Photo Essay: Nutrition Program Walk-Through

 

I’m managing our emergency response program addressing malnutrition in Niger for a few weeks. For those who work in the aid sector, you probably have a fair idea of what that actually means. For the rest (those of you who are interested), here’s what we’re doing.

First, some background, so we’re all speaking the same language.

Malnutrition, simply put, is the state that results when a person’s body doesn’t take in enough nutrients- the chemicals that allow our body to function correctly, which we do generally by consuming a balanced and sufficient diet. Malnutrition can be due to the overall food/calorific intake being too low, a poor diversity of food-groups, or an illness that inhibits the body’s correct processing of those chemicals. Malnutrition has a large number of indirect causes, and a large number of direct results. Key among the latter are nutrient deficiencies, poor physical development (‘stunting’), rapid weight-loss (‘wasting’), susceptibility to disease and, in extreme circumstances, death (although direct death through malnutrition is relatively rare- it is more likely to be caused by disease which is more virulent in a body weakened by malnutrition).

We deal with two main types of malnutrtion: Long-term, or ‘chronic’ malnutrition, and short-term, or ‘acute’ malnutrition. Chronic malnutrition exists where populations consistently lack access to sufficient or balanced diets, or are exposed to regular and frequent cycles of acute malnutrition. Acute malnutrition exists where there are substantial short-term shortages in food availability.

Niger experiences both chronic and acute malnutrition. It is a landlocked country which is two-thirds desert, so growing food is a challenge. Rainfall is erratic and unreliable, and the desert encroaches into arable land. Roughly 90% of its agricultural harvest is a single crop (millet) which grows well under the circumstances, but means that diets are unbalanced. Traditional childcare norms (non-exclusive breastfeeding, early weaning and poor hygeine and sanitation practices) mean that children are health-disadvantaged from an early age. So the background chronic malnutrition is high, primarily among children. It means childrens’ bodies do not develop as well as they should. They are stunted (small for their age), and their brains may also not develop as well as they would have with a good diet. It has huge implications for Niger’s development as a country.

The harvest is brought in once a year. Depending on how good the harvest is, villages will have enough to eat. However stocks will dwindle through the year, so as the months go by, people will drop back to having two meals a day, one meal a day, and sometimes not even eat every day. This is known as the hardship or hunger season (saison de soudure). The onset of the dry season (February through May) reduces the availability of wild foods, and also puts herds of cattle under pressure. The worse the prior year’s harvest, the earlier this hardship season begins, the more pressure this puts on communities’ abilities to cope, and the deeper the crisis.

The rains traditionally arrive in late June (although as the world’s climate changes, they are becoming increasingly erratic and unreliable) and last until September. This enables the next year’s harvest to grow and flourish- depending on how good the rains are. It also brings with it malaria. The relationship between disease- especially malaria and diarrhoeal disease- and malnutrition is such that children who are malnourished are more likely to get sick because their bodies are not as well equipped to defend themselves; and children who are sick are less able to maintain their nutritional status. It is a vicious cycle.

These factors then give rise to acute malnutrition. In Niger, acute malnutrition traditionally starts to rise from May and June and continue until after the harvest in October, but on a bad year may begin to spike in February, and can last throughout most of the year, with substantial caseloads still recorded in November and December. It affects mostly children, and mostly those children under the age of five. Child deaths also spike during this time. It is inevitable, and the less work that is done to manage acute malnutrition, the more children will die. We focus on children because physically they have the fewest bodily reserves to handle shortages of food and therefore they become malnourished quickest, and also die quickest. It’s worth noting that children who are chronically malnourished already will be the first to drop into acute malnutrition once food runs out.

There are different ways to manage malnutrition. In refugee camps, malnutrition is typically done on-site in feeding centres, where women bring their children to receive a cooked ration directly from the supporting organization. ‘Wet ration’ feeding centres are expensive to run, as they require staff to prepare and distribute the food, often for hundreds of children at a time, but they work well in relief-camp settings where tens or hundreds of thousands of people may be in one physical location which can be easily accessed- so they are efficient. The biggest advantage is that staff can actually watch the malnourished children receiving the ration, so they know it has been received.

In a peace-time context like Niger’s, where rural populations are low and spread over large areas, wet feeding centres are too expensive to put into every village, and distances too great to expect women and children to travel to twice a day. The solution is a model called Community Management of Acute Malnutrition (CMAM), which brings women to distribution points once a week or once a fortnight to receive a ration for their child, which they take home and give their children as instructed. This has the advantage of being far more affordable to reach a population spread over a large area, but requires trust that the women will in fact give their children the ration- not always the case, when they might have two or three other children at home also not eating properly.

The first stage of the program is ‘screening’. Community volunteers are trained to identify children in their village who they suspect could be malnourished. They encourage those children’s mothers to take them to the nearest government health-centre.

There, program staff working alongside government health workers assess the children for malnutrition. This is done using something called a MUAC (mid upper-arm circumference) tape, which goes around the child’s bicep to assess how badly wasted it is (apparently that circumference does not change greatly in young children above the age of six months). It is marked in millimetres to measure the actual circumference, and colour-coded. A green reading indicates the child is healthy, a yellow reading indicates moderate acute malnutrition (MAM) and a red reading indicates severe acute malnutrition (SAM).

If the child is malnourished, it is then weighed on a hanging scale, then placed on a measuring board to take its height (which generally encourages loud wailing from the hapless child). The child’s weight for its height is then assessed against the average weight for a child of that size; obviously, the lighter a child of a particular weight, the thinner it is. These measurements are taken at intervals while the child is in the program to track changes in its weight. Additionally, they are assessed against a chart of ‘z-scores’ which plots the average weight for a child of a particular height. If the child is more than two standard deviations below the average weight for its height, the child is moderately acutely malnourished, and if it is more than three standard deviations, the child is severely acutely malnourished.

It may sound a bit technical, but in fact it takes no more than half a minute per child using MUAC, or ninety seconds to weigh, measure and score children using weight-for-height. The child’s information (name, village, score) is then recorded on a health card which is given to the mother- blue for moderates, and pink for severes. Program staff also assess children for possible medical complications (e.g. malaria, oedema), and if these are present, children are refered to an intensive care facility, managed by another organization.

So to sum up, we have four categories. Healthy, Moderately Acutely Malnourished, Severely Acutely Malnourished, and Severely Acutely Malnourished with Medical Complications. Our program looks after the moderates and the severes. And because the physical needs of moderates and severes differ, we treat them differently.

Moderates receive a bi-weekly ration of a reinforced meal-mix (‘reinforced’ meaning the staple has had things added to it to increase its nutritional value). This is usually a cereal flour (in our case Corn-Soya Blend, or CSB), sugar and oil, mixed together. Mothers take this home and feed their children the ration over two weeks, then return to have the child re-measured for progress and receive another ration (if required).

Severes receive a weekly ration of therapeutic food. We use a product produced locally in Niger called Plump’ynut. Each ration is self-contained in a small foil packet and tastes like sweetened peanut butter. It is specifically designed to address severe acute malnutrition, and generally speaking, the kids (and, sadly, sometimes the adults too) love it.

There are tweaks to the program beyond this, but this is the core. Our biggest challenges include ensuring the malnourished children receive the ration they are supposed to, and that it isn’t shared with other children (or worse, adults). In fact it’s not unusual for mothers to deliberately underfeed their children so that they remain on the program, so that they can continue to access the food ration which can contribute to their whole family’s wellbeing. Sometimes, an additional ration is given to the families of malnourished children to try and prevent this from happening.

The harvest is slowly coming in. Between now and mid-October it will be gathered, and during this time the food situation in the villages here will gradually improve. Malnutrition levels will lag- October is the peak malnutrition month historically. Millet is fine for adults, but kids under two will not get its full nutritional benefits (we push as hard as we can for mothers to keep breastfeeding). During the 2005/6 crisis we were still seeing kids in the program as late as April and May the following year, and I’d certainly expect to see some of the same patterns this time round.

The nice thing about working on a nutrtion program- as opposed to many other programs aid and development workers can often get involved with- is the short-term horizon. It’s normal for us to phase out of a place and never actually see the work that we do bear much fruit, beyond, perhaps, the provision of some basic goods and services. Here, however, it’s pretty easy to tell when a really sick kid shows up at the nutrition centre. Most of the kids in our severe program are ill enough that if they were to get malaria or cholera, they could die in a matter of forty-eight hours. Getting them out of that state and to better health is the aim of the program, and if the mother is feeding the child the ration, stays in the program, and the child doesn’t get ill during this time, then we can turn them around in a matter of four to six weeks. The really sick ones- the ones we refer straight on to the intensive care clinics- may only have lived a day or two past when they come to us.

It really is the business of saving lives out there. The teams on the ground (across several organizations) do amazing work, and there are many children who will live who would otherwise have died without their assistance. It’s a privilege to be able to drop in and be a part of the work they are doing for a few weeks.

