assess needs, the freedom to deliver assistance and the freedom to monitor the outcome. If these conditions are denied, humanitarian action is likely to be compromised and sow the seeds for its own destruction.
Challenges to the 'System'
As mentioned earlier, many aid workers and policy officials refer to the international community and the humanitarian system. With the 'system' perspective in mind, systemic type reforms have been suggested, but a system is a group of related units forming a network with a common goal or a single purpose. Do all the humanitarian actors seek this purpose (to assist and protect victims)? When stated that there needs to be greater integration of humanitarian action into political affairs and construction of conditions for peace, such as in Afghanistan today, it is clear that the humanitarian system is not a system. Or if it is, it is not humanitarian. Why was access denied into Kosovo when the Serbs were in control? Why is access denied in Chechnya? Why is there limited access into North Korea? Why is it impossible to reach a major and severely effected proportion of the population in Angola today? Why does nobody even talk of the victims of the conflict in Tripura or Assam? Is it because political leaders or politically inspired individuals see themselves in opposition to the Western political system and see humanitarian action as part of this?
The politicization of humanitarian assistance has been well described and documented6,7,8. In the 90s, humanitarian action evolved from the poor cousin of development aid to become an organizing principle for much more than humanitarian/emergency assistance providers. While humanitarian agencies demonstrated on television that aid was being delivered, the West was paradoxically reducing aid and diplomatic resource flows to the least developed nations. Humanitarianism also justified an increased legitimacy of interventionism over sovereignty arguments, in order to protect the rights/needs of 'Man' in unjust societies. This contradictory force, on the one hand, used aid to demonstrate engagement where there was none and, on the other, concentrated aid flows to politically sensitive areas where aid was co-opted into the political address of the situation. These contradictory trends created an increasingly political logic to the direction of aid funds (geographically and in terms of activities). In the first situation, humanitarian aid became totally subordinated to higher political/societal objectives and aid became perceived as part of the political interference. In the latter, humanitarian agencies were left witnessing terrible crimes again humanity with no capacity to address the causes of the crisis.
Six aspects of current humanitarian action can be identified which hamper how the 'system' works today.
Humanitarian action is delivered to the victims of crisis. Paradoxically, the authorities who wage war are also those who have to agree to allow humanitarian access. They are held to respect humanity in war and exercise restraint in the use of violence. But in many conflicts today, those who wage war have low-levels of accountability to their citizens and tend to demonstrate limited respect for humanity or restraint in the use of violence against their own people. Civil war is often more violent and less restrained. The objective of war becomes the obliteration of the opposing society and not capture. In many modern crisis situations there is little support from authorities to allow humanitarian action. For humanitarian action to be meaningful it should have a high impact on the life of those it seeks to help and a low impact on a specific party's ability to pursue their political project. They should not allow humanitarian action because there is something in it for them, but because they respect the need for restraint in the use of force and the defence of humanity.
Therefore, imposing conditionalities on humanitarian aid logically should have little leverage over the political party (it is purposefully irrelevant to them) and enormous impact on ordinary victims8. The clearest demonstration of the fallacies of such a policy have been shown through the embargoes imposed on rogue regimes, including humanitarian assistance. In 1993, the UN and ECOMOG tried to put an embargo on Taylor-held Northern Liberia. The actions led to countless deaths of starving people and no substantial reduction in Taylor's grip on power. Embargoes from Iraq to Northern Sudan privilege the ruling elite and punish the poor9. If there is even less food available due to embargoes and one person has a gun and the other does not-who will eat?
Yet, even unquestionably good conditionalities have been shown to penalise the weak and vulnerable. When NGOs and the UN tried to form a collective front and hold their aid for Afghanistan conditional on the respect for human rights of women, the result was a massive reduction in aid flows, punishing the starving and the sick who were disproportionately women10.
Humanitarian assistance is a very poor lever on power. If the powerful suspect humanitarian aid is being used to gain leverage over them, they will act to deny the possibility of aid. There is no influence and the possibility of humanitarian action is lost, further contributing to the loss of restraint and lowering the value of what it means to be human at all.
Recently there has been a trend towards even more concentration of aid in the most politically sensitive areas to whitewash military interventions and hide the absence of genuine efforts toward nation building. Humanitarian action in such situations is truly a subsidiary to political intervention and a political excuse for avoiding full responsibility in such contexts.
The majority of resources are invested in crises with intense political interest3. This has various effects. Specifically, it diverts interest and resources to a few crisis situations. The numbers of NGOs and expatriate staff committed to Kosovo, E Timor or now Afghanistan, are disproportionate to the commitment to other areas. In addition, in these highly politicized environments the political machine co-opts humanitarian assistance for political ends. The food bombing of Afghanistan by the US on the same night as they began bombing (while hunger and famine were known to be at catastrophic levels for over one year) was clearly not delivered for humanitarian purposes, otherwise food bombing would have occurred earlier.
North Korea has been the recipient of one of the largest food aid programmes of modern times. The US and the EU have funded massive food and medical programmes to counter a reportedly devastating famine under a policy of 'constructive engagement'. However, the famine is heard but not seen and it is increasingly evident that the food crisis is structural and a result of the state structure. UN agencies and NGOs are not allowed to have significant numbers of expatriate staff in N Korea. Most agencies have almost no freedom to assess the needs independently, they are denied the opportunity to directly deliver assistance and they are unable to monitor the impact of assistance11,12.
Kim Jong-il, the leader of N Korea, has publicly proclaimed that only 30% of N Koreans have to survive for N Korea to reconstruct a victorious society. The state is militarily in control and seems unperturbed by the total collapse of the economy13. It is clear what his balance point is between the success of society and the freedoms and well-being of 'Man'. Many of the independent NGOs working in N Korea pulled out because they became aware of the game played to pretend the programme was an effective redress to people's acute needs. It is clear there is a massive structural food problem in N Korea and this probably requires massive and sustained food assistance to reduce mortality and stabilize society. There is significant evidence to suggest that all aid is channelled to members of society favoured by the regime through state man-aged distribution systems and the military12.
The aid programme no doubt supports some livelihoods, but fails to help those the regime does not value and only serves to stabilize a very dangerous regime. This may be a legitimate political action, in an attempt to reduce chances of a regional nuclear war, but this is the same regime responsible for the famine and complete denial of responsibility to look after its own citizens. Is this a humanitarian programme? What damage does this programme do to the possibility of humanitarian action? How accountable to voting publics is a programme of sustaining a dictator by food, hidden under the guise of a humanitarian mantle? How responsible is the political engagement by international states that seem unable to confront the problem? With this (non)humanitarian programme and lack of democratic accountability in our address of the N Korean problem, is the world hiding behind food as an alibi, avoiding the reality that it has no policy to deal with the horrors of N Korea14?
Research has shown a progressive increase in the earmarking of donor funds to particular crises. As the majority of humanitarian actors are driven by the availability of government donor money, humanitarian assistance is becoming increasingly selective in quantity and quality3.
If aid is provided according to a political logic, as argued above (non-neutral), it is also difficult to demonstrate that aid is provided on the basis of need alone and the most needy receive the most aid (impartiality). There are substantial differences in the quantities and standards of humanitarian action around the world. It is very moving to see the quality of hard dried grains given out in a typical food ration in Africa (usually too little, too infrequent and without sufficient complimentary quality foods). At first sight, it is hard to believe this is food for humans, however nutritious it might be. In the camps for Kosovars in Macedonia, on the other hand, large numbers of people were queued in a respectful way and rapidly given cloth bags filled with fresh baked bread, peppers, cucumbers, melons and tomatoes. This demonstrates that it is possible to feed large numbers of people in a respectful way and with a humane diet. Some refugee populations, especially in Africa, get a poor deal in comparison to others caught in 'preferred crises.' How do the people in these crises look at humanitarian actors when they arrive? As friends trying to help or as part of a system of discrimination and injustice in which they are caught in?
After the end of the cold war, refugees were no longer politically desirable reminders of the failure of the communist world to care for its citizens. Refugee camps became perceived as dangerous breeding grounds for criminals, lawlessness and radical militant action. Refugee programmes developed a life of their own, drawing in endless quantities of assistance. Policy concerns re-oriented to the containment of crisis and the rapid management down of relief flows. As the political control of humanitarian assistance increased, aid was co-opted to push people back into home situations or to move them to other areas.
Sierra Leone has been racked by a terrible war for nearly ten years. During this time, tens of thousands of people fled to Guinea to try and find some semblance of peace and security. Many of the refugees were treated as second class citizens and used for cheap labour, but they were safe. In 2001, preparations were made by rebel groups to destabilise N Liberia. Retaliatory rebel attacks were launched across borders into Guinea and focused on refugee camps in an attempt to catalyse mass movement and chaos. Humanitarian and human rights groups called for the refugees to be moved out of border areas to safety. International powers and the Guinean military had no interest in seeing potential enemies spreading out across Guinea, and tried to contain the crisis. Military, police and civilian militias began victimizing refugees on the basis of ethnic identity, with no proof of their involvement in rebel activities. Men were stopped at check points and stripped for evidence of tribal scarring marks. Many were brutalised, arrested and executed.
Eventually when the situation had calmed down, it became politically expedient to move the refugees. Refugees were told to relocate deep into the forest where there were no alternative sources of income or livelihood, except total reliance on international assistance and leaving them much more vulnerable to manipulation. While this programme offered real safety to thousands of refugees and was eagerly accepted, there was a large number of refugees who did not want to move away from the border. These refugees were told that their camps would be flattened and they would no longer receive assistance if they remained in the border regions. The only way to receive foreign aid is to move to the new camps.
It might be true that insecurity would limit the possibility of provision of regular humanitarian assistance, but to declare no more would be provided was an abandonment. The refugees' only choice was to relocate to new camps and live under uncertain conditions for an unspecified length of time, entirely at the mercy of the aid givers. Is this expanding the choices of refugees and assisting them in managing their own lives and possibilities in terrible times? Given the very erratic and low quality aid programme over the past ten years refugees are reluctant to put the lives of their families in the hands of the international community.
These patterns of coercive manipulation of vulnerable populations dependent on food aid and other assistance have been repeatedly seen over the past couple of years in Iran, Pakistan, or Zambia to name but a few. WFP's own figures show a trend in decline of food support to protracted refugee operations and a major increase in food diverted to protracted displaced persons operations15. Food is used more within countries to support containment of crisis situations and refugee outflows.
All systems of order and organization develop interests and organizational imperatives, no matter what their objectives. Most professionals in this field have a general desire to have a real impact in assisting people's lives and relieving the misery and humiliation of hunger. However, organizations have their own norms and interests and workers who exercise their own personal interests through these organizational processes. An agency can only be convincingly humanitarian (single minded in its desire to help people today), if it is driven by a humanitarian impulse, or, if it is strictly mandated, monitored and held accountable to that mandate.
In order to have the possibility to enter dangerous areas and deliver resources and stand by people in times of need, the international aid community needs to organize. There has to be a balance between the motivation of the people trying to make a difference and the necessity of the organization to give those in-dividuals power to act. The organizational interests are only acceptable as long as they do not eclipse the humanitarian impulse.
There is an increasingly bureaucratic imperative driving the humanitarian sector today. This is true of donors, UN agencies, international and local NGOs. In the past, UN agencies were largely state funded and relied little on media coverage. Today, the UN agencies are paralysed by intra-agency and inter-agency turf battles, which has become progressively worse in the last decade as they are squeezed for funds. The UN increasingly needs to advertise rather than depend on reliable state support. States support different agencies in different ways over different times. Different themes and agencies become 'flavour of the month'. Different governments are seen to support one agency and to 'own' it, which deters other states from funding that agency. UN agencies act to define their own interests and imperatives, expanding or contracting to fill certain spaces and modes of action or mandate, without a comprehensive analysis of all the spaces that need to be filled.
With changes in the refugee regime and declining political support for sustaining large refugee populations outside of conflict and crisis areas, UNHCR tried to become involved in moving people back. As a result UNHCR displaced UNICEF as the UNs largest non-food humanitarian agency. But as funds and support declined even further UNHCR has now retracted its mandate, responsibilities and ambitions. Who will (re)fill the gap?
There is an increasingly bureaucratic imperative driving the humanitarian sector...different governments are seen to support one agency and to own it, which deters other states from funding that agency...cutting at the heart of...humanitarian action and placing peoples needs after bureaucratic/agency interests
The bureaucratic imperative is enhanced by the funding patterns and competition between UN agencies and NGOs fighting for media space and funds. The bureaucratically interested agency is peculiarly vulnerable to political manipulation, because it steers towards opportunities for agency advancement, which are easily offered by political (funding) sources. Donor governments have a responsibility to support impartial humanitarian action and should not use funds to create turf battles and competition. This bureaucratic imperative is cutting at the heart of the truth of humanitarian action and placing peoples' needs after bureaucratic/agency interests. This is a major reason why the UN system does not function as a system and why the UN agencies fight desperate turf battles over coordination and areas of responsibilities. This happens particularly in the high profile political emergencies where resources, prestige and career opportunities will be abundant. In the moments of great crisis, the operational logic behind the humanitarian sector is partially driven by institutional interests. The turf battles undermine the ability of agencies to work together and act to create ownership of sectors. It leads to an increasing compartmentalisation of responsibilities and technical capacities. The verticalization of agency capacities means it is far more difficult to generate and implement complex multi-sectoral strategies which we know are critical for supporting livelihoods in crisis situations and reducing distress and mortality.
However good, impassioned and driven to improve the lives of hungry and insulted people professionals may be, if they are working in an agency that has lost the balance between an organizational imperative and the moral imperative of its workers, then that agency is no longer humanitarian in drive. One's work will be swamped and frustrated by a bureaucratic logic that may be hidden behind nice words, but is inherently inhumane, ineffective and amoral.
Technicalization and Cost-Effectiveness
Humanitarian assistance is still about delivering services. Therefore, the majority of professional development, planning and monitoring resources are expended on estimating if the agency is doing its job, delivering materials and providing services. Humanitarian action is a management challenge, which denies the political reality of the lives people are living. It is critical to have close contact with people in crisis situations to understand what they are facing and what are the major limitations in their daily struggle to stay alive. The underlying assumption that governs humanitarian action today is that what matters is delivery of services coupled with a desire to improve cost-effectiveness. This has allowed a focus on notions of quality that only reflect needs as determined by absence of material. These notions of quality do not ask why there are no services and such needs. There are fewer and fewer international aid staff on the ground and insufficient resources to commit numbers of experienced experts in the design, implementation and monitoring of humanitarian programmes. The needs of the vulnerable cannot be respected, protected or reacted to without that proximity.
Who is it that sets the indicators by which agency actions are monitored? If there is no monitoring of the frequency and equity of distribution mechanisms, aid agencies will not place the same emphasis on these quality dimensions of the aid interaction. Working in crisis situations means working in highly corrupt, inequitable and perverse anti-social environments. Many of the institutions of society will be co-opted and predatory in nature, manipulating scarce resources and people's lives to enhance power and wealth. If aid is poured into these social systems without adequate attention to quality aspects, and the quality of the aid relationship and service to the beneficiary, these resources will feed into systems of repression.
A decade ago people would criticize WFP for being a logistics machine, and it remains so today. Without new incentives for enhanced quality of their actions, will they be different tomorrow? In order to further reduce costs of food distribution and avoid the critical nature of some partner NGOs, there is increased use of local and non-transparent organizations. The increased focus on the costs of food distributions has had a major impact in reducing the concept and efficacy of humanitarian intervention, and particularly in understanding the challenges to protection of victims in crisis3.
In Goma, MSF withdrew from the Rwandan refugee camps after demanding increased accountability of food aid and seeing no change. The amount of food was far in excess of the numbers of people in the camps, but people remained malnourished. MSF were prevented from doing a proper registration or from distributing directly to the beneficiary. The organisers of the genocide controlled the food supplies and used the food as a resource to re-build their military capacity. Even though this is well known, these same challenges continue today. In Mazlak camp in Western Afghanistan, WFP provided food for 300,000 people while NGOs estimated the population to be half that. Yet, nutrition monitoring in the camps showed that there was growing malnutrition and the camp residents were progressively more malnourished than new arrivals. Vast amounts of food were delivered to community leaders who had hundreds of ration cards. The leaders then sold these bulk quantities. The food was shipped in and then out of the camps. MSF and ACF have pushed for a proper registration, which was recently accomplished by IOM and the UN to reveal a population of only 110,000 people. The next step must be to move towards individually provided rations and not via corrupted and discriminatory community delivery systems. Community based delivery maybe cheaper, but it is not always the solution to ensure egalitarian distribution of food in emergency situations.
These factors undermine the perception and experience of humanitarian assistance by political actors and beneficiaries. Humanitarian assistance then loses its respect and is either blocked (as in Chechnya today) or is cynically manipulated by local warlords. Furthermore, the aid recipients do not work with aid agencies to achieve maximum benefit from the assistance, but rather work against aid agencies to extract maximum personal benefit. There needs to be an explicit responsibility for the provision of services all the way to the beneficiary: to feed, secure, protect. Can humanitarian action under the current 'system' be humanised, making it truly responsive to differing needs of people caught up in crisis? Can this be done without major changes in structure and putting more people next to the victims?
What To Do
This macro-level critique tries to recognize some of the challenges that effective sector wide humanitarian action. Of course implementing apolitical humanitarian action in the real political world will always present major problems. This critique is not meant to imply that everything is hopeless and nothing can be achieved.
There has been enormous attention and public resources given to humanitarian action. The general public has vigorously understood and supported the humanitarian imperative. The UN and NGOs are significantly involved in the humanitarian debate and committed to action. Access to people in crisis is won and sustained and military and political leaders around the world are aware of humanitarian obligations and allow some form of action. There has been real commitment to improved quality of intervention and many people have given time and energy to push forward knowledge and thinking in how best to intervene in crisis situations.
It is partly because there are so many experienced and committed people in the field of humanitarian action that it is expected and desired rapid improvement in overall capacity to access, assist and protect. It would be na to simply ask for greater political investment in addressing the causes of crisis at a mo-ment when investment in the military has expanded rapidly, at the same time as investment in diplomatic representation, civic interaction and overseas aid has collapsed16. The West has moved towards a militarization of international relations with declined capacity for diplomacy. We should recognize this and reassess the possibilities for good aid in the changing context.
The predominant rhetoric and actions for those who genuinely want to see reform and improvements in our ability to feed people with dignity and restore their own capacity to take control of their lives and reinstate their agency and choice is driven along a notion of technical 'systems' improvement. So there is an agenda: better donor policies, better donor coordination on objectives, better UN management, better UN agency cooperation, better coordination of NGOs, and finally, better integration of humanitarian action within a political framework for the creation of peace and progressive development and participative politics. But the current humanitarian aid environment means that the proposed agenda above will have to work along side such impeding factors such as:
· a decline of political investment in crises in areas of limited political interest
· donor manipulation of humanitarian action (to favour friends or hide disengagement)
· donor funds tied to political conditionalities
· UN agencies funded in a way as to increase internal competition
· no state responsibility for the fulfilment of the mandate of the UN
· no UN capacity to respond to the state agenda,
· a massive diversity in philosophies of action by different actors and host societies
· increased military intervention in some crisis zones,
· betrayal of universal impartiality-and the clear prioritizing of certain victims over others
· the institutionalisation of the humanitarian impulse; increasing public questioning of the humanitarian sector, and
· a vast array of organizations with different ideas, motivations, legitimacies and objectives all called NGOs.
So it is little wonder that the 'system' does not function systematically in the pursuit of humanitarian objectives. Actions that assume a systems orientation and serve to force development of the overall coordination and technical capacity of the system are doomed to fail in promoting substantial improvement in the ability to address hunger, misery and de-humanisation. Worse, they may lead to increasing political instrumentalization.
