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Number 41 December 2008 Humanitarian Practice Network

HPNManaged by Humanitarian Humanitarian Policy Group Exchange

In this issue Commissioned and published by the Humanitarian Practice Network at ODI The Cyclone Nargis response in 2 Negotiating humanitarian access to cyclone- affected areas of Myanmar: a review 5 ASEAN’s role in the Cyclone Nargis This edition of Humani- response: implications, lessons and tarian Exchange focuses on opportunities the humanitarian situation 8 The Village Tract Assessment in Myanmar, in Myanmar, with special July 2008: lessons and implications reference to Cyclone Nargis, 10 Nargis and beyond: a choice between which struck the country on sensationalism and politicised inaction? 2 and 3 May. In all, over 13 Responding to Cyclone Nargis: key lessons from Merlin’s experience 140,000 people were killed 16 HAP and Sphere focal points in Myanmar: and 20,000 injured. The early lessons homes, communities and 19 Support to local initiatives in the Nargis livelihoods of around 2.4 response: a fringe versus mainstream million people were affect- approach ed, with the damage 23 Helping the heroes: practical lessons from caused to infrastructure, an attempt to support a civil society commerce and agriculture ©REUTERS/Stringer emergency response after Nargis 26 HIV programming in Myanmar estimated at $4 billion. 30 Protracted crisis in eastern Burma 33 Anti-personnel landmines in Myanmar: a Articles in this issue cause of displacement and an obstacle to explore the roles played by return major international insti- tutions in organising the response, in that there is a wider humanitarian crisis in Practice and policy notes 35 Targeting humanitarian assistance in DRC particular the UN and the Association of Myanmar that deserves greater attention. 39 Does humanitarian space exist in Chad? South-East Asian Nations (ASEAN); 41 Aravanis: voiceless victims of the issues of access for expatriate aid Other articles in this edition revisit Médecins 43 Including chronic disease care in emergency workers and assistance; needs assess- Sans Frontières (MSF)’s approaches to responses ment; and the importance of prior accountability, the need for health agencies 46 MSF and accountability: from global buzzwords presence in enabling an emergency to take chronic diseases into account in their to specific solutions response. Other articles focus on the response and the immensely challenging 49 In praise of dependency role of national civil society in the initial security environment for humanitarian agen- About HPN response, and initiatives to support cies in Chad. One article examines the exclu- The Humanitarian Practice Network at the Overseas national civil society through grants, sion and neglect facing Aravanis (people Development Institute is an independent forum training and capacity-building sup- who may be born inter-sex or apparently where field workers, managers and policymakers in the humanitarian sector share information, port. Taken as a whole, the articles males, dress in feminine clothes and gener- analysis and experience. The views and opinions suggest that the initial restrictions on ally see themselves as neither women nor expressed in HPN’s publications do not necessarily state or reflect those of the Humanitarian Policy access perhaps forced international men) in the response to the tsunami in Tamil Group or the Overseas Development Institute. actors into a more creative and Nadu, . We also have a topical examin- flexible response, one which valued ation into how humanitarian assistance is Britain’s leading independent local and regional capacities more being targeted in the Democratic Republic of think-tank on international development and humanitarian issues than is often the case. Congo. Finally, Maurice Herson challenges the idea of dependency in relief. Overseas Development Institute Away from the Nargis response, a 111 Westminster Bridge Road London SE1 7JD set of more general articles As always, we welcome any comments or examine conflict-related displace- feedback, which can be sent to hpn@odi. Tel. +44 (0) 20 7922 0300 Fax. +44 (0) 20 7922 0399 ment in eastern Myanmar, org.uk or to The Coordinator, Humanitarian landmines and chronic health Practice Network, 111 Westminster Bridge HPN e-mail: [email protected] HPN website: www.odihpn.org issues – a salutary reminder Road, London SE1 7JD, UK. HE41 crc18/12/083:46pmPage2 2 THE CYCLONE NARGIS RESPONSE IN MYANMAR THE CYCLONE NARGIS RESPONSEINMYANMAR My disasters. accepted offersofinternationalassistanceinresponse tonatural 2 Itshouldbenotedthat,inthepast,Myanmar hasvery rarely 53,836 are listedasmissing. 1 The authoritieshave statedthat84,537peopledied,andafurther needs. anassessmentof affected areas inorder toundertake there wouldbeaneedforimmediateaccesstoany assistance totheMyanmar authorities,underliningthat Humanitarian Coordinator madeaformaloffer of Resident and Before thecyclone struck,theinterimUN Access difficulties suggest that140,000peoplemayhave died, areas, includingtheformercapital . Officialstatistics and heavyrainfall leftmajordamageandfloodingininland the low-lying townships ofthelower Delta,andstrong winds tidal surge causedwidespread devastation andlossoflifein the Ayeyarwady Deltaregion ofMyanmar. The accompanying On thenightof2May2008,Cyclone Nargis madelandfallin Julie BelangerandRichard Horsey Ne we agencies withongoingprojects intheseareas. Butsupplies of using theoperational capacity(includinglocalstaff) ofcontingencyplanningprocesses, and positioned aspart oftheDelta,basedonstockspre- the affectedparts immediatelyin Yangoninternational agenciesstarted andin of thisscale.Asmall-scalehumanitarianresponse by would have beenabletorespond ontheirown toasituation capacity ofthenationalresponse. Indeed,fewcountries natural disasterinMyanmar’s history, overwhelmed the ofwhatwasrequired. fell farshort The cyclone, theworst The nationalresponse toCyclone quickly, Nargis started but 2004 IndianOceantsunami. similar inscaletothatsuffered by Indonesiafollowing the showed thattheimpactofCyclone Nargis onMyanmar was carriedoutinmid-June The ‘Post-Nargis JointAssessment’ affected andinneedofemergency humanitarianassistance. assessments indicatethat2.4millionpeoplewere severely internationals outsideof Yangon. to relax thecumbersomeprocedures governing travel by the issuingofvisasforinternationalhumanitarianstaff, or immediate stepswere takenby theauthoritiestofacilitate of internationalrelief operation. Significantly, no r tothenational the emphasiswasclearlyonsupport anddiplomatson5May.to theUN However, atthatpoint assistance, andthispositionwasformalisedinabriefing early as4Maythattheywouldbeopentointernational themselves badlyaffectedby thecyclone. had littleexperienceofhumanitarianemergencies and were esponse through bilateral channels,rather thananyform HUMANITARIAN re g

