The Humanitarian Times

November 19, 1999


- N IRELAND'S IRA, IRISH REPUBLICAN ARMY, AGREES TO WORK WITH DISARMAMENT Commission, it said this week, as a first step to disarming, in return for Protestant recognition of the Sein Finn political party.

- CHECHEN CIVILIAN DEATHS OVER 4,000 IN CURRENT RUSSIAN BOMBARDMENT said Chechen Foreign Min. Akhmadov this week. Russia continues to shell villages & the Baku-Rastov highway alone which civilians flee. 350,000 have been displaced in the N Caucasus in the last 3 months. Last week the Red Cross (ICRC) pulled out of Chechnya, leaving Halo Trust as the last aid agency in Chechnya (now assisting medical & urban water chlorination).

- BOSNIA'S 3 PRESIDENTS SIGN NEW PEACE AGREEMENT PROMISING TO RESETTLE the 1 million still-displaced to their original homes, in this week's New York Declaration.

- UN REPORT ACKNOWLEDGES UN FAILURE TO PREVENT 20,000 MURDERS IN BOSNIA safe areas, including Srebrenica (July 1995)

- INDONESIA DRAFTS NEW RULES FOR LIMITED AUTONOMY FOR ACEH PROV. Even after the recent destruction East Timor, planned by the Indonesian military as a warning against other separatists, the Timor precedent is purring enthusiasm in Aceh province for its own independence, encouraged this month by some ambiguous statements by incoming Pres. A Wahid who said that an undefined referendum might be allowed; while military leaders were more clear in stating that no referendum would occur.

Yet Wahid ordered withdrawal of the Indonesian army from Aceh, promised to prosecute violators of human rights, created a new human rights affairs ministry, & appointed an Acehnese its 1st Minister. If community protests increase in Aceh, forcing Wahid to make further concessions, the fear of further fragmentation of Indonesia (& loss of Aceh's gas & timber revenues) could compel a military coup against Wahid. Reports grow of increasing numbers of nervous Achenese withdrawing savings & fleeing the province for abroad.

- MILITARY JUNTA MISMANAGEMENT CAUSES BURMA'S POVERTY, SAYS WORLD BANK in a report the Bank delivered to Burma last month & made public this week. It concludes that major political reform is a prerequisite for economic growth in Burma. In a separate report, the Bank warns that current agricultural subsidies, per Burma policy, will accumulate so much debt that a banking crisis will be occur.

- ETHNIC CLEANSING, SLAVERY, FORCED DISPLACEMENT, CHILD SOLDIERS IN SUDAN were reported this week by UN Special Representative Leonardo Franco.

- DONORS PLEDGED OVER $1 BILLION MORE AID FOR KOSOVO'S REHABILITATION at a pledging conference in Brussels this week, convened by the EU & World Bank, bringing the total to $3b.

- "KOSOVO PSYCHO-SOCIAL NEEDS ASSESSMENT" BY EXPERT TEAM LAST MONTH, led by the International Rescue Committee (IRC), concludes that "although ethnic reconciliation is a laudable long-term goal, it is not feasible now. Kosovo is seeped in pain, hatred & desire for revenge against Serbs.... no Kosovars speak of reconciliation... hatred is an accepted norm... transferred from adults to youth." The report recommends programs for ethnic tolerance that, among other things, bring to Kosovo "a team of religious, human rights & other leaders" that "might include Elie Weisel, Bishop Desmond tutu, Vaclev Haval, Veton Surroi, Amb Robert Seiple" & "should meet with the Kosovar Transitional Council & challenge these leaders to make Kosovo an example of peaceful coexistence for the rest of the world."

- UN SEC COUNCIL EXTENDED UN OBSERVER MISSION IN TAJIKISTAN while noting progress in peace & governance.

- SYPOSIUM ON DEC 3-4: HUMANITARIAN ACTION & CODES OF CONDUCT in Lyon, France, by Bioforce & Sorbonne; email:

- UPCOMING CONF: GLOBAL DISASTER INFORMATION NETWORK (GDIN), IN TURKEY will be held April 26-29, 2000; the 3rd in a series of GDIN meetings. See:

-TUFTS UNIV ACCEPTING APPLICATIONS FOR 2 FACULTY POSITIONS IN HUMANITARIAN studies, based in Massachusetts: in biology/health (contact, & in intl relations (Fletcher School).

- COEXISTENCE-INITIATIVE SEEKS EXECUTIVE DIRECTOR, IN LONDON, TO LEAD NGO in its conflict resolution work & organizational growth. Candidates contact:




Three recent books stand out as texts on health in emergencies; each are anthologies covering a range of case studies, operational & ethical issues. Not surprisingly, there is much overlap of the same authors across books. Each takes health in emergencies a leap beyond 1980s classics such as S Simmonds' "Refugee Health Care", & Sanders/Jones "Medical Care of Refugees." See also the recent & recommended MSF "Refugee Health" - was rated #2 book of the year in the Dec. 1998 issue of The Humanitarian Times.