Triage: News Media and the Disasters that Languish

If I ask you to recall which humanitarian emergencies stand out in your mind, I can pretty well predict the top contenders that will appear.  At the top of the list, the recent Haiti earthquake, most likely followed by the December 2004 Boxing Day Tsunami.  This year’s earthquakes in Chile and Tibet may also be on the list, as they’re fairly recent.  Most of you will probably recall that there’s been a refugee crisis in the Darfur region of Sudan, but you may be a little hazy around the dates and details of what was actually happening out there.  Those of you with a broader understanding of the context may include the wars in Iraq, Afghanistan and even Pakistan over the last 9 years in your analysis, while the older among you will recall events such as the eruption of Mt. Pinatubo in 1991, the Kobe earthquake of 1995, the Loma Prieta earthquake of 1989 in California, or maybe the Mexico City earthquake of 1985.

I remember most of those events (except maybe the Mexico City earthquake, as I was a little young to be watching the news at the time, although I studied it at school later).  The more recent ones I have a little more intimate knowledge and memories associated with, given my choice of profession (and a long list of other lower-profile emergencies to boot).  The older ones I have particular images in my mind that relate: A stratospheric plume of grey ash over the Philippines; toppled segments of raised highway in Kobe; cars flattened beneath the Oakland Bridge in San Fransisco.

Disasters such as these stick in our minds for precisely that reason.  The images that get broadcast into our homes via news and media outlets.  The more relatable the image, the more likely it is to have an impact on us.  The Boxing Day Tsunami was a shocking, rapid and overwhelming disaster which both stunned people by its scale, and also struck areas with which western donors were familiar (the beaches of southern Thailand, where many have taken vacations).

This is why natural disasters tend to have a greater pull on the public imagination than war-zones.  They are more easily summed up by a photograph or a thirty-second video clip.  They can be easily communicated.

Because of this, they also continue to captivate for longer.  The shock value lingers.  The fascination with destruction on that scale claws at the insides of our souls, searching for answers.  Why?  How?  Could that happen to me?  Why or why not?

Ultimately, of course, these images reach us because news media outlets choose to broadcast them.  The longer that media outlets continue to broadcast, the more the events are likely to reach us, and have an impact on us (within parameters).

And the more we’re affected, the more likely we are to give to an emergency.

By contrast, there are emegencies that we never hear about, or which don’t have as much impact.  For example, the displacement of Pakistanis following the (western-backed) military offensive into tribal areas in early 2009 was one of the largest and most rapid population displacements in the last century.  However the humanitarian implications of the event, while overwhelming the capacity of NGOs and the UN to manage, got very little screen time compared to the warfighting itself.

The Darfur crisis did get some coverage, but comparitive to the needs, moderately little.  In Darfur in excess of 200,000 people are thought to have died, and over the seven years since the conflict erupted, 3-4 million displaced, and 5-6 million affected.  These numbers, standing alone, are relatable to the scale of the tsunami.  When you examine them qualitatively, in fact, the extent of need and human suffering in Darfur is far greater than that suffered by the survivors of the tsunami.  However Darfur has received just a fraction of the media attention- and just a fraction of the material support.

Similar emergencies that get little attention are things like the war and displacement in eastern DRC (ostensibly the highest death-toll of any conflict since World War II); routine food crises across the Sahel; the ongoing war and humanitarian emergency in Somalia; and a long, long list of other sorry situations where the UN and aid agencies struggle to operate on underfunded program budgets while people wrestle with a range of natural and human-made impediments to a full and healthy life.

The reason you hear little or nothing about these other emergencies is generally the fact that they don’t get much media air-time.  There are in turn reasons for this, which I’ll discuss below.

However, the question which I wrestle with, and which I’ve asked myself many times in the past is, how much is our media accountable for which humanitarian emergencies get funded, and which get forgotten?

And I’d like to suggest, very.

Working part of my career in an NGO office based in a western country which works to raise funds for overseas emergencies, I am acutely aware of the interplay between media coverage and money-through-the-door.  If a story gets headline time, we get cash, phone-calls, offers of assistance.  If it stays in the headlines (Haiti, Tsunami) then we raise millions of dollars.  By contrast, if a story doesn’t make the news much- or at all- we get next to nothing.  The recent earthquakes in Chile and Tibet are good examples.  Both had less than 3 days in the news media here, and we raised very little for either.

DRC, which remains one of the worst crises on the planet, gets almost no media airtime, except on obscure late-night news analysis or foreign correspondant shows.  We get almost no money for it.

The correlation is solid.  Even our own fundraising efforts are limited without the appeal of mass media.  We can run advertisements or send letters asking for funding, but if the request is about something that the public knows nothing about, then we don’t get much back for our investment.  As a rule, it is not financially worthwhile for us to do so, and a poor use of our resources.  We simply don’t have the reach to be able to educate the public about what’s going on out there in the same way that the major news networks do.

In short, if it ain’t in the headlines, it ain’t getting paid.

News agencies, certainly in western countries, are free to run what stories they see fit.  Or at least, what stories Rupert Murdoch sees fit.  So how much should we hold them accountable?  In principle, if news organizations choose to run a humanitarian crisis as a lead story for two weeks (as opposed to, say, a story about Paris Hilton, or the British Prime Minister insulting one of his constituents by accident), they could arguable transform the level of resources raised for that emergency.

By contrast, if they choose to not run a story on a particular crisis, they effectively damn it to obscurity, and can guarantee that it will be nearly impossible for agencies to raise funds from the general public.

And not even the general public.  NGOs and the UN receive large amounts of funding from state governments.  As well as recieving information through their own channels, these governments are influenced themselves by what gets reported in the news media, and also by what their constituents are clamouring about.  If the public gets riled about a crisis, chances are the government will want to be seen to be doing something.  The reverse is equally true.  Will the Australian public be pleased to hear that their government has just contributed twenty million dollars of tax-payer’s money to some obscure war-zone they’ve never heard of?  That’s not the sort of stunt that gets you re-elected.

The influence of news media on raising support for emergencies is hard to knock.

Of course, it’s only partly fair to blame media organizations for this process.  They are responding to public demand.  If stories are run that are not interesting to the public (long, complicated, lacking dynamic images, or uncomfortably confronting), then channels are changed, papers are not sold.  Ratings go down.  Profits go down.

So there’s an extent to which the public themselves, in their appetite for soft, easily-consumable newsertainment is equally guilty.

I’d argue that media itself has helped create this dynamic, in its quest to become ever more about entertaining the lowest common denominator, with fast-changing topics and brief soundbites that communicate a punchy message but little depth to an audience that wants to be stimulated but not challenged.  Pitching to the lowest demoninator, attention-deficit consumerist junkie.

With different expectations about what media should be about, perhaps demand itself would be different?

Realistically, in my mind there’s two levels of responsibility.  There’s what the news media portrays (both in terms of content and in terms of expectation).  And there’s what the public demands.  As a rule, people aren’t interested in educating themselves about world affairs.  That’s not to say there aren’t exceptions.  But let’s face it, if you’re a regular reader of this blog, you’re well aware that there are all sorts of information resources out there about what’s going on in the humanitarian field, some of it listed down the right-hand column of this blog.  Anybody who wants to know what’s going on out there can do so.  They just have to spend a few minutes of their day learning.

But I submit that if the news media were routinely highlighting, in a balanced, intelligent and informative fashion, what was actually happening in humanitarian situations around the world (as opposed to cliched fifteen-second summaries to a dramatic soundtrack), they’d change the way the donor public looks at world affairs, and ideally change both the giving and the living practices of that public to be more geared around global realities and understandings (and not reflexive reactions and cereal-box interpretations).

Yes, there are economic realities.  Yes, there’s donor fatigue.  But I’d like to believe that, on the whole, people do care about the plight of others.  And the more that those ‘others’ in humanitarian crises overseas can be brought perceptively closer to those with the power to give and act, the more we’ll see people and societies making changes and sacrifices for a greater good.

I believe international media has a lot to answer for to the people caught in forgotten emergencies around the world.

Back in the Headlines: Niger

I spent a year living in Niger from mid-2005, courtesy of a media-labelled ‘famine’ that put about a third of the county’s population at risk of acute food shortages, and during which time tens, possibly hundreds of thousands of children died. From time to time I run into former Nigerien colleagues, and they always tell me, ‘you must come and visit us again’. Of course, they don’t really mean it. Given my role in emergency response, the only time I visit a country is when it’s in a really, really bad way. Nobody wants that.

The title of this post is, unfortunately, a total misnomer. Niger isn’t in the headlines. It’s barely ever been in the headlines. It got a couple of weeks of coverage in mid-2005, courtesy of a BBC camera crew who visited an MSF feeding centre in the east of the country and snapped some shots of a few skeletal children, thus propelling the story of a famine into the headlines. It also made a blip a couple of months ago when a low-level military coup deplaced Mahmoud Tanja as President of the country, all in the name of a more streamlined democratic process. Maybe 2 days’ worth.