anmar: areview extremely limited,andlocalstaffbasedintheDelta 2 otiating humanitarian access tocyclone-affected areas of otiating humanitarianaccess exchange The Myanmar authoritiesindicatedinformallyas 1 and UN • • F necessary accesstointernationalhumanitarianagencies. authorities were initiallyreluctant toprovide the whytheMyanmar It isdifficulttosaywithcertainty with insufficientorganisational support. had toworkforextendedperiodswithoutrotation and affected areas. Italsomeantthatlocalstaffontheground large quantitiesofrelief suppliesquicklyand efficientlyto establishing thelogisticalsystemsnecessarytomove strengthening coordination andresponse capacityandin critical delaysingettingreliable dataonneeds,in in theregion andbeyond. The lackofsuchkeystaffledto only realistically befilledinternationally–from countries previously suffered adisasteronthisscale,gapcould major disastersituations;given thatMyanmar hadnot ofkeystaffwithexperienceinresponding to shortage visa andaccessconstraints meantthatthere wasa to accessaffectedareas andprovide Butthe vitalservices. country were alsoabletofindwaysforinternationalstaff international NGOswithalongstandingpresence inthe much assistanceastheycould.Insomecases, and workedtirelessly toassessneedsandprovide as They were abletotravel toandwithintheaffectedareas, localstaffdidnotfacethesamerestrictions. Agencies’ our factors are likely to have been important, however.our factorsare likelytohave beenimportant, sudden influxoforganisations, no prompted inpart, concern abouthow todealwith(and,indeed,control) a This ledtoarange ofconcerns:atastrategic level, unfamiliar withwhataninternationalresponse entailed. The Myanmar authorities,atvarious levels, were Limited familiaritywithinternationaldisasterresponse keen senseofgeo-strategic self-preservation. from a from nationalisticpride,andpartly stems partly economic), even ifthisentailshardship. The doctrine kind ofoutsideassistance(whetherpoliticalor population musttakecare ofthemselves andeschewany –theviewthatcountryandits of ‘self-reliance’ 1960s, successive regimes have reinforced thedoctrine points inthepast,remains strongly isolationist.Sincethe withinternational engagementatcertain it hasflirted doctrine The ‘self-reliance’ national response ov disaster inMyanmar’s history, the cyclone, theworstnatural erwhelmed thecapacityof . The Myanmar junta,although . THE CYCLONE NARGIS RESPONSE IN MYANMAR 3 umber 41 • December 2008 umber 41 • December N essure otect’some quarters. being mooted in principle einforcing. These efforts took one of generally einforcing. The UN Statement Presidential Security Council issued on 2 situation in Myanmar, on the political the reached cyclone the news of the May (before confer earlier decision to as the well Council), as on pro- Gold Medal the US Congressional which Kyi, leader Daw Aung San Suu democracy US signed by was (coincidentally) President struck, days after the cyclone Bush four W. George certainly political the international raised for Myanmar. temperature context that the It was in this challenging had to find the most international community access way to negotiate humanitarian effective populations. to cyclone-affected wake of Cyclone Nargis, with the possibility of the possibility with Nargis, of Cyclone wake to ‘Responsibility the action under coercive Pr Negotiating access for gaining humanitarian of strategies A range not were access was pursued, although these various the between always well-coordinated or necessarily mutually- actors involved r two forms. Pr not were As it became clear that the authorities access to immediately opening up international began to pressure international affected areas, supported the UK by mount. , and US, to a agree asked the Security Council on 7 May to UN Coordinator briefing from Relief Emergency John Holmes; the request was rejected by other by was rejected John Holmes; the request the invoked France members. Significantly,

©REUTERS/Stringer as it became clear that the not immediately authorities were opening up international access international to affected areas, began to mount pressure rule nothing out’. At the same time, a US naval group rule nothing out’. At the same time, a US naval eign and Security Policy, said that the international eign and Security Policy,