What actions might such a critique suggest? Here are some suggestions, which are by no means exhaustive:
· Food is life and food is dignity. In a survey on mental trauma in Sierra Leone in 2000, MSF found that the majority of people assessed were suffering some form of acute mental stress17. The causes of stress were multiple and bound up with the collapse of society, fear and experiences of violence. By far the highest proportion of people attributed some of their mental trauma to the debilitating and humiliating effects of hunger. In a country so beset by violent chaos, this illustrates the importance of food as a means to basic dignity of life. The international aid community has a tremendous responsibility and should be motivated to pursue that responsibility
· The current system is not a system, or at least not one driven by humanitarian concerns. It is important to have a greater sense of realism about what the major momentum in humanitarian and political intervention entails, so as to recognize opportunities and threats for the development and promotion of effective humanitarian action. Following a systems-based agenda serves to reinforce a depoliticized and technocratic agenda without much power for change
· The current organization of relief activities is limited by a range of factors including incoherent objectives and perverse funding incentives, as well as political conditionalities tied to assistance. Further work is needed to define how to react to acute nutritional crisis situations in open situations and across different cultures. The challenges of the HIV/TB pandemic must be dealt with and the livelihood and nutritional challenges it creates addressed. Investments can be made into simple means to assess and respond to adolescent and adult acute malnutrition and mortality. Well grounded aid strategies, sound needs assessments and clear and unequivocal action plans, aimed primarily at responding to real needs of people, are compelling arguments for improved practice
· States will try to manipulate humanitarian assistance for their own ends. States have signed the Geneva conventions and have a basic responsibility to appreciate and support vital independent and impartial humanitarian action. The funding patterns of donor governments should reflect on their humanitarian responsibilities. Humanitarian funding should be given to mandated bodies in a manner to promote effective impartial action in support of humanity. Funds should not be provided to mandated agencies (such as ICRC and the UNHCR) on a project basis, as this promotes concentration of funds in certain crisis situations and undermines the impartiality of the specialist agencies. This does not mean that these bodies should not be held accountable, on the contrary, they should be held more accountable to justify their successes and failures on a global scale
· It is unacceptable that the policies of states and UN agencies are so dependent on the personal political ideologies and experiences of senior technocrats. States and UN agencies have formal responsibilities, which should not be open to interpretation. States should enact laws to define and control the use of humanitarian budgets, to enforce separation between the use of humanitarian funds and the pursuit of political interests and to define their humanitarian responsibilities
· Clear categories of intervention in crises should be developed, with concordant principles and clarity of objectives to guide intervention. Not all assistance provided in emergency situations needs necessarily to be humanitarian, but the objectives and mode of operation needs to be clearly stated in order that decisions to act are held democratically accountable. Interventions aim to achieve their true objectives, correct institutional capacities are developed to maximize intended goals and humanitarian action is not degraded by incoherence and degradation of its principles through association
· There needs to be much better reporting on aid flows, achievements and quality indicators. Information must be able to be aggregated so there is increased transparency about what is being done, for what reason and what are the trends. Today, academic observers claim it is impossible to aggregate data on funds and material flows. It is also impossible to review what happens to materials once they have entered a country. Accountability systems need to avoid overlap and focus on real funds and material flows (not pledges), all the way to the beneficiaries
· UN agencies must be given a mandate and then funded in such a way as to enhance cooperation and fulfilment of the mandate. If they fail they should be held technically accountable, whilst states should be held politically accountable. There should be an independent review capacity, to map out the UN mandate, to what degree the UN agencies fill their mandates, and if the sum of UN agency actions fulfills the total mandate. The review capacity should be ongoing and should not just determine gaps and failures, but isolate and identify causes of failure (technical or political), so as to point to the responsible actors and promote reform rather than avoidance
· Humanitarian workers/activists must always be aware of the critical balance between an agency's real drive to meet the needs of people and the bureaucratic interests of the organization. The value of the work of aid agencies must be insisted on and the bureaucratic imperative must be countered
· Food and nutrition crisis is central to understanding the political economy of most crisis and conflict situations today. The dynamics in a crisis situation are deployed to destroy economies, deprive people of opportunities and target the basic productive means in society. Therefore, food and nutrition perspectives are uniquely placed to describe the cross-cutting impacts of crisis and to advocate for broad based and comprehensive response. The SCN must reconstruct an agenda for multi-sectoral and multi-agency action, resurrecting real positive dynamic interaction between the various food and nutrition agencies, with distinct roles and inter-active programming possibilities. If there is limited competition and distinct roles, there should be the possibility for enhanced action and inter-action
· There must be more funding for quality interventions. The meaning of quality must be defined in terms of the degree to which victims are saved and can exercise choice in their own lives. Humanitarian actors should recognize that there is a responsibility to deliver assistance to the individual beneficiary. In having such a field presence, there is a requirement to interact with the beneficiary to understand the diversity of challenges they face. Only an interactive relationship can inspire the crafting of solutions that do not impose assumed good things, but rather help expand the victim's horizons of choice. This will mean increases in programme costs. The argument to increase programming cost must be well constructed and championed and must resolutely serve the vulnerable and not institutional interests
· There must also be greater investment in rapid establishment of epidemiological surveillance in crisis situations, to be able to follow real problems and genuinely monitor progress. Political proclamations by agencies that there is a famine and later that they have averted famine, without demonstration of the facts that they have done so, does not promote learning or better practice. This is agency focused and not people focused, obscuring accountability to improve our actions
· There must be more funding for applied research and the development of appropriate intervention strategies, following good epidemiological surveillance and appreciation of people's needs
· There needs to be sustained peer review and critique of developed knowledge. Too often, we are driven by very circumstantial evidence and personal ideology. Scientific methods and the academic tradition needs to be more widely applied to humanitarian action.
The basic perspectives on food security analysis, famine theory, nutritional assessment and food and nutrition intervention have been established for some time. There is also general consensus that effective reaction to nutrition challenges depends on a multidisciplinary approach strategically and practically coordinating avoidance of migration, health and epidemic control, food security and livelihood support and sustenance of care environments. Humanitarian action is grounded in a set of principles designed to promote maximum access to people in crisis and the prioritization of a particular set of objectives relating to alleviation of acute human need and the preservation of dignity. There are no major gaps in our conceptual knowledge that should inhibit our actions.
There have been some considerable advances in the technical and logistic capacity of the various aid agencies to deliver timely and effective responses to nutritional crises around the globe. However, despite major technical advances there has been little substantive progress in our shared capacity to effectively assist, protect, support and care for the needs of the majority of people in most desperate need. Why is this? The 'community' of donors, UN agencies, NGOs often try to find solutions based on an assumption we are all part of a 'humanitarian system'. But different political and bureaucratic interests, different ideological perspectives, the technical compartmentalisation of aid delivery; and a focus on service delivery and cost-effectiveness ignore important ethical and political considerations. Without a commitment to humanitarian principles the immediate needs of people, using aid to promote agency and not coerce populations, and alignment of the objectives of the humanitarian aid community the 'systems' perspectives will not serve to enhance our capacity.
1. Berg A (1991) Sliding Toward Nutrition Malpractice: Time to reconsider and redeploy. Martin Forman Memorial Lecture, June 24, 1991. Crystal City: Virginia.
2. New and Noteworthy in Nutrition (2002) 36.
3. Macrae J (2000) International Humanitarian Action: A Review of Global Policy Trends. Overseas Development Institute: London.
4. Coupland R (2001) Humanity: What is it and how does it influence international law? International Review of the Red Cross 83 (844): 969-990.
5. Pictet J (1979) The Fundamental Principles of the Red Cross. Henry Dunant Institute: Geneva.
6. Disasters Special Issue (2001) Politics and Humanitarian Aid: Debates, Dilemmas and Dissension. Disasters 25: 4.
7. Disasters Special Issue (1998) The Emperor's New Clothes: Charting the erosion of humanitarian principles. Disasters 22: 4.
8. Leader N and J Macrae (2000) Terms of Engagement: Conditions and Conditionality in Humanitarian Action. A Conference Report. Humanitarian Policy Group Report. Overseas Development Institute: London.
9. Garfield R (1999) The Impact of Economic Sanctions on Health and Well-Being. Humanitarian Practice Network paper. Overseas Development Institute: London.
10. Atmar MH (2001) The Politicization of Humanitarian Aid and its Consequences for Afghans. HPN Newsletter 9 November 2001. Overseas Development Institute: London
11. Evaluation of EMOP DPR Korea 5959. Emergency assistance for vulnerable groups. http://www.wfp.org/index.asp?section=7_1.
12. ODI (1999) North Korea: Conflict Management, Food Aid and Humanitarian Principles. HPN Discussion Paper. Overseas Development Institute: London.
13. Terry F (2001) Feeding the Dictator. The Guardian 6 August 2001.
14. Kristof N (2002) North Korea: The lack of US policy raises the risk of war. Letter to the Editor. International Herald Tribune.
15. WFP (2002) http://www.fao.org.
16. Nye JS (2002) The Paradox of American Power: Why the World's Only Superpower Can't Go It Alone. Oxford University Press: Oxford.
17. Jong K, Mulhern M, Ford N et al (2000) The trauma of war in Sierra Leone. The Lancet 355: 2067-2068.
Contact: Austen Davis email@example.com
A world fit for children
Outcome document for UNGASS
Editors Note: These excerpts are taken from the outcome document of the United Nations Special Session on Children, held in New York in April.
The outcome document was written and negotiated over a period of about two years, with UNICEF serving as the Secretariat for this lengthy process. The document reflects world leaders renewed commitment to children.
14. Care for every child. Children must get the best possible start in life. Their survival, protection, growth and development good health and with proper nutrition is the essential foundation of human development. We will make concerted efforts to fight infectious diseases, tackle major causes of malnutrition, and nurture children in a safe environment that enables them to be physically healthy, mentally alert, emotionally secure, socially competent and able to learn.
Plan of action
Goals, strategies and actions
36. We are determined to break the intergenerational cycle of malnutrition and poor health by providing a safe and healthy start in life for all children; providing access to effective, equitable, sustained and sustainable primary health care systems in all communities, ensuring access to information and referral services; providing adequate water and sanitation services; and promoting a healthy lifestyle among children and adolescents....
c) reduction of child malnutrition among children under five years of age by at least one third, with special attention to children under two years of age, and reduction in the rate of low birthweight by at least one third of the current rate.
37.5 Protect, promote and support exclusive breastfeeding of infants for six months and continued breastfeeding with safe, appropriate and adequate complementary feeding up to two years of age or beyond. Provide infant-feeding counseling for mothers living with HIV/AIDS so that they can make free and informed choices.
37.22 Achieve sustainable elimination of iodine deficiency disorders by 2005 and vitamin A deficiency by 2010; reduce by one third the prevalence of anaemia, including iron deficiency, by 2010; and accelerate progress towards reduction of other micronutrient deficiencies, through dietary diversification, food fortification and supplementation.
A REVIEW OF THE ADVANCES AND CHALLENGES IN NUTRITION IN CONFLICTS AND CRISES OVER THE LAST 20 YEARS
Frances Mason, Action Against Hunger/Action Contre la Faim and Anna Taylor, Save the Children UK
The international community is being faced with new injustices and new challenges to ensure the human right for adequate food and nutrition. This paper is intended to remind us of where we have come from in emergency nutrition and to highlight how far we have to go before the rights of disaster-affected communities are respected and upheld.
The main purpose of this paper is to assess the principle advances made over the past years in nutrition in conflicts and crises and to propose direction for further advances in the field. The term 'advances' refers to developments in technical knowledge and nutrition policy and practice. The project cycle management is used as a framework for presenting these advances and the challenges that remain. Specifically, the paper:
· considers the objectives of the advances and describes how well they have been achieved
· determines the challenges and issues that still exist in relation to the advances, and
· provides recommendations on how these challenges might be overcome and issues resolved.
Advances made over the last 20 years are considered with historical reference. This paper is not intended to be an exhaustive listing of all achievements and challenges, but builds on the advances documented in the SCN 4th Report on the World Nutrition Situation1. Recommendations are intended to contribute to the development of a plan of action for the international community that will accelerate the pace of advances in the field of emergency nutrition and lead to significant improvements in relieving the suffering, death and degradation of disaster-affected communities. The first step in this process would be a collaborative effort by bilateral agencies, UN agencies, and NGOs through the SCN.
This paper is not able to provide significant detail on how highlighted advances took place, but it is essential to emphasise the important role that interagency collaboration has played in furthering the sharing of technical knowledge and improving the policies and practice of nutrition in conflicts and crises.
Interagency meetings held since 1988 initiated many of the interagency collaboration and policy developments described below. These meetings provided a forum for improved coordination, mutual understanding and enhanced analysis of the constraints within the humanitarian system. A central focus of the interagency work was the move towards Public Nutritiona, which is a shift from the individual to the population level and from a narrow set of technical interventions to a wide range of strategies, policies and programmes to combat malnutrition2. These interagency meetings have also provided a catalyst for a number of initiatives that have enhanced policy formulation and practice guidelines.
a Public Nutrition is a broad-based problem-solving approach to addressing nutritional problems of populations or communities in which the broader factors of health, water and sanitation and social care play significant factors in the causes of malnutrition, alongside food insecurity. This approach requires a contextual analysis from the macro to the micro levels.
The Interagency Group was instrumental in recommending the establishment of the Refugee Nutrition Information System (RNIS), to be managed by the SCN Secretariat, in 1993. The RNIS project was the first to systematically collect, compile and report on interagency nutrition and mortality data in response to the lack of information on the observed high rates of acute malnutrition and crude mortality in emergency affected refugee and displaced populations. The reports present recommendations and priorities for action, including key constraints to operational response and act as an advocacy tool in raising awareness of the seriousness of particular contexts and often focus on emergency situations that are not covered by the media or have been 'forgotten'.
The Emergency Nutrition Network (ENN), which also originated from an interagency meeting, has become the key forum for information sharing amongst nutritionists working in emergencies. Its primary focus has been to ensure that experiences and lessons learnt are documented so that institutional learning can take place in the short to medium term. The ENN is now funded by approximately 20 agencies (UN, bilaterals and NGOs).
An unprecedented example of interagency collaboration was evident in the preparation of the nutrition chapter for The Sphere Project Humanitarian Charter and Minimum Standards in Disaster Responseb. This project aims to improve the effectiveness of humanitarian action and to make humanitarian actors more accountable. The Sphere initiative has stimulated much debate, ranging from enthusiastic support to concern over the limitations it might place on humanitarian action. Beyond the limited number of official Sphere translations that exist, the Sphere project has been translated into 19 languages.
b The Minimum Standards specify the minimum acceptable levels to be attained in sectors of humanitarian response. Each standard has a set of key indicators which signal whether the standard has been attained. They provide a way of measuring and communicating both the impact, of the programmes as well as the process methods used.
These interagency initiatives are becoming increasingly inclusive, aiming to consider operational as well as technical and academic agencies and endeavouring to ensure the participation of southern NGOs and agencies. However, interagency collaboration is one small part of the process of facilitating real advances. The development of technical guidelines is another and there has been much investment in these. Capacity building, not discussed in detail here, is the growing area for consideration and investment. For real progress to be achievable and sustainable, global, national and local capacity for sound nutritional analysis and response remains perhaps the biggest challenge for the coming years. This fact becomes apparent throughout the subsequent sections of this paper as the limitations of the advances achieved are described.
Analysis and Assessments
As the paradigm of public nutrition began to be established in the early 90s, UNICEF developed a conceptual framework for understanding the causes of malnutrition. This was incorporated into their policy, as part of their Triple A approach. This framework was largely based on the Tanzania (Iringa) Nutrition Programme3. The framework was later adopted by a wider group at the International Conference on Nutrition in 19924. This framework has been instrumental in ensuring an understanding of malnutrition that goes beyond inadequate intake to include the range of food security, care and health factors that contribute to malnutrition. Analysing these processes in specific contexts has created opportunity for intelligent nutrition programmes that address real rather than assumed causes.
Assessment of malnutrition and mortality, which is located at the apex of the conceptual framework, has become increasingly widespread in emergency-affected communities, so much so that the prevalence of acute malnutrition (wasting and oedema) of children 6-59 months is now a widely used currency for understanding the extent of the impact of a crisis on populations. This demonstrates the usefulness of anthropometry in providing objective data in situations where information may be limited and also indicates the importance given to levels of malnutrition for understanding the likely impacts on mortality5. Standard survey methods are now largely agreed upon in key emergency nutrition guidelinesc and combined with freely available software for statistical analysis, such as Epi-Info, have facilitated comparison of affected populations both spatially and temporarily.
c Examples include The Management of Nutrition in Major Emergencies World Health Organisation: Geneva; WFP (2000) Food and Nutrition Handbook. World Food Programme, Rome; MSF (1995) Nutrition Guidelines Mcins Sans Fronti; Prudhon C. (2001) La Malnutrition en situation de crise, Action Contre la Faim.
While the usefulness of anthropometry is not in dispute, knowing a level of malnutrition alone does not allow a humanitarian agency or government to respond appropriately unless there is information on the causes. Causal analyses (using the conceptual framework) are frequently conducted alongside anthropometric assessments6 and bring together quantitative and qualitative approaches. These are important developments which must be invested in further to establish best practice approaches.
There is also increased understanding of the importance of the analysis of epidemiological data alongside that of anthropometric data. Measles coverage data has become a fundamental component of regular data collection within anthropometric surveys and the importance of assessing mortality indicators in conjunction with malnutrition has become more widely recognised. In Burundi in 2001, standardized reporting of the numbers of malnutrition cases in centres and the number of malaria cases, combined with analysis of the worsening food security situation proved to make a strong case for assistance7.
Although the assessment of malnutrition in children under five years and the estimation of prevalence has become routine work for many emergency nutritionists, there remain substantial gaps in understanding how to measure acute malnutrition in other age groups, namely infants (<6 months), adolescents, adults and the elderly. This is due to the inadequacies of reference population data and inter-ethnic variation. In the last few years the limits of our understanding of how to measure these groups have become more widely discussed and the research agenda has become clearer.
Progress in assessment of malnutrition has been paralleled by the more widespread establishment of early warning systems in emergency prone countries. Some of these are based on analysis of food supply (e.g. famine early warning systems and more recently FIVIMS) while others use an understanding of access to food. The Vulnerability Assessment Mapping, which is one of the most important emergency management tools used by WFP, is used to improve understanding of food security issues and to identify the most appropriate strategy for addressing food insecurity.
Progress made in the assessment of household food and livelihood security has been extensive both in terms of the development of sound methodologies and in their widespread use across large parts of emergency-affected countries. These methods have moved beyond analysing food balance sheets, mapping environmental conditions and monitoring agricultural production and vegetation to understanding households' access to food. The development of the household economy approach (HEA) for assessing food aid needs by Save the Children UK was a significant part of this process. This approach uses entitlement theory to determine the effect of a shock on different socioeconomic groups in different communities8. HEA was followed by the development of other approaches to assessing livelihoods which all hinge on understanding access to, rather than simply availability of, resources with a concern for longer term support of livelihoods and self sufficiency as well as immediate needs9. This has allowed for a greater understanding of how individuals and communities cope with food insecurity, particularly through determining the role of community structures and the use of available traditional resources.
Despite consensus on appropriate anthropometric survey methodologies, there remain frequent examples of poorly conducted surveys or assessments that serve to misinform rather than inform decision making10. Common mistakes include fundamental errors on sample selection, unclear and untransparent presentation of data and failure to include assessment of oedema. These errors reflect poor human resource capacity and the failure of those agencies responsible to take technical expertise in nutrition seriously.
The importance of clear case definitions for micro-nutrient deficiencies, adequate sample size and, where possible, biochemical confirmation during micronutrient deficiency assessments has been widely recognized. However, challenges exist in their implementation and the lack of validated field-friendly sample collection and analysis technology.
There remain substantial shortfalls in the way information generated by early warning systems is used, making them not as effective in preventing emergencies as had been expected. While the increased use of anthropometric figures in planning emergency response can be regarded as progress, levels of malnutrition are usually impacted late in a crisis and therefore ideally should not be used to trigger response. The reliance on anthropometry for response undermines the value of comprehensive food information systems that monitor early indicators of a food crisis in generating timely humanitarian responses.
FOOD AID RESOURCING Since 1989, the proportion of global food aid allocated to emergenciesd has increased from one eighth to one third in 1999 when it equalled 4.7m MT11. The remaining two thirds are allocated to projecte and programme food aidf. In 2000, 86% of WFP food aid went to emergency activities, the highest proportion for 23 years. The increasing proportion of food aid allocated for emergencies should be seen in the context of greatly fluctuating total food aid allocations over the 90s. While the proportion of food aid allocated to emergencies has increased, the overall quantity has varied substantially through the decade, peaking in 1992, declining substantially in the mid 90s to 2.8m MT in 1996 and increasing again in 199811. The latter increase is unlikely to be sustained and is attributable, as are previous food aid trends, to the appearance of global surpluses and the subsequent increase in programme food aid for Russia11. These recent surpluses (primarily from the US) have also provided impetus for initiatives like WFP's global school feeding programme launched in 1998.
d Emergency or relief food aid is targeted and freely distributed to natural and man-made disasters.
e Project food aid is provided on a grant basis to targeted groups to support specific developmental activities.
f Programme food aid is provided bilaterally for sale in developing countries, the funds being used either as general budgetary support or to finance specific development projects.
There have been notable advances at donor level (bilateral and multi-lateral) with regard to the provision of food aid and other resources for food and nutritional emergencies. Many of these advances have been in response to the political, institutional and bureaucratic constraints that affect donors in very specific ways. For example, in 1996 the EC implemented Regulation 296 which, among other initiatives, established a cash facility for supporting food security measures. This allowed for a significant move away from providing food aid. In 1996, the US Congress replaced the wheat reserve by a Food Security Commodity Reserve of wheat, corn, sorghum and rice to be used to meet unanticipated emergency needs in developing countries. In addition, WFP has worked to improve the efficiency of its food aid resourcing and programming.
The implications of the potential negative effects of food aid have also begun to permeate donor thinking in recent years. WFP recently held a workshop on food aid in conflict12 that concluded that there was a need to identify and elaborate the principles that guide WFP operations in conflict settings. Further, ECHO recently commissioned a study in southern Sudan, which in part examined the role of food aid in fuelling conflict. DfID also has emerging policies on the potential of food aid to damage local economies13. In 2000, the ODI Humanitarian Policy Group and Nutrition-Works14 reviewed the principles and practice for food distribution in conflict and made the following key recommendations:
· programme situation analyses should include risks to lives and livelihoods, war strategies and war economy and political contracts to determine the risk of diversion of food aid
· agreement with authorities and coordination between agencies should be based on an analysis of accountability of local authorities
· appropriate distribution methods should be identified considering whether beneficiary representatives or local institutions can be relied on to distribute to the most vulnerable and if not whether registration is possible for direct distribution, and
· risks of abuse at each stage of the distribution process should be identified and strategies developed to minimize them.
Despite these notable achievements, the politicization of food aid in emergencies is at times scandalous. The mismatches in food aid allocation between emergency affected populations is a profound embarrassment to those working in the humanitarian aid sector. The geo-political factors underpinning these imbalances are plain to see. This problem extends beyond food aid. For some countries, the international response has met less than 10% of estimated needs. For example, Eritrea in 1998 received less than US$2 for every person affected by the emergency while the former Yugoslavia received US$166 per person11.
Bureaucratic impediments to efficient release of funds for the purchase of food aid or other resources to support food security are also at times scandalous. The difficulties currently being experienced within the EU under the new regulation 296 is particularly noteworthy in this regard.
A series of external and internal reviews have identified numerous constraints that WFP face in implementing effective emergency food aid programmes15
· lack of resources for the immediate response account (IRA) and international emergency food reserve (IEF)g
g The IRA is completely untied cash. The IEFR is a commodity-based facility with an annual replenishment target of 500,000 tonnes. There is an increasing tendency on the part of donors to insist on advance information on where resources given to the IEFR are to be used. Combined with under-pledging of the IRA this means that the WFP has to go back to governments if it needs to reschedule a commodity. At the very least, this increases storage costs, and at the worst can considerably delay emergency assistance.
· the fiscal cycle of some donors and the length of time it takes to approve appeals for emergency assistance does not coincide with those of WFP, affecting the timing of pledges and whether funds can be made available in advance or not
· increasingly rigorous and complex administrative and accounting procedures substantially increase the lead-time of emergency food assistance delivery, and
· difficulties in obtaining accurate estimates of population numbers in need. Inaccurate population estimates can easily lead to donor under-provisioning.
RATION QUANTITY During the refugee crises of the late 70s, (most notably those in South East Asia), there was little understanding on the part of the health-oriented aid workers, of the importance of the nutritional content of the food rations given. The focus of nutrition was very much on nutrition surveys, supplementary feeding, and various manuals were devoted specifically to the management of nutrition programs in refugee camps. However, it was only in the late 80s that there was an agreement among the major humanitarian organisations to increase the daily ration for refugees from 1500 to 1900 kcals per person per day16. In 1997, the UN technical agencies agreed that this should be increased to 2100 kcals as a planning figure and provided information to allow context specific requirements of populations to be calculated.