Most people outside France confuse the country with Nigeria, can’t prononce its name, and wouldn’t know the proper noun for its inhabitants (Nigerien, versus Nigerian). I remember doing media interviews with Australian press when I was in the field. Standing on some street corner with a Thuriya Satellite telephone against one ear, the conversations always started the same way: “We’re joined now by an aid worker in Niger. Tell us, where exactly is Niger?”

Niger is facing another food crisis. At this point in time, failed rains have precipitated a state whereby 7.8 million people, more than half the population of the country, are facing food shortages. The government and aid agencies in Niger have all sounded the alert, far earlier than in 2005 (when it wasn’t until mid-year, as the country approached the height of the traditional ‘hardship season’ that the media, and by inference the world, finally started to pay the emergency any attention), and the implications are that 2010 will be a worse year for Niger than 2005 was.

Of course, nobody outside NGO circles is talking about Niger at all.

It Just Ain’t Sexy

There are all sorts of reasons why countries like Niger don’t get press coverage, fitting neatly into the category we in the industry refer to as ‘forgotten emergencies’. That Niger is a geographically obscure former French colony doesn’t help. But beyond that, there’s the dynamic of the emergency itself. Complex.

The media labelled the 2005 crisis as a ‘famine’. The word ‘famine’ makes for a great headline. It has an emotional hit with it. We get images in our head like Ken Carter’s infamous pullitzer-prize winning image of a vulture stalking an emaciated toddler in Sudan. We think of Ethiopia in 1984 and Band Aid; of the Biafra famine and airlift of the late sixties; of the great famines of the Victorian period in India which cost millions and millions of lives.

What happened in Niger, of course, was not a famine. Which was a double-edged sword. On the one hand, no country wants a genuine famine. On the other, it meant that as soon as people started to delve into the root causes of what was happening in Niger, they lost interest. It was too complex to stay on the front pages. Not sexy enough.

It’s the old challenge we’ve faced for years in the aid industry. Natural disasters are fast, shocking and simple to explain. From a media perspective, they are attractive. People eat them up. Disasters like the Haiti earthquake, or the 2004 Boxing Day Tsunami, jolt themselves into the public conciousness and hold headlines- and attention- for weeks. Sympathy- and cash- flows.

By contrast, complex emergencies such as famines, wars, refugee crises and political emergencies are slow-moving, complex, and distinctly lacking in hope. They take far too long to explain to an audience used to the sort of oversaturated ADD-pandering stimulation provided by MTV, Jerry Bruckheimer and Fox News (complete with soundtrack). People lose interest. If they bother to learn even the slightest bit about the crisis, they feel their money will be wasted there. If it’s a war, then anything they give will just get blown up. If it’s a political crisis, then it’ll get eaten by a corrupt system. If a famine, then the children whose lives they save this year will just die in the next hunger season.

There’s more than a grain of truth in this prejudice.

A Beginner’s Guide to Famine

Famine is already a complex proposition. Hunger and starvation are pretty straight forward, but in fact famine is invariably a symphony of contributing elements. It’s food shortages, distribution systems, politics, purchasing power, economics, growing practices, feeding practices, health systems, soil mechanics, climate patterns, and many other things all wrapped up together. Famine deaths are rarely (though occasionally, in acute circumstances) due to actual lack of food, but usually a vicious interplay between nutrient deficiency and disease.

This downward spiral is in itself multipronged and complex- if quite easily explainable if you’re willing to take the time.

We eat food because our body needs certain inputs to maintain healthy life. Energy in the form of sugars, carbohydrates and fats. Building-blocks in the form of proteins. Specific functions supported through the intake of vitamins and minerals- micronutrients. Reduce the intake of any of these things, and the body doesn’t work so well. Reduce them enough over the long-term (chronic malnutrition), and the body doesn’t develop properly- it becomes smaller (stunting) and brain function is reduced. Reduce them enough over the short-term (acute malnutrition), and the body starts to consume itself (wasting), ultimately leading to death if not checked.

In both instances (but particularly situations of acute malnutrition), the lack of essential supplies means that the body is more succeptible to disease. The inbuilt defence mechanisms to fight bacteria and viruses are weaker. At the same time, many diseases also inhibit the correct absorbtion of different nutrients- resulting in a downward spiral, where poor nutrient intake results in disease, which in turn slows nutrient intake. The alternative cycle is equally true where certain diseases (such as malaria, or diarrhoeal diseases) are endemic in a population- disease inhibiting nutrient intake, leading to higher succeptibility to disease.

In both cases, high mortality results. Usually among the most vulnerable members of a population- young children.

There are additional complicating factors. The biggest is hygeine, which contributes to the prevelance and spread of diarrhoeal disease. This in turn is driven both by mechanical factors (is there a sufficient supply of clean water for drinking, washing and cooking?) and behavioural factors (do people wash their hands after going to the toilet and before handling food? Do they boil water?).

A nation’s public health system is the next tier. Is there a network of hospitals, clinics, doctors and nurses to support a population and treat illness? Are there campaigns to reduce endemic and epidemic diseases (such as vaccinations, or mosquito net distributions)? Are there public health messages reaching remote communities to reduce risky behaviour?

Yet another driver that contributes to mortality cycles is population displacement- and particularly, relief camps. Cramming large numbers of people together puts huge stress on food and water production and distribution systems, and existing health care systems. People quickly become under-nourished. Hygeine systems and fecal waste management become difficult. The physical proximity of people to one another vastly accelerate disease transmission rates. The chances of an outbreak of diarrhoeal or viral disease increases by orders of magnitude, and the rapidity with which it can take hold can have catastrophic impacts on existing support networks, and ultimately on mortality.  In the aftermath of the 1994 Rwanda genocide, tens of thousands of ethnic Hutus died in a matter of weeks after diarrhoeal disease ravished displacement camps on the Congolese border.

In short, camps kill.

Malnutrition

The term famine, in the international public health context, relates to a state of excess mortality driven by food shortages- both acute and chronic- across an entire population. In other words, if we call it a famine, we should be expecting to see a rise in the number of people dying in multiple age cohorts, attributable directly to these physiological effects of limited food intake.

In Niger, this was not the case. In fact, during the 2005 hunger season, there wasn’t a single case of a recorded adult death directly attributed to food shortage. The mortality and morbidity was almost exclusively confined to the cohort of children and infants under the age of 5. A nutrition crisis, certainly, but not a famine.

Is this just semantics? Famine, nutrition crisis, surely it’s all pretty much the same thing. People need food, right?

Well, no, actually not right.

Famine, as we’ve already discussed, is a highly emotive word with which we immediately attach baggage. Drought, crop failure, rake-thin Africans and starving babies. People need food, and need it fast. We think famine, we think problem. We think solution, and we think food distribution. Trucks and airplanes loaded with sacks of grain, long queues of colourfully-clad black women with plastic bowls beneath a World Food Program logo. Donors expect it. And, sadly, aid agencies often jump to it as well.

But we’ve already talked about what famine is. It’s so much more complex than this. If we use simple, loaded language to describe the problem, we run the risk of failing to pause and fully understand it. We’ll be easily pressured into jumping into a knee-jerk response. We won’t tackle the problem where it needs to be tackled. And people- children- will die.

Complexities of the Context

Over the last couple of decades, Niger has been consistently ranked at the very bottom of the UNDP’s Human Development Index- somewhere among the poorest three countries in the world, as a rule. This is more than simple economics. It relates, yes, to the fact that the nation produces virtually nothing for the export market except a few crumbly chunks of Yellow-Cake Uranium, but also to the low adult literacy rate, the extremely high birth rate, or the catastrophic infant mortality rate.

Niger exists on the border between Sahel and Sahara- the former being that vast semi-arid band of mixed grass and woodland that stretches from east to west across the African continent and marking the gradual transition from the true-desert of the enormous Sahara to the moist tropical jungles that seethe around the Congo River. The Sahel is characterized by short, intermittent and unpredictable rains, high temperatures, and a current trend towards increasing aridity and desertification. A third of Niger- the southern region- is Sahel. The other two thirds are desert. The vast majority of the country’s population of 15 million live in this southern band, and it is here that the nation attempts to provide enough food to feed itself. 82% of the population are involved in agricultural or livestock production, much of it subsistence. Just 15% of the land area is actually arable.

Niger’s staple is millet, supplemented by sorghum, and small quantities of market vegetables. Millet is a hardy crop which grows well in drought conditions, but which is low in nutrients and hard to digest, particularly by children, and by people who are unwell. It is generally ground into powder and turned into a paste or porridge- something which takes a lot of physical work and energy. Children are typically fed millet from an early age- the traditional weaning age is two, disregarding the health status of the child or the potential benefits of remaining on breast-milk.

Adult males in the family are likely to be fed before children, as they are economically productive and need to be kept healthy to continue bringing resources into the family. Superstitious beliefs in many parts mean that children are not fed eggs (there is a fear that they will grow up to be thieves)- the best and most easily accessible form of protein in most villages. Strong conservative and male-centric values mean that men take the largest and tastiest portions of food, and children and women are fed only after men are satisfied. (There were many reports during our feeding programs of men taking the nutrient paste we had provided to infants and eating it themselves because they liked the sweet taste).