r otect doctrine). The EUotect doctrine). held a ministerial meeting on 13 May to discuss the humanitarian situation, and Javier for the Common High Representative Solana, the EU’s Fo doctrine of ‘Responsibility to Protect’doctrine of ‘Responsibility for Council as the basis authorising the action, and suggested that a resolution number of other European of aid was needed. A delivery authorities the Myanmar by countries suggested that refusal access could constitute a crime against humanity to allow to (one of the criteria for the application of the Responsibility Pr community ‘should use all possible means to get aid through community ‘should was persistent talk of There cyclone’. to victims of Myanmar’s of aid supplies; in an interviewunauthorised deliveries with UK Brown Minister Gordon Prime the BBC on 17 May, concerned, are far [unauthorised] air drops indicated that ‘as we . The senior leadership is . . Cyclone Nargis struck at a Nargis . Cyclone clone damage in Yangon clone damage in Cy also suspicious of the motives behind international also suspicious of the motives humanitarian assistance, which it tends to view as an in pursuit of its political West the instrument used by by tended to be amplified agenda. Such suspicions have efforts as to use the humanitarian situation in Myanmar part of the justification for UN Security Council action. been furtherSuch concerns may have heightened in the doubt, by ’s experience in post-tsunami Aceh; Indonesia’s doubt, by about the concern level, practical and at a much more workers (on a number of lack of facilities for relief genuine officials expressed occasions government concern to the UN about the lack of accommodation and other support teams in the Delta). for disaster response The domestic political context one week moment for the regime, politically sensitive in a national the country was to vote before new . In addition, on a controversial humanitarian/socio-economic issues had become much major demonstra- following politically sensitive more socio-economic tions in September 2007, sparked by a always demonstrated The authorities have grievances. socio-economic issues to willingness to subordinate political and security agenda, and it seems their broader focused they were clear that, in the wake of the cyclone, on political and security concerns. The international environment • • HE41 crc 18/12/08 3:46 pm Page 3 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 4

(designated, perhaps unfortunately, as a ‘Marine response is analysed in more detail in the following article). Expeditionary Strike Group’), a French navy vessel (a It facilitated the Post-Nargis Joint Assessment, a compre- similarly-designated ‘amphibious assault ship’) and a British hensive rapid assessment of the affected areas conducted frigate took up positions on the edge of Myanmar’s territorial with support from the authorities and without interference. waters, loaded with aid supplies. This was critical on two fronts: it demonstrated unambig- uously that the international assistance community had full Engagement access to affected areas, and it produced a credible In parallel, there were efforts to engage the Myanmar assessment of needs in those areas. These two criteria – leadership to persuade them to open up humanitarian access and a thorough assessment of needs – had been space. The authorities quickly activated their disaster identified by donors at the international pledging response committee, chaired by the Prime Minister, and this conference in Yangon on 25 May as the key prerequisites for provided the UN and other humanitarian actors with the increased funding. opportunity to develop closer links with the more engaged ministers, which would prove to be important once space did Challenges remain, however. There is certainly still more start to open. However, it was not possible for in-country bureaucracy than agencies would like, and difficulties actors to access the top leadership, who would be the ones continue to arise because of a lack of decision-making and to take any decision on international access. A series of high- implementation capacity within the government (for level visits to Myanmar took place, including by the example, it took some time for the commitment on access European Commissioner for Development and Humanitarian made by Senior General to be translated into Aid (14 May), UK Foreign Office Minister Lord Malloch Brown action on the ground, partly due to a lack of capacity to (17 May), the UN Emergency Relief Coordinator (18 May) and deal with the large number of outstanding requests, and the UN Secretary-General (21 May). partly due to a lack of appreciation of what was actually required). More fundamentally, it is clear that there are In addition, on 12 May a US military transport plane landed limits to the ability of the TCG structure to influence the at Yangon airport carrying USAID relief supplies. In a Myanmar leadership. The TCG has been most effective in creative diplomatic move, the plane also carried a number resolving procedural and bureaucratic issues (visas, of VIPs, including the head of the US Pacific Command (a exchange rate and tax problems, modalities for travel and 4-star general), the Pacific commander of the marine so on). More sensitive and policy-related issues that corps, and the USAID Administrator. The Myanmar require decisions at the leadership level remain difficult. It authorities were informed about the presence of these must also be noted that international NGOs have only VIPs only shortly before their arrival. While the intention indirect involvement in the TCG, through the Humanitarian was to directly engage the Myanmar military, in order to Coordinator. But, in the final analysis, there is significantly convince them of the peaceful intentions of the US and to more humanitarian space in the Delta than in any other pursue the possibility of direct aid deliveries to affected part of the country, and the TCG has played a key role in areas using US military assets, the presence of US securing this. warships just off the coast may have left open less positive interpretations in the minds of the junta. Once these Success or failure? warships withdrew, the authorities appear to have taken a Can anything be said, with hindsight, about which more positive view of the continued US military cargo approach was best? As always in such situations, it is flights into Yangon. (While the US military was allowed to difficult to draw firm conclusions. However, a number of make 185 aid flights to Yangon airport carrying points are worth making. USAID/OFDA assistance, no ship-to-shore operations were allowed by the Myanmar authorities.) Ultimately, the various initiatives being pursued, even if not well-coordinated, did produce the desired result: good But it was the meeting between UN Secretary-General Ban access to affected areas and close cooperation with the Ki-moon and Senior General Than Shwe in Naypyitaw on authorities. So the key question is not how a different 23 May which produced a commitment to allow inter- outcome could have been achieved, but rather whether national access to affected areas. Earlier, on 19 May, a this could have been achieved more quickly. meeting of Association of South-East Asian Nations (ASEAN) Foreign Ministers in had proposed an In this context, it should be noted that the delay of several ASEAN-led coordination mechanism for international weeks was extremely unfortunate but in the end not assistance. This ‘international assistance with a regional catastrophic. That is, the delay caused considerable character’ was less threatening, and provided a face- suffering to survivors and certainly increased the risks of saving way for the Myanmar leadership to accept an further fatalities. But the feared ‘second wave’ of deaths international relief operation. did not occur. This is no doubt partly down to luck, but is also attributable to the resilience of the communities The practical implementation of this mechanism – the affected and the strength of social networks, the Tripartite Core Group (TCG), consisting of three represen- extraordinary efforts of local civil society and private tatives each from ASEAN, the UN and the government – has donors, the rapid mobilisation of local staff from across proved to be an efficient confidence- and trust-building the country by agencies already on the ground and the platform, engineering solutions to some of the major government’s own response, the scale and impact of

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE humanitarian bottlenecks (ASEAN’s role in the cyclone which have not always been fully recognised.