RATION QUALITY During the famines of the early to mid 80s, refugee populations experienced several outbreaks of scurvy. This lead to the first realisation that the nutritional components of the diets of refugees needed to be considered in the same light as those of 'resident' populations16. Two meetings in 1991h,17,18 noted that despite international nutrition guidelines, relief programmes often fail to provide the minimum recommended daily allowances (RDA) of micronutrients such as vitamin A, thiamine, niacin, vitamin C, iron, and folic acid17. After the early 90s the number of reported outbreaks of micronutrient deficiency (scurvy, pellagra, beri-beri, xerophthalmia and iron deficiency) declined after this period (Figure 1).
h In November 1991, the Centre for Disease Control (CDC) in Atlanta, Georgia, USA hosted a one-day technical review of micro-nutrient deficiency diseases in refugee populations. In March 1991, an international symposium was held on 'Responding to the Nutritional Crises Among Refugees: The Need for New Approaches.
Source: ENN Field Exchange (Toole 1992)
It is important to note that most data come from refugee and displaced populations and it is likely that outbreaks in resident populations have remained unchanged over this period. Difficulties in addressing mi-cronutrient needs through provision of fortified foods in emergency situations include pipeline constraints in the early stage of an emergency, reduced shelf life of fortified commodities and the cost of fortified blended food in comparison to unfortified staple grains19. Recommendations made in early 199117 to strengthen surveillance of micronutrient deficiency diseases and develop standard clinical case definitions were still being repeated in 199820 and 200021. Questions remain concerning fortification, such as where fortification should take place and which foods should be chosen (i.e. within or near to the affected country or in the donor country). Data on the effectiveness of other types of interventions to address micronutrient malnutrition, such as local food production and increasing market access, remain sketchy22.
TARGETING OF FOOD AID Despite evidence of the difficulties of targeting in the late 80s23, the 90s saw a renewed emphasis on targeting because of increasing application of the relief-to-development continuum model, and a decline in resources with the increasing duration of conflict-related emergencies24. Although there have been well documented examples of appropriate targeting, in most emergency contexts, experience shows that targeting is rarely successful25. The necessary criteria for success include stable, non-conflict situations, and relatively large wealth differentials within communities, where a large proportion of households are targeted and the ability to identify community representatives that can be relied on to target the most vulnerable. There is growing consensus that the greatest gains in targeting efficiency can be made by improving information systems which inform decisions about geographic targeting rather than by refining intra-community targeting systems26.
LIVELIHOOD SUPPORT Over recent years there have been notable attempts to further the experience and understanding of humanitarian agencies in the effectiveness and appropriateness of interventions aimed at supporting livelihoods without the use of food aid. A paper by the British Red Cross27 looks at the potential of cash transfers as an alternative form of relief and concludes that these findings give cause for cautious optimism and point to circumstances in which cash relief can work to best effect. It is beyond the scope of this paper to describe the technical debates surrounding this approach.
Despite the significant lack of official policies or guidelines, donors have begun to explore different modes of food security support in emergencies. Yet, guidelines on the funding of different stages of an emergency are still needed. A negative aspect for NGOs is that as funding opportunities and mechanisms change and diversify, bureaucratic difficulties can multiply making it harder for NGOs to access resources quickly and efficiently. At the same time, unless donor policies and funding strategies for these interventions are clearly formulated and coherent, agencies applying for funds may be unclear about rationales to apply to project proposals and confused by donor responses that as often as not may be based on individual views of decision-makers rather than firm and coherent institutional policies13.
SELECTIVE FEEDING PROGRAMMES There has been considerable advance and consolidation of existing knowledge in relation to the treatment of severely malnourished children. Despite improved understanding of the pathophysiology and treatment of the severely malnourished child, the median case fatality rate of children in hospitals in non-emergency settings has remained unchanged over the last 50 years and is on average 20-30%, with the highest levels of 50-60%28. However, analysis of children in a number of therapeutic feeding centres in Africa, during emergencies, shows a case fatality rate of 9.6%29.
Efforts are now underway to address the sustainability of the treatment of severe malnutrition in emergency-affected countries. A study comparing four centres treating cases of severe malnutrition (two therapeutic feeding centres (TFCs), one specialised nutrition unit (SNU) and one day care center) in Liberia, showed that the chief factor that appeared to cause the higher rates of mortality in the SNU, in comparison to the other three centres, was the adequacy of the management and training skills of the senior staff. This example demonstrates the importance of longer-term efforts to build capacity at the national level in countries that are frequently affected by disasters.
In addition to the technical advances, progress has been made in giving recognition to the importance of care and stimulation for children during rehabilitation from severe malnutrition, to promote recovery. In emergencies these components of programmes are often overlooked but their importance is becoming more widely recognized.
Much consideration is being given to the role of 'at-home' treatment of severe malnutrition. TFCs for treatment of inpatients with severe malnutrition in emergencies have played a major part in saving children's lives in the past 20 years. Nevertheless, TFCs, especially in open situations (i.e. resident populations or internally displaced persons not in refugee camps), may have harmful effects on the food economy of patients' families, encourage increased population concentrations around them and create dependence from international agencies30. Furthermore, programme coverage as a measure of the impact or quality of therapeutic feeding programmes is less consistently used.
The challenge is still how to ensure that mortality rates for all children remain low while designing home-based treatment programmes that are appropriate to the operational, environmental and socio-economic context. Studies show that detailed analysis of data collected prospectively in real-life service settings can lead to major improvements in the management of severe malnutrition. Although the Prudhon Index can be used to assess expected mortality, attention should now be focused on ways to reduce mortality.
In addition to the work on home-based care, there are several key technical challenges to existing treatment protocols for malnutrition. Firstly, the misdiagnosis of dehydration and the inappropriate administration of saline solutions to severely malnourished children, as well as early overfeeding, seem to be responsible for many avoidable deaths. This aspect of treatment is not emphasised in any current guideline, training manual or textbook29. Secondly, the nutritional care and support of AIDS patients adds a new dimension to the work of treatment facility staff. Understanding how AIDS patients can be cared for in feeding programmes and within the community in emergency contexts is limited. Finally, despite the comprehensive best practices guides31, there is very limited understanding of the efficiency and efficacy of supplementary feeding programmes.
Monitoring and Evaluation
A publication by the Policy Department of Oxfam in the early 80s32 noted a growing resistance to the use of food aid i. This influential study demonstrated the importance of understanding the context for interventions and monitoring the immediate and wider impact of programmes. This was followed in the early 90s by the UNICEF 'Triple A' Cycle (assessment, analysis, action). Like the conceptual framework, this cycle has been influential in the emergency sector as well. Alongside these developments, the use of the logical frameworks, where monitoring indicators and sources of verification must be specified, has gradually been accepted by donors and in turn agencies, to the point where the presentation of logical frameworks is now mandatory for the majority of funding applications.
i The publication was mostly concerned with project and programme food aid, not emergency food aid.
These initiatives reflect the growing importance that agencies are placing on monitoring and evaluation. Donors are now increasing the availability of resources for these activities. This goes hand in hand with the increased need for accountability in humanitarian contexts. The Sphere project has also created a valuable impetus to monitor the context in which interventions are made, conduct evaluations and institutionalise learning. There have been several reviews of the application of Sphere standards in different humanitarian contexts. There remains, however, a significant dearth of thematic evaluations. For example, there has been no comprehensive 'overview' impact evaluation of emergency supplementary feeding programmes since Beaton and Ghassemi s seminal article in 1982.
Impact indicators (usually primarily quantitative) are prioritised in monitoring and evaluations, often to the expense of process indicators16. Too great an emphasis is placed on anthropometric and mortality indicators as a means of monitoring and evaluation. There is little agreement on appropriate indicators for early warning, recognising that deterioration in nutritional status is usually a late indicator of a crisis.
In many contexts where agencies have previously worked for many years under relatively stable conditions, on arrival of an emergency, there is frequently a substantial lack of base-line data available. The gathering of baseline information in emergency prone communities is an essential component of emergency preparedness.
One of the regular findings of independent evaluations (e.g. CDC, bilateral government evaluations, and material submitted to Field Exchange) is that there are still enormous difficulties with up take/implementation of best practice by implementing agencies. There may be many reasons for this, such as absence of guidelines at project level, poor training of field staff and lack of technical support by headquarters staff. There may be a number of factors that in turn underlie these constraints, including development agencies 'turning their hand' to emergency work but lacking the institutional expertise and support capacity; agencies trying to maintain capacity in all sectors of emergency food and nutrition (e.g. from therapeutic feeding to livestock interventions), but lacking the capacity to maintain expertise in the diverse array of activities involved.
Conclusions and Recommendations
This paper has illustrates some of the complementary roles that UN agencies, bilateral donors and NGOs can play in preventing and treating malnutrition in conflict and crises. All three groups of agencies have worked together to achieve significant information sharing and collaboration through interagency meetings, the initiation of the Emergency Nutrition Network and the unprecedented collaboration in the writing of the Sphere project nutrition chapter. In all areas of the project cycle, emphasis must now be placed on building capacity.
In assessments, the major advances in methodologies have sharpened analyses and improved programme design. However, information has proven insufficient to always initiate response and the effective translation of assessment recommendations into appropriate action remains constrained.
The proportion of food aid allocated to emergencies has increased over the last 20 years, though it remains low and the availability of this aid still fluctuates according to global food surpluses. WFP and donors have made substantial efforts in improving systems for the provision of food aid. In recent years guidelines have been developed to ensure these advances permeate to the field level. However, the politicization and dysfunctional structures remains a major frustration to humanitarian efforts.
In contrast to food aid programming, therapeutic feeding can be effective in reducing in-patient mortality due to rapid scientific advances and the development of nutritional products. There is increasing scope for innovative programming beyond general rations and feeding programmes in post conflict settings. This allows nutritional programmes to realize their broader cross-sectoral goals.
Prioritising of accountability in programming has greater investment in monitoring and evaluation methods strengthened and lesson learning initiated.
The recommendations generated by this paper could contribute to the development of a plan of action for NGOs, donors, and the UN agencies through the SCN. Some recommendations are made:
· an NGO-sponsored website should be established to enhance accurate media reporting on food and nutrition in humanitarian situations
· extension of the international cooperation and collaboration between international agencies to more regionalised initiatives involving local institutions and local nutritionists should be prioritised. This could be addressed through the existing SCN working groups
· the links between the donor and the practitioner need to be strengthened. Past experiences of failures and successes need to be shared. This requires the development of much stronger relationships between public nutritionists, donors and key decision-makers
· policies need to be translated into practice: All agencies need to ensure a routine incorporation of training modules into their human resource development systems and also to set up effective monitoring and evaluation
· readjustment of policies on the part of all major food aid players and institutions, in order to ensure that humanitarian needs are met adequately. This includes WFP, bilateral agencies-particularly the two largest bilateral food aid donors, the US and the EU-as well as international NGOs who deliver food aid. These agencies should engage in a paradigm shift from food response to nutritional response allowing for the reform of food aid to be consistent with a nutritional imperative
· food aid resources should be part of a more flexible system of response. In such a system emergency food aid would be procured and supplied from the most efficient and timely source for purposes of meeting the assessed quantitative and qualitative nutritional need. Similarly, resources for food should be more readily transformable into non-food inputs for health, livelihood or other inputs required to protect, maintain and recover people from nutritional assaults, and
· monitoring and evaluation needs to consider issues of accountability and a willingness to document mistakes. The Sphere project should be seen as a vehicle to achieve this. Agencies should work together to produce and reach consensus on interim indicators to monitor before anthropometric indicators are likely to deteriorate. This should be underscored by both the ENN and RNIS. Monitoring and evaluation systems must be expanded beyond inputs and outputs-e.g. must include usual threats to livelihoods, an understanding of the changes in the external environment, social, cultural, environmental and fiscal impact of programmes.
This paper is a shortened version of the complete paper presented at the SCN Symposium Nutrition in the Context of Conflict and Crisis March 2002. For a copy of the complete paper, please contact Fiona O'Reilly, The Emergency Nutrition Network firstname.lastname@example.org /www.ennonline.net.
1. ACC/SCN (2000) 4th Report on the World Nutrition Situation. ACC/SCN: Geneva.
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27. Peppiatt D, Mitchell J, Holzmann P (2000) The Use of Cash Transfers in Emergencies. British Red Cross. The authors examined a number of experiences of cash transfer programmes namely in Western Sudan (1984), Ethiopia (1984-84 UNICEF), Ghana (1994 Action Aid), Bangladesh (1998 SC UK), Guatemala and Nicaragua (1998 Red Cross), Albania (1999 UNHCR), Kosovo (2000 UN-MIK) and Southern Africa Safety Nets (2000 ESCOR).
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Contact: Frances Mason email@example.com and Anna Taylor A.Taylor@scfuk.org
NUTRITION AND LIVELIHOODS IN SITUATIONS OF CONFLICT AND OTHER CRISES
Helen Young, George Were, Yacob Aklilu, Andy Catley, Tim Leyland, Annalies Borrel, Angela Raven Roberts, Patrick Webb, Diane Holland, Wendy Johnecheck, and Karen Jacobsen (Members and Associates of the Feinstein International Famine Centre, Tufts University)
The work of humanitarian organizations over the past two decades has highlighted the continuing importance of nutrition in traditional forms of humanitarian response1. Nutrition is also an essential part of the evolving analytical toolbox that helps in understanding the impact of emergencies on livelihoods and the effectiveness of livelihood approaches in emergency response. This paper explores a 'livelihoods approach' for protecting the lives and dignity of people in emergencies, as related to concerns in nutrition and household food security.
The first part of the paper explores the linkages between livelihoods and nutrition in populations affected by conflict, by reviewing the definitions of livelihoods, vulnerability and resilience in the context of humanitarian response. The second part focuses on three case studies of livelihoods approaches in different pastoralist systems in East Africa, which illustrates the critical linkages with concerns in nutrition. The paper concludes with a discussion of the essential principals of a livelihoods approach, followed by an agenda for learning and further research.
Humanitarianism the old and the new
The imperative for humanitarian action is to protect the lives and dignity of people in conflict and crises, which is based on the 'right to life with dignity' and the over-arching humanitarian principles of impartiality and humanity.
In protecting lives and human dignity, humanitarian agencies seek to address not only the immediate life-threatening nature of complex emergencies, but also attempt to protect and support people's livelihoods. This is because livelihoods are central to the integrity, identity and autonomy of people. Or in other words, livelihoods are fundamental to human dignity.
In the context of protracted crises and conflict, disaster relief has become the predominant mode of international assistance in these areas. This has changed expectations of relief, which now include a broader range of goals for example, laying foundations of future development interventions, promoting conflict resolution and containing refugee flows. Strategies to promote or protect food security are one example of the broader range of interventions. These developments have been termed by some as the 'new humanitarianism'.
A problem of definition livelihoods, vulnerability and resilience in emergencies
Given the wide array of disciplinary backgrounds and sectors engaged in responding to emergencies, it is not surprising that many concepts lack common definitions and carry different meanings according to the background and objectives of the user.
Natural disasters and vulnerability
In relation to natural disasters the concept of vulnerability is central to the debate about their causes and solutions. It takes more than extreme physical events (hazards) to produce disasters. Vulnerability analysis focuses on the factors that make a community unsafe-a lack of resources, services and security. People most lacking these elements are very often constrained to live in areas least likely to be receiving the benefits of development, and most likely to face a range of hazards2. This does not imply that all poor people are vulnerable, nor that all vulnerable people are poor. The element of risk (what someone is vulnerable to) has to be defined, as does the potential for that person to deal (cope) with that risk3.
Natural disasters may appear to affect the poor disproportionately, but in fact this is not always the case. Earthquakes hitting cities or major floods may affect 'rich and poor' alike-however, it is the greater capacity of the rich to overcome such a shock that matters. Wealthier individuals and societies protect their assets and income streams (their livelihoods) through income diversification, the accumulation of disposable assets, and by means of formal and informal insurance. It is the fact that poorest households are constrained in their ability to pursue such avenues that makes them more vulnerable to the (perhaps otherwise equal) impact of an exogenous shock.
The nutritionally vulnerable
From a nutritional perspective, 'vulnerable groups' have a different yet distinct meaning. The nutritionally vulnerable are generally considered to be those facing particular nutritional risk, either as a result of their stage in the life-cycle (infants and young children, pregnant and lactating women, the elderly) or those who have relatively greater nutritional requirements as compared with their ability to meet those needs (women, the sick, the disabled). Estimates of the prevalence of acute malnutrition (wasting) among infants and young children are important 'proxies' for the nutritional (physiological) vulnerability of a population, but give no indication of how precisely a given shock has affected a community.
Because of the limited dimensions of physiological vulnerability, it does not necessarily identify the most vulnerable in all contexts, as it fails to take into account the multiple risks people face as a result of a failure in any of the three groups of underlying causes of malnutrition, related to food, health and care. In other words, while physiological risk is itself constant, the actual degree of risk associated with 'physiological risk' will be affected by context. For example, the elderly may have increased physiological risk, (decreased mobility, poor dentition etc), however, if family and community caring and support practices continue to exist to care for the elderly, they are not necessarily at increased risk. Furthermore, while the under-five year olds are physiologically at risk, it is not necessarily this group who are most vulnerable in all contexts (for example, in the Kosovo crises, and more recently in Afghanistan). Therefore, while the definition of physiological risk is extremely important, it does need to be viewed in the context of other underlying and influencing factors, including livelihoods.
Livelihoods and vulnerability
Livelihoods are a means of supporting human life4 or a means of living5. They represent more than just the necessities of life, since they are shaped by the goals, preferences and constraints of individuals, households, communities and societies. As Scoones puts it,
A livelihood comprises the capabilities, assets (including both material and social resources) and activities required for a means of living6.
The 'goals' of a community are likely to be multifaceted and context-specific. Studies of behavioural responses (coping and adaptive strategies) to food insecurity and famine have shown that these goals shape peoples responses according to perceived benefits, costs and trade-offs.
In many crises individuals are typically obliged to reduce the number of meals consumed, and the quantity of food consumed, and/or switch to cheaper but less preferred foods7,8,9. Indeed constraints to food consumption remain central to most people's experience of any crisis. For example, people forcibly displaced from their homes in central Burundi would return to try to retrieve root crops from their homesteads, which meant travelling to insecure areas and risking attack. Similarly, refugee women would travel from refugee camps in northern Uganda to insecure areas where they had plots of land cultivating crops, or were collecting wild foods10. The 'choice' to consume less food for a period of time does not imply a preference for less food, rather an imposed prioritization among alternative routes to survival. In this sense, people cut back on food to protect key resources upon which their livelihood depends.
These resources typically include:
· economic resources (access to employment, use of land and natural resources, markets and trading opportunities, small enterprise)
· technologies (agricultural- and production-related)
· financial resources (access to money or other liquid resources; assets, cash/savings and credit, remittances, debt)
· human capital (education, skills, ability to work (health and strength)
· social capital (networks, community relationships, claims and obligations, community security)
Empirical evidence from many countries demonstrates that 'less vulnerable' households in crisis situations tend to have more diversified income streams, and those initially more diversified (in terms of asset base and income sources) make faster and greater gains in both income growth and energy intake in a post-crisis environment11. However, in many complex emergencies even the previously wealthy may not be able to protect their advantage. A key characteristic of conflict-related emergencies is that the basis of livelihood sustainability comes directly under attack. The extent to which livelihoods (versus people) are 'vulnerable' to attack or loss is therefore a question central to any assessment of 'need' in a complex emergency setting.
Conflict and risk
In complex emergencies, a whole new dimension of risk related to conflict is introduced, because complex emergencies are characterized, in part,
by the deliberate exploitation of civilians. Undermining self-sufficiency and productivity are not merely byproducts of conflict, but also are the intended consequences of functional violence and war12.
'Functional violence' meaning violence with a strategic purpose beyond wilful harm, such as the destruction of the resource base of the opposition.
It has long been recognized that armed conflict is one of the major causes of famine in Africa, since it results in more rapid disintegration in the functioning of both the market and the state, and restricts the mobility necessary for livelihoods. The reverse is also true, in that famine and direct attacks on food systems have been used as an instrument of war13. The nature of risk introduced by conflict and violence varies according to the dynamics of each particular conflict. Various classifications have been proposed. Macrae and Zwi review attacks on food systems as a common instrument of war, and propose three categories of activity; failure of governments to take appropriate emergency measures; direct attacks on the means of producing and procuring food; and the selective provision of assistance to certain groups14.
Low levels of conflict, but nevertheless incorporating violence and insecurity, occur outside of the context of intra and inter-state war, and can in themselves have devastating impacts on livelihoods. In the Horn of Africa, there are several national border areas characterized by conflict and insecurity. Among the Turkana of north east Kenya, for example, the traditional livelihood-enhancing functions of livestock 'raiding' (through redistribution of pastoral resources), have to some extent been replaced by more predatory forms, which undermine livelihoods by restricting mobility which is the death knell for pastoralism15.
Violence is frequently characterized by the forced migration of communities away from the region of conflict to safe areas. Crossing borders usually grants the forced migrants the status of prima facie refugees, while the internally displaced have no such international recognition. Displacement of people automatically separates them from their means of livelihood. Without the resources upon which their livelihoods are based it is unlikely they will be able to secure an adequate living. Of more pressing importance however, is likely to be the health crises and greatly elevated risk of dying, that is common in the acute phase of an emergency, where there is limited shelter, overcrowding, lack of sanitation and clean water and lack of food.
For our purposes of considering livelihoods in the context of crises and conflict, we would therefore em-phasise the element of risk introduced as a result of conflict. We are concerned with 'vulnerability' as the risk of harm to people's resources as a result of the inability to counter external threat arising from conflict, or as a result of inherited or ascribed traits such as gender, class, race/ethnicity and age made salient by the nature of the conflict. Thus in a complex emergency the multiple risks facing people, include the risks engendered by conflict itself.
A definition of livelihoods in communities facing conflict might be as follows,
Livelihoods comprise the ways in which people access and mobilize resources that enable them to pursue goals necessary for their survival and longer-term well-being, and thereby reduce the vulnerability created and exacerbated by conflict.
This definition can be used as the basis for a preliminary framework for analysing livelihoods in conflict situations.
Nutrition and livelihoods; overlapping analytical frameworks
Livelihoods determine, and in themselves are determined by, the nutritional status of individuals. The interactions operate through a range of pathways, including both direct and indirect.
Within the livelihoods concept, nutrition is one of several fundamental components; nutrition is potentially either a type of resource, a recognized goal or measurable outcome. Nutrition is not necessarily the most important input or the most important goal, but a livelihoods analysis cannot afford to ignore nutrition.
