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PubMed1996

Historical roots of famine relief paradigms: ideas on dependency and free trade in India in the 1870s.

The principles upon which famine policies are based have changed less than might be expected over the last century. This paper examines the origins of the Indian Famine Codes of the 1880s, which set the administrative and, it is argued, paradigmatic precedent for famine relief in 'developing' countries, managed by 'developed' ones. In particular, the still-current questions of avoiding the creation of dependency through over-generous aid and of relying on free-market solutions to the problems of food distribution are re-examined. Although both of these issues are difficult, it is suggested that strong emphasis on their importance has historically been based on wilful misinterpretation of complex situations. The result has been famine relief programmes which served the interests of 'relievers' (in this case the colonial state) more than the relieved. The nature of famine policy-making is thus reconsidered, with a call for greater appreciation of the role of influential individuals and hidden state agendas. These are as significant today as ever.

Colonialism↗
PubMed1996

Setting and evaluating the energy content of emergency rations.

This paper examines the setting and evaluation of emergency rations for refugees and displaced people. After defining the purpose for which rations are designed, the variables affecting their quantification are discussed. The debate concerning the use of one as opposed to a range of energy levels for different populations is highlighted in a review of recent proposals for ration levels. It is demonstrated that up to a twofold range occurs if different combinations of the main parameters are used. This has important implications for the large-scale provision of food. The use of one figure for the setting and evaluation of rations for all populations is inappropriate; figures should be set according to specific context and need. To achieve this, a practical two-stage approach is proposed. Stage 1, probably a desk exercise, uses pre-calculated 'look-up' tables which provide energy values for each country. These figures are for immediate use as 'rule-of-thumb' estimates, based on clearly defined parameters. The second stage involves refining the values using improved information on local conditions collected by field assessment.

Activities of Daily Living↗
PubMed1996

Refugee density and dependence: practical implications of camp size.

Different refugee camps may have widely differing morbidity and mortality rates. Some of these differences are ascribed to environmental factors. This paper reviews the key issues relating to one environmental factor: the size of the refugee camp, and provides a tentative theoretical framework for examining the effect of camp size on refugees. This effect may not be considered because aid workers chronically underestimate the value of the refugees' contribution to their own survival. Large camps settle great numbers of refugees to the hinterland of the camp and limit their access to resources available there. This may increase refugee dependency and vulnerability. There is some slight evidence from the analysis of data provided by Mercer (1992) that child mortality rates (aged 0-4 years) are positively correlated with camp size (as inferred from child populations). If other factors allow, it might be wise for camp planners to try to limit camps to a size which allows refugees reasonable access to local resources.

Adult↗
PubMed1996

Evaluating the international humanitarian system: rationale, process and management of the joint evaluation of the international response to the Rwanda genocide.

The Rwanda evaluation has been termed a landmark in evaluation, not only because of its quality and the insights it has produced. It was also an unprecedented international collaboration to learn the lessons from the immense tragedy that was the genocide in Rwanda and its aftermath. This paper reports on the rationale, process and management of the joint evaluation of the international response to the Great Lakes crisis of 1994-5.

Altruism↗
PubMed1996

Early warning and response: why the international community failed to prevent the genocide.

The enormity of the genocide in Rwanda demands that it be subjected to searching enquiry and that members of the international community, collectively and individually, examine their own roles in the event. This paper draws extensively on Study II of the Joint Evaluation, and examines the effectiveness of international monitoring (early warning) and management of the Rwanda conflict. It is not intended to explore all the factors which together contributed to the genocide that were or might have been amenable to modification by the international community. The focus is on warning and response beginning with the start of the civil war in 1990, and culminating in an analysis of the international response to the genocide in April-June 1994.

Crisis Intervention↗
PubMed1996

An account of co-ordination mechanisms for humanitarian assistance during the international response to the 1994 crisis in Rwanda.

This paper examines the co-ordination strategies developed to respond to the Great Lakes crisis following the events of April 1994. It analyses the different functions and mechanisms which sought to achieve a co-ordinated response--ranging from facilitation at one extreme to management and direction at the other. The different regimes developed to facilitate co-ordination within Rwanda and neighbouring countries, focusing on both inter-agency and inter-country co-ordination issues, are then analysed. Finally, the paper highlights the absence of mechanisms to achieve coherence between the humanitarian, political and security domains. It concludes that effective co-ordination is critical not only to achieve programme efficiency, but to ensure that the appropriate instruments and strategies to respond to complex political emergencies are in place. It proposes a radical re-shaping of international humanitarian, political and security institutions, particularly the United Nations, to improve the effectiveness of humanitarian and political responses to crises such as that in the Great Lakes.

