Effective Aid

Humanitarian assistance is aimed at providing rapid, life-saving support in settings of high population vulnerability, such as in times of war, disaster, or displacement. The provision of humanitarian assistance is complicated by severe access restrictions, large-scale emergency needs, displaced populations, and complex political and social settings. Both war and disasters create, and often amplify, existing economic disparities and contribute to an environment in which gender inequities, human vulnerabilities, and human rights abuses are likely to be exacerbated. The emergency response to large-scale humanitarian emergencies such as the 2010 earthquake in Haiti creates a sense of public urgency and political pressure to intervene. The last decade has seen significant advances in the standardization and coordination of relief and development activities, including improved mechanisms for coordination and accountability. While these efforts provided a solid basis for improved efficiency, they have faltered in recent large-scale crises. As the global relief and development community contemplates the next decades of humanitarian operations, a few essential questions should be raised: What are the most important barriers to providing effective aid? What future issues must be understood to optimize the efficiency of aid? What is the cost of inaction and what are the ramifications of not changing the system? This article will focus on some of the factors contributing to ineffective humanitarian aid and discuss the progress toward humanitarian reform, including the need for professionalism, coordination, and accountability.

The Haiti Earthquake: Coordination or Chaos?

The 2010 Haiti earthquake was among the most devastating natural disasters in the 21st century. The magnitude 7.0 earthquake had an epicenter that was within 25 km (16 miles) of Haiti’s capital Port-au-Prince. Over three million people were affected with 220,000 deaths and the destruction of 300,000 homes and commercial buildings. Thousands of volunteer non-governmental organizations (NGOs) responded (Haiti is said to be home to over 13,000 NGOs) and were hampered by lack of coordination, restricted infrastructure, and security concerns

As many as 50,000 Haitians slept in this earthquake survivor camp in the Del Mas area in Port-au-Prince, Haiti, Jan. 21, 2010. It grew by thousands in a week of the U.S. Army 82nd Division's 1st Squadron, 73rd Cavalry Squadron distributing food and water there. - Fred W. Baker III

As many as 50,000 Haitians slept in this earthquake survivor camp in the Del Mas area in Port-au-Prince, Haiti, Jan. 21, 2010. It grew by thousands in a week of the U.S. Army 82nd Division’s 1st Squadron, 73rd Cavalry Squadron distributing food and water there. – Fred W. Baker III

The example of Haiti provides an example of three of the major challenges facing the international relief community: coordination, accountability, and effectiveness. The characteristics of the earthquake in Haiti created conditions that predisposed the response to chaos and undermined effective coordination. Consider the setting: Pre-earthquake Port-au-Prince suffered from a dysfunctional economy, ineffective leadership, profound corruption, and decades of aid dependency. The city itself had experienced massive urbanization as millions of Haitians settled in hundreds of thousands of poorly constructed homes. The earthquake decimated the city, but largely spared the airport, which had direct flights from Miami. The result was a sensational catastrophe with profound emergency needs that was within a two hour non-stop flight from Florida and accessible to everyone. And that’s who came: everyone.

Medical and surgical teams from across the United States arrived to provide assistance. Churches, community groups, small organizations, large multi-national organizations, and several foreign militaries and governmental actors arrived, all intending to provide relief. While it is certain that many lives were saved by these first responders, it is also certain that many people suffered at the hands of inexperienced aid providers who had no prior connection to the aid community or to the understanding of the principles, practices, or accountability associated with professional humanitarian agencies. Over 10,000 new organizations arrived over the course of a few months to provide assistance, each with its own mission and objectives.

The United Nations Office of the Coordination of Humanitarian Affairs (OCHA), the primary coordinating body for the humanitarian aid community, set up the Cluster Coordination System in Haiti, but it was unable to cope with the massive influx of thousands of non-professional responders who were unfamiliar with the Cluster system. While critics point out that OCHA’s leadership and management of the Clusters were weak, the scale of the response and the diversity of the responders created a relief scenario that was scattered, poorly monitored, and accountable to no one.