A considerable strength of the livelihoods approach is that the importance of nutrition is likely to vary according to the perceptions and priorities of people themselves and the nature of their vulnerability. Thus a livelihoods analysis attributes to 'nutritional well-being' the importance with which communities themselves ascribe to it-an uncommon departure from a disciplinary point-of-view. This has important implications for the success of nutrition interventions. For example, food aid may be the only form of liquid assets available, in which case consumption of the ration will be determined in part by households' need for currency.
Nutrition is not necessarily the most important input or the most important goal, but a livelihoods analysis cannot afford to ignore nutrition.
While one must be wary of assuming perfect knowledge or indeed the ability of malnourished individuals to 'express' a preference for better nutrition, this viewpoint overcomes one of the drawbacks of the current conceptual frameworks for nutrition16, which is their failure to include local cultural perspectives of malnutrition. Key questions outsiders frequently fail to ask relate to the role nutrition has played in shaping livelihoods; what is the cultural significance of malnutrition and how has that shaped societies and households subsequent behaviour? Patterns of resource utilization, such as household decisions about the use of food produced, do not necessarily maximize the potential for good nutrition, as explained in the earlier sections (coping strategies may involve reducing food consumption or sacrificing nutritional quality). The underlying rationale for these decision-making processes may be easily missed where a purely nutritional perspective is taken.
The conceptual framework of causes of malnutrition describes three clusters of underlying causes, related to food, health and care. Household food security is principally concerned with the livelihood activities or strategies that generate access to food and income. The importance of livelihoods as a determinant of household food security and even access to health services is fairly obvious, but less immediate is the importance of livelihoods in relation to the 'care' cluster of underlying causes of malnutrition. Livelihoods are clearly essential for maintaining functioning social net-works, based on mutually beneficial exchange in terms of labour, assets and food. These are the foundations of the direct care-giving behaviours, which if disrupted may lead to malnutrition.
The social and economic inter-dependence that creates social networks may be severely disrupted even replaced by more predatory systems in times of conflict. In Turkana district for example, the increase in extremely violent forms of raiding that incorporated a criminal element was felt to lead to a collapse in the moral economy17. Wider social changes have a profound effect not only on food security, but also on the social networks and care-giving behaviours that are necessary to ensure adequate nutrition. Issues such as social cohesion or the divisions caused by narrowly targeting interventions are central to understanding nutritional impact.
The household livelihood security framework developed by CARE incorporates food security as an aspect of nutritional security. This in turn is a central component of household livelihood security defined as sustainable, adequate access to resources to meet basic needs18. These authors consider it misleading to treat food security or nutrition independent of livelihoods, in other words there is a need to recognize multiple constraints, as well as opportunities facing households, which influence household decisions. A further dimension that a livelihoods analysis needs to consider is the recognized seasonal determinants of malnutrition19. Seasonal variations in anthropometric status are frequently associated with the 'hunger gap' and subsequent post-harvest period.
Based on the definition of livelihoods proposed earlier, a 'livelihoods analysis' in communities facing conflict might consider the following,
1. access to livelihood resources (their extent and mix)
2. the strategies used to access and mobilize these resources
3. peoples' own livelihood goals
4. livelihood outcomes (and pathways to these outcomes)
5. vulnerability (risk and resilience). In particular how the above are disturbed by conflict e.g. restricted mobility or restrictions on ability to pursue coping strategies.
Nutrition is a component part of each of these perspectives on livelihoods. The conceptual framework of underlying causes of malnutrition complements the livelihood analysis by elucidating the effect of risks to livelihoods on malnutrition, and also the mitigating effects of livelihoods interventions on malnutrition, through either indirect or direct pathways.
Case-studies of livelihoods, livestock and nutrition; reducing vulnerability and risk
Three case studies of interventions to support livelihoods based on pastoralism in recent emergency contexts in the Greater Horn of Africa are presented.
KENYA 1999-2000: DE-STOCKING
The 1999-2000 drought in Kenya was more severe and more widespread than either the 1992-93 or the 1996-97 droughts and had a massive impact on the livelihoods of both pastoralists and agro-pastoralists. It is estimated that more than 2.3m sheep and goats, over 900,000 cattle and 14,000 camels valued at approximately 5.8b KSh were lost. As a result many pastoralists dropped out of the production system altogether to settle in peri-urban areas, in close proximity to food relief distribution centres.
Previous responses to drought among Kenyan pastoralists were mainly based on the distribution of relief food, particularly cereals20,21. In some areas the distribution of free relief food has been extended well beyond a temporary short-term measure, and regions, such as Turkana district, have been receiving relief food on and off for at least the past 10 years. During the drought of 1999/2000 the distribution of food relief was more extensive than ever before due to the widespread nature of the drought. Food relief started in February 2000, and the number of beneficiaries increased steadily throughout the year from 1.7m in February to 3.3m in December 2000.
The livestock intervention program in pastoral areas that took place in 2000/1 is thought to be the largest of its kind in East Africa, possibly in the world. A total of 21 projects in 10 districts involving 13 agencies were implemented. Donors gave close to US$4m for the drought-related livestock intervention program between June 2000 and January 200122. These included: de-stocking interventions; animal health activities (veterinary projects); livestock transport subsidies; livestock feed; re-stocking; and cross-border harmonisation and peace initiatives23. Many of these interventions are not new as such, but the scale and level of coordination of the emergency livestock initiative in 1999-2000 was unprecedented.
The conceptual framework of underlying causes of malnutrition complements the livelihood analysis by elucidating the effect of risks to livelihoods on malnutrition, and also the mitigating effects of livelihoods interventions on malnutrition, through either indirect or direct pathways.
The total value of livestock saved and salvaged through the various interventions is estimated to be more than US$2m24.
De-stocking an overview During periods of drought, animals are generally in poorer condition due to a decline in vegetation, and mortality is increased. Over-supply in the livestock markets can lead to a collapse in livestock prices and an increase in the price of animal fodder (because demand is high). De-stocking interventionsa provides pastoralists with the typical market price for their livestock (generally small stock), and they are free to use this income as they see fit. There is a strong multiplier effect of the generated income; income from the sale of animals was used in Kenya for buying water for livestock, veterinary drugs, payment of school fees, purchases of essential household necessities including food, and for setting up small businesses, like tea-shops. While at the same time this economic activity would draw food and other basic necessities into local markets thus generating local business. The off-take of animals reduces pressure on grazing, making more available for surviving livestock.
a De-stocking in the traditional sense is done to reduce the livestock population from ranches etc., for marketing purposes to balance stocks with carrying capacity of the land. It is a management technique to sell finished animals, in contrast to 'culling' unwanted animals (old or sick animals).
The purchased animals are slaughtered, the hides and skins may be sold, and the meat is distributed, either as fresh meat or it may processed by air-drying to give it a longer storage life. The processing of animal carcasses has formed the basis of cash-for-work and food-for-work programmes.
In the Kenya programmes, local community groups or relief committees organized the distribution of meat and the selection of beneficiaries. In Worgedud, Man-dera, for example, beneficiaries were selected mainly on the basis of those who could not pay for borehole water fees for their animals. While in Takaba, Man-dera, selection was made on the basis of those with the most pressing cash problems such as having sick family members in need of medication, or families whose children were threatened with expulsion from school for non payment of fees, or families unable to buy the most basic food stuffs.
In Wajir, fresh meat was distributed on regular basis to beneficiaries at the following rates:
· two shoats per eight families per week for the duration of the operation
· two bulls or camels per week per school for three and later four high schools
· six goats per week to a hospital
· three goats per week to a tuberculosis centre, and
· three goats and one bull per week each for six orphanages.
Nutritional benefits Both fresh and dried meat obviously have a high nutritional value and in emergency contexts complement well the free distribution of grain-based rations. In addition animal fat is made available, which is energy dense and improves palatability of the diet.
The de-stocking interventions in Kenya indicated that the distribution of fresh meat was generally preferred to the processing and distribution of dry meat. Fresh meat was cheaper and simpler to produce, faster to distribute and entailed minimum wastage. For beneficiaries it was felt to be more satiating and above all was preferred by pastoralists.
The distribution of fresh meat with proper planning raises the possibility of replacing the vegetable protein (pulses) in the relief food ration with animal protein at a much reduced cost and enhanced nutritional value. Critical reviews of de-stocking programmes have argued they should be run in conjunction with other forms of humanitarian assistance25.
The success of de-stocking as an emergency intervention is contingent on the timeliness of its implementation in relation to cycles of drought, local knowledge on the part of the implementing agency, and the legitimacy or representativeness of the local relief committees or community groups that are involved.
The timing of this type of intervention is critical, before too many livestock deaths have occurred and to prevent pastoralist households from dropping out of pastoralism systems of production and joining the destitute in search of relief in peri-urban areas. Also the prompt sale of stock ensures more and better quality meat.
SOUTHERN SUDAN 1990S: PROVISION OF LIVESTOCK HEALTH SERVICES
Civil war and conflict has plagued Sudan for decades. In 1989 the first UN managed humanitarian pro-gramme known as Operation Lifeline Sudan (OLS) was established in response to the widespread humanitarian suffering in southern Sudan. This programme continues to provide international assistance to the people of southern Sudan to this day.
The majority of southern Sudan's 6m people are subsistence farmers, most of whom rely on transhu-mant pastoralism. In southern Sudan the Nilotic Dinka and Nuer own about 85% of the cattle26. Cattle raiding and extremely violent armed attacks on pastoralists have characterised the conflict in southern Sudan since 1983, and contributed to the worst famine the region has witnessed in 1988. Even before the raiding in 1988, the transfer of livestock resources from the south to the north was very great. Since 1994 the Dinka in Bahr el Ghazel were further subjected to raiding and destruction by Kerubino's forces (allied to the Government of Sudan). Extreme famine was experienced once again in Bahr el Ghazel in 1998, as a result of conflict and the resulting displacement combined with drought and poor harvests in 1997.
Veterinary projects-an overview Just as excess human mortality during famine is driven by a combination of starvation and disease brought about by localised health crises, livestock losses during drought and complex emergencies are similarly associated with increased disease transmission and a deteriorating condition of livestock. An increase in disease transmission rates occur as a result of concentrations of livestock numbers around remaining water holes and exposure through duress migration, or increased susceptibility to disease because of stress. Veterinary care of livestock can reduce livestock losses during drought periods by treating or preventing diseases in addition to the buffering capacity provided by preventative animal health care with regard to the physiological stress of migration or other conflict induced actions (similar to the saving both lives and livelihoods for humans). Furthermore, healthier animals make more efficient use of remaining grazing resources. Therefore, timely veterinary interventions can be very effective at preventing livestock losses and are highly cost-effective. Well-implemented community based animal health programmes have short and long-term benefits at both the individual and community level.
The Operation Lifeline Sudan Veterinary Health Care Services
Prior to the late 80s, the southern parts of Sudan were very poorly served by government veterinary services; only very limited livestock services were operative in the major southern towns of Juba, Wau, Malakal, and other GOS controlled towns. This lack of services in part contributed to the endemicity of Rinderpest, a cattle disease that is widely recognized and prioritised by pastoralists in the south. Prior to the 90s pastoralists in southern Sudan were also marginalized by the conventional livestock vaccination activities operated by the Pan African Rinderpest Campaign (PARC), because of the insecurity and logistical difficulties that limited use of cold chains and conventional, government recruited vaccinators.
The OLS veterinary programme aimed to improve household food security through two pathways: the Rinderpest vaccination programmes, which were initially to control and more recently, to eradicate Rinderpest, and the establishment of community based animal health programmes in southern Sudan on a cost-recovery basis.
In the early 90s the development of a thermostable Rinderpest vaccine meant that the area of service delivery was no longer constrained to where a cold chain could be maintained. In 1993 participatory approaches developed by NGO animal health projects in Afghanistan and the Greater Horn of Africa were introduced to operations in southern Sudan as a means to deliver this vaccine to remote pastoral areas. Community based animal health workers (CAHW) were trained and equipped to vaccinate cattle against Rinderpest with the active participation of livestock-rearing communities, and also to deal with problems such as internal and external parasites, wounds and miscellaneous bacterial diseases.
Nutrition is not necessarily the most important input or the most important goal, but a livelihoods analysis cannot afford to ignore nutrition
Output-efficiency of service delivery Southern Sudan covers approximately 800,000 km and the estimated cattle population is 5.8m in addition to 1-2m in government controlled areas27. Between 1989 and 1992, the UNICEF livestock programme used conventional cold chains and vaccinated an average of 285,000 cattle against rinderpest annually. In 1992 the programme came to a virtual standstill as insecurity disrupted cold chains and vaccination teams. In this year, only 140,000 cattle were vaccinated.
During 1993-95 CAHWs in southern Sudan vaccinated 1.1 to 1.7m cattle against Rinderpest respectively. There have been no confirmed outbreaks of rinderpest in southern Sudan since 1998. By 1996, a network of 563 CAHW's had been established. These CAHW's treated 1.3m cattle, about 156,000 ruminants and 100,000 domestic fowl during 1996. No records were available to compare these treatment figures to the period before the onset of the CAHW system. Further, only parts of Equatoria were accessible by road; the rest of the rebel-held areas had to be accessed by air, and the number of places accessed was limited.
Nutritional Impact Evaluation of the OLS veterinary programmes has traditionally focused on process indi-cators of service delivery as well as qualitative evaluations of program impact. A study in 2001 identified five broad categories of indicators to monitor impact. These included:
· impact on animal health and herd size
· impact on availability, access and utilization of livestock holdings
· impact on availability, access and utilization of livestock products in the home
· contribution to long-term viability of household coping mechanisms by strengthening kinship ties, and
· impact on health status of beneficiaries (nutrition, morbidity and mortality)28.
The programme's impact on nutrition is either a result of direct consumption of livestock products, or alternatively through a wide range of indirect pathways, that either influence consumption patterns or exposure to disease within the household29. Improved cattle health was also thought to contribute to improved human health and HFS by decreasing exposure to zoono-tic diseases, and the loss of income this would represent30.
In times of stress, like drought or the annual hunger gap, cows may be auctioned or exchanged for grain, or slaughtered for meat. It therefore appears that cattle resources are perhaps more important to daily food intake only in times of duress31.
Impact during times of crises A study three years earlier at the end of the dry season (hunger gap) in the same area coincided with severe drought and conflict in other parts of southern Sudan, which produced widespread hunger, and acute food shortages32. The study found that in each of the villages included, the amount of meat in the diet increased dramatically; some families reporting their diet solely consisted of meat and vegetables. In a society where excessive (daily) meat consumption is considered harmful to physical health and social well-being, this was a clear indication of a survival strategy. The local slaughterhouse also reported a 66% increase in the number of cattle slaughtered for consumption between the months of May and July 199833. One of the reasons for the steep increase in meat consumption was the lack of grain and declining terms of trade between livestock and cereals, which reveals an ideal opportunity for a combined intervention addressing both the need for grain and protection of livestock. Successful veterinary care programmes must be responsive to periods of stress, whatever the cause, by supporting their community based animal health workers and providing a wider range of livestock interventions to protect livestock and livelihoods34.
EASTERN ETHIOPIA 1998: RE-STOCKING
The Ogaden rangelands in southeastern Ethiopia are home to ethnic Somali pastoralists and agro-pastoralists. The environment is harsh and the region suffers as a result of its isolation, lack of infrastructure and years of political marginalization by the Ethiopian government. The Somali-Ethiopia border cuts through traditional clan territories and has little significance for either pastoralists or traders, but has played a major role in terms of regional conflict which has generated one of the worlds most intractable and severe refugee crises, with semi-permanent refugee camps close to the border since 1988.
Escalation of the civil war in Northwest Somalia/Somaliland in the summer of 1988 drove tens of thousands of refugees across the border into Ethiopia. The victory of the Somali National Movement in early 1991 did not bring immediate peace and stability to northwest Somalia. Drought in 1989-91 also drove local pastoralists and agropastoralists to the camps. A further influx of 90,000 refugees into existing camps occurred following conflict in Somaliland in November 1994. The vast majority of Ethiopian returnees were reabsorbed immediately by the local population, but a minority registered for assistance in the camps and received a resettlement package, but awaited further assistance in the camps.
Since 1993 agencies have been trying to take a longer-term view of assistance, and have developed rehabilitation programmes comprising interlinked agriculture, livestock human health, education and water projects. A main aim of this work was the reintegration of Somali returnees from Djibouti and Somalia into the Somali Regional National State. By 1994 the total returnee population was estimated to represent 20-30% of the rural population.
The boundary between Ethiopia and Somalia is long and unguarded, and Ethiopia did not restrict in-comers. People living along the border cross the border at will, so that the residents of the camps have continued to move freely between the camps and North West Somalia. Markets in the refugee areas have a wide range of goods on sale, many coming from abroad into Berbera and Somaliland. The area is a significant transnational trade route, with Hartisheikh (the site of refugee camps) being a major marketing center. The refugees, returnee's and local inhabitants of this region share the same Somali ethnicity and cultural traditions.
Re-stocking-an overview Re-stocking is usually a post-emergency/rehabilitation intervention focussing on pastoral households with substantial livestock losses, whereby an external agency buys livestock and distributes them to households identified by community based groups or relief committees according to established criteria.
Typically re-stocking aims to provide a sufficient number of animals to destitute pastoral households to ensure a return to pastoralism. This requires a definition of 'minimum herd size' for subsistence and the herd composition for a particular pastoral system. Restocking projects vary widely and include provision of virtually any livestock type, either as a donation or using numerous forms of credit. Recipients of livestock are likely to need additional assistance, for example, basic household items that they have been forced to sell during the emergency.
Re-stocking works best when traditional restocking practices are understood and form the basis for project design. Given the requirement for local purchase, such projects can be easily corrupted by local traders increasing the price of stock in the market, or the unfair selection of beneficiaries and inappropriate choice of livestock. To overcome these potential difficulties requires a long process of community dialogue, which is most effective if the implementing agency has a long history of involvement in the area and good community relations.
Provision of sheep and goats to Somali returnees in Ethiopia35
In 1995 Returnee Ethiopian Somalis arriving home in Somali National Regional State were welcomed by their communities and according to Somali tradition, received support such as basic agricultural inputs, allocation of land and livestock. Livestock were essential for those families who wished to resume herding activities and rebuild assets. Despite the assistance which returnees received from relatives, it was evident many returnee families were still struggling to meet basic household food and income requirements. The longevity and scale of the refugee/returnee problem had undermined traditional restocking mechanisms. In response to this problem in 1995 Save the Children Fund investigated traditional methods of re-stocking used by Somalis. This revealed that goats and sheep were preferred for re-stocking to other livestock for a number of reasons, including:
· their high fecundity and potential for rapid herd expansion
· young adult male animals, particularly sheep, could be sold or exchanged for rice and sold in order to buy other livestock such as cattle or camels. The rearing and sale of male sheep was a particularly important method of income generation
· goats produced more milk than sheep and so goat milk was consumed by the family especially children
· the skins and dung of sheep could also be utilised
· in terms of networks of reciprocity, sheep and goats were more likely to be provided in the form of a gift, while oxen for draught power or donkey for transport were commonly lent.
Traditional re-stocking practices also targeted particular beneficiaries, including female headed households, aged households and poor households who had lost livestock.
Based on this information, SCF designed and implemented a small-scale re-stocking project with 22 Somali agropastoral communities who had received returnees. The project provided six adult female sheep and/or goats to beneficiaries, who were selected during traditional community meetings. A system for redistributing offspring from the first beneficiaries to other needy families was designed; and assumed 50% of the offspring would go to 'second level' beneficiaries during the first year of the project. Veterinary care of livestock was arranged in partnership with the local Ministry of Agriculture veterinary staff and by training community based animal health workers. All stages of the restocking project were closely linked to traditional systems.
Impact of re-stocking on the nutrition of children Baseline information was collected which included beneficiaries expectations of the project. By far the most common expectation was increased availability of milk to give to children. As a result assessments of the quantities of goat milk fed to children of different ages in relation to other foods, were incorporated into subsequent monitoring activities. A mid-term review of the project attempted to assess goat milk off-take and compare this with the nutritional requirements of children. These estimates were not based on consumption studies, but instead from qualitative interviews with project beneficiaries. In the dry season milk off-take per goat was reported to be approximately 300ml per milking per day, whereas wet season milk off-take was reported to be 600ml per day. In the preparation of a typical milk-maize porridge 300ml was used to prepare one porridge meal, and 3 to 4 porridge meals would be fed per day. These calculations represent rough estimates, as cows milk was also used in some meals and children of different ages tended to eat communally from a single bowl. The review calculated that on a single day in the wet season, goat milk could provide the child with approximately:
· 658 kcal (more than 50% of the RDA for two year olds)
· 30.6 g protein (127% of RDA)
· 371 µg vitamin A (148% of RDA)
· 1205 mg calcium (267% of RDA)
Catley notes that this type of assessment and calculation could be a first step towards making detailed links between the provision of goats to returnee households and benefits to the children in those households36. It is noted however that the measurement of variables such as milk off-take and human milk consumption is technically difficult, and not necessarily appropriate for routine monitoring.
Essential principles of a livelihoods approach in complex emergencies
In reviewing these case-studies several principles in the application of a livelihoods approach in the context of conflict and crises emerge.
Assessment and analyses
Analysis of livelihoods and nutritional risk are relevant to understanding both the immediate life-threatening risks to people, and threats to their future survival. Life-threatening nutritional risks include; a failure to meet immediate food needs; increased exposure to disease as a result of contaminated water (or food), lack of sanitation, inadequate shelter; and the increased susceptibility to disease associated with severe malnutrition or other debilitating diseases. These are the critical components of an emergency needs assessment and upheld by minimum standards of humanitarian response37.
In order to assess the food security of households, several agencies have developed assessment methodologies38,39. Although the precise objectives vary for different agencies, they do have several elements in common. For example, they generally incorporate an analysis of the different sources of food and income (access); a review of coping strategies; and the stages or timing of applying different coping strategies40. It is not universal however, to consider food security in relation to the wider concept of livelihoods, nor to explicitly consider the socio-political dimensions of risk and vulnerability introduced as a direct result of conflict. A few agencies, including ICRC, CARE and Oxfam GB incorporate a form of livelihoods analysis into their emergency and development work41,42,43.
A preliminary framework for analysing livelihoods in conflict situations has been suggested in the earlier section on nutrition and livelihoods, which is based on the definition of livelihoods. More work is needed in developing and applying this framework, especially in relation to developing practical tools for evaluating livelihood interventions.
