1. HUMANITARIAN ASSISTANCE OCT 30, 2014 MCGILL EXECUTIVE EDUCATION

2. TODAY 1)-background to humanitarian principles, law -snapshot MSF connections and contrasts Development and Humanitarianism – how we work together to fight AIDS 2) rapid small group brainstorm based on MSF Case Studies -feedback one question to group Break 3) Humanitarianism part 2 – activities & challenges 4) Rapid small group brainstorm 2- Ebola -Q&A

3. PART 1 The concept of extending care to strangers is centuries old, has roots in major religions and writings of ancient scholars The rules of war are perhaps as old as wars themselves, across the world Early laws of war may not have been principally humanitarian but economic in intent but effect was humanitarian

4. Hippocratic oath: Medical Ethics Taken by physicians to protect all life, to hold in highest regard one’s teachers, to recognize one’s limitations, and to renounce self-interest in the treatment of patients. HIPPOCRATES C460 - 370BC

5. DURING CONFLICT: MEDICAL IMPARTIALITY 1859 Henri Dunant – founder of Red Cross (ICRC) Organized medical services for Austrian and French wounded First Geneva Convention (1864) formed ICRC – signatories agreed to impartiality and neutrality

6. DURING CONFLICT: MEDICAL IMPARTIALITY 1854, CRIMEAN WAR Historical records suggest preferential treatment of ‘friends’ over ‘enemies’ during conflict Nurses (F. Nightingale, D. Dix) the impartiality movement  treating all equally Roots of medical personnel seen as neutral  not taking part in war

7. F UNDAMENTAL P RINCIPLES OF THE I NTERNATIONAL R ED C ROSS AND R ED C RESCENT M OVEMENT Humanity ImpartialityNeutrality IndependenceVoluntary Service UnityUniversality First put in writing in 1921. Adopted in 1965 in current format by the International Conference of the Red Cross – which includes States Parties to the Geneva Conventions.

8. MAIN SOURCES OF IHL Hague Law (pertaining chiefly to means of war) The Petersburg Declaration 1868 Hague Regulations of 1899 and 1907 Gas protocol of 1925 NPT (non-proliferation of nuclear weapons) 1968 Biological weapons 1972 Convention on inhuman weapons (CCW) 1980 Chemical weapons 1993 Anti Personnel Mines 1997 Convention on Cluster Munitions 2008

9. DURING CONFLICT: MEDICAL IMPARTIALITY Four Geneva Protocols (1864-1949) plus 2 provisions – Humanitarian law Humane treatment for all persons (not hostile) Medical workers not punished for providing care to all (Medical Neutrality) Access to those in need  Article 3: impartial humanitarian bodies allowed to offer services (ICRC) Impartiality of treatment Attacks on civilians prohibited

10. MAIN PRINCIPLES OF IHL HUMANITY Distinction Military necessity Proportionality

11. PROTECTION OF WOMEN IN HUMANITARIAN LAW 1949 GC IV, Art. 27 Women must be protected against any attack on their honour, in particular against rape, enforced prostitution, or any other form of indecent assault. AP I, Art. 48 Parties to an armed conflict must take constant care in the conduct of military operations to spare the civilian population, civilians and civilian objects. AP I, Art. 76 Women must be protected against rape, forced prostitution and any other form of indecent assault…parties to a conflict must endeavour to avoid the pronouncement of the death penalty on pregnant women or mothers having dependent infants for an offence related to the armed conflict..

12. 19 JUNE 2008 SECURITY COUNCIL DEMANDS IMMEDIATE AND COMPLETE HALT TO ACTS OF SEXUAL VIOLENCE AGAINST CIVILIANS IN CONFLICT ZONES, UNANIMOUSLY ADOPTING RESOLUTION 1820 (2008)

13. DURING CONFLICT: MEDICAL IMPARTIALITY Humanitarian vs. Human Rights Law Humanitarian  indicates behavior for parties during war in relation to people at mercy of the conflict Human rights  the rights of individuals to treatment by or protection from government abuses

14. THE ICRC CONSIDERS SILENCE DURING HOLOCAUST “GREATEST FAILURE”

15. International Humanitarian Law Assistance to civilians in time of conflict Distinction between combatants and non- combatants Refugee law Principle of non-refoulement or freedoms could be threatened HUMANITARIAN FRAMEWORK

