Wednesday 31 August 2011

Joanna Kotcher Medical Evaluator in Dolo, Ethiopia


Joanna returned to work with Doctors of the World (DOW) in August 2011 as a medical evaluator in Dolo area of Ethiopia.  It is located on the border of Somalia.  Joanna was sent in response to the famine crisis to create a needs assessment plan.


“There are 4 camps in the Dolo area, including a transit (border) camp. When we first arrived in the region I focused on getting a broad public health picture of the situation. For the first days of the assessment, I spent time at the UN base, interviewing the field managers responsible for health, shelter, and nutrition. From there I moved onto the camps. After securing the permits, we held daily meetings with refugee families. I discovered quickly that there were many children and women who had not received any medical care. In the transit camp I started my assessment outside the official border of the camp, it was here that we found thousands of people living rough in the bush with no shelter. Although they were able to get into the camp twice a day, hot meals, the sanitation and water needs were enormous.

The water situation was critical. The problem was that the ground on which the camps have been developed is rock bed that requires special equipment for drilling, there was no alternative land. The agencies responsible for water worked very hard to supply the minimum needed for drinking and sanitation, but it was a difficult task. Many refugee families had less than 8 litres per day to live on. Everyday we met with refugees who had given up trying to get water from the tap stands and simply left their water containers in neat rows until the water might flow again. The most challenging situation is that there were simply not enough services to meet the needs. Everyone was working at their maximum but it was simply not enough.


After several weeks in the camps, we decided that the best use of our resources would be in establishing mobile health services in the larger camps, to try to shorten the distance between health care and those refugees who had scant access to services. We also made the decision to assist the Minister of Health together with the host population who were under great pressure to balance their own needs in the drought, and that of the refugees.


After returning to headquarters we put together a workable plan to put Doctors of the World’s resources where they can really work – in helping both the refugee and host populations. Aid equity is always an issue, but it is always surprising when a host population needs as much help as the refugees that arrive on their borders. My previous medical co-ordination work in Kosovo, Central Asia, and Darfur were almost identical. Whenever there is mass migration or people fleeing war and famine, the health and psycho-social problems are similar. But the worst situation, for me as a medic, is when we cannot get into the areas where the conflict is occurring. This is what happened in Kosovo and Tajikistan (Afghanistan).

I think the future of the famine crisis depends on continued response from the international community and on co-ordination from the ground. It’s always difficult to coordinate so many organisations and activities and this crisis is no different. I hope that we are able to get into Somalia itself as soon as possible to implement programmes for aid there. It is gratifying to know we are helping on the refugee side, but thousands are suffering on the Somalia side. In mass crises such as these, we have to look at options that involve the refugees and host populations too. We can’t work in a vacuum or ethically implement programmes that institutionalize refugee camps so that they become long term communities.”

Wednesday 10 August 2011

Somalia: The Humanitarian trap

Pierre Salignon
Pierre Salignon, Director General of Doctors of the World France writes about the complex situation facing aid agencies who respond to crises such as the famine that is facing Somalia.
He highlights the difficulties of humanitarian relief in Somalia, particularly for workers on the ground that get caught up in politics, looters and the difficulty experienced in accessing those in need.

Pierre Salignon, a trained lawyer, has most recently worked with the World Health Organization (WHO) and with Doctors without Borders.  As an author Pierre has published numerous articles on relief and humanitarian issues. 

Over the past few days, Somalia has made a noticeable return to the front pages of the media. According to numerous observers (NGOs, UN agencies and journalists), several areas of the country are now ravaged by the worst food shortages in twenty years. The United Nations no longer hesitates to talk about famine in southern Somalia. The alarm is being raised by aid workers on the ground in Somalia, as well as in Kenya and Ethiopia, where several thousand refugees are arriving destitute and exhausted every day. Once again, shocking images of starving, skeletal children are to be seen everywhere in the media and are focusing the public’s attention on the fate of the deprived populations of the Horn of Africa. All the ‘benevolent multinationals’ are calling for an extraordinary funding effort to tackle the tragedy and to deliver food to the country without delay, in order to “avoid the worst” and to save several millions of people from hunger.

Even as a new international humanitarian operation gets under way to save the starving, it is worth looking to the past, especially as the scenario is a well-known and recurring one in this troubled region that suffers from regular cycles of malnutrition. The dilemmas and risks of such an aid operation are identified and particularly well described by Jean-Christophe Rufin in his book, Le piège humanitaire (The Humanitarian Trap), published in 1992.(1) The French doctor writes: “it took months of editorial campaigning, of unprecedented efforts at communicating, for Somalia, having reached the very depths of despair, to ‘make it’ into the media. When the humanitarian machine got underway, it did so in spectacular and inappropriate fashion. The grand operation entitled ‘Rice for Somalia’ (…) represented an ill-judged response to the real problems. The difficulties on the ground in Somalia did not arise from a lack of food or financial aid: the media campaigns finally succeeded in releasing significant resources for the country. The constraining factor was the operational capacity of those supplying the aid and, above all, the country’s extraordinary instability. The omnipresent armed groups and their habit of demanding ransoms from the population, and of misappropriating aid destined for it, made distribution ineffective.”

