SUMMER 1999 - ISSUE NUMBER 48

The World of InternationalRelief
Insights from a relief worker

I have been struck by reports in the international media as of late that there is an upsurge of interest in applicants searching to work overseas with relief agencies. Having worked as an international relief worker for the last 10 years, I thought I might lend a small degree of insight into the workings of the world of international relief. This article will briefly describe the way the actors in humanitarian disasters, donor governments, recipient governments, the UN, and the international non-governmental organizations (INGO) all interact with one another and, hopefully in the end, bring relief to those in need. Simply put a humanitarian crisis is a disaster involving the dislocation of people, a subsequent rise in mortality and morbidity, and an accompanying violent conflict, or a momentous natural disaster. In this way, Hurricane Mitch's aftermath will be similarly considered as the carnage that is today's Sierre Leone.

ECHO, OFDA, DANIDA, SIDA, DfID, etc., are all acronyms of some of the larger donors of humanitarian aid. While most of these donor countries methodically budget their aid dollars, there are the occasional cataclysmic events (such as Kosovo) which trigger the release of unbudgeted funds. These emergency funds are often given during moments of great human suffering and public sentiment. But ironically despite the initial emotional impulses this aid is rarely given entirely altruistically or without due consideration for economic interests. Up until the end of the cold war, such donorship was defined along lines of spheres of real or wanted political influence. But after the Berlin wall fell those politically charged days were numbered and the 90's have brought the new doctrine of global markets to the fore.

To illustrate this shift in how donors respond to a humanitarian crisis we can examine two recent examples: Hurricane Mitch's rage through the Central American isthmus and DR Congo's continuing war. The devastation which followed Hurricane Mitch provided a tremendous response from the US, and Western Europe. Not surprisingly, Latin America is a huge economic partner with the US (NIFTIER, banana trade wars, the maquilladora, etc.) and it is in N. America's and Europe's financial interests to keep the infrastructure humming. However, if the countries involved had not been subscribing to the dictums of the donor governments' own economic interests (trade agreements, export driven economies and IMF led economic restructuring programs, war on drugs, etc.) it is not all together obvious that such an outpouring of aid would be forthcoming.

The DR Congo war, currently dubbed as the predecessor to WWIII, has attracted little in the way of aid. Sympathy, shuttle diplomacy, editorials, yes; necessary monetary aid to those suffering from the conflict, no. This is largely because apart from specific economic interests (gold and diamonds) there are few economic reasons for western/northern countries to spend money on it. Since the resources of any commercial worth (gold, diamonds, timber, etc.) are continuing to be extracted there is no corresponding economic crisis to push donor governments to change their policies from rhetoric to action. That's not to say that donor governments are keenly interested in the DR Congo war. They are, but they are giving their aid militarily rather than humanitarily. To ensure that the wealth extraction continues unabated, foreign governments are weighing in on both sides: on the Ugandan backed rebel movement in the north (gold, timber) and on the DR Congo government's side in the southern part of the country (diamonds). No one is lending much in the way of health aid because health isn't a necessary component for the extraction of DR Congo's natural wealth. Obviously, there is no shortage of desperately poor people of whom the labor demands of timber and mining industries can forever rely upon.

In places where there is no real economic basis for a lot of monetary aid, the donors will occasionally be compelled to respond on the basis of public sentiment fuelled by images coming over CNN or some other news show. Somalia, N. Korea, Sudan, and Kosovo all, to some extent, represent countries with huge problems but with little economic draw. A typical donor response will be to try to minimize the aid offered by either making preconditions for the aid's receipt (such as in N. Korea where the response to the famine in N. Korea was highly politicized; so much so that the N. Koreans decided not to take the majority of aid offered because of all the strings attached to it), or by offering commodities which are in overabundance in the donor's own country (and often heavily subsidized commodities).

This second phenomenon is referred to as "dumping". Food dumping and drug dumping are the most common forms. Rather than give the starving people of Sudan or Somalia food which they are familiar with, food which could be brought locally/regionally (and, thus spur the regional economy), or food which might be tasty, donor governments instead will ship tons upon tons of western maize, wheat flour, beans, whatever they have on hand (and, thus, depress the regional economy). Often the food has to come with instructions on how to actually cook it because it is so unfamiliar; a sad irony for those who happen to be unlucky enough to be both starving and illiterate. And commonly, the food is totally inappropriate for the situation. Beans, for example, either have to soak or be cooked for a long time to soften. This is not an easy task for a family that has only one pot, is on the move, or has a limited amount of fuel. For the donor, however, food dumping offers a rather painless way to be rid of overstock and at the same time proclaim some good deeds.