A large portion of the country’s agriculture is subsistence, with any surplus production usually sold on local markets for cash income. Families are large- Niger has a fertility rate of 7.1 children per woman, and it’s common for men to have more than one wife. Water in this arid country is in short supply- 3- 600mm per year, or around a quarter of that of continental Europe. Resource production is spread thin.

In rural areas, all kinds of traditions prevail in child-care. Generations of high infant mortality has resulted in a certain detachment by mothers towards newborn children. In places, mothers will not care for children until they are weaned (when it’s clear that they are not going to die as babies) and the task falls to other women. Colostrum- the thick, nutrient-rich substance that womens’ breasts produce during the first few days following childbirth and which provide newborns with a huge kick-start for life- is considered unclean, and infants are fed water until the mother’s milk becomes ‘normal’. This is a double-whammy, as it means that not only are children denied that boost they need to start life off, but they are often given unclean water, which makes them sick straight off the bat. Assuming they survive (almost 80 in every 1,000 children born in Niger die before they reach the age of 1), they start life off sick, and poorly able to absorb what nutrients come their way, paving the way for high vulnerability to malnutrition.

Roll all of this together, and nearly 170 out of every 1,000 children born in Niger die before they reach the age of five. That’s almost 17%, or more than 1 in 6. Given that the average woman gives birth to 7 children, that means that on average, every woman in Niger will lose at least one child.

In perspective, the infant mortality rate in Australia is 5 per 1,000 live births. The under-5 mortality rate is 6 (in other words, just one out of every 1,000 children born in Australia will die between the ages of one and five, compared to 90 in Niger).

I hope you’re getting the picture.

All this context mumbo-jumbo (that most readers have probably stopped perousing by now) really means that Niger’s population- and specifically, it’s children, are in any given year extremely vulnerable to anything that might reduce their food intake. If, in a normal year, these are the background statistics, and this is the difficulty people have in simply not dying, it means that when the resources available go down, large numbers of people are very rapidly pushed into a place where they will be at risk of death. Which is how, this year, 7.8 million Nigeriens now find themselves at risk of ‘starvation’.

The crisis, as we can see, is not so much an immediate, short-term issue, but rather it’s couched in this long-term situation.

Anatomy of a Crisis

Short-term factors still play a part however, layered into all this complexity. In 2005, the causes were manifold. First off, there were the combination of failed rains across the southern part of the country in the 2004/5 growing season, and a locust invasion which finished off the rest of the crops. So, acute food production shortages.

Merchants with significant purchasing power- many from Nigeria- foresaw that there would be a food shortage, and as soon as the harvests came in, they bought as much as they could from farmers. Many farmers even mortgaged off their coming season’s harvest before it was in- pushing themselves into debt and annihilating their own production and purchasing power to cover short-term needs. Many men left the land and moved to urban areas or out of the country to find waged labour.

As the year progressed and demand for food on the market spiked, it was trickled back onto the market by merchants who were hoarding it- but at hugely increased prices- a simple supply/demand effect. The merchants made a killing. Literally.

This layering of natural and man-made factors pushed a chronically food-insecure context into a critical emergency. Food shortages across the country meant that households simply didn’t have enough to eat. Children- already chronically underfed with low physical tolerance or resistance to nutrient deficiency and disease, bore the brunt of this. They started to waste away by the hundreds of thousands. Many died.

The politics of a male-dominated conservative society compounded things. It was commonplace for men to leave food and seeds locked away in their storehouses. They would take the key with them and forbid the women from touching the food supplies. They would be gone for months at a time without being in contact. We heard of many instances where women refused to take their dying child to a nutrition centre or hospital, because to leave the village they needed their husband’s permission, and he was travelling looking for work.

Into this mix came a government fearful of the implications of an emergency on its population. The last time there had been a major food emergency in the country the government had collapsed as an indirect result. Frightened the same might happen, they became aggressively defensive. Journalists who threw about the word ‘famine’ were kicked out of the country, accused of embarrassing the government which supposedly had everything under control. NGOs had to tiptoe around government sensitivities. Authorities were slow to admit anything was wrong, reluctant to ask for international assistance.

NGOs sent in their emergency teams, loaded with the ‘F’ word and all the professional expectations that carries. Fundraising campaigns were run, small amounts of money raised. We ran food distributions and set up feeding centres. Tens of thousands of metric tons of food aid flowed into the country. Tens of thousands of families received food. Tens of thousands of children were admitted to nutrition programs.

We undoubtedly saved lives.

We undoubtedly failed to prevent some deaths.

Lessons Learned?

Aid reached Niger too little, too late. NGOs rushed in expecting to find an acute famine based on food shortages (failed rains and locusts) but failed to understand the broader context for several months- everything from cultural practices to the ecnomics of supply and demand to a fragile and defensive state structure. While bits and pieces of the long-term situation in Niger certainly began filtering through in the early days, the complexity of setting up a time-critical emergency response and all the operational demands that such a program demands meant that precious little time was dedicated to reflection and understanding. Spurned on by the emotional sense of urgency, key clues were missed.

It took months to re-orient the response to focus on the structural issues. Food distributions- particularly the network of nutrition centres for young children- certainly kept many alive while the process was reshaped. Had the government been more proactive and had the international community (including donors and the international media) pulled their act together in a more timely fashion, that band-aid measure could have prevented far more deaths, and allowed that re-orientation to take place earlier in the journey. As it happened, by the time the context had been analysed and fully understood, donor and media interest had moved on, and there was little additional funding to run essential programs.

But dealing with these big-picture changes is not easy. How does an NGO change the child-care or hygeine practices of a nation? How do they influence government expenditure on health-care networks or vaccination programs? How do they transform the agrarian sector of an entire economy?

The fact is, they can’t. They can tackle the practical issues on a local (village) level. They can advocate to regional and national government officials. But the potential for this big-picture, long-term impact is limited. And sadly, small, short-term changes in a locale which is couched in a much bigger and more complex context tend to be easily undermined.

The Now and the Not Yet

Niger is again on the brink of a food emergency. It remains a severely impoverished country with political upheaval, and a long-standing set of cultural practices, beliefs and dynamics that are unlikely to have changed much over the past 5 years. Programs have been running to tackle chronic malnutrition and food insecurity, but I can’t comment on their efficacy. To the best of my knowledge, millions of children have once again been placed at risk of acute malnutrition, and by all accounts, the lead-in to the current crisis is worse than the lead-in we saw in 2004/5.

Once again, there is no media interest. Once again the year ticks on, and NGOs and the UN have all put out their early-warning reports, and nobody seems to care. Once again, other emergencies overshadow the crisis in Niger- such as the earthquakes in Haiti, Chile and China.

Niger’s hunger season traditionally runs from May to September. That is, the period after the seeds have been planted in the ground and last year’s harvest has been mostly consumed, but before the next harvest is brought in. Every year, rural Nigeriens have to struggle to find a way to keep food on the table- either ration their own dwindling supplies, cut back on the number of meals a day, scrounge for bush fodder, or look for waged labour in urban areas. The longer the hunger period, the harder it is to make these coping mechanisms meet the needs of families. It’s April, and we’ve been seeing signs of food stress for months. The hunger season has already been underway for some time.

If the world intervenes now, lives will be spared. If the media can raise public awareness, and governments and individuals give money and resources to respond to those needs, and NGOs can mobilize response programs early enough, fewer children need to die there this year.

If, as generally happens, we wait to see photographs of emaciated children in feeding centres on BBC and CNN, then lives will have already been lost. The time it takes to ramp up response programs will cost even more lives. This is the practical reality of the aid sector.

The government, at least, appears to be picking up on the mistakes of the past, and is already sounding alarm-bells at its level, accepting that there is a problem. NGOs too have been engaged since early 2006 with the structural issues in-country and are far more aware of the context than they were in 2005. Programs would be run differently. Best practice in the management of child malnutrition has come a long way even over the last 5 years. The UN and interagency partnerships are far better established than they were before, and long-term nutritional programs aimed at structural issues have been running. You can read more about how 2010 differs from 2005 in this analysis by IRIN here. But resource needs remain, without which programs can’t be run.

Sitting as I do in an aid and development charity, knowing full well that we can’t create resources out of thin air, I’m frustrated to know what to do. I have no power over what stories the media runs. I can’t swing government policy. I don’t have the ability to tell the Australian public where to give their [generously donated] funding. All I have is the memory of the faces I saw when I was there five years ago. The barren landscape and the fields dotted with sorry-looking stalks of millet. Skinny children with piano-key ribcages and oversized round skulls. Fierce heat. Looking at the statistics sheets on our feeding centres: The number of new children admitted; the number of those recovered; the number of defaulters; the number of dead.

I’m unlikely to be the guy on the ground this time round. My role doesn’t have me travelling quite so much at the moment, and that’s not likely to change into the near future. I have mixed feelings about this. I don’t particularly want to get embroiled in what is a complex, slow-moving and at times seemingly hopeless context like Niger’s. On the other hand, you don’t get involved with a country in a situation like that without leaving a bit of your soul there, and taking a little of its soul with you.