The issue of accountability is a major problem in emergency relief efforts. The mass influx of aid organizations, from large multinational agencies to small, specialized groups, creates a system that lacks both accountability and transparency. This is particularly problematic in places where local and national host governments are weak and disorganized. There are no mechanisms within that can prohibit an unqualified organization from participating in the aid effort, and also no international treaty that specifies standards of practice and legal requirements for humanitarian aid actors. A host government may allow multi-national assistance, but they often do not have the national structures in place to coordinate such a massive and chaotic influx of aid, much less the ability to assure quality and appropriateness of the response.

In addition to challenges of coordination and accountability, there is little attention paid to the effectiveness of aid interventions. Certainly the provision of basic services such as water, sanitation, and housing seems clear and measurable at face value, but the effect of aid on local communities, industries, health systems, and vulnerable populations is difficult to quantify and rarely measured. Donors do not insist on effectiveness measures, and the affected population has no choice in the matter. The very nature of emergency assistance, with the rapid provision of life-saving aid by hundreds of relief agencies, creates a setting where the amount of aid becomes more important than the effect of the aid.

Milestones in Humanitarian Reform

The expansion of the aid industry has occurred in very recent history. Before the 1990s, a few dozen major relief organizations such as CARE, Save the Children, International Rescue Committee, Medicins Sans Frontiers (Doctors Without Borders), and the International Committee of the Red Cross worked in major conflict and disaster regions. During the Kurdish and Somali crises, there was a major expansion in the number and size of humanitarian agencies and with this expansion came greater pressure to coordinate. A few sentinel moments in crisis response led to major changes in coordination and accountability:

 The 1990-91 Kurdish Refugee Crisis led to UN Resolution 46/812 and the establishment of the Interagency Standing Committee in 1992 as a governing body for humanitarian organizations, the role of the Emergency Relief Coordinator and new proactive funding mechanisms such as the Consolidated Appeals Process (CAP) and the Central Emergency Response Fund (CERF). This major step forward created proactive mechanisms for aid agencies to coordinate in the field and access emergency funds in a more streamlined fashion.

 The 1994-96 Rwandan Refugee crisis and the deadly cholera epidemic in the massive refugee camp in Goma lead to a 1996 Joint Evaluation in Rwanda and the ultimate creation of the Sphere Standards in humanitarian response, which created basic minimum standards for the provision of aid. Sphere provide clear, measurable targets for the provision of aid in emergencies, defining, for example, the amount of clean water needed per person, minimum standards in housing and sanitation, food and nutrition, and health services available to aid recipients

 The 2004 Indian Ocean tsunami highlighted the limitations of UN and NGO coordination mechanisms and lead to the creation of the “Cluster System” whereby sector specific actors (such as those working in water and sanitation) meet proactively and coordinate on the ground to provide a more coordinated response. The Clusters, as noted above, are collections of UN agencies and multi-national NGOs who coordinate services based on sectors. The Health Cluster, for example, has several members including health NGOs, WHO, UNICEF and others, and works at the field level to coordinate actors who are working in the health sector. These Clusters have provided a mechanism for organizations working in specific sectors such as food, water, sanitation, health care, protection, and housing to plan and work together.

 The 2010 Haiti earthquake revealed many weaknesses in humanitarian leadership and coordination, including the breakdown of the Cluster System. This led to the Inter-Agency Standing Committee’s (IASC) new “Transformative Agenda” to enhance coordination within the formal response system. The Transformative Agenda calls for improving Cluster coordination, improving accountability to beneficiaries, and enhancing humanitarian leadership within OCHA.