Drug dumping has become a huge international tragedy on its own right. During the Bosnian conflict there were literally warehouses filled with expired or useless pharmaceuticals. Drug companies have used humanitarian disasters to donate their slow selling products, their damaged batches, their expiring or discontinuing drug lines so that they can claim the tax write off and at the same time show a compassionate face to their customers. The consequence is that sick people end up with useless or toxic medicines. They are often packaged in unfamiliar languages, often in preparations unknown to the local inhabitants, often for ailments which aren't appropriate to the situation. One INGO brought a lot of local scorn upon itself for bringing antimalarials to Bosnia. As a result of this ongoing embarrassment, a movement which started from within the INGO community has recently culminated in a something called the Revised Drug Strategy which was adopted unanimously by the World Health Assembly in May, 1999. This stratagem will, among other things, help put a halt to drug dumping practices.

Recipient governments know that there is no such thing as a free lunch. It is generally accepted and understood that international aid offers a great many advantages but also can come with some pretty impressive compromises. On the one hand it offers a way to strengthen the recipient government's own political base by demonstrating its responsibilities to care for its own people. On the other hand, the INGO's and the UN and the donor government's oversights and agendas can wreak havoc on the recipient government's own ability to actually be responsible for its people. In Sudan, for example, the bulk of the relief effort for the south is being delivered from northern Kenya. The one million dollar a day UN umbrella'd Operation Lifeline Sudan effectively has negated Sudan's own sovereignty by ignoring its right to control air traffic and the flow of goods across its own borders. Some countries have recognized the double edge sword that comes with accepting such aid. Eritrea for one, has decided to refuse any and all INGO's from working in their country for the simple fact that they would be too compromised.

The donors themselves never actually carry out the work that they pay for with their aid agency funds. This is left to the recipient agencies: the nongovermental organization community. The alphabet soup that the world's international non-governmental organizations (INGO) make up is even more convoluted than that of the donors. MSF, ACF, OXFAM, SCF, CARE, ADRA, CRS, etc. are but a few of the larger ones. Literally thousands of small and medium sized INGO's , local as well as international, receive money from the donor governments. Like the donors, the NGO's all have their motivations for their actions and every INGO seems to have their own particular reason for existing. Some INGO's act as global watchdogs &emdash; threatening to denounce behaviors that are deemed to be outside of international norms (like violations of human rights). Medicines Sans Frontiers is one example of a group that is willing to call attention to actions that they deem to be unjust or inhumane. Other INGO's have religious convictions that are part of their charter. For example, Catholic Relief Services (CRS), an INGO with very strong pro-life leanings, was running a food program in Kosovo delivering food to health institutions for the sick and destitute. They refused to provide food to one birthing center for prenatal and postnatal patients because abortions were also carried out at the same center. Yet another category of INGO are those that depend entirely upon donor money for their very existence. This dependency upon grant money and the inability to survive as an organization from one grant to the next means that their motivations for being part of relief work is as simple as wanting to keep their jobs. These INGO's cast themselves into molds of every sort of service provider. Need psychological care for refugees? They will step forward. Need water and sanitation coverage? They will raise their hand. Need provision of primary health care - you don't need to look further. Naturally, this has led to a degree of poor relations among recipient governments, the refugee populations, and the INGO community. Disasters are bad enough without needing lousy services to be part of it.

There is a bit of clamour among the INGO's right now about whether INGO's actually contribute to the crisis itself by prolonging its course. Bosnia for one, and certainly Sudan, can be seen as long drawn out conflicts with huge civilian casualties where the INGO's have informally become part of the mis-en-scene themselves. Would the ugliness and horror of war cause the perpetrators to come to settlement quicker if it wasn't for the palliating nature of INGO work allowing the war to be more tolerable and, therefore, less in need of a quick resolution? To paraphrase the SPLM/SPLA (which is fighting the Khartoum government for control of south Sudan) "you do the humanitarian assistance and we'll do the war".

Whatever the philosophical debate is about the utility and importance of INGO's, there is no argument that the world of humanitarian relief is big business. A chilling testimony of the big business that humanitarian relief has become is the three billion dollars per year that is spent on it. This kind of money provides a lot of incentive for people to regard it as their gravy train leading to reasons other than altruism for their involvement in the relief effort. People have to be compensated for their work, and good, talented people, should be rewarded, but there is an increasing recognition that people are making lucrative careers out of relief work. A revealing joke remark about the multitude of USAID consulting firms that have their offices on the outskirts of Washington, DC is that they are referred to as "beltway bandits". Routinely these organizations will fly business class, book rooms at the expensive N. American quality hotels at 150 dollars/night, and have per diems that run up to $250 per day. Seems almost immoral to do this kind of spending under the guise of humanitarian aid in countries where a $1/day wage is all most people can hope for. And, this easy spending comes out of the USAID budget: so there is less money available for direct contact with the suffering. A final ugly note on the industrialization of aid is the realization that in order for this industry to survive, as any industry will seek to do, there has to be an international disaster involving human suffering to keep it going.