I sincerely and with all my heart hope that people can get their act together and choose to do something to prevent people dying needlessly in Niger this year.

Photos:

1. Niger River at Sunset: The sun sets over the Niger River as viewed from the Grand Hotel in central Niamey.

2. Feeding Centre Mother and Child: A woman and her malnourished child await registration at an NGO-run feeding centre in central Niger.

3. New Admission: A malnourished infant awaits registration at an NGO-run feeding centre in central Niger.

4. Maria: 2-year old Maria exhibits signs of acute malnutrition. NGO staff talking with her mother try and convince her to take her daughter to hospital.

5. Food Queue: Women queue at an NGO-run food distribution in rural Niger.

6. Warehouse: An NGO warehouse stacked with WFP food aid in rural Niger.

7. Millet Stalks: Staple crop of Niger.

8. La Nutrition: An NGO staff member registers an acutely malnourished child into a feeding program.

9. Recovery: A child who has been in an NGO-run feeding program for some time exhibits signs of improvement.

10: Split Peas and Mais: At an NGO-run food distribution, a man demonstrates the food being distributed.

11: Traditional Coping Mechanisms: An elderly woman sells a plate of baked leaves which she has foraged from the bush as a food source.

12: Hilltop Sunset: The sun goes down over the hills beyond the Niger River near Niamey.

The Civ-Mil Debate

In the next day or two, non-governmental organizations expect to begin mass food distributions to earthquake survivors in Haiti. They’re planning to do this in conjunction with military support- specifically, the US Marines and the United Nations Mission in Haiti (MINUSTAH).

It’s taken more than two weeks to organize. I’ve explained some of these reasons elsewhere. In short, the logistics of trying to organize food distributions to hundreds of thousands of people simultaneously is an immense undertaking. As well as importing and moving that amount of food (food is heavy stuff), there’s the matter of locating and organizing distribution sites, coordinating dozens of agencies, working through broken infrastructure, communicating the details to the residents of Port-au-Prince, and trying to define the relationship between the military and aid agencies.

The interaction between the military and NGOs has long been a contentious one, and the controversy has only snowballed over the last decade.

It can seem like an academic discussion. Who cares about soft issues like ‘humanitarian space’, ‘independence’ or ‘identity’ when lives are at stake?

Compromising meta-level ideals in a short-term response is part of the aid business. A colleague of mine has defined it as the balance of ‘Pragmatism versus Principle’. It happens every time we run a response. Maintaining principles in the face of complex realities is not always achievable when lives are at stake.

In Port-au-Prince, the argument hinges on security. Reports and rumours of insecurity (see, for example, today’s news from Reuters Alertnet) make aid workers on the ground rightly sceptical about waltzing unprotected into the middle of Port-au-Prince with a truckload of aid supplies. They make a tempting target in a desperate city that was until recently one of the world’s kidnap capitals, and where 4,000 prison inmates escaped when in Biblical fashion their cells were broken open during the quake.

Tempering this, of course, is the recognition that in any disaster aftermath, the stories that get picked up are those of things going wrong, not right. The media jumps on tales of woe, from the stumbling coordination of aid to the voyeuristic fascination with violent mobs of survivors seizing food by force. These stories can skew a context to appear worse than it really is.

Most agree that the security situation in Port-au-Prince is actually better now than it was prior to the quake (not that this is an accolade; as J. points out from the ground, rough estimates suggest fifty percent of distributions turn violent). Though take these comments from a senior UN Peacekeeper in response to MINUSTAH troops firing tear-gas to disperse a crowd at a food-distribution gone awry: “They’re not violent, just desperate. They just want to eat.”

Wise and tempered words from a man at the pointy end of the Civ-Mil debate. They give us balance, and remind us not to dehumanize the vision of an angry mob. Whatever the Haitians’ reaction in the face of grief, fear and need, these are the human beings we as aid agencies are here to help.

The debate on how NGOs should engage with the military, however, is a fierce one. Balancing what needs to get done, with doing it the right way, has vociferous proponents in both sets of trenches. Here’s a bit of a summary of the argument.

Why Aid Agencies Might Want to Work with the Military

Logistics. The military do this well. They have hardware- trucks, choppers, transport planes, landing craft, armoured bulldozers (cool)- and they know how to use them. An army marches on its stomach, or in this day and age, its fuel tank. The success or failure of a military operation depends on its ability to supply its frontline troops with food, ammunition, weapons, fuel and parts, without which even the most highly-trained forces in the best-conceived campaign will grind to a halt. Look to Hitler’s Panzer divisions in Western Europe and North Africa whose advances were so rapid that they left their logistics tails far behind them, with disasterous results. If you absolutely, definitively, imperatively have to get a whole load of stuff moved from A to B in a hurry, call the Marines.

Security. Aid workers don’t carry guns. In fact, aid workers are actively discouraged from carrying guns (precisely so they’re not confused with military personnel- and so they don’t accidentally shoot beneficiaries- or themselves). Most NGOs have very clear guidelines around the carriage of firearms and the hiring of armed guards for security purposes. The logo of an AK-47 with a red line drawn through it is one of the most recognizable symbols of international charities in war-zones around the world, stamped on the side of every white Land Cruiser in sight. Soldiers, however, do carry guns, and spend much of their career learning how to fire them properly. Valuable and vulnerable aid supplies can be easy pickings for armed gangs- and have been targeted by violent men for as long as there have been relief responses. Both for the supplies and for the people delivering them, there is a comfort in knowing the cavalry is close at hand.

Site Organization. Setting up a perimiter is second nature to military forces. Distributing food to thousands of people at a time is a complex affair which requires careful site management to avoid panic, crushes, security incidents and chaos. Nothing quite says “behave yourself” than a platoon of green-clad soldiers with M4 Carbines and kevlar helmets.

Communication. Getting hundreds of thousands of people to arrive simultaneously at a bunch of different distribution sites across a city takes some serious coordination, and some pretty solid information flow. Military forces have communications gear, personnel and vehicles handy to be able to spread this message.

Problem-Solving. When it comes to getting through no matter what the challenges, the army usually has the hardware to deal with it. Got a blocked road? A barricade? Need to find an alternative route? Choppers, engineering plant and trained personnel can make quick decisions and usually have access to better, more holistic and more up-to-date information than NGO staff, who will have only a portion of the pie. This is, of course, assuming you’re not trying to navigate a convoy out of Mogadishu’s Black Sea quarter…

Decision-Making. NGOs are consensus-driven beasts.  Getting a rapid decision out of just one NGO can be like squeezing milk from a railway girder.  Put twelve of them in a room together, well, those of who who’ve ever been in a UNOCHA coordination meeting know what I’m talking about.  You don’t normally have this problem with the army.  When they want something done, they tend to get it done.

Envy. Because let’s face it, pretty much every male aid worker out there at one time or another thought about being in the army.  And those armoured trucks with the self-inflating tyres are AWESOME.

Why Aid Agencies Should Not Work with the Military

Identity. The “N” in “NGO” stands for “Non”. As in “Non-Governmental Organization”. Militaries, by contrast, are every bit governmental organizations- however they may present themselves. No army deploys without the consent and instruction of its government, and no government deploys its most valuable military assets without having something to gain. The Red Cross Code of Conduct is an internationally-recognized agreement between international aid agencies which outlines how organizations should operate in an emergency. Point 4 of the 10 guidelines states “We shall endeavour not to act as instruments of government foreign policy”. Working alongside military organizations, however ‘humanitarian’ their mandate may appear, compromises this code.

Fear. Guns and uniforms trigger a response in almost anybody. Sometimes that response can be a reassuring one, such as the sight of armed officers at airports to protect from hijackers. However that argument comes from a Western worldview where the military and the police are well-behaved, disciplined and highly trained. In most disaster-affected countries that NGOs respond in, militaries are not. They can be violent, abuse their power, are poorly disciplined, and often represent either themselves, or a particular minority of the political spectrum. This is certainly true in a country like Haiti. Having armed soldiers at a distribution point, far from being reassuring, can trigger fear in aid recipients. We don’t want this. These are not cattle. They are survivors and the families we are trying to help.

Trust. NGOs operate on trust, and it’s a fragile currency. We spend years building relationships with communities. We maintain impartiality so that we can deliver aid to people who need it on both sides of a war-zone, often garnering respect from both parties, able to cross front-lines and in some instances, acting as mediators between fighting groups. When it works well, it means we can travel in areas of conflict without military escorts and without worrying about being attacked (although, admittedly, those days are waning). When we engage with military actors, our message to our beneficiaries is, “we don’t trust you not to hurt us”. This is not respectful, does not treat the recipients of our assistance with dignity, and compromises their ability to trust us in the future.

Worst-case Scenario. What if something does go wrong? What if an aid distribution gets rowdy and military personnel feel compelled to use deadly force to protect themselves or the aid supplies? The first tragedy is that somebody has been killed instead of helped. Furthermore, if members of a crowd get shot during an NGO distribution, the crowd that witnesses that (and any media who happen to be filming at the time) will associate that violence not just with the military, but with the NGO running the distribution. Will that NGO ever be able to work with that community again?