Future Challenges

There are many factors that lead to the complexity and dynamic nature of the humanitarian environment and the need for large organizations to adapt to a changing world. The rise in natural and climate-related disasters combined with the demographic shift to urbanization will change the way that UN and NGO actors provide assistance. New actors have emerged, including multinational businesses, consulting firms, and the US and foreign militaries, leading to a far more complex environment for coordination. The shrinking humanitarian space and erosion of neutrality create a far more challenging environment for NGOs and their expatriate staff. Advances in information technology and the ability to measure, map, and evaluate humanitarian interventions will lead to new ways of providing and coordinating aid. There is also a clear recognition that the humanitarian aid community must invest proactively in national actors and administrative structures to create a more appropriate response and to ensure that funding available for aid is able to contribute to sustained efforts in rehabilitation and recovery.

Three Pillars of Improved Response

Professionalism

The humanitarian community is undergoing an important transformation toward professionalism. There is an increased recognition for the need for standardizing training and credentialing for over 220,000 humanitarian aid workers and a need for ongoing exchange of information to advance the professional profile of aid and development workers. The Enhanced Learning and Research for Humanitarian Assistance (ELRHA) scoping study of 2010 indicated that the vast majority of humanitarian workers (over 90 percent of the 1500 surveyed) desire greater professionalization of the field and greater formal mechanisms for certification.

The introduction of major academic programs into the arena of professional development has created a greater awareness of the need for credentialing, certification, and professional development. Organizations are proactively engaging academic organizations and universities to assist in professional education and leadership development and encouraging dialogue on professional standards, ethics, and critical analysis. Major university programs such as the Harvard Humanitarian Initiative and the new Humanitarian Academy at Harvard have created new ways to measure humanitarian impact and further advance humanitarian professionalization. These programs have changed the nature of academic engagement in humanitarianism to become more field-focused and more intertwined with the operational needs of NGOs. Universities can provide the research and analytic basis for he operation and policy needs of the UN and multinational agencies. As the humanitarian community evolves toward a more evidence-based pursuit, the role of academia has become more clear and more relevant.

Coordination

IASC’s Transformative Agenda Chapeau and Compendium of Actions describes the next steps toward improved humanitarian aid in crisis. This includes enhancing OCHA’s capacity to coordinate and provides incentives for organizations to cooperate with OCHA. This will require organizations to participate with the Cluster System and to acknowledge a set of universal standards. The willingness to coordinate has been a key feature in the success of the Clusters, but, as seen with Haiti, there are many organizations who fall outside of the normal response system who have not agreed to any form of organization or accountability. Not all relief is good relief, and it is only through the creation of national governmental coordination structures of host governments, such as Ministries of Health, that ad hoc responders can be properly regulated, and, when appropriate, prevented from participating.

One significant step toward regulating the quality and consistency of medical relief providers was the World Health Organization Guided Consultation on Foreign Medical Teams (FMTs) in Havana in 2012, which developed a consensus on the function of FMTs and the rules for engagement. These recommendations called for an international registry of FMTs and provided parameters for minimum services that they could provide, as well as describing standards for coordination, information sharing, ethical standards, and credentialing of participants. Participation in the FMT registry will allow these organizations to access central funding from UN and its donor nations and provide recognition as a certified organization. While this will still be voluntary, and will likely not establish a mechanism for prohibiting amateur actors, it does mark an important step forward in establishing standards for organizations that provide emergency medical services.

Accountability

Many humanitarian organizations recognize that the lack of accountability toward beneficiaries represents a major barrier to professionalizing the humanitarian community. Accountability includes both demonstrating effectiveness to donors and also responsiveness to beneficiaries of aid. In many ways, these two types of accountability can be diametrically opposed. Accountability to donors requires attention to the efficiency, cost effectiveness, and some measure of the outcome of aid. Donors, by definition, can insist upon certain process or outcomes measures, which may or may not be relevant to the recipient. Establishing accountability measures that incorporate the needs, desires, and opinions of aid recipients is quite different. Accountability toward beneficiaries entails creating feedback mechanisms that can empower communities to become active participants in the relief and reconstruction process. This is not a simple process, and providing ways for communities to criticize the often times free services that they are being provided is difficult and can inject local and regional politics into the aid process. This may be desired, but it is not easily managed.