Altruism↗
PubMed1996

Why aid agencies need better understanding of the communities they assist: the experience of food aid in Rwandan refugee camps.

Refugee views on food aid reveal the ignorance of the international community regarding Rwandan culture, economy and politics. This ignorance carries a number of costs. On one level, the main cost is that a professional service is not carried out to the best of one's ability. Ignorance of Rwanda's North-South divide, for instance, has caused agencies to be insensitive to in-camp discrimination based upon regional identity and its impact on programme activities. On a deeper level, agency ignorance about Rwandan culture, economy and the dynamics of camp politics, reduces refugee confidence in humanitarian agencies and workers. Better information would not only result in the greater likelihood of appropriate responses to specific needs, but would also encourage greater credibility in the political arena where the ultimate stake is to see lasting peace and a dignified return of refugees to their homes.

Agriculture↗
PubMed1996

Food aid and nutritional programmes during the Rwandan emergency.

In contrast to several other recent emergencies, the response of the international relief community to the Rwandan emergency appears largely to have prevented widespread malnutrition and related mortality. While it is true that aspects of the response in the food and nutrition sector were in various ways open to criticism and may have contributed to unnecessarily high levels of wasting in some camps at various points in time, the appalling excesses of famine witnessed in other recent African crises was not revisited during this emergency. Indeed, the main factors contributing to mortality and morbidity during the Rwandan emergency were violence and epidemics rather than lack of food and nutritional support.

Emergencies↗
PubMed2006

El Niño platforms: participatory disaster response in Peru.

Climate change is expected to lead to greater extremes (droughts and floods) in river regimes around the world. While the number of major calamities is predicted to rise, the efforts of the public sector, experts and local stakeholders are badly coordinated. Consequently, aid does not reach target groups, resulting in unnecessary losses. Hence, there is a need for more participatory and integrative approaches. To ensure a more concerted response to climate-induced disasters, stakeholders could coordinate and negotiate within Multi-Stakeholder Platforms. Such roundtables are increasingly being established for vision-building and integrated water resource management, but could be employed in disaster management as well. After discussing the advantages and disadvantages of participation, this article trace the rise of and the problems facing two 'El Niño' platforms: one in Ica, a city on the Peruvian coast that flooded unexpectedly in January 1998, and one in Ayacucho, which saw a climate change-induced drought around the same time. The issue of internal and external legitimacy receives particular emphasis.

Community Networks↗
PubMed2004

Ethics and health systems research in 'post'-conflict situations.

Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in 'post'-conflict situations, addressing both generic issues for developing countries and those issues specific to 'post'-conflict societies, citing examples from the author's Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of 'knowledge generation' as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed.

Cambodia↗
PubMed2006

Justified commitments? Considering resource allocation and fairness in Medecins sans Frontieres-Holland.

Non-governmental aid programs are an important source of health care for many people in the developing world. Despite the central role non-governmental organizations (NGOs) play in the delivery of these vital services, for the most part they either lack formal systems of accountability to their recipients altogether, or have only very weak requirements in this regard. This is because most NGOs are both self-mandating and self-regulating. What is needed in terms of accountability is some means by which all the relevant stakeholders can have their interests represented and considered. An ideally accountable decision-making process for NGOs should identify acceptable justifications and rule out unacceptable ones. Thus, the point of this paper is to evaluate three prominent types of justification given for decisions taken at the Dutch headquarters of Médecins sans Frontières. They are: population health justifications, mandate-based justifications and advocacy-based justifications. The central question at issue is whether these justifications are sufficiently robust to answer the concerns and objections that various stakeholders may have. I am particularly concerned with the legitimacy these justifications have in the eyes of project beneficiaries. I argue that special responsibilities to certain communities can arise out of long-term engagement with them, but that this type of priority needs to be constrained such that it does not exclude other potential beneficiaries to an undesirable extent. Finally, I suggest several new institutional mechanisms that would enhance the overall equity of decisions and so would ultimately contribute to the legitimacy of the organization as a whole.

Community-Institutional Relations↗
PubMed2006

Is it ethical to study what ought not to happen?

In the Democratic Republic of Congo, only an estimated 2% of all AIDS patients have access to treatment. As AIDS treatment access is scaled-up in the coming years, difficult rationing decisions will have to be made concerning who will come to gain access to this scarce medical resource. This article focuses on the position, expressed by representatives of Médecins sans Frontières (MSF), that the practice of AIDS treatment access rationing is fundamentally unethical because it conflicts with the ideal of universal treatment access and the human right to health. The conclusion is that MSF's position lacks coherence, has negative practical implications, and is unfair to governments struggling to increase patient's access to AIDS treatment in unfavorable circumstances.

Acquired Immunodeficiency Syndrome↗