Global Messaging. The era of CNN has peaked. The first point of contact for instant breaking news is no longer news websites, but sources like Twitter and text message. In-depth analysis is still carried out by edited publications like the Guardian and the New York Times, but people increasingly refer to unaccountable blogs (like this one) that can say whatever they feel like. Information can travel from one corner of the world to the other in seconds, and be re- (and miss-) interpreted as it goes. Images of NGO X working in Haiti alongside US Marines can end up on a computer terminal or cell-phone in northern Pakistan, Afghanistan or Indonesia, and that NGO be identified as an extension of US foreign policy. Staff of NGO X in Pakistan, Afghanistan or Indonesia are then tarred with the same brush, and put at instant risk. The loss of trust is no longer local, but global, and has both operational and security implications.

Rules of Engagement. Military forces have often engaged in assistance missions to populations affected by war or disaster. However it’s important to realise that soldiers are trained to fight and to kill first and foremost, and that is the raison d’etre of any army. The US Army didn’t equip its AH-64 Apache gunships with Hellfire missiles so that they could provide aerial guidance for aid convoys driving through broken cities. Likewise the US Marines aren’t certified as Riflemen and given highly accurate assault-rifles so they can stand around and oversee aid distributions. Any humanitarian operation they engage in is a secondary skill-set. Mixing forces designed and honed for extreme, precise violence with humanitarians whose sole purpose is to distribute assistance to survivors of disasters is not necessarily a healthy combination.

Legacy. There is often a historical link between an army providing assistance, and the country they are operating in. More often than not this is because the country sending the army has a foreign-policy interest in the country they are assisting. This is plainly obvious in Iraq and Afghanistan, where US and British forces both carry out ‘humanitarian’ assistance missions (it’s important to note the deliberate misuse of the word ‘humanitarian’, which carries with it connotations of neutrality and seperation from parties to conflict). Likewise in Haiti, the US military has been complicit in affecting domestic politics, particularly under the Clinton regime when US pressure and military engagement helped to re-enstate then-recently-deposed President Aristide. NGOs associating with military forces automatically attract this same historical baggage.

***

The debate really centres around the issue of what is called Humanitarian Space. It’s the idea that truly humanitarian organizations (which have special status under International Humanitarian Law) are distinct from military organizations in that they are never party to a conflict, do not support one side over another, do not use force to achieve their aims, and maintain neutrality. This provides them access to people in need regardless of political or other affiliation, central to NGOs’ purpose of reaching the most affected in any emergency. Military actors, by contrast, always have an ulterior motivation, most easily summed up in the cliche “Hearts and Minds”- that is, attempting to win over a population to support your own cause rather than that of an enemy. (This is why US, British and Australian field commanders in Iraq and Afghanistan often have discretionary funds to spend while on manouevres- whether to rebuild a school, install a water system, or bribe a local community leader in their ongoing battle with insurgency.)

Humanitarian Space refers to the notional and academic seperation between humanitarian agencies and military actors, to ensure that observers can clearly differentiate between the two. The fear among NGOs is that with the destruction of that space (by NGOs working alongside uniformed military, or by military forces refering to their operations perversely as a “Humanitarian Mission”), observers (particularly those who carry guns or drive vehicle-borne improvised explosive devices) will fail to draw that distinction. We point to a growing list of serious security incidents carried out not just by bandits but by politically-motivated military and para-military forces who identify the international aid community with a Western invasion of their homeland and culture- the bombing of the UN compound in Iraq, the kidnapping and/or killing of numerous aid workers in Afghanistan, Iraq, Somalia and Darfur, and the bombing of the World Food Program headquarters in Pakistan late last year, to name just a smattering.

To balance the above we must recognize that aid agencies don’t help themselves by frequently espousing a very western view of multiparty democratic form of government touted by the same governments carrying out military invasions in some of these countries. Agencies themselves can carry out culturally insensitive and alienating project work- sensitive topics in conservative societies include female education or sexual health. Likewise, western agency staff can make themselves targets of extremists through personal behavious such as ostentatious lifestyles in the face of extreme poverty, dress-codes, or the consumption of drugs and alcohol. I’m pretty sure that aid workers don’t deserve to get shot, blown up or beheaded for this, but it does set them up as figureheads of a western imperialistic regime which observers have come to hate but can’t find another way to strike at.

Ultimately, the decision whether or how to work with the military must espouse this balance between ethical principles and the pragmatic need to support people in need. It needs to balance short-term gains with long-term strategy. It must not be reactive, based on unfounded fear or knee-jerk reactions to perceived insecurity and cultural differences. It must be based on careful context analysis and a thoughtful, engaged decision-making process.

Of course, in the midst of a chaotic emergency response operation, where information is scant and changing every half-hour, and staff are stretched to capacity already, this care and deliberation is not always possible, and grace in the process is necessary. The Humanitarian Principle- the need to save lives- is always our number one priority. However where possible, thoughtful balance needs to be our approach.

There is room for compromise. Using MINUSTAH forces rather than US Marines will be a far more palatable option in Port-au-Prince. Soldiers providing route security (i.e. running patrols on specific transit corridors to limit the chances of violence) is preferable to directly escorting food convoys with Light Armoured Vehicles. Foreign troops supporting national army and police forces to re-establish order and control in neighbourhoods is better than having armed footsoldiers with M16s standing guard by sacks of grain at a food distribution.

By establishing good relations with community members, clear communication with and registration of recipients prior to a distribution, and establishing a clear and well-organized distribution site will go a long way to minimizing the chance of violence. Crowd control may well be possible using a couple of uniformed hired guards armed with nothing more than a baton and a walkie-talkie (I’ve seen less than this controlling crowds of ten thousand and more in camps in Darfur). This won’t stop malicious interference by armed gangs. But then, if you have the community on-side, they can go a long way to minimising the chances of this sort of event taking place.

All that in an ideal world. The important thing is that the debate between pragmatism and principle takes place, and that well-founded ethical positions fought for over decades of bitter experience are not flushed in the name of getting a few good shots of your particular brand of aid agency handing out timely food parcels to starving masses.

Good luck to those on the ground trying to navigate this particular minefield.

Note: For those wanting a more succint and punchy version of this topic, check out J.’s very readable post entitled Send in the Marines? Or Not…

Why Aid is Slow Getting into Haiti- Re-posted

The above-mentioned piece has now been re-posted following publication as an editorial in Australia’s The Age newspaper. Fun times.

Article now posted under the “Articles on Aid Work” section of this site- click here to read more.

Why Aid is Slow Getting into Haiti- Where Did You Go?

Hi folks,

The article I posted on Friday about the constraints faced by the international community on getting aid into Haiti has had to be pulled from my site for a little while. The piece is being picked up by The Age newspaper (one of the larger national papers in Australia) to be run as an editorial tomorrow and they have requested I suspend the post until after the paper is published tomorrow. I’ll have the post back up by 9am Melbourne time Tuesday. Sorry about that. Thanks for all of you who have dropped by to read, leave comments, retweet, etc. etc.- I’ve really appreciated the interest and coverage.

Tris

Why Aid is Slow Getting in to Haiti

It’s been two and a half days since a magnitude 7.0 earthquake hit Haiti’s capital Port-au-Prince, leveling the city and killing what the Red Cross is estimating up to 50,000 people. Hundreds of thousands more are injured or homeless.

Already- and who can blame them?- people are complaining at the slow pace of aid delivery. At the time of writing (Friday night in Australia) there had been reports of angry residents blocking roads with the bodies of earthquake victims in macabre protest (I’m not sure how this is supposed to improve aid delivery).

It isn’t uncommon, in the wake of a disaster, for aid to take a while to reach those who need it. There is always footage of some angry resident complaining that promised aid has not arrived. However in the prevailing culture of Port-au-Prince, dissatisfaction of this kind swiftly leads to violence. This is a problem that needs fixing fast, or there will be a lot of very cross Haitians, who have over the years repeatedly demonstrated a penchant for angry mobs and violent protest.

In addition, slow aid delivery gives the international community in general a bad name. The UN and NGOs get flak in the media. Our donors get suspicious and edgy. We get given less money. (I hear the eyeballs of the cynics out there rolling, but in reality this does mean, for better or for worse, less material assistance reaching people directly impacted by the disaster, which is ultimately what we’re about).

In the case of Haiti, there’s every reason to think that aid delivery is going to be slow, and far slower than appears acceptable in the face of a disaster of this magnitude. It will be easy to point the finger at governments, charities and the UN for not overcoming obstacles in their way and doing what they’re supposed to do best. However, let’s take a moment and look at why aid has been- and will continue to be- slow reaching Haiti’s victims.

Airports– Port-au-Prince has one. It’s small for an international airport. I’ve flown into it, and there’s not much there. I understand it actually has capacity for nine or ten planes at a time. Planes take time to land, to offload, and to take off again. There’s things like refueling, paperwork and clearances to consider. Different types of planes require different types of equipment to offload them, and different amounts of time.