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The question then arises whether a different strategy could have had an ultimately detrimental effect on humanitarian have reduced this delay. On balance, perhaps not. A more space in Myanmar in the medium term. forceful strategy is unlikely to have been successful – some form of humanitarian intervention, such as unauthorised The experience in the aftermath of Cyclone Nargis air-drops of aid, would almost certainly have been demonstrates that allowing space for creative ineffective in meeting the needs of the affected population, engagement with the authorities can produce results. In and may even have put them at risk of military retaliation. It the wake of this devastating cyclone, there is now a would also have created a highly counterproductive unique opportunity to pursue a form of humanitarian political confrontation. On the other hand, less pressure, engagement in Myanmar that has not been possible in the while it may have made it easier to convince the junta that past. Increased support from donors, particularly for the intentions of the West were purely humanitarian, would recovery activities, together with steps by agencies to not necessarily have produced a positive outcome any more ensure regular monitoring and reporting on the modalities quickly. and impact of assistance, are now critical if this opportunity is to be seized. However, it must be kept in The compromise solution that was worked out, that of a mind that the future of humanitarian space, both in the tripartite structure involving ASEAN, the UN and the Delta and beyond, will ultimately depend in part on THE CYCLONE NARGIS RESPONSE IN MYANMAR government, turned out to be not only a successful formula decisions taken by the Myanmar leadership on the basis of for ensuring access, but also an effective forum for achieving domestic political considerations. This means that, along a close and constructive relationship with the authorities, at with the opportunities, we can expect significant least at the working and ministerial level. This had not challenges ahead, particularly as the country is now existed to the same degree before Nargis, in part due to the entering a sensitive period of political realignment in the suspicions outlined here, and in part because humanitarian lead-up to elections scheduled for 2010. needs in other parts of the country stem much more directly from the policy and governance environment. The positive Julie Belanger ([email protected]) worked with the atmosphere created has the potential to bring significant Office of the Resident and Humanitarian Coordinator in dividends for future cooperation, both as regards post- Yangon from 2005 to October 2008. Richard Horsey Nargis recovery efforts and as regards assistance in other ([email protected]) works with the UNOCHA parts of the country. A more forceful approach to negotiating regional office in . The views expressed in this access, even if it could have been successful, would not have article are those of the authors, and do not necessarily led to the same positive working environment and could reflect the views or policies of the .

ASEAN’s role in the Cyclone Nargis response: implications, lessons and opportunities Yves-Kim Creac’h and Lilianne Fan

The Association of South-East Asian Nations (ASEAN) has region’s states, including Myanmar. The organisation was in the past been strongly criticised for its position on and founded on a set of core principles: non-interference in its relationship with Myanmar, in particular for its policies of members’ affairs, consensus, the non-use of force and ‘non-interference’ and ‘constructive engagement’. In its non-confrontation. These principles have governed response to the devastation caused by Cyclone Nargis, ASEAN’s relationship with Myanmar, and have been the ASEAN as an organisation took a bold step by proactively source of the harshest criticism of its stance towards the assuming a leadership role, both in convincing the regime there, not only from Western governments but also Myanmar government to cooperate with the international increasingly from pro-democracy forces within its own community and in managing the response itself. In so member countries. doing, it has helped to open up an unprecedented level of humanitarian space. While much work still needs to be Throughout most of the 1990s, ASEAN’s engagement with done, ASEAN’s approach to the post-Nargis response may Myanmar consisted of quiet diplomacy and confidence- well offer a model for other regional organisations. Natural building measures. Following the country’s accession, disasters such as Cyclone Nargis are likely to become however, members increasingly presented their position increasingly frequent, and expertise in responding to and as a realist response in light of the country’s isolation and managing them will be needed in the future. xenophobia, rather than as tacit consent for the policies and practices of the regime. ASEAN’s strongest and most ASEAN’s position on Myanmar united criticism of the junta came in the wake of its brutal ASEAN was founded on 8 August 1967. Initially comprising crackdown on civilian protesters in September 2007. five members – Indonesia, , the , Following the crackdown, ASEAN members were divided Singapore and – by 1999, with the accession of over the degree to which they should uphold the principle , the organisation encompassed all ten of the of non-interference in relation to Myanmar. The decision to