16. Anti-Slavery Movement (ongoing but started 1700s) Abolition of Torture 1800s Factory Act 1833 England – humanize working conditions Rights of women 1800s Humanitarian law, International Committee of Red Cross 1863 Nuremberg Tribunals –WWII, Genocide Convention 1948 Criminal tribunals – Former Yugoslavia and Rwanda 1993 &1994 Ottawa Treaty (Landmines) 1997 International Criminal Court – 1998 UN Convention Against Transnational Crime (trafficking) 2003 Convention on Cluster Munitions 2008 GLOBAL COOPERATION FOR HUMANITY & RIGHTS

17. HUMAN RIGHTS LAW 1948 UN Declaration of Human Rights 1966 Covenant on Civil & Pol Rights 1966 Convention on Economic Social & Cultural rights 1965 Convention on the Elimination of all forms racial discrimination 1984 “ on the Elimination of Discrimination against Women 1989 Convention Rights of The Child 2005 Enforced Disappearances Regional conventions 1950 European Convention on Human Rights 1969 American Convention on Human Rights 1982 African Charter on Human and People’s rights

18. HUMANITARIAN LAW & HUMAN RIGHTS LAW IHLHRL Times of war, int’l armed conflict, non-int’l armed conflicts All the time Conduct of hostilitiesDoes not deal with conduct of hostilities States duty to implement Categories of persons affected Derogations in times of emergency

19. HRL IHL Right to life Prohibition of torture & ill treatment Non discrimination Respect of judicial guarantees Protection of the wounded Protection of civilians Regulation of means & methods of warfare Providing humanitarian relief Economic, social & cultural rights Right to education, work family life Civil & political rights Freedom of association Of the press Of conscience

20. % OF CIVILIAN CASUALTIES OF WAR WWII Vietnam Today UN Commission on the Status of Women: “international humanitarian law, which prohibits attacks on civilians, is systematically ignored, and human rights are violated in armed conflict, affecting especially women, children, the elderly and the disabled”

21. CONFLICTS, WAR, DISASTERS, NEGLECT, ABUSE

22. IMPACT OF CONFLICTS, WAR, DISASTERS, NEGLECT

23. MDGS AND HUMANITARIAN OVERLAP

24. LACK ACCESS TO MEDICINES 1/3 worlds population Up to 50% parts of Africa & Asia

25. CLIMATE CHANGE Year-long Commission The Lancet & University College London Institute for Global Health. Climate change will have greatest impact on those already poorest in the world: deepen inequities The Lancet, Volume 373, 16 May 2009Volume 373, 16 May 2009 “is the biggest global health threat of the 21st century.”

26. RESPONDING TO DISASTER AND ACTS OF INHUMANITY

27. MSF Charter: “Médecins Sans Frontières observes, independence, neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance and demands full and unhindered freedom in the exercise of its functions...” Medical aid where it is needed most. Independent. Neutral. Impartial

28. OVERALL PURPOSE OF MSF FOUNDED 1971 Preserve Life Alleviate Suffering Protect Human Dignity Restore Ability of People to Make Their Own Decisions “Two inseparable elements are combined in MSF’s work: medical aid and witnessing (temoignage)…- Chantilly 1995

29. RWANDA 1996

30. Child vaccinated against measles, DRC. Photo: Gwenn Dubourthoumieu DEMOCRATIC REPUBLIC OF CONGO (ZAIRE)

31. MSF in Ajiep, Southern Sudan 1998 SOUTHERN SUDAN (PRE-INDEPENDENCE)

32. MSF in East Timor in 1998 following mass violence EAST TIMOR (JUST AFTER REFERENDUM)

33. PERU

34. Child living with HIV taking pediatric antiviral medicines – a scientific innovation also created by a local and global demand for equity and access to resources SOUTH AFRICA 2008 AIDS PANDEMIC

35. ACCESS TO MEDICINES

36. WHO ARE THE HUMANITARIANS? 17 billion in funds and an estimated workforce of 274,000 aid workers internationally growing at 4% annually In 2009, 178 humanitarian aid workers were killed, kidnaped or seriously injured in violent attacks, the highest number on record.

37. PART 2

38. WHAT TO DO THEY PROVIDE Water: Why is water a critical issue? Promotes public health, reduces patient visits to health clinics. Reduces social burden on women and children as well as protection risks. Livestock, brick building, gardens Sanitation Medical including psychosocial Refugees, IDP health Food support Fuel Shelter Training/mentoring Advocacy

39. IDP HEALTH The Host Government is responsible, as for refugees. However… Under the Cluster Approach, the World Health Organization (WHO) facilitates coordination among health actors. Ex: Haiti Earthquake (2010) Ex: Pakistan Floods (2010) Other Important Clusters: UNICEF leads WASH and Nutrition Clusters WFP leads the Food cluster. UNEP leads on “Environment” as an issue cutting across all clusters.