The airport was damaged in the earthquake and is not yet back up to full capacity. Planes need fuel, but there’s very little available in Port-au-Prince, and it’s heavy and expensive to fly in.  Airport staff are among the victims, and many will be digging their families out of rubble. The US army is reputed to be stepping in to manage the airport. A strict system to allow planes in and out of the airport will be established, placing an absolute ceiling on the physical volume of aid that can come in. In other words, it doesn’t matter how organized, prepared or resourced you are: there’s only one airport, and it can only process so much cargo a day.

Seaports- The main seaport in Port-au-Prince was damaged in the quake. The access road from the port to the city is ostensibly buckled five feet into the air. Aid ships have already been turned away from the dock. Offloading cargo ships at a modern dock isn’t a matter of pitching sacks over the side- there are 20- and 40-foot steel containers to contend with which must be craned or trucked off decks. If the heavy lifting gear is damaged, you can have all the aid supplies in the world- you can’t offload it. Until the port is functioning again, there will be serious restrictions on how aid can get through.

Roads– As of today the roads into Port-au-Prince from neighbouring provinces were largely accessible. However roads inside Port-au-Prince remained blocked by debris and by people too scared or unable to return home. Some roads are accessible by four-wheel drive. Heavy trucks- those not damaged in the quake- will struggle to get through the debris. There will be a limited number of transport vehicles (and drivers to run them) available, and a limited number of access roads to drive on until they are cleared. So even if supplies make it to key points of entry, distributing them within the city will be a slow process, again limited by available logistical resources.

Neighbours– The Dominican Republic borders Haiti, was unaffected by the earthquake, and has seaports and an international airport. It is already established as an alternative logistics hub for the relief effort. Roads between the two countries aren’t great and there are reputed to be some safety issues in driving them. Again the limitations on (and inflated cost of) transportation vehicles- trucks and helicopters- from the DR to Haiti will be the main limiting factor.

Communications– Landline, cell-phone and internet communications (not to mention power) are all down at the moment in Port-au-Prince, so communicating with different parts of the city to identify access routes, populations, resources and alternative solutions is difficult. Communicating needs to the outside world is also difficult. Problem-solving, especially where multiple stakeholders are involved, such as trucking companies, government bodies or partner NGOs, is complex and frustrating when telecommunications are not functioning.

Staff– Many if not most of the UN and international agency staff- national and expatriate- in Port-au-Prince at the time of the earthquake have been affected. Some have been killed. Many have lost homes, or loved ones, or both. Many will be unable to assist in relief operations. Key roles lie unfilled. The same is true of transportation companies, service providers, and government departments overseeing infrastructure and logistics. New staff are flying in to fill some of these gaps, but they are less familiar with the Haitian context and will not make decisions as smoothly or as quickly as their local counterparts may have.

Solutions– All of this not to say that the operation is hopeless, or nothing can be done. The response community as a whole and as individuals are aware of these challenges, and are tackling them in a myriad of different ways, so that hopefully, over the coming days, solutions will be found. Access roads can be cleared, staff brought up to speed, communication systems replaced and streamlined systems put in place. However the reality is, this will still take time.

During this time, an equal reality is that people will die. Men, women and children injured in the earthquake will not get the treatment they need. Infants forced to drink unclean water because the pipe network has broken will die from dehydration brought about through diarrhoeal disease. Frail or chronically ill people left shocked and exposed without shelter may pass away.

We acknowledge this will happen. But the constraints listed above will not simply go away because we don’t like them. We will address them as quickly and efficiently as possible, and we hope that in doing so, the number of people who die needlessly will be minimalized. We hope that in doing so, we will not make unecessary mistakes that cost the lives of innocents.

Many of these challenges remain outside our direct control, lying either with physical constraints that are effectively absolute, or with levels of state authority we cannot easily manipulate.

Of course it is not acceptable to sit back, throw up our hands, and say, “Oh, there’s nothing we can do to solve this problem. Woe is me!” We must- and are- throwing all our efforts at these problems to solve them.

But in keeping the above in mind, we should be careful not to slam the international community unfairly for the slow delivery of assistance into a highly complex and challenge-wrought environment.

The optimum solution is to have the necessary systems and resources in place before an event like this occurs. Alternative logistics plans, sufficient hardware, expanded port and airport facilities, redundant systems of governance should an event paralyze the existing structure.

As you can see when you write it out, not very realistic.

What is important to bear in mind is that the most valuable resources are the ones already on the ground. Our organization, for example, already had stockpiles of emergency supplies based in different warehouses around the country that could be immediately mobilized, irregardless of airport snaffus. Likewise, over 350 in-country staff to call on to assist without needing to fly them in, many of them already trained and experienced in disaster response. Many other agencies are in a similar position.

Community members are always the first responders and the people who, far outstripping the efforts of the UN and NGOs, save the most lives. They pull loved ones and neighbours from the wreckage, share the limited resources they themselves have with their communities, and are both the first and most effective responders.

By providing the local people themselves with basic first-aid, rescue and survival skills- not to mention encouraging people to have an emergency stockpile- food, candles, bottled water- the effectiveness of this first response can be greatly enhanced. This is undoubtedly the most effective and impactful way forward, and is the way many NGOs, my own included, continue to approach disaster relief in concert with more traditional response mechanisms.

Today all we can really do is hope that the authorities able to make decisions make them wisely, and that those attempting to overcome obstacles find creative insight. And we can pray that the community members themselves who have survived the earthquake and are now supporting others will continue to have the strength and capacity to keep their brothers and sisters in good health and spirits.

A Good Day in a Bad Place

The following post was written some time ago for friends and family while on deployment in a restricted context.

The day I get my permission to head north we get clearance to get into the camps. They’re controlled by the military- an affront to International Humanitarian Law (IHL)- but this isn’t our country so we work with what we’re given.

The Checkpoint is twenty k’s north of Town. The IDPs (our user-friendly acronym for Internally Displaced People; the word refugee relates to people who flee across an international border and has specific conotations under IHL, while IDPs stay within their country of origin) come through here to get to the camps. The UN reckons up to 190,000 of them are stuck in a tiny strip of coastline a few kilometres long and about sixty klicks from here. They’re in an area known as the Safe Zone (SZ). The SZ is a few hundred metres from the battle lines pitched between the army and the rebels.

Sitting in the SZ, these civilians are getting shelled by either the army, or maybe the rebels, or maybe both. Nobody knows. But we do know that they’re getting shot at if they try and leave the SZ by the Rebels, who are using them as a human shield to stop the army using aerial bombardment and heavy artillery, and that the SZ is one of the greatest misnomers since ‘misnomer’ was first coined. It’s not a pretty picture. One of the worst, actually. Dozens are getting killed each day, hundreds more injured and maimed. The IDPs trickle through in small groups, risking their lives to do so. When they make it to ‘safe’ territory, the government considers them as possible terrorists, so it takes them first to a screening post deep within the military-controlled north where there are no international monitors, before shipping them south to the Checkpoint.

The Checkpoint is the second screening post. The IDPs get trucked here, then dropped off and detained for a while. Maybe a few hours. Maybe a few days. Military intelligence is looking for any rebels it can find hidden in the population. They’re not wrong to be worried. A few weeks ago a female rebel blew herself up at one of these checkpoints, killing nearly a dozen people including three soldiers. However it doesn’t merit locking up an entire subpopulation of the country on the basis of their ethnicity.

The Checkpoint is up in no man’s land. Aid agencies haven’t gotten in here for six months. We’re going this morning for the first time…

Click here to keep reading…

World Humanitarian Day 2009

It’s World Humanitarian Day today. You may not have realised this. That’s probably for two reasons.

1) You don’t work for the UN

2) It’s never been held before

Without mincing words, World Humanitarian Day is designed to highlight the work of humanitarian workers and operations around the world, joining a long and prestigious list of other international awareness events in the calendar for the globally-minded which raise awareness around issues of international concern such as HIV/AIDS (World Aids Day- December 1), the environment (Earth Day- April 22 (US) or March 20 (UN)), breast cancer (which gets the entire month of October for National Breast Cancer Awarenss Month) , and pirates (International Talk Like a Pirate Day- Arrrr, September 19, me hearties).

Wait.  That was a real word-mince.

The day aims to remember and honour humanitarian workers who have been killed or seriously injured in the name of bringing assistance to people in need around the world, and to highlight the ongoing humanitarian plights globally that continue, most of them largely out of sight of public awareness. According to a Humanitarian Policy Group report published by the Overseas Development Institute, 2008 saw the most attacks against aid workers since the industry began, with increasing trends towards the politicisation of attacks, and the kidnapping of expatriates for ransom in many parts of the world. It is now statistically more dangerous to work as a humanitarian worker than it is to be a UN Peacekeeping soldier.

I should have joined the army.