Number 41 • December 2008 5 HE41 crc18/12/083:46pmPage6 6 THE CYCLONE NARGIS RESPONSE IN MYANMAR months andmore regularly ifnecessary. agreed tomeetatleastonceamonthforthefirstthree on broad strategic planning,prioritiesandtargets. The AHTF the Task Force andadvisethe istosupervise TCG, including countries. The mainfunctionof from eachofthetenASEAN officials (oneseniordiplomatandonetechnicalexpert) Secretary-General aschair,including theASEAN andtwo Secretariat, The AHTFhas22members,twofrom theASEAN Humanitarian TaskThe ASEAN Force (AHTF) AS Secretariat toassembleanddeploy an in coordination withtheASEAN M Three dayslater, on8May, the and Emergency Response (AADMER). Agreement onDisasterManagement through theframework oftheASEAN to provide urgent relief assistance Pitsuwan calledonallmemberstates AS Just afterthecyclone struck,on5May, to forge acommonposition. r play amajorrole intheCyclone Nargis AS Y body, Humanitarian Task theASEAN Force (AHTF),anda r states, workedondesigninganappropriate mechanism. The from member Secretariat, inconsultationwithexperts medical personnel’.Over thenextweek, theASEAN effective deployment ofrelief workers,especiallyhealthand international community, includingtheexpeditiousand distribution andutilizationofassistancefrom the coordinating mechanismto‘facilitatetheeffective meeting, ministersagreed toestablishanASEAN-led Ministerial Meetingon19May. Atthe was submittedtoaSpecialASEAN M AS tries. Inthefirst-ever suchmissionfor andNGOsfrom membercoun- experts officials, disastermanagement T T Conference in Yangon. Adetailedtermsofreference forthe the mechanismwascirculated atthe25MayPledging facilitate day-to-dayoperations. The firstconceptpaperfor esult wasatwo-tiered structure, consistingofadiplomatic esponse gave ASEAN anopportunity esponse gave ASEAN eam (ERAT), madeupofgovernment angon-based Tripartite Core Group (TCG), consistingof CG followed soonafterwards. yanmar government agreed towork yanmar from 9–18May. Itsreport HUMANITARIAN EA EA EA EA N Emergency Rapid Assessment N, theMyanmar government andtheUnitedNations,to N Secretary-General Surin ,EA wasdeployed to N, ERAT building measures diplomacy andconfidence- M AS throughout mostofthe1990s, exchange yanmar consistedofquiet EA N’s engagementwith Children shelteringinadamagedschoolnear Yangon The PONJA M or twiceaweek, andisperceived by aidagenciesworkingin provide asrequired. technicalsupport The TCG meetsonce r operational agencies,ona and theheadofoneUN HumanitarianCoordinator,the UN theResident Coordinator and twoothers. The UnitedNations componentcomprises government, appointedby theCentral Coordinating Board, of the TCG isrepresented by aseniormemberfrom the ondisastermanagement. The Myanmarexpert component in Yangon), Secretariat andan anofficialfrom theASEAN countrybased member (i.e.anambassadorfrom anASEAN componentofthe TCG comprisesaseniorASEAN The ASEAN ation ofresources, operations, monitoringandreporting. The Yangon-based TCG wassetuptooversee thecoordin- The Tripartite Core Group (TCG) The World Bank seconded some 20 experts to ASEAN, and The toASEAN, World Banksecondedsome20experts teams, spenttendaystouringthecyclone-affected area. L r Tr wasanalysedthrough the component ofthePONJA Village spatially-clustered methodology, therelief andrecovery Usinga international financialinstitutionsandINGOs. involving theUN, theMyanmar government, ASEAN, massive multi-stakeholderjointassessmenteffort waslaunchedin YangonThe PONJA on8June.Itwasa commissioning thePost-Nargis JointAssessment(PONJA). r objective andcredible needsassessment. This becamethe access forrelief workers,andthepreparation ofan two majordemands:theprovision offullandunfettered At theInternationalPledgingConference, donorsmade facilitating thecyclone response. otating basis. Additional technical experts canbeinvitedto otating basis.Additionaltechnicalexperts ecovery componentwasreviewed through aDamageand esponsibility ofthe TCG, whichresponded by

oss Assessment (DALA). Oveross Assessment(DALA). 300people,dividedinto32

act Assessment(VTA), whilethemacro andlong-term yanmar tobegenerally effective inoverseeing and ©REUTERS/Stringer (Myanmar) ©REUTERS/Stringer THE CYCLONE NARGIS RESPONSE IN MYANMAR 7 (lilianne.fan@gmail. umber 41 • December 2008 umber 41 • December N Lilianne Fan Lilianne Fan ([email protected] ) is the N’s role in the Cyclone in the role N’s EA Nargis response holds important response Nargis lessons and implications, opportunities AS view simply duplicates the cluster approach and is approach view simply duplicates the cluster es-Kim Creac’h ith the intensification of climate change, cyclones, ith the intensification of climate change, yanmar government to recognise the role of NGOs, and of the role to recognise yanmar government ent on, was ‘vital in building trust with the government and with the government ‘vital in building trust ent on, was ondon. He was coordinator of the Village Tract Village of the ondon. He was coordinator esponse. Such regional capacity will allow the quick will allow capacity esponse. Such regional edundant. This overlooks the fact that access to the Delta the fact that access This overlooks edundant. in the a presence to establish ecently been allowed econstruction and governance, based in , based in Kuala econstruction and governance, humanitarian community. According Holmes, following a following Holmes, According community. humanitarian us showed July: ‘Nargis in late areas cyclone-affected visit to of humanitarian partnership,a new model adding the special Southeast the Association of capabilities of position and working United Nations in to those of the Asian Nations ASEAN with the government’. Holmes effectively leadership, w saving lives’. as key in been acknowledged actions have While ASEAN’s and legitimacy to the structure leadership, providing it took some time for ASEAN response, Nargis and the M The include any NGO representatives. does not TCG the Periodic has also faced criticism that the organisation Re r the PONJA, of through was the result and was granted intervention ASEAN. by been a While OCHA might have not it was process, home for such a review natural more and has only to the cyclone prior in Myanmar operational r continuity, ensures hosting of the review ASEAN’s country. mandate means that all and the organisation’s with process stakeholders can engage in the review commitment and accountability. W earthquakes calamities will become and other natural is there common. In this new global context, increasingly mechanisms to regional need for effective an urgent identify priorities in the early stages of an emergency r experts, of disaster deployment the establishment of and a smooth institutional arrangements appropriate appeal mechanisms, to linking into existing emergency in a addressed that the needs of victims are ensure and that the transition timely and adequately manner, is well-supported and effectively to recovery relief from managed. Yv based in Team, Response Emergency head of Merlin’s L Joint Assessment component of the Post-Nargis Assessment (PONJA). com) is an independent consultant on humanitarian policy, r Senior Policy she was ’s Malaysia. Previously, and Humanitarian Policy for Aceh, Coordinator for Myanmar. Coordinator er 90% of needs were at the community level and level at the community er 90% of needs were total of $1 billion was needed for recovery over the over total of $1 billion was needed for recovery ported food stocks or less, having only one day of yanmar’s projected GDP projected yanmar’s in 2008. N’s role in the Cyclone Nargis response holds important response Nargis in the Cyclone role N’s v