It is essential to explicitly incorporate analysis of the political economy of conflict, and its impact on livelihoods and the underlying causes of malnutrition. Tools for analysing the complexities of conflict and their implications for field based organizations implementing both relief and development have been developed and widely applied44. But these have not been generally incorporated within a livelihoods analysis, and there remains a need to develop analytical tools that could help us understand the ways in which people respond, adapt and even subvert the effects of violence on their lives, in relation to their livelihoods and the costs they incur by following particular survival strategies.
Local priorities and expectations will shape the success of any external intervention. As shown in the Eastern Ethiopia case-example, the expectations of more milk for children from the de-stocking project formed a central part of subsequent monitoring activities, as from the communities perspective the success of the project would in part be judged by increased availability of milk. In Southern Sudan, Holland showed the importance of monitoring not only output indicators but also patterns of utilization of livelihood resources, in order to evaluate how they translate into improved household food security and nutrition. For example, an intervention strategy that supports animal health through vaccination and treatment may indeed increase herd health and herd size, but unless the resources are tracked, their impact on nutritional outcomes will remain unclear.
Monitoring can also reveal the potential negative side effects or risks associated with a given livelihood intervention, for example, the potential negative impact on nutrition of monopolising water sources for livelihood interventions, making less water available for washing, bathing, cooking and drinking.
An understanding of local perceptions and priorities must be balanced with the knowledge of specific known health or nutrition risks. For example, measles immunization and distribution of vitamin A supplements are absolute priorities in terms of saving lives in times of nutritional crisis, yet may not be recognized as such by local communities. Humanitarian agencies and professionals clearly have a responsibility to ensure these priorities are adhered to as part of a broader response strategy.
Prioritising response strategies
As a matter of principle, external intervention in a nutritional crisis should include a range of combined strategies to promote access to food and provide access to health care, while at the same time supporting and protecting livelihoods. In all three case-examples, the livestock interventions complemented a broader range of interventions, including the distribution of free food assistance, which was a critical aspect of food security.
Local priorities and expectations will shape the success of any external intervention
More work on analytical frameworks is essential if needs are to be prioritized according to their life-threatening risk, or their affect on livelihoods, or, as is becoming increasingly popular, in accordance with hu-man rights. These frameworks need to be especially conscious of the financial, staff, and security constraints agencies face during conflict situations in both implementing an assessment and subsequent interventions. Allocating priorities is of course much easier said than done in a context where agencies must work in accordance with their mandates and demonstrated institutional competencies. Nevertheless the need for a range of combined strategies to address risk is widely recognized by humanitarian agencies, and generally promoted within agency guidelines and the minimum standards of humanitarian response. Given the context of an increasing proliferation of agencies working in protracted crises situations, prioritizing and combining relief strategies is in large part reliant on effective coordination mechanisms. Although the Kenya case-example is restricted to emergency livestock interventions, the degree and level of coordination of multiple agencies and a wide array of interventions was unprecedented.
Partnership and advocacy; combining appropriate technical and local knowledge
None of the interventions in the case-studies would have been possible without specific technical input from specialists not just in veterinarian science or agricultural economics, but also in participatory ways of working and community based interventions. A wide range of technical and social skills are essential to livelihood programming success and this includes the particular knowledge and skills represented by public nutrition. Both public nutrition and livelihoods approaches challenge the barriers of sectoral viewpoints imposed by individual disciplinary training and focus, termed 'academic tribalism'45.
Within food security interventions generally, and the three case-examples, it has been a long held assumption that successful interventions will produce tangible benefits for human health and nutrition. Despite this underlying premise, monitoring and evaluation of such programmes rarely extend beyond an assessment of efficiency (numbers of cattle vaccinated etc). In all three of the case-examples, human nutrition benefits were acknowledged as general project objectives, but were not linked explicitly on an operational or evaluative level.
As a starting point, we suggest that an understanding of the types and degree of malnutrition in the project area, together with an analysis of the underlying causes is essential for judging the potential impact of a project on nutrition. Furthermore, this knowledge is essential in recognizing those factors that will restrict or limit programme impact on nutrition. This type of knowledge and understanding does not require more nutritionists, but it does necessitate a public nutrition approach, whereby nutrition is every body's business, and that all concerned have a basic understanding of the core nutrition principlesb. The reverse is also true, a public nutrition approach requires nutritionists to consult and work collaboratively with a wide range of stakeholders and technical experts. Creating a wider awareness of the role and importance of nutrition requires job related training on a vast scale, and advocacy among donors and other supporters of livelihood interventions. Basing training activities within regional institutions will help create greater regional ownership and responsibility for livelihood approaches in emergencies.
b Tufts University in conjunction with the World Food Programme has designed Food and Nutrition training modules that are targeted at non-technical national and international staff members.
The success of all of the livelihood case-examples described earlier was in part dependent on a detailed local ethnographic knowledge and understanding. In Ethiopia this was generated by a specific study of traditional re-stocking mechanisms, in southern Sudan by a long history of working in the area and knowledge of pastoral systems; and in Kenya by working with local organizations, especially where the external agency lacked experience of working in an area.
Learning as a way forward: a research agenda for the international humanitarian community
Improved tools and frameworks are needed for monitoring and evaluation of nutritional impact of pro-grammes that combine both qualitative and quantitative approaches. This requires a substantive shift from the current focus of analytical tools on emergency needs assessment, to analytical tools and learning in relation to monitoring the nutritional impact of livelihood interventions. Although the basic indicators for monitoring and impact assessment of nutrition related factors are well known, typically operational constraints and donor reporting requirements limit agencies interest or capacity (at least in the case of livestock agencies in these case-studies) to look more deeply at nutritional impact. The challenge, therefore, is to develop usable methods for these particularly difficult contexts.
There is a plethora of studies needed to explore the linkages between nutrition and livelihoods with a view to maximising the nutritional benefits of livelihood initiatives on nutrition. These include for example:
· how different livelihood strategies affect nutrition during periods of crisis relative to periods of greater stability, and how livelihood interventions impact these
· the effects of different livelihood initiatives on quality of the diet, including micronutrients (particularly, vitamin A, vitamin C and iron) and macronutrients (fat and protein) in relation to expected dietary deficiencies
· how best to enhance the complementarities of food distribution pro-grammes and other livelihood initiatives. The distribution of free food assistance is usually intended to meet immediate requirements for food, but nevertheless studies have shown it contributes significantly to the resource base of the household, as a portion is either traded or exchanged to obtain other essentials46, or alternatively to fulfil social obligations. In Turkana, beneficiaries of free food expressed a preference for combined intervention strategies, that included both food and livelihood support47, and
· the affects of food aid on local food production, market supply and prices of foodstuffs.
Finally, the potential difficulties that arise from attempts to combine both humanitarian and more devel-opmentalist principles within one programme should be acknowledged. For example, how far can we take community based approaches within a humanitarian principles framework that emphasizes neutrality and values speed of operations? Striking a balance here will promote more effective programmes, but also will begin to break down the 'Berlin Wall' between relief and development practitioners.
...external intervention...should include a range of combined strategies to promote access to food and provide access to health care, while at the same time supporting and protecting livelihoods
Nutrition in emergencies has developed and consolidated as a professional sector, but there is a need now for a broadening of the sector to extend the public nutrition approach into other programmes which impact on malnutrition. Conceptually nutrition is already incorporated within the livelihoods analytical framework (as a resource, a goal and measurable outcome). A livelihoods analysis, that incorporates an assessment of vulnerability related to the conflict, can contribute much to our understanding of the causes of malnutrition and barriers to its improvement.
The case-studies illustrate that we have moved well beyond analytical frameworks to the practical implementation of livelihood initiatives that impact on nutrition. An essential step needed to further the understanding of how livelihoods improve and protect nutrition is partnership with an increasing range of stakeholders, which requires the nutrition sector to continue to boldly reach out to other sectors to show how these nutritional benefits may be analysed and improved upon.
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THE RIGHT TO NUTRITION IN CONFLICT SITUATIONS
Urban Jonsson, Iain Levine and Hamish Young UNICEF
In July 1999, Namanga Ngongi, then Deputy Executive Director of WFP asked:
What are the right criteria to help guide humanitarian agencies in deciding when to get involved, when to stay involved and when to withdraw in the emergency context (especially when governments deny access to civilians)? Do we stay knowing that our food aid relieves the government of some of its obligations? Or do we take a high moral stand and withdraw, knowing that this, at least in the short term, will mean that those living in poverty will continue to suffer1
Ngongi has posed a question based on various ethnical dilemmas that most agencies face when running programmes to support the right to adequate nutrition of civilians affected by conflict.
This paper looks at case studies drawn from UNICEF's experience in Sudan and Burundi that highlight the types of ethical dilemmas referred to by Ngongi and why operational agencies are facing these dilemmas more often. It concludes that a number of interrelated factors are creating more ethical dilemmas. These, include the changing nature of warfare and conflict throughout the twentieth century: the increasing focus on human rights violations as a cause and a consequence of contemporary conflict, and the increasing application of human rights principles to guide programming by operational agencies.
In 1998 agencies working to realize the rights of civilians in the Bahr El Ghazal (BEG) Region of Sudan faced a number of ethical dilemmas. In particular agencies were faced with the dilemma of what, if any, actions they should take when faced with large-scale diversions and theft of food and other humanitarian supplies. The scale of the diversions raised serious questions as to the neutrality and impartiality of the operation; however suspension of deliveries or other sanctions would have threatened the on-going efforts to meet the humanitarian needs.
In 1998 the government of Burundi adopted a policy of forced relocation or regroupment of civilians to restricted camps. The government claimed that it was entitled to take this action for the security of the civilians and that it was legal under the Geneva Conventions. However, most observers and legal experts were of the opinion that the action was illegal under International Humanitarian Law (IHL) and was a violation of a number of human rights. Despite international protests the government proceeded with its policy and called on the UN and NGOs to provide food, health-care and other humanitarian services to the regroupment camps. The agencies were faced with the dilemma of on the one hand fulfilling their commitment to the humanitarian imperative and meeting the humanitarian needs of the civilians in the camps, but on the other hand, assisting and legitimizing the government in an illegal action that violated the rights of many of its citizens.
a state's scope for derogation from its legal obligations in emergency or conflict is very limited, and in many instances, non-existent
Nutrition and Nutrition as a Human Right
The adequate nutritional status of an individual requires simultaneously household food security, adequate care and protection, and adequate access to basic health services. During 1990-1996 the SCN debated intensively how to conceptualize the causes of malnutrition. This paper uses the conceptual framework proposed and used by UNICEF2.
Except for the Convention on the Rights of the Child (CRC), nutrition is not explicitly recognized as a human right in most conventions and declarations. This is mainly because a 'food-biased' approach dominated the concept of nutrition; nutrition was more or less equated with lack of food. As addressed in a large number of UN Conventions and Declarations, 'freedom from hunger', and the 'right to food', therefore, often meant, implicitly at least, a right to nutrition.
Nutrition as a Human Right During Conflict
NON-DEROGABLE HUMAN RIGHTS Critics of international human rights law and its use to support programming by development and humanitarian agencies (through what has become known as the human rights approach to programming (HRAP)) are always quick to highlight its lack of enforceability and difficulty of application, particularly in emergency and conflict situations. Much of this criticism stems from a commonly held misunderstanding that most human rights law does not apply during conflict situations because it may be derogated.
Derogation is a procedure through which a state may temporarily suspend certain of its obligations under international human right law and it is the general concept of derogation that has lead to the confusion or misunderstanding that human rights law has little or no application in conflict. However, on close examination it is clear that a state's scope for derogation from its legal obligations in emergency or conflict is very limited, and in many instances, non-existent.
The derogation clause most commonly referred to by those who argue that there is little scope for application of human rights law in conflict is Article 4 of the International Covenant on Civil and Political Rights (ICCPR) which states that 'in times of public emergency which threatens the life of the nation States Parties may take measures derogating from their obligations under the present Covenant with their other obligations under international law and do not involve discrimination solely on the ground of race, color, sex, language, religion or social origin.'
Paragraph 2 of Article 4 goes on to stipulate that there can be no derogation from: Article 6, the inherent right to life of every human being; Article 7 the prohibition against torture and cruel, inhuman or degrading treatment or punishment; Article 8(1) and (2), prohibition against slavery and servitude; Article 11, prohibition against imprisonment for failing to fulfil a contractual obligation; Article 15, the prohibition against retrospective criminal prosecution; Article 16, the right of recognition before the law; and Article 18, the right to freedom of thought, conscience and religion.
So, quite clearly, the so called 'derogation clause' in the ICCPR does not in any way permit States to suspend or reduce their legal obligations to ensure the adequate nutritional status of their citizens during times of emergency conflict. Finally, it is also important to note that many international treaties simply do not have derogation clauses, and therefore cannot be derogated from at all. Critically, the International Covenant on Social, Economic and Cultural Rights (ICSECR) and the CRC cannot be derogated and therefore apply equally during times of conflict as during times of peace.
As well as having a continuing legal obligation to maintain the nutritional status of its own citizens during times of conflict, a state also has certain legal obligations towards foreign nationals seeking refuge in their territory including facilitating access to adequate food, health services and protection necessary for the maintenance of an adequate nutritional status. In addition, states also have an obligation to cooperate with UN High Commissioner for Refugees in order to provide adequate care, assistance and protection for refugees (see Convention Relating to the Status of Refugees, 1951).
Article 54 specifically prohibits starvation of civilians as a method of warfare
THE RIGHT TO NUTRITION UNDER INTERNATIONAL
HUMANITARIAN LAW (IHL) International Humanitarian Law (IHL), or the 'Law of war' as it is sometimes referred to, is a branch of public international law which is applicable during international and non-international armed conflict. It is meant to restrict or limit the right of the parties to a conflict to use the method or means of warfare of their choice and to protect persons and property affected or liable to be affected by the conflict.
There are a plethora of international humanitarian law instruments and customary IHL jurisprudence. This paper will focus on the Geneva Conventions of 1949 (primarily Common Article 3, and the 4th Geneva Convention on the Protection of Civilians) and the two Additional Protocols of 1977.
INTERNATIONAL ARMED CONFLICT In the case of international armed conflict, the Fourth Geneva Convention provides certain legal safeguards and provisions for the civilian population of opposing states, which if adhered to would ensure their adequate nutritional status.
When one state occupies the territory of another, the civilian population of the occupied state becomes protected persons under Article 4 of the Fourth Geneva Convention. Section III provides specific provisions, which if fully applied and respected should ensure the nutritional status of the civilian population. In particular, Article 55 provides for the provision of adequate food and Article 56 provides for adequate health care.
If an occupying power is unable to adequately address the food and health requirements of the civilian population, it is required by Article 59 to 'agree to relief schemes on behalf of the said population, and shall facilitate them by all the means at its disposal'.
In addition to the protection provided by the Fourth Geneva Convention, additional protection for the civilian population affected by international armed conflict by Additional Protocol I of 1977. Article 54 specifically prohibits starvation of civilians as a method of warfare and population, such as foodstuffs, agricultural areas for the production of food, crops, livestock and irrigation and water supply facilities. Article 69 supplements the Fourth Geneva Conventions and provides that the occupying power shall, to the fullest extent of the means available to it and without any adverse distinction, also ensure the provision of clothing, bedding, means of shelter, other supplies essential to the survival of the civilian population of the occupied territory and objects necessary for religious workshop.
Finally, in addition to refugees, one state to a conflict may have nationals of the opposing state(s) on its territory at the outbreak of hostilities. Foreign nationals in this situation are defined as 'protected persons' under Article 4 of The Fourth Geneva Convention and are entitled to specific protection, which if applied fully, should include such provisions to ensure their adequate nutritional status.
NON-INTERNATIONAL ARMED CONFLICT Various forms of protection are also available to civilian populations in civil, or non-international armed conflict. Article 3, common to each of the Four Geneva Conventions (usually referred to as 'Common Article 3') provides for the protection of civilians in non-international conflict against violence to life and person (in particular murder of all kinds, mutilation, cruel treatment and torture) against them being taken as hostages and against outrages upon personal dignity, in particular humiliating and degrading treatment.
Additional protection for civilians and their rights is provided by the Second Additional Protocol of 1977, which develops and supplements Common Article 3. Article 14 of the Additional Protocol II provides, in addition to the various protection of life in Common Article 3, that starvation of civilians as a method of combat is prohibited. It is therefore prohibited to attack, destroy, remove or render useless, for that purpose, objects indispensable to the survival of the civilian population, such as foodstuffs, agricultural areas for the production of foodstuffs, crops, livestock, drinking water installations and supplies and irrigation works.
Finally, it is important to note that there are strong arguments that the Additional Protocols apply even to States that have not signed them because they have become part of the body of customary international humanitarian law. This also means that in case of non-international conflict, the Additional Protocol II also applies to non-state warring parties such as liberation movements and rebel groups.
The Changing Context
THE CHANGING NATURE OF CONFLICTS Though there is obviously great variation amongst contemporary conflicts, there are also many similar features that have important implications for humanitarian work and those who seek to realize the right to adequate nutrition.
Most contemporary conflicts are internal, often ethnically based. They usually pit government forces and associated militias and paramilitaries against insurgents of various kinds. These insurgents may be motivated by ideology, ethnic identity and grievances or a pursuit of economic gain. There may be several different groups operating at any one time. Contemporary conflicts are particularly lethal for children because they make little distinction between combatants and civilians. In recent decades, the proportion of war victims who are civilians has leaped dramatically, from 5% to over 90 %.
many of today's conflicts grow out of human rights abuses
Most of today's humanitarian crises have grown out of human rights crises. Indeed, as Mary Robinson, UN High Commissioner for Human Rights has often pointed out, many of today's conflicts grow out of human rights abuses. The targeting of civilians is often a deliberate tactic of war entailing horrific levels of violence and brutality, employing any and all means-from systematic rape, to the destruction of crops and the poisoning of wells, to ethnic cleansing and outright genocide. Too often, combatants have abandoned all human standards traditional values as well as standards defined by international human rights and humanitarian law. Children themselves can be drawn in as fighters, not just the targets of warfare but even the perpetrators of atrocities.
During the 90s, more than 2m children died as a result of armed conflicts, and more than three times as many have been permanently disabled or seriously injured. Currently, approximately 20m children have been uprooted from their homes, either as refugees or internally displaced. At any given time, more than 300,000 children under the age of 18 are being used in hostilities as soldiers.
The manipulation of aid for their own purposes by warring parties is increasingly common. This has become particularly the case as, for many western governments, humanitarian assistance has become their principal tool of foreign policy amongst countries of peripheral economic and political interest. Though international humanitarian law calls on warring parties to provide safe and unhindered access to populations in need, especially women and children, such access is often denied. Aid agencies are often accused of prolonging conflicts. In addition, humanitarian actors are often criticised for prolonging conflict and sustaining violent status quos by seeking to feed all sides and failing to prevent the diversion, taxation or extortion of humanitarian supplies.
Traditionally, wars were played out on the battlefield between young men in uniform fighting for their countries. Most contemporary conflicts are internal and are, in so many ways, much more complex. The fighters may be government soldiers, insurgent groups, paramilitaries of government supported militia, warlords, criminal gangs, traditional tribal forces or security forces belonging to economic actors. In some conflicts, men act as soldiers by day and rebels by night. Young children are abducted and-most brutally in Sierra Leone and Northern Uganda-turned from victims to perpetrators overnight. All of these features serve to blur the once clear distinctions between civilians and combatants. Given that humanitarian law and principles are predicated upon the ability to distinguish between military and civilians, many serious dilemmas result.
The vast inconsistency in mobilising resources for war-affected children is one of the most brutal inequalities in the world today. Sierra Leone received less than US$20 per child in 1999 compared to US$216 per child in Kosovo. Donors' response is frequently inconsistent, short term linked to strategic interests rather than impartial definitions of need and media driven. Humanitarian agencies are left to respond inconsistently to malnutrition and humanitarian crises.
Humanitarian crises are generated and sustained by a plethora of different actors-many of whom cannot be held accountable for their actions. Government forces and militias, insurgent groups, UN agencies, international and national NGOs, economic actors including transnational companies, neighbouring governments, intergovernmental organisations all influence the political and economic environment that affects access to food, health care and protection. Though most conflicts today are internal, almost all have a regional context, with flows of small arms, mineral resources, refugees and mercenaries across borders. The conflict in the DRC-especially since the resurgence of fighting in late 1998-is perhaps the best example
HUMANITARIAN CRISES AND THE PEACE AND SECURITY AGENDA With the end of the Cold War, the rise in failed states and internal conflicts and the growth of the so-called complex emergencies, the UN and the Security Council increasingly found itself addressing threats to peace and security that were also humanitarian crises. Through the 90s, the 'human security agenda', led by Canada and countries such as Norway gained influence at the global level. As outlined in the Lyseclaration signed by Norway and Canada in May 1998, the human security agenda addresses land mines, the International Criminal Court, human rights, international humanitarian law, women and children in armed conflict, small arms proliferation, child soldiers and child labour.
The human security agenda saw some major successes through the 90s. The Mine Ban treaty, the ICC statute, the Optional Protocol to the Convention on the Rights of the Child on participation in conflict marked significant progress in the creation of new legal standards. In addition, the Security Council made major steps forward in acknowledging the human dimensions of its mandate in passing resolutions on the protection of civilians in conflict (Resolutions 1265 and 1296); children and armed conflict (1261, 1314, 1379), women, peace and security (1325) and HIV/AIDS and peacekeeping (1308).
The right to nutrition in conflict situations is violated in many countries and in many ways
The Council has been much slower than it ought to in ensuring the integration of the principles and commitments made in these resolutions into its work on specific country situations. Humanitarian agencies need to recognise the opportunities raised by these developments to sharpen their political advocacy and ensure that the humanitarian dimensions-or the human security agenda-of situations on the SC agenda-are more consistently developed.
DEVELOPMENTS IN INTERNATIONAL HUMAN RIGHTS LAW AND MECHANISMS International human rights law applies to States and their obligations to their citizens. Human rights mechanisms and NGO watchdogs such as Amnesty International traditionally eschewed addressing the activities of rebel groups or economic actors even where their actions had a major impact on civilians. In addition, throughout the Cold War, the emphasis on respect for state sovereignty as defined in the UN Charter, meant that the UN system was reluctant to take any action that might be perceived as interfering in the domestic affairs of the nation state.