- RECENT BOOK: "HUMANITARIAN CRISES" PLUMBS MODERN DILEMMAS (1999 Cambridge: Harvard Univ Press). Jennifer Leaning (the editor, along with S Briggs & L Chen) defines complex emergencies as having "mass population dislocation, destruction of community & infrastructure, pervasive insecurity, & gross human rights violations.. ..that require expertise in a population approach to issues of medical triage & austerity." Dr. M Toole explains that most of the deaths in complex emergencies occur among children & are avoidable with simple health interventions: "The most common causes of death have been preventable conditions, such as measles, malnutrition, diarrheal diseases, pneumonia & malaria -- the same conditions that cause most deaths in non-refugee populations in developing countries." Noji & Burkholder review guidelines for refugee camps ("avoid creating settlements with more than 10,000 people") with an emphasis on early attention to hygiene, sanitation & water supply: "the organization of chlorination brigades at untreated water sources, the designation of physically isolated defecation fields, community outreach to identify & treat patients outside clinics & oral rehydration therapy… providing buckets with lids to each family & then chlorinating each bucket at the distribution source has proved to be an effective prevention..." Several chapters elaborate the point that we know little about the overall psychosocial effects of complex emergencies: "most of the research has focused on pathological outcomes & on people who seek care, rather than community-based assessments of entire exposed populations." After reviewing techniques for assessing trauma, Harvard's R Mollica concludes "only recently have large-scale population studies of combat veterans, Nazi Holocaust survivors & refugees been attempted...revealing the prevalence of psychiatric morbidity & related risk factors of major public health importance." A fascinating chapter by A Neier & Leaning examines how traditional human rights methods -- of stigmatizing authorities responsible for abuses -- are ineffective in recent emergencies like Somalia, Bosnia & Rwanda where oppressors "are independent of the great powers & act outside the customary network of political leverage." They observe that the human rights community (which seeks justice -- comprehensive trials) is increasingly at odds with humanitarian (operational) agencies who "consider the establishment of peace & development initiatives more important;...this disagreement has perhaps the most serious implications for the future of the international human rights movement." Writing from the point of view of one humanitarian NGO (CARE), Marc Lindenberg observes "NGOs have many strengths in responding to a complex emergency.

They are quick, flexibly, innovative & pragmatic...courageous...capable of building local coalitions...& local capacity." Yet Lindenberg finds there is no absolute moral calculus NGOs can refer to: "it is even harder to document the number of lives lost & saved in such situations" (emergencies). Acknowledging the many ways NGOs like CARE have improved their professional response capacity he notes the evolution of fast- disbursal rotating emergency funds, new personnel roster systems, more pre-positioning of supplies, new standing agreements with donors, clearer division of labor among NGO affiliates, & joint NGO coordinating committees. On ethical dilemmas, he writes "Many NGOs have gotten around the problem of serving refugees in the territories of only one political faction by maintaining the principle of balanced service. For example, CARE works with displaced people on both sides of the conflict zones in Sudan." The final chapter by Perrin explains the Intl. Comm. Red Cross' approach: "Whereas the ICRC handles violations of intl. humanitarian law by dealing directly & confidentially with the authorities, other org's denounce such violations & stigmatize those who commit them.The 2 strategies are complementary, but they cannot be used by the same organization."

- "A FRAMEWORK FOR SURVIVAL: HEALTH, HUMAN RIGHTS & HUMANITARIAN Assistance," edited by K Cahill (1999 NY: Routledge) in its new 2nd edition includes 21 chapters by experts, also from ICRC, CARE & academia, & it too is led off by a chapter 1 by Mike Toole who writes "Experienced technical personnel should be given a greater role in decision-making early in emergency programs. During both the Kurdish & Rwandan relief operations, certain basic skills were lacking among many relief workers.... in the management of diarrhea & dehydration & child nutritional problems...NGOs need to invest more heavily in training their personnel." Physician Jack Geiger calls on the American medical establishment to forge a coherent, proactive policy on intl health & contribute more to intl efforts, including training & human rights. N Fisher writes that young children "are the most vulnerable to sickness, exploitation, violence & death," & finds that "the identification, care, family tracing & reunification of children with families is becoming increasingly systematized & effective in times of crisis." R Falk relates the state of flux in intl law & north/south relations to the advent of human rights considerations over sovereignty (unless the country whose sovereignty in question is China, Russia, India or Indonesia). Further chapters are rich with the insights of the heads of Concern, Care, UNHCR, & the Women's Comm, plus Cyrus Vance & L Minear. Because of its wide coverage of cases & organizational perspectives, this makes an ideal text for courses on humanitarian aid.

- "THE PUBLIC HEALTH CONSEQUENCES OF DISASTERS" EDITED BY ERIC NOJI (1997 Oxford: Oxford Univ Press) is the definitive review of technical knowledge about health risks by type of emergency, with chapters on cyclones, earthquakes, floods, famine, industrial disasters, nuclear accidents, & complex emergencies, as well as on epidemiologic techniques, surveillance, disease control, mental health & media relations. 468 pp; & over 1,000 references.

- Also of interest: B Levy & V Sidel "War & Public Health" (1997 Oxford Univ Press)-also an anthology of cases by leading public health scholars