ffected households were extremely vulnerable – 55% – vulnerable extremely ffected households were otal economic losses amounted to about 2.7% of otal economic losses amounted to agencies and INGOsagencies to the contributed significantly following three years. Damage from the cyclone was the cyclone Damage from years. three following estimated at $4bn. M re supplies. of relief on the steady flow reliant and were that inflicted on The scale of the impact was similar to the tsunami in 2004. Indonesia following community-based through could be addressed approaches.

EA y findings of the PONJA report included: yanmar. ‘In May,’yanmar. access for requested he said, ‘donors erify and address gaps in the recovery effort. gaps in the recovery erify and address ollowing the PONJA,ollowing ASEAN a monitoring unit to created ecovery period. Regular ‘Periodic Reviews’ ‘Periodic period. Regular ecovery are (three for the detailed methodology develop effort.To ecovery Implications, lessons and opportunities AS implications, lessons and opportunities for the international Monitoring and review F of the humanitarian response, the progress measure dispatched ASEAN UN personnel to pre-established hubs in the field and commenced joint planning for the early r of the the progress designed to evaluate planned) are r being conducted technical consultations are the review, and local government with aid agencies, the Myanmar is process of the review NGOs. One of the key advantages that, like the PONJA, the efforts it should capture of every to private programmes government from stakeholder, and local spontaneous action, as a sector initiatives complement to the cluster monitoring systems. It will also information to identify, independent and objective provide v technical experts were also brought in from the Asian the in from expertstechnical also brought were the UN(ADB) and Bank Development Social and Economic (ESCAP). Pacific for Asia and the Commission Operational UN VTA PONJA,teams (the the assessment both through – see the following Merlin by coordinated teams were detail) in more process article,VTA the which discusses writing of various the analysis and and through reportcomponents of the lent two technical (Oxfam to the PONJAcoordinators and writing teams for the water sections). recovery sanitation and early at of the PONJA findings presented The preliminary were fed into on 24 June, and an ASEANYangon in Roundtable on 10 July, York launched in New Flash Appeal, a revised on the million. On 21 July, $303.6 which requested 41st ASEANoccasion of the in Ministerial Meeting ASEANSingapore, and the UN jointly launched the final PONJA the launch, UN report. Relief Following Emergency visit to John Holmes paid a three-day Coordinator M objective workers and a credible, international relief in place.’ both now assessment: these are Ke •A •T •A • •O HE41 crc 18/12/08 3:46 pm Page 7 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 8

The Village Tract Assessment in Myanmar, July 2008: lessons and implications Richard Blewitt, Yves-Kim Creac’h, Adelina Kamal, Puji Pujiono and Yohannah Wegerdt

This article looks at the multi-sectoral assessment following • loss of food stocks; the cyclone in Myanmar. The assessment consisted of two •loss of agricultural income (before and after maps); processes – the Village Tract Assessment (collecting primary • loss of fisheries income (before and after); data) and the World Bank Disaster Loss Assessment (largely • loss of livestock income (before and after); relying on secondary source information and limited field • loss of seed stocks; visits). These complementary assessments were coordin- •loss of shelter, levels of destruction; ated by ASEAN to provide funders and response actors with • changing nature of temporary shelter; a concise, clear picture of post-cyclone needs. Here, we • salination of ponds; identify the main policy lessons emerging from the VTA • sanitation situation (before and after); experience, and examine how it could be further strength- •damage to schools; ened and applied in other settings. • access to credit (before and after and from whom); • levels of psychological stress; and The survey •reach of the humanitarian effort (food and shelter). The Village Tract Assessment was part of the Post-Nargis Joint Assessment (PONJA), which was designed to deliver The survey cost around $1,100,000 (covered by DFID and the a clear, comprehensive and objective picture of needs EU). The main costs were logistical and personnel-related. resulting from Cyclone Nargis. It involved around 5,000 questionnaires and visits to 283 villages by around 300 people from all stakeholders (the government, the Red the assessment team was given Cross, the UN, civil society, the private sector, NGOs and ASEAN). There was a core team of nine: a coordinator, a the space to operate technical coordinator (an epidemiologist), two independently, underpinning the statisticians, two GIS specialists, two advisors (one NGO and one retired senior UN official visiting Myanmar) and a integrity of the work logistician. This core team was supplemented by two WHO specialists. Assembling this team was challenging due to problems with visas and staff availability. The system’s reaction to the VTA process Due to the complex operational environment there was The survey instrument was piloted four weeks after the unanimity across all humanitarian actors on the need for a cyclone (ideally this should start around day ten after a broad-based assessment. This, it was hoped, would disaster); there was a rapid training session for the field encourage the government to open up access and build personnel and some rapid planning to establish the basic trust and engagement among all the actors involved. logistical capacity to support the survey. The field work Support to the VTA was manifested by: took 11 days. Tough terrain and conditions in the monsoon meant that a wide variety of transport was used • The broad collective cluster engagement and individual (helicopter, boat, motorbike and car). Data inputting took agency engagement of NGOs, Red Cross, INGOs and UN 12 days (partly running concurrently with the survey). actors and the government of Myanmar in planning, Around 45 personnel were involved in data inputting. The survey work and analysis. analysis took around 12 days (running concurrently with • The willingness of key UN agencies, INGOs and the the survey and the data inputting). The analysis involved government to provide staff to the VTA exercise. the core statistical team and the epidemiologist working •Political leadership from ASEAN and support from both with technical cluster specialists and the World Bank’s the Resident Coordinator and Humanitarian Coordinator. disaster loss assessment (DALA) team. The team was given the space to operate independently, The VTA assessment provided overall information on: underpinning the integrity of the work. ASEAN provided a vital platform, and there were daily coordination meetings •Perceptions of why the disaster was so bad. between the VTA and the DALA teams, which comprised •Proportion of deaths by age and gender. over 50 international experts. Throughout the assessment, • Support needed by communities. DALA staff recognised the value of the primary data •Priorities for repairing infrastructure. collected by the VTA, which complemented or enhanced • Household expenditure priorities. their own assessment.