Among other things, the Gulf War brought with it a change in the way relief operations during disasters was carried out. The Kurdish exodus into the Iraq/Turkish border country was a terrible mess. People without any sort of shelter, food, water, or warm clothing were pushed up into high altitudes and very quickly began to suffer from exposure, dehydration, and hunger. NATO responded first and most effectively to advert this unfolding crisis. Delivering food, shelter, water, and medicines on a huge scale the argument has been made that only a logistics operation like that of an army is capable of rendering the necessary assistance that emergency refugee settings demand. Insidious as this double role may seem (the military being both the perpetrator and the care giver during war), the current Kosovo war as shown just how broadly NATO has prepared for what might be aseptically referred to as the management of war. However oxymoronic this might seem, the rapidity and efficiency by which NATO responded to setting up the Balkan refugee settlements areas leaves little doubt to their prior considerations and planning. Hit them with one hand and comfort them with the other: nice.

Ironically, the liberalizing aspects of global telecommunications has brought new levels of suffering and repression to some conflict areas. Military leaders and authorities have access to CNN, WWW, and satellite phones. This allows them to talk to each other, learn from each other, co-ordinate their regional strategies, and, in general, become much more sophisticated in how to interact with foreign aid agencies or INGO's. There is no longer the prototypical teapot despot or the backwater dictator - increasingly these people are speaking the language of international awareness and playing better at getting what they ultimately are after.

The conflicts that are often part of humanitarian crisis no longer fit into recognizable international lines or happen between recognizable sovereign entities. Regional and ethnic fighting groups predominate in the post cold war world. Official members of the international community, such as member states of the UN, are all called upon to recognize some standards of international behavior. These norms usually flow from the UN charter and the various covenants that have to do with conduct during war (Geneva conventions, Tokyo declarations, etc.). The newly emerging loosely organized regional armies are beholden to no one or no larger organization and are often unaware of codes of conduct during war. The use of civilian populations as legitimate war targets and as means of defence is now almost common place. "Human Shield" has taken its place next to "ethnic cleansing" and "collateral damage" as part of the lexicon of war. The killing of 3 Spanish aid workers in Rwanda in 1997, the downing of 2 UN planes in Angola this year, international red cross workers abducted and killed in Chechnya provide sobering examples of how there is a loosening of respect for the Geneva Conventions. Kofi Annan, Director General of the UN, has called for more attention to be placed on this new insecurity. The presence of military personnel (such as NATO) providing relief to refugees only adds confusion to what already was a dangerous situation. Asking a poorly trained, poorly informed, and over armed soldier to differentiate between an aid rendering NATO soldier and an aid rendering INGO relief worker is asking a lot.

Before signing up for an overseas relief effort, no matter what your motivations may be, I would strongly suggest getting as much information as possible about both the organization involved as well as the local place and context to which you are being sent. Arriving to some far flung destination and discovering an intolerable work situation will be an unhappy event for both you and the organization. The organization's mission statement is a good place to start. Or if you are more interested in sponsoring an organization's work I would again suggest finding out as much as possible about the organization, and even talking with one or two returned aid workers. This will provide first hand accounts of the quality of the relief work and the motivations that are behind it.

Another useful suggestion would be to give greater support to locally based NGO's (such as Neahtawanta's "adopted" Casa Materna in Maltagalpa, Nicaragua). This keeps donated money and other items closer to the recipient's home community. Even overhead costs of these local NGO's (such as salaries for their staff) translates into local jobs and payments directly into the local economies. These local NGO's can be quite sophisticated even if they are small and under funded. Often, by virtue of their greater abilities to engage the local populations, they can do much much more with far less than better known INGO's.

Humanitarian relief work can be very rewarding, but it is not the kind of reward that is so obviously found. There are periods of great personal duress and frustrations which have to be negotiated and, as mentioned, there can even be real dangers to life and limb. It is certainly not for everyone with a desire for some travel off the beaten path. But, to those that really are interested in adventure and a rewarding work experience, humanitarian relief work provides a novel way of attaining it.

Jim Sanders: When I'm not in the U.S. working as a Family Doctor, I do international public health in relief settings. I also have a masters in public health. Countries where I've done relief work: Haiti, Guatemala, Thailand, Nicaragua, Kosovo, Kenya, Uganda, Sudan. Agencies I've worked for:

• Intentional orthodox Christian charities
• Nos pequenos hermanos
• Minnesota International Health Volunteers
• United Nations
• Doctors of the World, USA
• Medicines Sans Frontiers, Holland

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