40. FUEL Nearly half of the world’s population – about 3 billion people – cooks their food each day on polluting, inefficient stoves Current Initiatives Fuel & Firewood Initiative (Women’s Commission) Objective: Develop and disseminate guidelines concerning safe access to cooking fuels and to encourage rigorous field testing of alternatives to wood. Global Alliance for Clean Cookstoves Objective: Save lives, improve livelihoods, empower women, and combat climate change by creating a thriving global market for clean, efficient cooking solutions. Future Opportunities Costing/Replicating alternative energy sources Improving evidence base for fuel efficient stove uptake/usage Expanding partnerships with universities, foundations, private sector.

41. TRENDS & REALITIES Urbanization Increasing displacement as a result of conflict and natural disasters. People affected by natural disasters increased from 150 million in 1990 to 300 million in 2008 Population growth Insecurity, lack of access to populations of concern Gender inequity, gender based violence Mixed migration flows Extreme climate events

42. APPROACHES TO DEVELOPMENT AND HUMANITARIAN ACTION: NGO PROFILES AND SYNTHESIS NOV 2010 Terminology broad, activities quite broad World Vision - Christian humanitarian organization - working with children & communities in context of poverty & injustice CARE - leading humanitarian organization fighting global poverty, improve human condition (health), social position (gender & ethnic discrimination), enabling environment (policy, governance). MSF - impartiality and medical ethics, IHL, independent Oxfam- Regional focus, multi-country & regional solutions, advocacy All but MSF think of themselves as development actors but views development through specific lens: children’s wellbeing, women’s empowerment, faith, entrepreneurship, housing

45. REBELLIOUS HUMANITARIANISM (MSF) Go where needed, not where allowed Bear witness to human rights violations and blocked relief “Temoignage”– commitment to testimony, open advocacy and denunciation when working with endangered populations Violating neutrality – MSF called for military intervention in Bosnia, Rwanda

46. SOME HUMANITARIAN ACTORS OF MANY International OCHA OCHA - Office for the Coordination of Humanitarian Affairs UNHCR - Office of the United Nations High Commissioner for Refugees UNICEF- United Nations Children's Fund UNRWA- United Nations Relief and Works Agency for Palestine Refugees in the Near East UNFPA - United Nations Population Fund ICRC- The International Committee of the Red Cross IFRC - International Federation of Red Cross and Red Crescent Societies IOM - International Organization for Migration WFP - World Food ProgrammeUNHCR UNICEFUNRWAUNFPAICRCIFRC IOM WFP NGO: IRC, MSF, MDM, Merlin, ACF, CRS, Islamic Relief Services, Care National humanitarian organizations e.g. -Red Crescent societies -many local NGOS and community based organizations

47. SOME DEVELOPMENT ACTORS OF MANY Local NGOS & Community organizations INGOs - Action Aid International - CARE International - Oxfam - Welfare Association, Geneva Gov. Agencies & other Donors - CIDA - Asian Development Bank - AUSAID - DANIDA -DFID - Irish Aid - World Bank - Commission of the European Union UN Bodies UNAIDS, Geneva, Switzerland - United Nations Environment Program [UNEP] - UN Industrial Development Organisation INGOs - Action Aid International - CARE International - Oxfam - Welfare Association, Geneva International Labour Organisation Research Org. and Networks - Institute of Arable Crops Research - International Institute for Environment and Development [IIED] - Natural Resources International Private companies & consultancies

48. SORT OF… Source: Humanitarian Coalition

49. HUMANITARIAN & DEVELOPMENT AID A CONTINUUM Humanitarian aid designed to save lives, alleviate suffering maintain and protect human dignity Development aid responds to ongoing structural issues that may hinder economic, institutional and social development Source: Humanitarian Coalition

50. LIMITS OR PERCEPTIONS OF DEVELOPMENT LIMITS Development can have political motivations Entrenches relationship of dependence on poor countries to West Neo-liberal critique Dambisa Moyo denounces relationship of dependence of recipients on donors Ineffective technical cooperation ODA high % in servicing foreign debt repayments Excessive transaction costs Needs more funding and more funding for climate events