Most organizations recognize that empowering beneficiaries in recovery efforts provides them the best chance to accomplish quality programming with a long term benefit and ensures the ability of organizations to be independent and impartial under international humanitarian law.

Maintaining accountability and transparency to all stakeholders, including donors, host states, local authorities, and affected communities, is increasingly seen as a vital part of humanitarian interventions.

The adoption of formal accountability measures by organizations has been slow. While several hundred organizations have affirmed and adopted the Sphere Minimum Standards in humanitarian programming, significantly fewer have officially become members of the Humanitarian Accountability Partnership (HAP), an organization developed to create and voluntarily enforce standards in accountability and transparency. Established in 2003, HAP International is the humanitarian sector’s first international self-regulatory body. Membership in HAP requires compliance with standards in accountability, quality management, and transparency, and allows a forum to provide feedback and even peer complaints. As of 2013, over 100 agencies, such as Oxfam, International Medical Corps, and Save the Children have joined HAP.

Cost of Inaction

The challenges humanitarian agencies face in the field have grown in complexity over the recent decade, creating a dynamic environment for humanitarian actors. Recent humanitarian emergencies in the Syria, Lebanon, and the Palestinian Territories exemplify the difficulties in assuring humanitarian access. Restricted access in Darfur and the Democratic Republic of the Congo illustrate the widespread nature of civilian abuses and human rights violations. Military humanitarian operations in Iraq and Afghanistan contribute to the blurring of humanitarian motives and pose a challenge to humanitarian neutrality. If there is one consistent feature in the enterprise of providing humanitarian relief in conflict and crisis, it is the certainty of change.

It is essential that the aid industry undertake bold and unified efforts to define itself as professional, accountable, and well-coordinated. The costs of inaction are significant. Without efforts aimed at professionalizing individuals and organizations within the aid community, responses to the growing number of complex humanitarian emergencies will be ad hoc, poorly-coordinated, of poor quality, and have limited long-term effectiveness. The number of international actors, including military, private industry, and governmental participants will continue to increase, and without a clear and functional mechanism for coordination and accountability, there will be no voice for recipients of aid. Without proactive engagement of local and national authorities before and during a crisis, there will be no strengthening of governmental capacity and limited long-term recovery options.

Toward More Responsible Relief

The dynamic nature of the humanitarian relief enterprise will create unique pressures and difficulties for organizations. In this rapidly evolving global field, the humanitarian community must develop unprecedented adaptive strategies in order to be relevant and effective. For example, the growing adoption of humanitarian outreach as a military strategy will continue to create tensions within the civilian aid sector. The US Department of State’s Quadrennial Defense Review indicates the centrality of humanitarian intervention as a Department of Defense military foreign policy priority. This will challenge the perception of neutrality of civilian NGOs and likely further restrict humanitarian access. Climate change and urbanization will force organizations to change the way they plan for future humanitarian intervention and how they access vulnerable populations. Urban humanitarian operations create a unique set of problems for organizations providing services in impoverished urban slums.

Effective aid organizations must address the destabilizing effects of water insecurity, population migration, emerging health threats, and the impact of chronic conflict and war on global security. Based on past efforts, the aid community has shown its ability to adapt and evolve. By working together to maximize coordination, professionalism and accountability, the humanitarian community can face the global threats that await them and tackle the challenges brought about by war, conflict and disaster. The lives of millions depend on it.


Michael VanRooyen is the Director of the Harvard Humanitarian Initiative (HHI) at Harvard University.  He has worked as a relief physician in over 30 countries affected by war and disaster and has been a policy advisor to several UN and governmental agencies.

About Author

Michael Vanrooyen

Michael VanRooyen�is the Director of the Harvard Humanitarian Initiative (HHI) at Harvard University.� He has worked as a relief physician in over 30 countries affected by war and disaster and has been a policy advisor to several UN and governmental agencies.