This analysis remains astonishingly pertinent, casting light on the tragedy unfolding before our eyes. It also serves as a reminder of the fact that if, as the United Nations states, famine is raging, the reason for it cannot solely be the drought and the current lack of rainfall, suffered by the majority of nomadic herding peoples. The food emergency that is blighting Somalia (and surrounding region) is the result of a lengthy and progressive deterioration arising from a combination of recurrent climatic stress and conflicts, which have ravaged the country since the beginning of the 1990s. Rufin emphasises that, “through successive schisms, political authority has blown apart like a grenade, and loose formations of rival groups divide the country”, with matters made worse by the absence of a government since 1991. A host of external political and military interventions should not be overlooked either, ranging from the US military operation, Restore Hope, to more recent intervention by the Ethiopian army and deployment of United Nations troops, as well as the setting up of foreign Islamist cells following the attacks in Nairobi and New York. A widespread and chronic state of anarchy has bolstered the predatory power of local chiefs and turned Somalia into a kingdom where every kind of shady activity, including that of Islamic militiamen, is engaged in. For civilians, survival becomes a daily challenge.

Faced with this insecurity, aid workers, despite repeated attempts, have found it impossible to maintain an effective and permanent presence in the field. Some have been killed or have become targets of criminal violence and kidnappings, forcing the monitoring of operations from a remote base in Nairobi, now the humanitarian platform for the region. This is the price paid for maintaining the drip feed of humanitarian assistance, but it is accompanied by a loss of control over aid.(2) As Islamic militias gradually took control of southern Somalia (3) and imposed their conservative vision of Islam, the World Food Programme (WFP) was forced to suspend food distribution, due to insecurity, large-scale misappropriation of international food aid and widespread corruption that was severely testing the United Nations food distribution system.(4) In other words, all the necessary conditions were in place to ensure that chronic poverty degenerated into a fresh disaster for populations particularly afflicted by deprivation and violence, and by the terrible drought that the war sometimes hid from view. The refugees currently arriving at the camps in Kenya and Ethiopia provide tangible proof of an historic but very real tragedy, even though it has been turned into something of a media event in recent years.

Recent statements calling for international aid (while refusing to talk of famine), issued by Islamic militia groups controlling the areas declared by the UN to be in a state of famine, are not particularly reassuring. Is there anyone who really believes that Somalia is now, as if by magic, going to open up to international aid without there being any quid pro quo or risk involved? The challenge is enormous for aid workers already striving to consolidate their efforts to contain a disaster that has been widely broadcast and warned of in the media. While they must act quickly, they are going to have to deploy their resources extremely carefully in a region where they are not welcome and where nothing will be made easy for them. In other words, there is a huge risk of food aid being misappropriated.

The recent history of humanitarian interventions in Somalia teaches us another important thing: the mobilizing of funds currently underway, necessary as it is, will not be enough to ensure the aid missions are successful and to get Somalia out of its present-day vicious circle. There will be no humanitarian resolution to this crisis as there has not been for others. While the humanitarian response is, at this stage, the only conceivable one, given the gravity of the situation, it is far from satisfactory. In the absence of other more politically focused options, it will doubtless make it possible to contain, but not assuage, the raging food crisis. The Somali government may be moribund, but the current tragedy also points to the collective failure of the international community and governments in the region. The drama of this country without resources or strategic value can be summed up in one word: abandoned. Nothing has changed in 20 years. In the absence of a long-term vision, the international community, in the form of the United Nations, is satisfied today, as it was yesterday, with temporary, humanitarian solutions to each fresh crisis, in the time it takes for attention to move away from the Horn of Africa and its starving populations deserted by their own governments. And why should tomorrow be any different? Without a change of approach and “long-term investment”, as the FAO is demanding (on the issue of agriculture in particular), it will be impossible to escape from the trap that a humanitarian response represents, and impossible to avoid this type of crisis reoccurring.

Endnotes

1 «Le piège humanitaire”, followed by “Humanitaire et Politique depuis la chute du Mur”, Jean-Christophe Rufin, Collection Pluriel, 1992 (“The Humanitarian Trap” followed by “Humanitarianism and Politics after the Wall Came Down”).

2 La Revue Humanitaire , 29th July 2011, see the article by Stéphane Berdoulet,” MDM en Somalie : l’art difficile du travail à distance” (DOW in Somalia: The tricky art of working remotely”), on the reasons which have led the organisation to close its programme a few months ago at Merka in southern Somalia, pointing out how difficult it is for foreign aid workers to intervene in this country.

3 Except for certain neighbourhoods in Mogadishu where the TFG – what remains of the government recognised by the UN – maintains a presence with the support of UN soldiers.

4 “L’aide alimentaire du PAM s’évapore en Somalie avant d’atteindre ses destinataires” (“WFP food aid vanishes into thin air in Somalia before reaching intended recipients”), LE MONDE.FR with AFP, 10.03.2010.

This article also featured in Humanitarian Practice Network here: http://www.odihpn.org/report.asp?ID=3220