51. “David Rieff had been humanitarianism’s obituarist, first in his Newsweek article The Death of Humanitarianism (1999) and then in his book A Bed for the Night: Humanitarianism in Crisis, 2002.” inadequate, selective and inequitable application of humanitarian budgets across the vast spectrum of human need; humanitarian co-option into war aims posed by belligerent funding and military encroachment into humanitarian activity which is seen as causing a dangerous blurring of belligerent and humanitarian interests and action However this has always been the case says Hugo Slim. Not end of humanitarianism “The long cherished dream of humanitarian coordination might best be set aside for the more effective (and more achievable) vision of strategic variation.” CHALLENGES

52. TO SPEAK OR BE SILENT – CHALLENGES OF IMPARTIALITY Biafra, southern Nigeria 1971 MSF formed by doctors and journalists who could not keep ICRC oath of silence.

53. NICARAGUA 1972 MSF first medical mission was to Managua, 10,000-30,000 people lost their lives.

54. MSF 1975 Cambodian refugees in Thailand 1976 War in Lebanon, first major intervention in war 1990s War former Yugoslavia 1994 Genocide in Rwanda, 800000 Tutsis & moderate Hutus died 2000 HIV/AIDS Pandemic, ARV therapy, advocacy 2003 US invades Iraq, MSF remains in Bagdad and criticizes American government failure to provide medical assistance to civilians. 2004 Tsunami South East Asia 2010 Haiti Earthquake

55. AIMS & LIMITS OF HUMANITARIANISM “You can’t stop genocide with doctors.” MSF called for an armed intervention in Rwanda, 17 June 1994

61. MSF relies on private donations to carry out its work More than 80% of all funds raised come from individual donors MSF is able to act quickly in emergencies and deliver aid to people based on need, irrespective of political, economic or religious interests

62. Every year, MSF sends thousands of professionals (doctors, nurses, logistical experts, engineers etc.) to respond to emergencies around the world BUT over 90% of MSF staff are locally hired This ensures continuity in MSF programs Provides training and jobs to local people Teams share local knowledge and international

63. “REBELLIOUS HUMANITARIANISM” The Nobel committee cited MSF’s commitment to “independent medical humanitarian action” and to “speaking out, which helps to form bodies of public opinion opposed to violations and abuses of power.”

64. MSF recognizes that there is no clear temporal distinction between humanitarian and development interventions: the organization has been in countries experiencing protracted crises for decades (e.g. Afghanistan). As nations stabilize and develop their own health infrastructure, however, MSF gradually scales back or discontinues operations.

65. MSF ‘EMERGENCY’ CONTRADICTION Sudan (present since 1979), Democratic Republic of Congo (since 1987), Myanmar/Burma (since 1992) and Somalia (since 1991)

66. ACCOUNTABILITY -continuously reflect on the impact of our humanitarian action -keep the people who support us informed -transparent and specific about costs and benefits of our operations. -publish lengthy reports about our work e.g.Haiti six months after the devastating January 2010 earthquake and again six months later, after the nation was further stricken by a cholera outbreak. -end of 2011, we similarly documented our work in the Horn of Africa— in Somalia, Ethiopia, and Kenya—during the malnutrition crisis that contributed to the death of tens of thousands of Somalis and the displacement of hundreds of thousands more. -ground our decisions in our medical and humanitarian ethics, that experienced MSF teams conduct independent assessments of the needs on the ground before we open a project.

67. …MSF is respected, not always loved. It has a tendency to arrogance, self-righteouness and sometimes ignores or fails to understand the broad context. Its fractious nature can lead to the establishment of 2-3 independent MSF operations in a single country. It usually arrives after an emergency starts and it pulls out as soon as it has decided its work is done. Used for political means THE DOVE IS NEVER FREE CRITIQUES

68. SUMMARY OF LESSONS LEARNED Emergency response must be based on accurate information and use a public health approach Major causes of mortality in emergencies are preventable through well-proven, low-cost public health interventions Protection of affected populations, maintenance of humanitarian space and safety of humanitarian workers is becoming increasingly difficult (CDC)

69. SUMMARY OF LESSONS LEARNED (CONT.) Emergency response has evolved as a specialist field with its own indicators, policies, procedures, manuals, and reference materials Agencies that developed institutional expertise in the key technical areas of humanitarian aid and invested in staff training have proven their effectiveness Relief agencies must be accountable to agreed standards Better outcomes with involvement of host government staff and use of local skills Preparedness and coordination between agencies is key for effective response. CDC