Information showed spatially across the 30 most-affected Following the VTA, the core team planned a monitoring townships covered: system (via periodic reviews) to succeed the assessment, THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE

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•provides a reasonably broad baseline for future strategic monitoring of the evolving humanitarian context; •provides clear information on which donors can base their funding decisions; • supports with hard data public fundraising by humanitarian actors; and •provides a basis against which to measure the ade- quacy of the response and outstanding needs over time. THE CYCLONE NARGIS RESPONSE IN MYANMAR

Despite these benefits, the ©REUTERS/Stringer process could have been im- proved. In particular, the experi- ence highlighted the need for an institutional ‘home’ for exercises of this type. There Water being distributed in Yangon was a lack of useful analysis of the vulnerability of different with input from an experienced Save the Children groups affected by the cyclone (landless people, older colleague and an ASEAN technical specialist. The people, the disabled people, women-headed households). monitoring system was introduced by ASEAN, and despite That said, there is some anecdotal evidence that the VTA has some reservations among UN actors it has taken shape supported donor decision-making in response to the and will provide added value to the humanitarian and humanitarian appeal. recovery response in Myanmar. Conclusions and emerging policy issues Lessons learnt The VTA worked, and when combined with the World Bank The lessons learnt set out below are drawn from the VTA DALA approach provided a powerful tool for humanitarian core team’s experience, the views of the authors and and recovery practitioners, policy-makers, national information taken from a participative review of the VTA governments and donors. Despite many global efforts in carried out in Myanmar in September 2008. They include: this area there has been limited road-testing of such an approach. Here we have a method that delivers, and it • The value of a quantitative, broad geographical survey would seem logical to build on this experience. that can provide verification of numbers and needs. • The value of the assessment exercise itself in building At the global level, the UN Disaster Assessment and trust and shared understanding of the context, through Coordination (UNDAC) team assists in rapid assessment at strengthened partnerships and collaboration between the start of a major emergency. This is a useful tool to stakeholders. orient the system in line with the broad scale and scope of • The cost-effectiveness of the survey as a way of the disaster and ensuing needs. However, there is no solid providing hard facts to support appeals for humani- methodology to back up this assessment approach, and it tarian, early recovery and reconstruction needs. is really only useful in the first week of a disaster to get a • The importance of strong technical leadership and the flavour of needs. The VTA would complement the UNDAC capacity to get the job done in a maximum of four weeks. approach, providing assessments for the Common • Complementarities with the World Bank’s assessment Humanitarian Action Plans and associated CAP appeals. methodology, whereby the primary data collected by the VTA complemented the secondary data used for the Globally, considerable effort and investment has been DALA. made in strengthening assessment capacity and sharing • The value of cluster engagement, matched with the assessments. Efforts have also been made in three of the inability of clusters themselves to lead and drive an global cluster teams (Health, Nutrition and WASH) to overall multi-sector survey. develop an Inter Agency Rapid Assessment (IRA) tool. UNICEF has led work to establish a broad assessment tool Overall, the survey: for disasters, and WFP, in many ways a natural leader around food security and some parts of a multi-sectoral •provides clear evidence of the scale and nature of survey, has growing capacity and specialisation in humanitarian needs, and their multi-sectoral dimen- assessments, building out of its Vulnerability Assessment sions; Mapping (VAM) work.