Human rights standards remained of little relevance or comfort to victims of internal conflicts for many years. Even international humanitarian law provided little protection for victims of internal as opposed to international conflicts. Though the Rwandan genocide of 1994 and subsequently events in Kosovo, East Timor, Afghanistan, Bosnia and other civil wars and humanitarian crises have sensitised human rights activists and human rights mechanisms to the links between state sovereignty, human rights and humanitarian action.
In recent years, the Office of the High Commissioner for Human Rights has become much more operational and now has a presence-independent or as part of a broader UN presence-in many of today's conflicts: Sierra Leone, Colombia, DRC, Burundi, Afghanistan to name but a few.
Challenges for Humanitarian Agencies
CHALLENGES The right to nutrition in conflict situations is violated in many countries and in many ways. According to the 2002 UN Consolidated Appeals, there are millions of people who suffer from both acute and chronic malnutrition as a result of conflicts and the ways in which they are being waged.
Many of the reasons for the continued widespread prevalence of malnutrition in conflicts are programmatic and operational. These include inadequate or inconsistent funding, denial of access of diversion by warring parties, forced displacement, and insecurity for humanitarian staff. Lack of professionalism may be a cause in some cases. This section seeks to address some of the changes in the way in which humanitarian action is carried out and will seek to identify some of the ethical dilemmas resulting.
HUMANITARIAN DILEMMAS Changing patterns of conflict, as described above, have created some serious challenges and opportunities, for humanitarian agencies. Some of these have already been implied or referred to but it is important to spell them out in some detail.
Given that most humanitarian crises today are also crises of human rights, the obligations of humanitarian agencies to address protection, as a fundamental and integral aspect of humanitarian action, has to be more systematically addressed. This is perhaps the most important challenge to be addressed. Humanitarian workers are often the first to witness or know of human rights violations. However, understanding of and commitment to the human rights dimensions of humanitarian work remains inconsistent and weak. There are also valid concerns that to advocate for protection issues may reduce access to populations in need and endanger the wellbeing of staff and programmes.
Further, those who control access to civilians may well be war criminals. Humanitarian agencies thus have to risk legitimizing these military leaders because of their need to engage with them. Yet, how should humanitarian agencies engage with non-state actors devoid of any political structure or ideology (non-state actors cannot sign and ratify international treaties), and if so under what conditions?
How to hold non-state entities accountable when their command and control structures are often weak? In the case of UN agencies, how to reach those in need in areas outside of Government controls without contravening sovereignty? Humanitarian actors are accused of prolonging conflict in different ways: through uncontrolled diversion of humanitarian supplies, through taxation and extortion, and through fundability of resources.
Except in extreme cases (e.g. Goma camps in 1994), few would argue that aid should be withdrawn from those in lifesaving need but how can humanitarian agencies ensure that they do not become part of the problem as many have so often alleged3,4,5.
International humanitarian law and humanitarian principles are predicated upon a clear distinction between civilians and the military. How does one keep food from an irregular militia member where wife, mother, sister, daughter is a beneficiary of food aid? How does one ensure that 'selected civilian beneficiaries' are just that?
CHANGING PARADIGMS OF HUMANITARIAN ACTION
The most basic obligations of humanitarian actors in working with those affected by humanitarian crises is to save lives and to alleviate suffering, while preserving the dignity of all those affected. Humanitarian action therefore has to be concerned with protecting people from violence and abuse, and protecting or restoring livelihoods that have been threatened or destroyed by disaster or conflict. Humanitarian action is born out of and guided by human rights, humanitarian law and humanitarian principles including a sense of compassion and solidarity with those affected by disaster.
Humanitarian action traditionally focused on service delivery: health, water, nutrition, food aid and shelter. Humanitarians eschewed any mention of human rights though their beneficiaries were some of the most vulnerable populations imaginable. Reasons for this included a belief that human rights were somehow 'political' and controversial-while humanitarianism was safe; a concern that advocacy on human rights issues would compromise access to populations in need and a belief that attention to human rights would somehow compromise neutrality. As Slim argues, 'Throughout the second part of the 20th Century, the greater part of humanitarian activity and ideology has remained firmly in a philanthropic mould'6.
In recent years, in response to the changing nature and increased complexity of humanitarian crises, humanitarian action has expanded its scope and the range of its actions. This includes the development of programmes such as family reunification, psychosocial care of children and education-all critical elements of humanitarian work. But, more importantly, humanitarian action has slowly begun to engage with the need to protect as well as assist victims of conflict.
The move towards a rights-based approach to humanitarian action has been a slow and painful one for most humanitarian agencies. Few really understand the meaning of protection in a humanitarian setting and even the most basic definition of protection competencies is not yet achieved. Training on human rights, humanitarian law and associated standards such as the Guiding Principles on Internal Displacement is inconsistent. Experience from a diverse range of humanitarian crises suggests that few humanitarian agencies engage on what they still perceive to be controversial or sensitive issues.
In addition to the slow progress made in addressing human rights in the context of humanitarian action, humanitarian workers have also recognized the need to root their work within an ethical framework. Such a framework is made up of what are known as humanitarian principles. Though there is no one definitive list of humanitarian principles, they are widely seen to include: the humanitarian imperative, neutrality, impartiality, independence, transparency, accountability, do no harm, protect from future vulnerabilities, and respect local custom
Various attempts have been made to codify and enforce these principles. These include the IFRC/NGO Code of Conduct for NGOs working in disaster relief that has been endorsed by most of the major NGOs to initiatives at country level to create a consensus amongst humanitarian actors themselves such as occurred in Sierra Leone and Liberia. Other initiatives have also sought to establish agreements with warring parties. The Operation Lifeline Sudan Ground Rules, for example, adopted a joint commitment between the rebel groups and the humanitarian actors towards the Convention on the Rights of the Child and the Geneva Conventions as well as a declaration of humanitarian principles. The Ground Rules sought to define not only the legal and moral standards pertaining to both parties but clear accountabilities-do's and don'ts of all sides so that all concerned knew what they could and could not do. Though only partially successful, the Ground Rules did represent an early attempt to deal with the concept of claim holders and duty bearers in such situations.
Human Rights Actors in Conflict Situations
CLAIM HOLDERS AND DUTY BEARERS Human rights represent relationships between a subject with valid claims (claim-holder) and objects with correlative duties and obligations (duty-bearer). International human rights law only recognises the obligations of the state. The CRC is an exception, because parents or child caretaker are also recognized as duty-bearers. There is a need to extend the claim-duty relationship to increase additional subjects and objects at sub-national and community levels. In armed conflict this would include all key non-state actors. As a matter of fact, many of the 'principles of humanitarian actions' reflect exactly such relationships.
It is interesting to note that both the ICESCR and the ICCDR state in their preamble:
Realizing that the individual, having duties to other individuals and to the community to which he belongs, is under a responsibility to strive for the promotion and observance of the rights recognized in the present covenant
This statement can be understood as recognition of other duty-bearers than the state.
In a Human Rights Approach to Programming (HRAP), such an approach requires the identification of all key duty bearers in relation to each specific human right, including the right to nutrition. Such an analysis is called role or pattern analysis.
In such an analysis, it is important to recognize that very often the individuals may be a claim holder and a duty bearer at the same time, but in relation to different rights. For example, parents are the prime duty-bearers in realizing the rights to nutrition for their children. However, this right might be violated because some of the crucial rights of the parents are violated.
The parents may have a right to emergency food and the area commander has the correlative duty to ensure this, but violates this right. There is a web or a pattern of human rights relationships. An example of these relationships from the famine in Southern Sudan in 1998 is summarised in Table 1.
DEFINITIONS OF ACCOUNTABILITIES As mentioned above human rights express relationships between a subject with a valid claim and objects with correlative duties and obligations. These duties or obligations specify what the objects are supposed to do; in other words for which the objects are to be held accountable. Human rights are, therefore, closely related to accountability.In order to hold someone accountable three conditions must be met. First, the person must accept that she/he has a responsibility, i.e that she/he should act. This includes awareness and motivation. Second, the person must have the authority to act, i.e. she/he may act. It must be legitimate for she/he to act. Third, the person must control resources, i.e. that she/he can act.
Responsibility, authority and resources are necessary components of capacity. Very often lack of action where an objects duties are not met or carried out, is due to a lack of capacity, rather than because of negligence or ill-will. In a HRAP it is therefore important to identify the specific gaps in the capacity of all duty bearers. Programmes can then be designed to close the specific gaps between the duty and capacity of specific duty bearers.
Where a duty bearer is intentionally violating rights, different types of programme interventions are required as lack of capacity is not the problem.
CASE STUDY 1. THE 1998 FAMINE IN SUDAN
As is well known, famines are rarely, if ever, freak and unpredictable events. They are almost universally manufactured, either intentionally or out of negligence, because governments and other governing authorities want them to happen or do not care if they happen because they have other political, economic or military priorities. The famine in Sudan in 1998 was no exception.
As the famine was developing in the Bahr El Ghazal (BEG) region at the beginning of the year the government of Sudan placed a complete, and then maintained a partial, flight ban over the worst affected areas for six weeks. This effectively denied aid agencies access to populations in need at one of the most critical points, and right at the moment when assistance was required to prevent the full scale catastrophe that was to develop shortly after. The flight ban was lifted in mid-March and agencies were able to deliver large amounts of food and health services to the worst affected areas. After some logistical constraints, the operation was at full scale by June, delivering enough food and health services to meet assessed needs. However, despite the amount of food and health services that were being provided malnutrition rates were not declining.
Table 1 Claim-Duty Relationships during the Bahr El Ghazal Operation (1988)
Claim Holder SPLA
Distribution of assistance
| || || || || |
Distribution of assistance among the household
Inform about distribution
| || || || |
| || || ||
Collect food to the army(tax)
| || || |
No recruitment of child soldiers
Ensure access and prevent theft
| || ||
Provide food to the IDPs
| || || || || || |
Support according to needs
| || ||
Neutrality and impartiality
| || ||
Neutrality and impartiality
Ensure basic services
| || || || ||
Ensure access by air
In this table vulnerable people are shown to have a right against SPLA not to recruit children for the army. SPLA is the duty-bearer. On the other hand SPLA has a right against Relief Workers that they perform their work in a neutral and impartial manner. The Relief Workers are the duty-bearers. The table is far from complete and only shows some examples.
There was much debate as to why malnutrition rates were not declining, or declining fast enough, and it was agreed to conduct a joint assessment by UNICEF and WFP, NGOs and the non-state entity that controlled the BEG region, the Sudan Peoples Liberation Movement/Army (SPLM/A) and its relief organization, the Sudan Relief and Rehabilitation Association (SRRA), an NGO registered in Kenya. This strategy was controversial because the SPLA was taking the food for its soldiers and that therefore there was no way that the SPLM/A and SRRA could objectively assess the situation. It was decided to conduct the assessment jointly because even if it were determined that the SPLA was the cause of the problem, the SPLM/A and SRRA were the only groups that could solve it.
The main findings of the joint assessment were:
· the SPLA was taking relief food and other supplies, but this was not the major contributing factor to the problem
· there may have been some under assessment of overall needs and total population, but his was not the major contributing factor to the problem, and
· following distribution to targeted recipients (assessed beneficiaries) there was a re-collection of food by local political leaders (chiefs, traders, military commanders, SPLM and SRRA officials all exercising personal not organizational political authority) and redistribution based on the local social socio-political hierarchy, rather than on the basis of assessed needs, and this was major cause of the problem.
The SPLM/A and SRRA resolved to take immediate and urgent measures to rectify the problem and correct the distribution of food and other relief supplies. By the last quarter of the year, although malnutrition and mortality rates were substantially declining, it was clear that there was still a major problem and that the SPLM/A and SRRA were either unwilling or unable to address the problem. The relief operation was seeking to meet the first humanitarian principle of the humanitarian imperative. However, with the well-documented continued diversion of food and other relief supplies, it was very difficult for OLS to maintain that its operations in BEG were neutral, impartial or transparent and it was very difficult to be accountable to anyone-beneficiaries-or donors for the humanitarian assistance. Neutrality, impartiality, transparency and accountability are all vital humanitarian principles. UNICEF, as the lead agency in OLS but in close consultation with sister agency in OLS but in close consultation with sister agency WFP, considered two options for resolving the problem, both of which created ethical dilemmas. The first was to suspend the delivery of food to BEG, and the second was to suspend non-life saving capacity building support to the SRRA.
Ethical Dilemmas: Both of the above solutions created or risked the creation of serious ethical dilemmas. With the first, suspending operations to restore neutrality and accountability would have meant violating the humanitarian imperative. With the second, there was the risk that the SPLM/SRRA may have retaliated by expelling OLS from its areas, denying access and preventing OLS from seeking to meet the humanitarian imperative.
Resolution: The ethical dilemmas were never fully resolved. The OLS management team rejected the first option on the basis that seeking to meet the humanitarian imperative was the primary reason for OLS' existence and that it was preferable to accept some partial subjugation of the other humanitarian principles in order to maintain the supremacy of the humanitarian imperative. However, in certain circumstances deliveries of food to some locations were cancelled on the basis that the level of diversion was so high that there was no food at all reaching targeted beneficiaries and therefore continued supply was doing nothing to meet the humanitarian imperative in any event.
The second option was put by the OLS management team to the OSL consortium of NGOs at a meeting in mid-November and a vote was taken. Of the approximately 30 NGOs at the meeting, only one voted in favour of suspending building support and risking loosing access. So again, seeking to meet the humanitarian imperative was considered to be of overriding importance.
CASE STUDY 2: REGROUPMENT CAMPS
Some humanitarian crises create situations where civilians are forced-against their will and against international law-into situations where they should not be but where they will suffer and possibly die. A dilemma exists in fulfilling the right to nutrition but, by doing so, legitimizing the forced displacement. This is happening in Angola currently since late 2001, the Government Armed Forces (FAA) have been carrying out major counter insurgency operations in Eastern/Central Angola. The displacement is often 'forced displacement. The objective of the strategy is to cut off logistical support to UNITA as well as further weaken the movement by limiting their contact with local populations. OCHA estimates that over 50% of displacement currently is caused by the Government. The impact on civilian population has been devastating with an estimated 30,000 people being displaced in December and early January alone. Government services have not been established at any location to adequately cope with the consequences of the counter insurgency. In such situations, humanitarian agencies are faced with a need to feed those displaced without endorsing or condoning the actions of the government.
In 1998 the government of Burundi adopted a policy of forced relocation or regroupment of civilians to restricted camps. The Government claimed that it was entitled to take this action for the security of the civilians and that it was legal under the Geneva Conventions. However, most observers and legal experts were of the opinion that the action was illegal under International Humanitarian Law (IHL) and was a violation of a number of human rights. Despite international protests the Government proceeded with its policy and called on the UN and NGOs to provide food, healthcare and other humanitarian services to the regroupment camps.
Ethical Dilemmas: The agencies were faced with the dilemma of, on the one hand, fulfilling their commitment to the humanitarian imperative and meeting the humanitarian needs of the civilians in the camps, but on the other hand, assisting and legitimizing the Government in an illegal action that violated the rights of many of its citizens.
Resolution: The UN system, and most NGOs that were facing the same dilemma, resolved it by applying maximum pressure to the Government of Burundi through diplomatic means to change its policies while at the same time providing a minimum amount of humanitarian assistance to maintain an adequate nutritional status of the populations in the regroupment camps. All agencies involved agreed not to provide any form of assistance that could help sustain the camps on a long-term basis. This sometimes meant that the assistance that was provided became considerably more expensive (for example water was trucked in rather than provided by digging bore holes which would have been cheaper but permanent), but, this was considered an acceptable cost to pay in order to find a balance between meting the humanitarian imperative and not supporting the illegal actin of regroupment.
Conclusions and Recommendations
Recognition of the right to nutrition in situations of conflict has increased at global and field level in recent years. The ongoing UN reform, launched by the Secretary General, has helped to advance the thinking amongst UN agencies to develop and use a human rights approach to programming. Humanitarian assistance and protection of human rights are more closely integrated than before, although inconsistently and frequently with little real impact.
The Humanitarian Charter of the Sphere Project states:
we reaffirm our believe in the humanitarian imperative and its primary. By this we mean the belief that all possible steps should be taken to prevent or alleviate human suffering arising out of conflict or calamity, and that civilians so affected have a right to protection and assistance. It is on the basis of this belief, reflected in international humanitarian law and based on the principle of humanity, that we offer our services as humanitarian agencies.
The conclusion from this paper can be summarized as follows:
· The changing nature of armed conflicts has limited the applicability of International Humanitarian Law (IHL). The difference between combatants and civilians is frequently no longer clear
· This, however, does not mean that IHL no longer is useful in armed conflicts. The principles and standards enshrined in the IHL remain vital to the protection of civilians and require intensified promotion and dissemination
· Human Rights Law (HRL) is not so often derogable in conflicts as many assume. The ICESCR and CRC, for example, are not derogable at all
· There is a need and a possibility to extend HRL to define duty bearers other than the states parties.
· The Preamble of the UDHR and the two Covenants recognize this possibility. This would mean that duty-bearers should be identified at all levels of society with specific accountabilities
· In summary, International Humanitarian Law and an extended Human Rights Law should be used in conflict situations.
1. ACC/SCN (1999) Right to Nutrition: Symposium Proceedings. SCN News 18: 12-83.
2. Jonsson U (1997) An approach to assess and analyse the health and nutrition situation of children and women in the perspective of the Convention on the Rights of the child. The International Journal of Children's Right 5:367-381
3. Anderson MB (1999) Do No Harm: How Aid can Support Peace or War. Lynne Rienner Publishers: Boulder.
4. de Waal A (1995) Humanitarianism Unbound. African Rights: London.
5. de Waal A (1997) Famine Crimes. Politics and the Disaster Relief Industry in Africa. James Currey: London.
6. Slim H (2001) Not Philanthropy But Rights: rights-based humanitarianism and the proper politicisation of humanitarian philosophy. Paper presented at a seminar on Politics and Humanitarian Aid: Debates, Dilemmas and Dissension. Commonwealth Institute, London.
Contact: U Jonsson (UNICEF/ESARO) firstname.lastname@example.org
I Levine (UNICEF/NYHQ) email@example.com
H Young (UNICEF/ESARO) firstname.lastname@example.org
Doing the Right Thing: Addressing Humanitarian Dilemmas
Chair: Professor MS Swaminathan, SCN's Distinguished Nutrition Advocate
Principles of humanitarian action were first developed by the ICRC to guide humanitarian action in conflict situations. Since the early 90s, there have been an increasing number of agencies working in on-going conflicts, which has led to a renewed emphasis on humanitarian principles. In particular, this includes the adoption of the "Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief" (see box, p 48).
Minimum standards for disaster response were first developed in 1998. These are aimed at improving the quality and accountability of humanitarian response. Accountability, in terms of compliance with agreed minimum standards, is a means of achieving impartiality. Minimum standards are given in the Sphere Project Handbook, which also incorporates the Humanitarian Charter. The Humanitarian Charter re-inforces the core principles of humanity and impartiality, as well as others set out in the Code of Conduct. It also contains aspects of humanitarian, human rights and refugee law.
On the ground, the principles of humanitarian action (and aspects of Humanitarian Law) have been incorporated into agreements between agencies and warring parties. These agreements have taken the form of local codes of conduct or ground rules. They usually outline the respective responsibilities of different actors in achieving a principled, humanitarian response, including for example, ensuring the security of aid workers and obtaining access to populations in need.
International aid agencies and workers are faced with the challenge of applying principled approaches during emergencies, but what is the appropriate response when principles and standards cannot be met? How do you "do the right thing"?
The Principles of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Response Programmes
In order to maintain high standards of independence, effectiveness and impact in disaster response, eight* of the world's largest disaster-response agencies came together in 1994, to agree on the following:
*Caritas Internationalis, Catholic Relief Services, the International Federation of Red Cross and Red Crescent Societies, International Save the Children Alliance, Lutheran World Federation, Oxfam, and the World Council of Churches
· The humanitarian imperative comes first.
The full text of the Code of Conduct can be viewed on the IFRC website http://www.ifrc.org/publicat/conduct/index.asp
Why are we not meeting standards?
Manuel da Silva, WFP
In my experience at WFP, there are four reasons why the international community is not meeting standards. First, denial of access to vulnerable or affected populations is becoming more frequent. In the past when there were fewer emergencies, it was easier to separate the political linkages from the emergency. Today, the political linkages are very much embedded within the emergency, increasing the need for negotiated access to affected populations. For example, in Angola in 1996, the UN faced a dilemma: agree to have 50% of emergency aid distributed in UNITA areas, where needs were assessed to be low, or not have access to government areas. If the UN refused to cooperate with UNITA, 25,000 people would starve, of which 15,000 were women and children. In cases when life is threatened, agencies need to adjust to the context. However, flexibility in fulfilling standards, or in general principles, should only be considered in clear life threatening situations. In these situations, the medium term consequences need to be balance against the short term benefits.
Second, there is a lack of agency presence on the ground. Standards, knowledge and research for emergencies exist. What is lacking is implementation. In the earlier stages of the Ethiopian crisis in 2000, with the exception of MSF and ICRC, there were no agencies on the ground. This stems mostly from attention being diverted from implementation to advocacy, so much so, that we are not doing as much as we should do.
Third, issues of security are hampering aid workers' ability to meet minimum standards during emergencies. WFP has a higher relative percentage of staff killed than Americans killed in Viet Nam. It is rare to come across someone at WFP who has not lost a friend or colleague at some point in his or her career. Security conditions reduce the presence of humanitarian agencies on the ground more than in the past.
Finally, resources are insufficient to respond to emergencies today. Although, there has been an increase in resources, we need to compare that increase to the number of emergencies over the last five years. WFP had many more resources in Sudan in 1999 than available today. In West Africa, specifically in Guinea, Liberia and Sierra Leone, only 17% of required resources have been raised for this year. This means that by June there will be no food in any of the refugee camps in this region.
Building local capacity: does it comprise the humanitarian principles of neutrality, impartiality and independence?
Susanne Jaspars, Nutrition Works
Principles are particularly relevant in relation to food distribution in conflict, because food distribution has been shown to be the intervention that is most subject to abuse. Further, abuse of food distribution may result in the exclusion of the most vulnerable groups. War strategies are often designed to deny access to food to people perceived to support the opposition, and they may be excluded from food distribution through denial of access, attack, manipulation of assessments, under-registration etc. Food may also be diverted, taxed, or stolen to benefit the army or militia, local authorities or powerful groups or individuals. At the same time, in financial terms, food assistance forms the largest component of humanitarian assistance.