70. HUMANITARIAN ORGANIZATIONS: WHAT DO THEY DO WELL? Usually have excellent advocacy or lobbying capacity Can fill gaps-specialised skills/capacity Usually mobilise quickly Often well connected at local level

71. WHAT DON’T THEY DO WELL? Duplicate services Turf wars can erupt May step outside their areas of specialty Often overcommit/overextend capacities May not be so good at sustainability May be a Political tool

72. A GOOD CHALLENGE BUT IN MEANTIME… (DIFD) Department for international Development has witnessed a change in stressing the importance of preventing conflict, more than providing humanitarian aid. DIFD expanded it activities towards prevention initiatives to include new areas, such as removing land mines, changing military assets, reducing undersized arms, as well as being involved in analyzing war by conducting an impact evaluation. Useful to address underlying vulnerabilities vs only shock-driven response

73. WHO MONITORS NGOS? Little External Monitoring Self-Regulation: NGO Standards Red Cross Code of Conduct Sphere Minimum Standards in Disaster Response

74. SPHERE PROJECT www.sphereproject.org 1997 Humanitarian NGOs and related organizations, including Red Cross and Red Crescent movements Collaboration Expression of commitment to quality and accountability Minimum standards in disaster response

75. CRITIQUES SPHERE Griekspoor (WHO) stresses the need for a localised, contextualised response instead of a standardised approach that can crumble in high-pressure, complex scenarios MSF Jacqui Tong myth of ‘homogeneous humanitarians’ “entertains idea humanitarian aid is only about providing water, food, shelter and health services” linking quality and accountability to technical standards. This can be exemplified by the hackneyed example — ‘there are a sufficient number of wells but women are raped when go to collect water’

76. MDGS & HUMANITARIAN RESPONSE Head of International Rescue Committee David Miliband argued goals of humanitarian action need to be reassessed and humanitarian goals – "HuGos" – need to be set.David Miliband Drive to create a humanitarian counterpart to the millennium development goals … But.. “Try explaining to an armed opposition member that the purpose of your humanitarian aid is to build the capacity of the institutions of the state that he has taken up arms against.” (Jonathan Wittall)

77. COORDINATION military everybodyelse Aid workers consider military to be bureaucratic and unsuitable. Military workers view aid employees as unorganized, insecure and without discipline wrong

78. CIVIL-MILITARY COOPERATION The need for civil-military cooperation may be the exception rather than the rule The two should not be mixed when avoidable However the logistic support provided by larger NGOs or the military in support of smaller NGOs can be invaluable

79. EXAMPLES OF CIVIL-MILITARY CO- OPERATION SERVICES REQUESTED BY NGOS Security Services Landmine Locations Security Briefings Convoy Support Guidance on Local Security Technical Assistance Access to Remote Areas, Ports, and Airfields

80. “Post conflict development defies the exact boundaries of traditional forms of assistance: it is neither sustainable development nor is it humanitarian response.” Mark Malloch Brown, VP, External Affairs, World Bank. (Conflict Prevention and Post-Conflict Reconstruction: Perspectives and Prospects, 1998)

81. OUR COMMON FUTURE Development In 1987 Brundtland report defined sustainable development as “development that ‘meets the needs of the present generation without compromising the ability of future generations to meet their needs’ (WCED 1987). Humanitarian assistance: Based on need Restore Ability of People to Make Their Own Decisions Most vulnerable people must be core of both: The most vulnerable people living in countries with protracted and recurrent crises have been left behind in the MDG process. And too many humanitarian organizations stay away from where need is most…Somalia for example.

82. COOPERATION & HEALTHY TENSION Independence, neutrality: distance may be necessary especially in conflict situations In contexts such as natural disasters and epidemics, development groups, humanitarians and state actors should certainly work together for long-term benefits MSF UK Programs Unit, André Heller Pérache

83. FOOD FOR THOUGHT The impacts are interlinked: protracted humanitarian crises act as a barrier to sustainable development by undermining long-term recovery and resilience, and conversely, a lack of development can trigger a relapse and magnify the impact of crises on vulnerable people Humanitarian assistance can be an investment in development Give Law teeth: avoid need for post-mortem justice

84. Sierra Leone, Sylvain Cherkaoui/Cosmos for MSF 2014 SMALL GROUPS: EBOLA BRAINSTORM