On August 19 2003, the humanitarian world was changed forever. An Iraqi truck bomber drove into the UN headquarters in Baghdad and blew himself up, together with 22 humanitarian workers, including the UN’s representative in Iraq, Sergio Vieira de Mello. While not the first time aid workers had been targeted, this was the first time the UN had been directly attacked, and marked a shift in perception that aid workers were no longer neutral contributors to the innocent needy, but had become a part of the political landscape and, by inference, a legitimate target in conflict. A few weeks later, the sentiment was reinforced when the Red Cross headquarters was similarly bombed. Within twelve months, nearly all humanitarian operations inside Iraq, helping millions of displaced people, had been suspended for security reasons.

I remember the morning of the 19th quite well. I had only been working in the industry for a few months at that time, but I remember coming in to a very quiet office here in Melbourne. A friend and team-mate was based in Baghdad at the time, and people hearing the news had been instantly concerned for him. In the event, he was fine. He had left the UN building just an hour prior to the bombing, however, and I’m sure he remembers the day far more vividly than I do.

As an aid worker I’ve been very lucky, in that I haven’t lost any personal friends to violence in the field. Many of my own friends and colleagues have not been so lucky. Although the numbers of aid workers killed in the line of duty is relatively small (in 2008, 122 aid workers were killed, 76 injured and 62 kidnapped), we’re a small community.

The saddest issue perhaps centres on the fact that aid workers are now being increasingly deliberately targeted. Issues of impartiality and humanitarian space (both of which I have, or will, discuss elsewhere) have clouded our landscape. Factions with grievances and guns see us as part of the problem, not necessarily as a solution. Countries wreacked by chronic insecurity (what we once called civil war) such as Iraq, Afghanistan, Pakistan, Somalia and Sudan, are particularly difficult places to work. Last week a team of ours flew back into central Somalia after being evacuated for security reasons. Within four days of their return, a neighbouring humanitarian compound had been attacked and three people killed (for once, the attackers). Kidnapping international aid workers in these places is now a fantastic revenue stream for armed groups struggling to raise money to buy weapons and explosives. It’s often hard to see where political insurgence ends and profiteering begins.

I’ve also been lucky in that I have survived my own run-in with targeted violence in the field, and in a situation where, looking at the circumstances, I probably shouldn’t have come away unscathed. That, too, is subject of another post. But on this World Humanitarian Day, when we think of aid workers who have been injured or killed in the line of duty, I think of my three colleagues with me in the car that day nearly two years ago, Mohammed, Essam and Abdul-Rahman, all of whom were shot and wounded. While two have made full recoveries, the third continues to struggle with a lasting physical disability as a result of the incident. While we are all grateful to be alive, he in particular will continue to carry the scars of his decision to work to help people in need.

One of the biggest challenges we face in the humantarian world is the sheer lack of awareness of what is happening in the wider world. Unless (like me) you’re a relief junkie, most people tend to switch off their minds and their tv sets once news of wars and catastrophes comes on. Not natural disasters, mind. Big earthquakes and volcanoes and tsunamis get people excited. They watch, they’re interested, they’re sympathetic. But start talking about fighting in northern Uganda or unrest in Guinea, and they’ll quickly glaze over. This isn’t a criticism per se. People can only take so much of this sort of thing. But it makes our job- finding the resources to help an already desperate situation- so much harder. These situations of ongoing violence we refer to as “Chronic Humanitarian Emergencies” or, in our hip three-letter-acronym parlance for which the industry is so renowned, CHEs. And it doesn’t take too long for these CHEs to transition into the pool of what we refer to as the ‘forgotten’ emergencies.

These include places such as:

Democratic Republic of Congo– Fighting in the east of the country since 1997- an ethnic conflict spilled over from the 1994 Rwanda Genocide- has claimed more lives than any conflict since the Second World War, and hundreds of thousands of people continue to live in camps for displaced people, or fear for their lives in remote forest villages.

Chad– Hundreds of thousands of people displaced from fighting across the border in Sudan’s Darfur region continue to live in the camps they have been stuck in since 2002 and 2003, in desperately harsh conditions in the desert and facing the threat of violence from local militia groups- one of the world’s most desperate situations.

Northern Uganda– A combination of ethnic rivalries fighting over cattle and a brutal insurgency lead by the bloody Lord’s Resistance Army has left thousands dead, mostly the innocent. While the LRA has moved northwards into southern Sudan, insecurity between ethnic groups remains in the eastern Karamoja district, and the region remains critically poor and isolated.

Sri Lanka– A little under three hundred thousand ethnic Tamils have been displaced by fighting earlier this year into government-run displaced people camps which are more like detention centres- including the infamous Menik Farm camp, the largest such camp in the world today. Largely lacking in personal freedoms or any quality of life, the displaced people have been exposed to horrendous violence and repeated population movements over the last couple of years, but are still being treated with suspicion and like second-class citizens by their own government, and aid workers still have only limited access to them to meet their needs- in contravention of a ream of international standards.

Afghanistan– Nearly eight years on from the US-led invasion following the September 11 bombings, Afghanistan is a country that continues to be wreacked by ethnic unrest and political rivalries. A country that has effectively been in a state of chronic warfare since a Soviet-backed coup in 1978, rebuilding efforts have been tragically slow, and insecurity (including repeated attacks on aid workers) is currently on the rise again. The country is currently undergoing its first stab at democratic elections- a pivotal time in its history- but with the ongoing violence and staggering levels of political corruption, it’s unlikely very much satisfaction will be drawn from the endeavour.

Pakistan– One of the largest and most rapid people displacements in recent history went largely under-reported in international press earlier this year when, with tacit approval from western powers, the Pakistani government launched a military campaign to shore up the tribal regions near the Afghan border, ostensibly to root out Islamic extremism. Millions of people were displaced in a matter of weeks by violence which included shelling and aerial bombardment, and several months on, only a portion have been able to return home, while fresh displacements continue to occur on a monthly basis. Saddest of all, any gains the military might have taken by force will be more than offset by the alienation of the citizens impacted by the fighting.

Iraq– This one needs no real introduction, suffice to say that six years since the end of the campaign to overthrow President Hussein, Iraq is a country struggling to hold itself together, and while some security gains have been made, millions of people remain in need of basic services, including hundreds of thousands of ‘forgotten’ Iraqis displaced into other middle eastern countries, where they lack basic rights and access to services.

Darfur– One of the most complex and violent corners of the world, since a 2003 insurgency against the government took hold, releasing a counter-insurgency of ethnic cleansing and burning villages, hundreds of thousands of people are estimated to have died and millions displaced. Up to two thirds of the 6 million strong population require outside assistance to live, while at last count nearly thirty different armed factions were battling for control of the region.

Southern Sudan– Emerging from the better part of forty years of internal conflict with northern Sudan in 2005 which claimed two million lives and saw millions more flee its borders, Southern Sudan remains one of the poorest and most underdeveloped regions on the face of the planet. Gripped by long-standing ethnic rivalries, violence continues to disrupt development efforts and the political process, which is due to come to a head in 2011 with a referendum on whether or not to join with northern Sudan or seek independence- a move which in and of itself could trigger a new civil war.

Central African Republic– Bordering southern Sudan, Chad and DRC, the CAR never really had a chance. Hosting displaced people from other nations, as well as ethnic unrest of its own, CAR is the archetypal ‘forgotten emergency’- few people even know the country exists, far less anything about it, and there is little humanitarian support to help tens of thousands of displaced people living in harsh conditions.

Somalia– Since the ousting of its President in 1991, Somalia has seen little but violent militia-led warfare since. An abortive US military incursion on the back of a flailing UN assistance operation did nothing to endear the western world to the Somali community, and Somalia has since become one of the most dangerous and difficult locations in the world for aid delivery. The latest iteration of the violence comes on the back of an ill-thought-through Ethiopian operation to quell the rise of Islamic extremism, with the result that Al Shabbab, a conservative and violent group, now controls large swathes of the southern part of the country. Fighting continues to claim lives on a weekly basis, while millions of people remain in acute need of external support which can only periodically reach them.

On the right-hand side of this post, among the clutter, is a list of websites of humanitarian agencies, most of whom have operations in most of these crises. For those that feel motivated to respond in some financial way, I’d never presume to suggest what you should do with your money, but please consider these organizations as a starting point for your thinking. For those that pray, please pray for the people who are affected by these crises around the world, that their lives and wellbeing would be preserved, and for the humanitarian workers who help them, that they might have the wisdom and the integrity to use the resources they have as effectively as possible. Finally, I know that many people, when reading this sort of information, feel a desire to help more practically, for example through volunteering. For those that are genuinely interested in bringing their personal and professional skills to a career in humanitarian work, fantastic. For those curious about more short-term voluntary work, I’d like to recommend to you a rather interesting series of posts on the subject by my friend and fellow blogger J., who raises a lot of the complexities and controversies around this. Not to discourage, only to inform.

You can also count on J. for all sorts of other articulate and thought-provoking insights into the world of humanitarian work. And some highly amusing and frivolous ones as well. I highly recommend his pages to you if this is you area of interest. 

He’s also a lot more concise than I am.

Thanks for your time today.