In the Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief, it is stated that:
· agencies will attempt to build disaster response on local capacities, and
· ways shall be found to involve programme beneficiaries in the management of relief aid.
In practice, capacity building can mean a variety of things, ranging from education and training, to supporting local coping strategies. In food distribution, agencies sometimes try to build on local capacity by distributing food through local authorities or traditional elders, local NGOs or community based relief committees.
Working with local institutions, however, poses serious risk of compromising the core principles of neutrality and impartiality for several reasons. Each institution will have its own particular agenda, ethnicity and political affiliation which position civilians as well as the military, local institutions may be under pressure to favour the more powerful, and local institutions may have different perceptions of vulnerability and entitlements.
In a workshop in Nairobi in December 2001, agencies agreed that in situations of acute crisis, capacity building was usually the first principle to be abandoned in the interest of the humanity and impartiality.
To achieve an impartial response, it is necessary to take active measure to reach the most vulnerable. This includes:
· objectively assessing the severity of crisis and, therefore, the need to intervene
· analysing the risk of abuse
· identify distribution methods that effectively reach those most in need
· work with accountable local institutions or distribute directly to beneficiaries
· independent monitoring, and
· minimize taxation and diversion through specific strategies.
Distribution methods include, for example, distribution to elders, to local authorities or NGOs, to relief committees, or directly to households or to individuals. There are a number of agency practices to ensure a neutral and impartial response. For example, with increasing severity of exploitation and abuse, the following may be used:
· agreements with local institutions to adhere to principles
· registration, ration cards, and monitoring
· distribution to small units, direct to malnourished
· less desirable foods, frequent distributions in small quantities, and
· soup kitchens.
The key points to remember when designing a principled food distribution, or any humanitarian intervention, are that the humanitarian imperative, and the victims' interests, should always come first. Some approaches, or principles, may compromise the application of others, and in acute crises, capacity building as part of food distribution may have to be abandoned in the interests of humanity and impartiality. Finally, principles can promote consistency and predictability in humanitarian action. If we, as the humanitarian community, can agree on an overall ethical framework to guide our actions, we may have more power to bring about an adequate and effective response to humanitarian crises.
Can Aid 'Do No Harm'?
Lessons learned from experience
Wolfgang Heinrich, Church Development Services (Germany)
In 1994, a group of international agencies were commissioned to conduct the Local Capacities for Peace Project (LCPP). Different types of aid agencies and relief and development projects were reviewed in conflict settings ranging from outright organized warfare to situations of sporadic inter-communal violence. The goal was to discover and define certain common-alties and dilemmas in delivering humanitarian assistance and use this information to develop a tool that assists in future planning. There were six main lessons learned from this process that demonstrate clear challenges to many principles and standards agreed upon today.
When international assistance is given in the context of a violent conflict, it becomes part of the conflict. Although assistance agencies intend to be impartial in relation to who wins and loses in a conflict, the actual impact of their activities is never neutral regarding whether conflict worsens or abates. In conflict settings, relief or development projects can (and often do) reinforce, exacerbate and prolong conflict. However, they can also help to reduce inter-group divisions and support people's capacities to find peaceful options for solving problems.
Situations of violent conflict are characterized by two types of factors. First, conflicts are always characterized by inter-group divisions and tensions. These factors are commonly termed "dividers" or "sources of tensions". On the other hand, the context of violent conflict is also characterized by a number of factors that link and connect people even though they are at war. These are called "connectors" and "local capacities for peace" (LCP).
When relief or development assistance is brought into the context of violent conflict, it inevitably affects those factors that exist in that context that divide people as well as those that connect them. Assistance both feeds into and worsens intergroup tensions and divisions, or it reduces them. The way in which assistance is provided, it either ignores or bypasses existing connectors and peace capacities and, thus, weakens and undermines them or it supports, and thus reinforces, them.
The relief and development workers involved in the LCP found that the resources transferred by assistance projects into areas of violent conflict affect the context in five predictable ways:
· resources are often stolen by warriors and used for their purposes to support armies to buy weapons
· resources have market effects through their on wages, prices and profits; through these, assistance either reinforces incentives for continued violence or incentives for peace
· assistance projects have distributional impacts in that it targets some groups and not others; when a project is directed toward one of the subgroups in conflict, it can exacerbate intergroup jealousies and tensions
· resources brought in through assistance projects can substitute for local resources that, without the assistance project, would have been required to support civilian life; this, in turn, can free up local resources for the pursuit of conflict, and
· assistance projects can legitimize some people and some activities and delegitimizes other people and other activities; insofar as their effects legitimize warriors and their actions, it can reinforce violent conflict.
LCPP also found that how assistance is provided carries "messages". How aid is given, how staff interacts with local people, how protection is arranged, and the like, all convey messages that either reinforce the modes of violence, or reduce them. Seven patterns of "implicit ethical messages" were identified, including: hiring armed guards to protect goods or staff, international agencies' refusal to cooperate with each other sends the implicit message that others do not need to cooperate with them, those who control resources may use them without accountability to others who might need them more, evacuation of expatriate staff and high value technical equipment over local staff sends the implicit ethical message that different lives have different value, and use of gruesome pictures for fund-raising demonises one side of the war and makes innocent the other.
The details of an assistance programme are what deter-mine its impacts on the context. Details that can feed into divisions and tensions or support connectors and LCPs include: the timing of an assistance intervention (when and for how long), the location; the staffing (both expatriate and local), the selection of partners and of "target groups", and the decisions about what and how many external resources to supply. Finally, and most important of all, is in the how of programmes (what kind of distribution system is chosen, how the terms of access to goods are defined and enforced, etc.) that most direct impacts of assistance projects are felt.
Are humanitarian funds only for lifesaving initiatives?
Alain Mourey, ICRC
Can humanitarian funds be transferable from lifesaving initiatives to programmes that support livelihoods? The dilemma can be looked at from various angles and raises many questions, including what are the reasons for the dilemma and what is the real dilemma?
First, all donors are not alike in their allocation of funds. Any generalization is dangerous in this respect. The attribution of funds to live-saving activities rather than the support of livelihoods may be related to quite different issues, such as:
· the specialization of funding towards specific types of projects
· the fragmentation and specialization of the nutrition intervention, meaning that funds are requested accordingly, further influencing the specialization of funding
· the prioritization of live-saving activities over the support of livelihoods
· a preference for activities that make fund raising easy, i.e. those that capture the media's attention. Unfortunately, those activities are mostly oriented to direct live-saving activities (this preference stands true for both donors and humanitarian agencies)
· a preference for activities that can be easily justified, and
· the priority given to a political agenda rather than to humanitarian imperatives.
Such reasons are probably more contextual than conceptual and, as such, do not represent a real difficulty since there is room to maneuver. What is more worrying, though, is that the question of transferability. This implies that funds that can be qualified as humanitarian are only those supporting live-saving activities, whilst those supporting livelihoods are not considered as humanitarian. This represents either a conceptual problem over the meaning of what is humanitarian and/or a manipulation of this meaning. There, perhaps, lies the actual problem.
It is a fact that humanitarian interventions aim to both prevent and alleviate the suffering of victims. As for nutrition, preventive activities are those that support and protect livelihoods, meaning victims are allowed to have access to their own food. Along this line, it is also quite recognized that humanitarian interventions should aim to get the victims off of assistance through supporting, restoring and protecting livelihoods. Further, when humanitarian live-saving activities are necessary, they testify to a failure to avert crisis, which represents a failure to respect Human Rights and International Humanitarian Law.
Under the threat of famine, what people fear first is destitution related to the loss of livelihoods, long before fearing starvation. Hence, if humanitarian activities are restricted to what is live-saving only, this would kill a true, comprehensive and coherent approach to prevent, mitigate and solve nutrition crises. The challenge remains to promote a coherent approach in donor and humanitarian agencies.
However, up to which point is there an actual dilemma between life-saving activities and supporting livelihoods? Further, at what point is supporting livelihoods considered less humanitarian than live-saving initiatives? Experience has shown that there are indeed many donors requesting and funding programmes that support livelihoods, besides just live-saving activities. Donors believe that this is the only way for humanitarian intervention to make sense. The funds may come with different titles and from different budgets, but money is available for both types of programmes; hence, transferability is not an issue.
If it is still felt that the intervention to properly tackle nutrition crises is confronted with an actual or intended dilemma because of the restriction on humanitarian funds to only live-saving activities, it is then urgent:
· to demonstrate through hard data that there is an actual problem
· to work with the main donors to discuss the issue and find solutions, and
· to stop giving wrong messages about nutrition interventions by bringing some coherence to activities so that it does not only focus on the measurement of nutritional status and on supplementary and therapeutic feeding. But encompasses as well, through any appropriate measure, the protection, rehabilitation and development of livelihoods. This depends on the access to food, as well as, the capacity to meet most of the other basic needs allowing living in dignity.
Tom Marchione (USAID): USAID is among the largest donors of assistance in cash and in kind to complex emergencies largely through its Office of Foreign Disaster Assistance and Office of Food for Peace. Last year alone USAID provided food assistance to nearly 30m people, mostly women and children. The greatest proportion of those assisted was currently or recently suffering from complex emergencies. Our official humanitarian assistance goal, toward which we track our performance, includes saving lives and reducing suffering, while protecting children and other vulnerable groups. We are also increasingly mindful of the value of livelihood support. These goals are taken seriously and we track our performance against them using mortality rates and young child malnutrition (wasting), among other indicators. Our approach towards achieving these goals requires us to respond quickly and to work in cooperation with UN specialized agencies, NGOs and other donors in mitigating the impact of conflicts and restoring development conditions as fast as possible. Wherever we can, we seek to promote peace and good governance in the process of providing our humanitarian assistance in efforts to prevent future conflicts.
USAID adheres to principles of neutrality in assisting all affected civilians. USAID has a policy that actually says a hungry child knows no politics. There is also a policy of doing no harm in our provision of food and other assistance and of keeping humanitarian workers out of harms way. As has been pointed out by the panel, it is easy to state these principles, but in reality it is very difficult to apply them.
On the question of neutrality or impartiality, to the US this refers to beneficiaries or affected civilian populations based on the assessment of need. We do not discriminate against one group of needy people in favour of another group in our provision of assistance. This does not mean in any sense that the US will not pursue its foreign policy goals with regards to parties in a conflict, such as the RUF in Sierra Leone or the Tali-ban. We continue to provide food and other assistance to meet needs in places like Liberia and N Korea. Nevertheless, we have no illusions about the nature of these governments and are in no way neutral toward them.
With regard to the question of doing no harm, especially the issue of prolonging conflicts, we have no good evidence that food aid does actually prolong conflicts. We doubt that withholding food from hungry and innocent civilians will induce warlords to make peace and allow free flow of humanitarian assistance. We oppose diversions to combatants and do everything we can to prevent it from happening.
On the question of risks to NGOs, we are attempting to get NGOs access to populations in need of nutrition programs, but the US does not consciously put NGOs in places that would be too risky. In fact, we pay to train NGOs in matters of personal security. Still NGO and WFP personnel make heroic efforts to gain access to protect the nutrition of affected groups in conflict areas, putting themselves at risk.
Urban Jonsson (UNICEF): We seem to easily treat different aspects of law, rights and morality without being clear about what is allowed and what is permissible within each of these entities. For example, we talk about human rights and sometimes equate that with human rights law, which is not the same. Although they are related, we talk about international humanitarian law, the law of war, which is rather specific to the Geneva Conventions, and then we have this enormous grey zone of principles for humanitarian action, which in my view, has been created because of the limitations in international humanitarian law.
Given the complexities of conflicts today, sometimes we come up with ethical dilemmas that are more part of philosophy and we begin to have rules for doing no harm. I do not agree with that. Ethical dilemmas almost always mean that at least two types of impacts occur, one good one and one bad. That is the dilemma. So I will have to accept to do some harm if I think the lesser of the evils is preferred.
For example, in Burundi UNICEF had to decide what type of water program it would pay for, but such that President Buyoya's government would not be legitimized by our actions. So we established some very temporary bore holes that could not be used for the long term. Of course it was immediately used by Boyoya. However, to put in bore holes was the lesser of the evil. Although, we did some harm we also did some good.
So my point is when we talk about ethics and morality there are certain rules. When we talk about human rights law and international humanitarian law there are other rules. They are related, but not the same.
Susanne Japsars: Concerning the increasing proliferation of principles, I completely agree with Urban Jonsson. We are adding on more and more principles and moving further away from the original principles that were developed by ICRC. Some principles given in the Code of Conduct may be contradictory to the core principles of humanity, impartiality and neutrality and cannot always be applied at the same time. Therefore, it is a matter of defining what the various principles mean and how to manage them. The principles of humanity and impartiality are generally acknowledged to be the overriding principles.
There are problems with some aspects of the do no harm approach, where the focus is very much on how aid can fuel conflict. It is possible to prevent harm completely, but we can try to minimize it through various strategies. Instead, let us shift the focus on doing good, rather than doing no harm.
Wolfgang Heinrich: The title, do no harm was taken from the Hippocratic Oath. The title was suggested to the LCPP's working team by an aid practitioner working in Goma in 1995-96. The argument was that in the medical profession the Hippocratic Oath of doing no harm is the vision. Every surgeon knows that he has to inflict harm and sometimes has to inflict substantial harm in order to do good. But in spite of that, the medical profession has continuously struggled to minimize harm and continuously struggled to improve the quality of their work.
The argument of the aid worker was that the "do no harm" project addresses the fact that many of the aid practitioners working in situations of violent conflict are continuously haunted by the experience that the projects they are in charge of have inadvertent negative side effects. They are being criticized for this, but are hardly ever given substantial support in how to deal with these situations.
We are trying to keep the vision, knowing that we must continuously face dilemmas and deal with situations where there are no magic bullets, no blueprints, nor easy fixes.
Question from the audience: Wouldn't it be better to use our understanding of livelihoods to make decisions on the type of emergency response we implement, knowing that while they may not be absolutely ideal in terms of their composition, they will perhaps in the long run enable those communities to be a bit more secure?
Manuel da Silva: In the case of WFP, there is a difference between what we do today and what we did ten years ago. Ten years ago, WFP was mainly receiving food in kind. This has changed and today about 50% of our resources are still in kind. Actually, WFP is purchasing food in Africa. More than $45m of food last year was purchased locally in Africa. But this does not mean we can always use the right food at the right time. There are issues of priorities and timing.
Abraham Besrat (UNU): Susanne Jaspars mentioned that capacity building approaches compromise principles of impartiality and neutrality, and says that in acute crisis capacity building should be abandoned completely. I think this begs clarification.
There was also mention of principles of impartiality and non-discrimination and that food should not be diverted to political or military purposes, but that primary responsibility rests with national authorities. Isn't there some conflict here? If it is up to the national authorities, how would it be possible for this to be nondiscriminatory and then to be used for military purposes?
Susanne Jaspars: In terms of capacity building being abandoned during situations of acute crisis, the kinds of capacity building that people often associate with free distribution it could be argued that is not building capacity at all. Rather it is co-opting local NGOs or local people distribute the food for you. It is sometimes even a way of doing it cheaply.
Alain Mourey: Regarding equal distribution of food aid by national authorities in conflict, we know this is a very big problem because national authorities are part of the conflict and cannot be impartial. Obviously, it is a problem to deliver aid into the hands of authorities where there is conflict, and where it will probably fall to corruption, distortion, and diversion.
Serge Male (UNHCR): One way to empower people in refugee camps is to inform them of their rights. If you share with refugees what they are entitled to receive (which amount of which type of food per week), they begin to feel empowered.
Manuel da Silva: We need to inform people of their rights when we are in situations where we cannot fulfil those rights. During food distributions, the people in the camps should be informed about what are the quantities that are being provided. They should not be told that every month they are entitled to receive a certain amount because if resources run out, this may cause security problems.
Question from the audience: Agencies have said that they will not treat the refugees with a higher standard than the local population because the local population will migrate into the refugee areas. The dilemma is that this inevitably leads to deliberate underfeeding of the refugees so that they are kept at the standard of the host population. This is clearly an unacceptable situation and a dilemma of resources. Do you feed the whole population or do you deliberately starve or underfeed the refugees so they are not better off than the host population? How do we solve this dilemma?
Alain Mourey: This is a consensus amongst agencies that when we can and if required, we should feed equally those who are displaced, refugees and the local population. It is probably the best way to create links between the local population and displaced persons.
Manuel da Silva: I think we can do a much better job in raising the public's awareness of the difficulties in mobilizing resources and I think this depends very much on having a more active nutrition community involved with mass media.
Alain Mourey: As long as we have CNN style media I do not think we cannot make much progress. There is no analysis of background factors or causes. If I put a stone in a person's shoe and oblige him or her to walk with it nobody will remark that he or she has a stone in their shoe. They will see that this person is not walking very well; perhaps he or she is disabled. It is the same for the media and emergencies. As long as reporting continues this way, we are not going to make much progress.
Anderson MB (2000) Options for Aid in Conflict: Lessons From Field Experience. Collaborative for Development Action, Inc.: Cambridge, MA.
Anderson M (1999) Do No Harm: How Aid Can Support Peace-Or War. Lynne Rienner Publishers: Boulder, CO.
Anderson MB (1999) The Implications of Do No Harm for Donors and Aid Agency Headquarters. Available at http://www.cdainc.com/lcpp-policy.htm.
Atkinson P and Leader N (2000) The Joint Policy of Operation and the Principles and Protocols of Humanitarian Operation in Liberia. HPG report 3, ODI: London.
Bradbury M, Leader N, Mackintosh K (2000) The Agreement on Ground Rules in South Sudan. HPG report 4.
Foley M, Jaspars S, Buchanan-Smith (2002). Principles and Food Distribution in Conflict. Report of a workshop held in Nairobi, December 11-12, 2001, ODI: London (forthcoming).
Jaspars S (2000) Solidarity and Soup Kitchens. A Review of Principles and Practice for Food Distribution in Conflict. HPG Report 7, ODI & Nutrition Works: London.
Leader N (2000) The Politics of Principle: the Principles of Humanitarian Action in Practice. HPG Report 2, ODI: London.
Mackintosh K (2000) The Principles of Humanitarian Action in International Humanitarian Law. HPG report 5, ODI: London.
Wallace M (2001) The Learning Process of the Local Capacities for Peace Project. Development & Practice (forthcoming).
Contact: Manuel da Silva email@example.com; Susanne Jaspars firstname.lastname@example.org; Wolfgang Heinrich email@example.com; Alain Mourey firstname.lastname@example.org
UNHCR Refugee Women: A Pictorial Gallery
Women and girls make up about 50% of the worlds refugee population, and they are clearly the most vulnerable. At the same time, it is the women who carry out the crucial tasks in refugee camps - caring for their children, participating in self-development projects and keeping their uprooted families together. To honour them, and to draw attention to their plight, the High Commissioner for Refugees dedicated this years World Refugee Day (June 20) to women refugees.
This photographic gallery shows some of the may roles uprooted women play around the world - bringing to life the tremendous human dignity and courage of women refugees even in the most difficult circumstances.
Keeping Schools Open: School Feeding in Conflict and Crisis Dr. Abraham Horwitz Memorial Lecture
Graduate Student in International Nutrition, Tufts University
"Human history becomes more and more a race between education
H.G. Wells (1920)
It is an honour to deliver the 6th Dr. Abraham Horwitz Lecture. I am also privileged to speak on the subject of nutrition in the context of crisis and conflict, coming as I do from Lebanon, which has had more than its share of both.
Much of this lecture has been influenced by my own experience growing up amidst conflict and internal displacement. However, these remarks also stem from a unique opportunity in the summer of 2001 as a World Food Programme (WFP) School Feeding Associate. I was among twenty-eight students selected to travel to fifty-four countries, many of which were experiencing emergencies (e.g. Sierra Leone, East Timor, Colombia) to assess school feeding programmes in place. The stories and perspectives of all the associates considerably broadened my experience. The consensus at the end of the summer was that schools have the potential to address nutritional issues, as well as, provide a safe haven and a source of stability for children and their families both in areas experiencing emergencies, and where relocation as a result of such emergencies has occurred. School feeding programmes can play an instrumental role in keeping schools open in crisis and conflict.
The early school feeding activities a century ago, e.g. following the Boer War in 1908, were concerned with "the poor health of army recruits"1. Offering food in schools was perceived as a good way to ensure that children were healthy and well nourished, which would eventually make them strong soldiers. Today, the objectives of school feeding, we hope, are different.
Although there is no formal definition of school feeding in the literature, school feeding here refers to the use of the school institution as an instrument for delivery of food to children. Using the school structure ensures fast distribution of food when the facility is already in place, regular distribution when the structure is relatively stable, and optimal reach when the target group consists of those covered under the school activities. Typically, school feeding consist of food delivery in the form of wet meals, dry snacks, and/or take-home rations. While school meals are supplied on a daily basis as breakfast, mid-morning snack or lunch, take-home rations are distributed less frequently.
Defining the Objectives
In stable situations, school feeding programmes are often designed to enhance academic performance and cognitive development. Improved nutritional status of school-age children leads to better attention and cognition, and thus, better educational outcomes2,3. The objectives of school feeding have also been expanded to include food securitya, providing an income transfer to caregivers and reducing the opportunity cost for parents of sending children to school4.
a Food security is defined by the World Bank (1986) as access by all people at all times to enough food for an active, healthy life.
Improved nutrition and school attendance, however, present particular challenges in the context of crisis and conflict. School feeding can improve attentiveness in class by reducing short-term hunger-many children come to school on an empty stomach-yet they remain surrounded by the distracting and disturbing facets of the crisis. Although school feeding can provide an incentive for increased school attendance, such crises also tend to pull children into the work-force either as formal labour or as child soldiers. In the case of formal labour, successful school feeding programmes in emergency situations should constitute an income transfer sufficiently large enough to outweigh an alternative income that children might earn elsewhere. For child soldiers who often support their families financially, the transfer must outweigh the benefits, especially access to food, provided by armed groups5. Hence the need to clearly define what the realistic and feasible objectives of school feeding in conflict and crisis are, especially during the acute stages of emergencies.
Refining the Objectives
Keeping schools open in times of crisis provides children with a sense of normality, an unbroken routine and a friendly and structured environment6. This is why, where at all possible, children should continue to go to school. School feeding may itself provide an incentive for keeping schools open. However, in times of crisis, school feeding is more than just an incentive, otherwise programmes that are less costly could be an alternative. Being tied to education, school feeding has the potential to preserve a generation of human capital, an advantage measurably more important in com- plex emergencies than in normal situations. In situations when other social support structures may be broken down, school feeding could also enhance the role of schools as social support structures for children. It may then be possible for educational, nutritional and psychological gains to emerge from this existing school infrastructure with benefits accruing synergistically.
The Wider Benefits of Emergency School Feeding
War is an adult problem, however, war's effects extend to all age categories. Children are emotionally and physically vulnerable, and often suffer profoundly because the conflict not only disrupts their normal routines and perceptions of security, but also predisposes them to psychological risks7,8.
The familiar is reassuring, and going about the school routine helps children adapt better to the new situation. Children derive from the school system and their peers at school the ability to cope more effectively with intense emotions, stress and anxiety. The school, therefore, becomes more than an educational institution, it becomes a stable support structure.
When I was a child, we continued to go to school despite the bombshells. At school it was possible to block out the images of war, even though teachers were constantly adjusting school routines because of special circumstances. Most importantly, we were not allowed to "play war" during recess. Peers and teachers were an invaluable source of support for me and for my generation of children of war.
Cooperation and Complementarity
Keeping schools open in such circumstances is difficult but not impossible through coordination of various groups. Ideally, the local communities would mobilize to restore schooling for their children. UNICEF would make educational inputs available plus access to water, sanitation and health services. WFP can identify the requirements for food aid and the logistics of delivery. Local NGOs can implement school feeding activities as prioritized by the community. Also community members themselves can participate in the reconstruction and food delivery works.
In Sierra Leone, humanitarian aid agencies and workers were able to access the town of Daru in the Kailahun District only after the UN deployed troops in the area, which ensured that Daru remained one of the few safe havens in continuously unstable surroundings9. The Norwegian Refugee Council (NRC), with the support of UNICEF and UNHCR, expanded their Rapid Educational Programme (REP) to the region. REP is designed for children aged seven to 12 years (mainly refugees, displaced persons and returnees) who have missed out on years of schooling because of the war. The programme has been successful in promoting the reintegration of children into the standard school systems and, thus, in furthering their educational growth. WFP, in turn, contributed cereals, pulses and vegetable oil, the main ingredients of the school meals provided by NRC to children attending the REP schools. In the first half of the 2000-2001 school year, the enrollment in the ten existing REPs was around 1,000 children. By February 2001, the number of enrolled children almost tripled and nine new REPs were added, an improvement appreciated both by the Government and external observers. Success in Daru led to the reopening of schools in other Kailahun District chiefdoms, despite the fact that the district itself remained unsafe for resettlement. By September 2001, the Ministry of Education had opened ten additional schools and the total enrollment had risen to over 6,500 children (40% of whom were girls).
The school....becomes more than an educational institution, It becomes a stable support structure
WFP's Sierra Leone country office attributes this achievement in school enrollment and retention to community ownership of the programme as well as to the solid cooperation between partners: the NRC, WFP, UNICEF, local NGOs and community groups. All partners coordinated their efforts to collectively provide school facilities, teaching materials and food. Host communities provided labor for the construction of kitchens and food preparation, as well as cooking utensils and condiments. Communities rallied to make the emergency school feeding programme a success because having a school facility for their children provided a stable community institution in a volatile area.
In addition to enrollment figures, monitoring indicators such as perceived quality of education, parental satisfaction, and learning performance would be important to show overall effectiveness of the programmes in providing education to increasing numbers of children without decreasing the quality of that education.
Challenges to Emergency School Feeding
School feeding initiatives serve the developmental goal of building human capital as an investment in the future. Yet, implementing school feeding operations in an emergency, however, has more than its share of challenges and concerns. The major areas of concern relate to security, the political nature of the crisis and related vulnerability analysis, nutritional issues such as targeting and programme design, availability of teachers and school infrastructure, availability of complementary health activities, as well as gender-related issues.
The first issue of concern is security. Relative security is a prerequisite for all activities in emergencies to ensure access to the targeted areas, mobility of children and teachers to and from school, transport of food commodities to the target areas and, importantly, delivery of food to its intended beneficiaries.
Complex emergencies are highly political and of long duration10, in addition, war strategies are often aimed at particular social, ethnic or political groups who are not necessarily the poorest11,12. Therefore, understanding the political interplay that causes vulnerabilityb, and incorporating this understanding into assessment and scope of school feeding programmes, is important to ensure that they effectively cater to those most in need13. In the case of children, vulnerability is often physiological and emotional, and possibly social, economic and political. School feeding goals would then be best served if the programmes are part of the wider nutritional strategy for the area experiencing conflict. This strategy might address livelihoods protection, food security and nutrition rehabilitation programmes, based on comprehensive needs assessment and the community priorities specific to the region.
b Vulnerability is defenselessness and insecurity in the face of particular risks (Chambers, 1989).
Closely related to vulnerability assessment, is the issue of targeting. Often, malnourished children are delayed in enrolling in schools14 or may have dropped out to assist with household income generation. Moreover, targeting schools in the most food insecure areas, might not yield the desired returns because these are the schools with the least resources. Therefore, building monitoring and surveillance within the project is important to evaluate and understand effectiveness15. Adequate monitoring requires looking beyond the enrolment figures into the characteristics of those enrolled, and also, those who are not enrolled in schools. Moreover, school feeding programmes usually reach children between five and 15 years of age, a group that is often overlooked by assistance organizations that normally target younger children in supplementary feeding programmes. The objectives of the two, however, are different, and there is need for complementarity when they are implemented simultaneously, so that when malnourished children are identified, they could be rehabilitated before they enroll back in school.
Supplying culturally acceptable and familiar foods is another frequently noted concern in donor-assisted school feeding operations. Supplied food is usually tied to the surplus available from donor countries. (It goes without saying that any food aid provided should not have the effect of disrupting local markets or providing a disincentive to local agriculture.) The types of food provided become of particular concern when they fail to match the local eating customs of the recipient country. Some agencies have, however, addressed this challenge with creativity. In Bolivia, for example, the local NGO in charge of school feeding printed copies of the WFP Food Cook-Book for school staff in charge of food preparation. The booklet illustrates recipes using WFP-provided basic ingredients, to familiarize the cooking personnel with the new ingredients. In addition, the food provided for schools tends to be the same throughout the year. In rural Port-Sudan, active parent-teacher associations work to transform basic food ingredients into edible -and even desirable- food by their own contribution of condiments, flavourings and other seasonal crops.
This is the essence of genuine cooperation in food aid, namely, the provision of food aid to communities, who then take responsibility for its ultimate use. More so, when school feeding is built into analysis of existing government policies and commitment to continuing the programme beyond the emergencies, the exit strategy or the transition from emergency to government-assisted school feeding programme, becomes easier.
The need for an adequate number of trained teaching personnel is another important challenge. Because teachers are often among the first people to leave affected areas, a useful response may be the provision of incentives (in the form of food-for-teaching, where food shortage is an issue) to encourage them to remain in town. Related to teacher shortages is the problem of classroom overcrowding. Overcrowding, indeed, is often a by-product of school feeding, which has the effect of drawing more children to school than can be accommodated. Foreseeing the problem and rehabilitating schools in ways which might permit subsequent expansion, or rehabilitating a larger number of schools is an important consideration in view of the set objectives and expected impacts. In any case, school feeding programmes should not undermine the quality of education provided at the school.
It is often noted that school feeding ensures meals only to schools that are accessible. Consequently, schools in less accessible areas where children are most likely to benefit from food assistance, are often excluded. Overcoming this problem is a great challenge under any circumstances, particularly in complex emergencies where the school structure might be destroyed or considerably damaged. For example, in cases where the school structure has been destroyed and/or access to schools made impossible because of population displacement, an alternative school setting has been initiated by UNICEF through School-in-a-Box c. Tents are set up so that children can continue to go to school despite their displacement and the lack of school infrastructure (e.g. Liberia, Democratic Republic of Congo, East Timor)16. A combination of the School-in-a-Box and a food ration for every child and teacher attending the temporary school could be a useful short-term means of addressing immediate needs for a swift restoration of normality.
c A School in a Box is a portable kit developed by UNICEF and UNESCO. It contains basic school supplies and educational materials for up to 80 children.
It must also be recognized that school feeding is but one element of school nutrition and health. Complementary health activities, including immunization (especially measles in internally displaced camps), de-worming, and the availability of safe drinking water and sanitary facilities are yet more important in emergencies than at other times. De-worming activities are carried out in conjunction with Ministries of Health and Ministries of Education's partnership with WFP-assisted school feeding in many countries (e.g. Nepal, the Dominican Republic, Mozambique). These integrated programmes require in-depth understanding of the health priorities in the area, as well as appropriate expertise and capacity to monitor health programmes.
Special attention also needs to be given to gender issues that may well emerge around emergency school feeding operations. It is recognized that girls experience war and displacement differently than boys because of their culturally defined social roles and expectations17. Girls are often reluctant to attend school when safety concerns exist and are often the first to drop out when the family resources get scarce18. Their safety may be at risk while commuting to and from school, but also at school because of the potential for female child abuse and HIV/AIDS transmission (e.g. Ethiopia, Mozambique). Drop-outs also increase when the head of the household is absent because of war, or when both parents are absent, adding income generation and sibling care to the already heavy household responsibilities of girls. Improving girls' well-being by increasing their opportunities is, accordingly, an important goal. School feeding as an incentive for education is an important means of achieving this goal. Gender-based educational incentives have worked particularly well in drought-affected Pakistan where a WFP-assisted programme distributes oil rations for girls attending at least 20 days of schooling in a month. Enrollment, as a result, increased in participating schools by 76% and attendance increased from 76% to 93% in one year19. The oil ration in Pakistan, importantly, represents fully 10% of a poor family's monthly income and provides a substantial monetary incentive for these families20.
Summary Table: Areas and issues of concern and means of addressing them
Issues of concern
Potential means of addressing these issues
- safe access to target areas by children, teachers and aid workers
- active government involvement
- safe transport and delivery of food
Political and pro- tracted nature of conflicts
- particular groups targeted by the conflict (e.g. ethnic, social)
- vulnerability analysis to properly identify target groups
- school feeding as part of the national nutritional strategy addressing priorities (livelihoods, food security, nutritional rehabilitation)
- malnourished children start school late
- vulnerability analysis to properly identify target groups, areas and priorities
- schools in food insecure areas are difficult to reach
- monitoring systems built into the programs
- age group reached by school feeding programs is often not prioritized by assistance organizations
- Complementarity between programs (especially school feeding and supplementary feeding)
- supply is tied to surplus from donor countries
- matching donated food items to local eating habits
- same foods are provided all year round
- community involvement and input
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- preparing for transition from donor-assisted to government-assisted programs
- teachers may be targeted in the conflict
- security and vulnerability assessment
- classroom overcrowding may result from short- age of teachers and/or as a byproduct of offering food in schools
- incentives for teachers
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- monitoring the quality of education
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- teacher training
- rehabilitating adequate numbers of schools or foreseeing expansion
- school premises may be damaged and/or have limited resources
- flexible alternative school structures (e.g. school-in- a-box)
- immunization and de-worming complement school feeding
- integrated and complementary school health activities
safe water and sanitation facilities are available in schools
- assessing health priorities
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- cooperation among agencies
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- monitoring programs
- social roles and expectations are culturally defined
- gender-based educational incentives
- commuting to and from school and unsafe school environment (child abuse and HIV transmission)
- food benefits outweigh the cost of sending girls to school
- income generation and sibling care
- advocating child rights and gender equality
Again, this needs to be done in conjunction with advocacy to address child rights and the underlying gender inequalities within the cultural norms, otherwise, achievements remain a temporary gain that has not addressed the root-causes of the problem.
The new WFP's emergency Food-for-Education operation in Afghanistan which is intended to start in April 2002 as part of their emergency response, addresses some of these issues21. It is intended to assist the government (the interim authority at this point) to establish and maintain an educational system that supports quality education for all by combining five components, three of which are food-for-work programmes: food for school construction or rehabilitation, food for teaching, and food for teacher training. The other two components are school feeding pro-grammes: take-home rations for non-formal education, and in-school feeding (and, where necessary, take-home rations) for elementary school children (boys and girls, but especially girls). The challenges WFP is facing in Afghanistan are numerous, mainly availability of implementing partners capable of operating on a large scale quickly and efficiently; security concerns; limited resources of the interim government; safety of girls and women in commuting; and shortages in water supply. However, there is a window of opportunity for getting comprehensive attention to the education and nutrition of school-age children in Afghanistan. This opportunity ought to be addressed in the context of a comprehensive understanding of vulnerability, food security interventions and longer-term school feeding policies for the country.
The importance of keeping schools open in times of crisis for the comprehensive well-being of children cannot be overstressed. The challenges are great, as they are in any venue in complex emergencies. What is needed is courage, not to be hindered by the complexity of the task or fearful of the limitations, rather be aware of the social role of education and the great potential of schools to serve multiple functions.
Mahatma Gandhi wrote, If we wish to create a lasting peace we must begin with the children. Universal education and good health are basic children's rights, and they converge in one institution, the school. Protecting these rights when children's physical and psychological well-being are at stake, represents a formidable challenge. School feeding could play an instrumental role in meeting this challenge by helping maintain the school structure, and consequently providing education, contributing to good health and reinstituting normality in times of crisis.
In Lebanon, food was not short during the seventeen years of war, hope was. Schools were the most precious source of hope, they maintained our faith in the future.
The author is indebted to Prof James Levinson for his continuous guidance and support, Prof Patrick Webb for his comments and suggestions, Ms Annalies Borrel for the operational insights, and Ms Arlene Mitchell for providing data sources and facilitating contacts.
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2. Levinger B (1986) School Feeding Programmes in Developing Countries: An Analysis of Actual and Potential Impact. USAID Evaluation Special Study No.30. USAID: Washington DC.
3. Glewwe P, Jacoby A and King E (1996) An Economic Model of Nutrition and Learning: Evidence from Longitudinal Data. World Bank Policy Research Department: Washington, D.C.
4. Hicks KM (1996) Food Security and School Feeding Pro-grammes. Excerpts from: Levinger B, Janke C and Hicks KM CRS School Feeding/Education Companion Handbook. CRS: Baltimore.
5. Ty S (2002) Seng Ty: Manuscript Autobiography (In press), Child survivor of the Khmer Rouge regime: Cambodia 1975-1979.
6.UNICEF (1999) A new beginning: Education in emergencies. In: The State of the World's Children 1999: Education. UNICEF: New York.
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9. Callanan A (2002) Personal Communication.
10. Duffield M (1994) Complex Emergencies in the Crisis of De-velopmentalism. IDS Bulletin 25(3): 37-45.
11. Duffield M (1994) Complex Political Emergencies; with Reference to Angola and Bosnia. An Exploratory Report for UNICEF. University of Birmingham: Birmingham.
12. de Waal A (1994) Dangerous Precedents? Famine Relief in Somalia 1991-93. In: War and Hunger. Zed: London.
13. Jaspars S and Shoham J (1999) Targeting the Vulnerable: A Review of the Necessity and Feasibility of Targeting Vulnerable Households. Disasters 23(4): 359-372.
14. Glewwe P and Jacoby HG (1995) An Economic Analysis of Delayed Primary School enrolment in a Low Income Country: The Role of Early Childhood Nutrition. The Review of Economics and Statistics 77(1): 156-169.
15. Borrel A and Salama P (1999) Public Nutrition from an Approach to a Discipline: Concern's Nutrition Case Studies in Complex Emergencies. Disasters 23(4): 326-342.
16. UNICEF (2001) School-in-a-Box http://www.supply.unicef.dk/emergencies/schoolkit.htm.
17. UNICEF (1996) War hits home when it hits women and girls. In: Impact of Armed Conflict on Children: Report of GarMachel Expert of the Secretary-General of the United Nations. UNICEF: New York.
18. UNESCO (1999) Education in Situations of Emergency and Crisis, Assessment EFA/2000. Thematic Study. Emergency Educational Assistance Unit (ED/EFA/AEU): Paris.
19. WFP (1995) Project Pakistan 4185: Promotion of Primary Education for Girls in Baluchistan and NWFP. WFP: Rome.
20. WFP (2001) Country Programme- Pakistan (2001-2003). WFP: Rome.
21. Mitchell A (2002) Personal communication.
Assefa F, Jabarkhil MZ, Salama P and Spiegel P (2001) Malnutrition and mortality in Kohistan District, Afghanistan. JAMA. 286 (21):2723-8.
Chambers R (1989) Vulnerability, Coping and Policy. IDS Bulletin 20(2): 1-7.
Del Rosso JM and Marek T (1996) Class Action: Improving School Performance in the Developing World through Better Health and Nutrition. Directions in Development, World Bank: Washington DC.
Del Rosso, JM (1999) School Feeding Programs: Improving Effectiveness and Increasing the Benefit to Education. A Guide for Program Managers. Partnership for Child Development. World Bank: Washington, DC.
WFP, UNESCO, WHO (1999) School Feeding Handbook. Technical Support Service (ODT), Operations Department, WFP: Rome.
Contact: Soha Moussa email@example.com
The next issue of SCN News #25 (December 2002) will feature
School-Age Children: their health and nutrition
We welcome suggestions from our readers on books, web sites,
Global Consultation on Child and Adolescent Health
At the 12-13 March 2002 Global Consultation on Child and Adolescent Health, world leaders, WHO Director-General Dr. Gro Harlem Brundtland, UNICEF Executive Director Carol Bellamy, policy-makers, academics and a senior World Bank delegation gathered to discuss the dangers faced by the worlds children and young people. An outcome of the Consultation was the Stockholm Commitment by World Leaders, which served as a framework for the UN General Assembly Special Session on Children, held in May.
The Stockholm Commitment, which makes no reference to nutrition, states:
We envision a world where children and adolescents enjoy the highest possible level of health, a world that meets their needs and enables them to attain their full potential. We gather in Stockholm...to commit ourselves to intensify our efforts to achieve this aim, and to join together in partnership to seek bolder approaches to reach the most vulnerable, the most isolated and the poorest.
For more information and conference materials
On 9 March 2002, the world's public health nutrition community was shaken by the unexpected death of Dr. Paul Arthur at the age of 45 years in Ghana.
Paul was born in Kumasi, Ghana on 20 March 1956. He graduated with distinction from Ghana Medical School, Legon in 1981. After his housemanship at Korle Bu Teaching Hospital, he worked as primary health care coordinator for Offinso District and as programme manager (EPI and CDD) on the Ashanti Akim Rural Health Programme before embarking on further studies. He was awarded an MPH from Leeds University in 1988 and an MSc from the London School of Tropical Medicine and Hygiene in 1989. During his MSc he contributed to the proposal development of one of the two Ghana VAST trials in northern Ghana, namely the child health study and subsequently became its field director. This, his first major research involvement firmly established him as a leading contributor in the vitamin A community.
The Ghana VAST trials were the first to demonstrate an impact of vitamin A supplementation on child morbidity and mortality in sub-Saharan Africa. They were also unique in including a detailed assessment of supplementation on morbidity, in the same setting as an assessment of the impact on mortality. They found significant reductions in the occurrence of severe (but not mild) episodes of illness, on clinic attendances, on hospitalisations, as well as a 19% reduction in mortality, suggesting that vitamin A supplementation protects children by reducing the severity of illness, rather than by increasing resistance to infection.
Paul followed this with the establishment in 1994 of the Kintampo Health Research Centre and wide programme of research into strategies to improve the health and nutrition of women and children, including asessing the benefits of linking vitamin A supplementation to early childhood vaccines, exploring dietary approaches to improving vitamin A status, identifying ways to enhance health seeking behaviour, and the evaluation of the safe motherhood programme. Paul's contribution to micronutrient malnutrition did not stop with vitamin A. In recent years, he spearheaded studies in the area of iron and zinc interventions in collaboration with the University of Toronto. These were centered around the innovative approach of "sprinkles," a powdered mixture of essential trace elements (iron and zinc), which represents an approach to targeting additional nutrition to infants in the weaning period by mixing the sprinkles as a condiment to porridge-type complementary foods. Feasibility studies in Ghana showed promise for this strategy in initial trials recently published.
At the time of his death, Paul was heading the field-research effort toward the resolution of the latest of the public health issues of vitamin A nutrition in low-income countries, namely the benefits for pregnancy outcome and maternal mortality reduction of regular weekly low dose vitamin A supplementation to women of childbearing age. This will be his living legacy as the study advances and the results are disseminated and published.
Paul fulfilled many roles at once, working effectively on many different levels. His achievements in setting up and directing Kintampo Health Research Centre speak for themselves. His experience in large scale field research is only equalled by a handful of people in the world. He also worked tirelessly on Ministry of Health commissions within Ghana. He played a leading advocacy role for the articulation of policy and the establishment in 1996 of the Ghana national vitamin A deficiency control programme. He was on their technical advisory group, and made major inputs to the development of protocols for the national vitamin A survey and for the evaluation of the impact of the programme. In addition, he was a senior lecturer at the London School of Hygiene and Tropical Medicine, and made important contributions to both the research and teaching programme. Last but not least, Paul was internationally regarded as a pre-eminent epidemiologist, and made significant contributions to a variety of international advisory committees, for WHO, UNICEF, World Bank, and others. Paul was a member of the steering committee of the International Vitamin A Consultative Group since 1996, and an instrumental charter member of the Child Health and Nutrition Research Initiative within the Global Forum for Health Research. Paul was always in demand, and he always fulfilled expectations.
Paul always worked for the public good, any personal acclaim he received of course gave him pleasure but was always a secondary consideration. He networked quietly and widely forming effective partnerships to achieve wider goals. He inspired trust and confidence within moments of meeting him. Paul was extraordinarily gentle and kind. He was generous with his time and advice to friends, colleagues and students alike.
Paul was dedicated to developing the capacity of public health research both within Ghana and in the wider context. At KHRC he placed staff development high on the agenda, and raised scholarships for several staff to attend post-graduate masters' programmes. He also accepted young scientists from the UK for exposure to epidemiology and field research. Paul was a role model to more people than he ever realized. He was a superlative teacher, an inspiration both to listen to and to watch in action.
Paul was a truly remarkable man who touched the hearts and minds of so many of us. His dedication to public health and in particular to improving the health and well-being of women and children in disadvantaged areas was total. This was grounded in his own family bonds. He combined research of the utmost quality with a commitment to translating research results into programme action and policy. Paul's work has made a difference both in Ghana and more widely. He is truly irreplaceable. His death is a loss that Africa and the wider international public health community could ill afford.
Paul leaves a wife Dinah Newton and three sons.