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four weeks to complete, feeding into and validating a realistic, broad, multi-sector, major humanitarian appeal. 4. Donor leadership in this area has been limited. multi-stakeholder assessments Through the Good Humanitarian Donorship initiative, are very rare animals in donors are clearly committed to transparent and effective humanitarian action, and they systematically humanitarian settings support broad assessments when asked to do so. Overall, donors should expect and demand the establishment of broad baselines that would All of this work has consumed great resources and effort, strengthen effective response and improve overall but to date has not yielded the sort of broad and relatively humanitarian accountability. simple assessment carried out through the VTA in Myanmar. The main policy issues limiting progress in this All of these constraints can be opportunities to take area seem to be: forward the VTA experiment, to see how the best aspects of this approach might be captured and supported to 1. The lack of an institutional home for such broad-based inform future assessments. There is also considerable assessments. Here, OCHA needs to be given the scope for the VTA to be used alongside and possibly as responsibility of bringing together common assessments part of future World Bank-supported disaster loss as and when they seem useful to improve response and assessments. There is significant donor, UN and IASC accountability frameworks. This would complement interest in the VTA model, and how it might be adjusted to OCHA’s current role in facilitating and coordinating other contexts. External evaluation of the impact of the UNDAC. Myanmar VTA and the periodic reviews should yield 2. The lack of standby technical capacity to support the interesting findings to inform future work. Realistic, broad, conception, planning and implementation of multi-sector, multi-stakeholder assessments are very rare assessments. The people are there but the system is animals in humanitarian settings. When done properly, not. A principle of having a core independent technical such assessments can provide crucial objective team, working in partnership with the clusters and information on the realities facing affected communities DALA teams, represents a solid approach. and the priorities of those in need. 3. Attempts to create assessment instruments at the global level have tended to be too complex and too This article was written by Richard Blewitt (Helpage drawn out, with far too much expected from a broad- International), Yves-Kim Creac’h (Merlin), Adelina Kamal based assessment tool. Keeping things realistically (ASEAN), Puji Pujiono (UNDP) and Yohannah Wegerdt simple is essential to get a workable, timely (ASEAN). A complementary paper on the technical details assessment done and analysed to feed into appeal, and learning from the VTA will be available in January programme and funding decision-making in real time. 2009. To access the results of the VTA surveys, go to the The VTA type of common assessment could happen ASEAN website (www.aseansec.org) and search for the full from week two of a crisis, and most likely would take Post Nargis Joint Needs Assessment (PONJA) report.

Nargis and beyond: a choice between sensationalism and politicised inaction? Phillip Humphris, MSF

One could be excused for being perplexed regarding the tsunami of 2004, the survivors had difficulty finding refuge humanitarian response after Cyclone Nargis. On the one quickly because of the extensive flooding of the flat land- hand, it was predicted that, in the wake of the cyclone, we scape of the . Needs were massive in terms would be faced with thousands of subsequent deaths from of emergency food relief, water and sanitation and basic disease and , and all would be lost unless household items. At the same time, however, the coping foreign organisations were immediately present. Meanwhile, mechanisms and resilience of the surviving population the government of Myanmar was strongly reproached for meant that aid had only a limited impact in terms of saving restricting the presence of outside actors. On the other hand, lives. The pertinence of the humanitarian response was more once permission was given, the response to basic needs on about the fast restoration of minimum living conditions and the ground was slow, both by the government and by most psychological and economic recovery. For instance, amongst international actors. Even so – fortunately – the predicted the 23,000 medical consultations and 21,000 nutrition medical catastrophe did not happen. screenings done by Médecins Sans Frontières (MSF), by far the majority were for non-lethal diseases. Despite some In retrospect, the scale of the disaster was indeed huge, with areas of the Delta receiving almost no external food aid, no

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE 130,000 people dead or missing. Unlike after the India Ocean significant increase in acute malnutrition was observed in

HUMANITARIAN 10 exchange THE CYCLONE NARGIS RESPONSE IN MYANMAR 11 warships had left, was a warships

umber 41 • December 2008 umber 41 • December approach were apparently more apparently were approach Only than humanitarian. political short-termwhen the attention of and major political the media the and after actors diminished, US possible to formally dialogue humanitarian access. establish of political During this period of inter- posturing, a handful actors national humanitarian country had in the present already and assess been able to access for the areas some of the affected the large first time, establishing that was scale of basic relief disap- needed. It was therefore freedom pointing that the official to external assistance three given after the incident to four weeks was not quickly exploited, given of catastrophe predictions the dire many had made. In fact, it took MSF teams another month before N

©MSF yanmar of its responsibility to respond to the relief to respond yanmar of its responsibility elatives floating in the surrounding water and floating in the surrounding elatives esponses are complicated by the policies of the the complicated by esponses are began to see the arrival of the majority of actors currently of the majority of actors began to see the arrival on the In the end, the assistance given in the Delta. present was small coverage, speed and in terms of quantity, ground, to the survivors of the 2004 provided to that compared tsunami. is in Myanmar the humanitarian environment Overall, the logic of sanctions highly politicised, tarnished both by government. of the country’s the approach and by needs and appropriate assessments of Objective r the and by it imposes, and the restrictions government By taking a of humanitarian actors. political approach often in line with their political position in the country, donors, international humanitarian actors government further their ability to conduct objective compromise needs assessments and implement efficient programmes. challenging the would not preclude Such an approach of the humanitarian situation on the grounds government to access. and restrictions The inefficiencies of international aid evident in the of the government do not excuse response Nargis M MSF of the Delta where needs of its people. In the areas to compared was slow this response active, teams were placed on Official constraints the scale of the disaster. international humanitarian actors in the country were This meant after the disaster. weeks three still present inadequate access during this time, and only unofficial One possible. were needs assessments and limited relief still identifying hit, MSF teams were month after Nargis some badly affected populations surviving on rainwater with cases of dead and spoiled crops, and immature r had deposited the cyclone where suspended in the trees them. MSF at work in Bogaley by taking a political position in by taking a political position international the country, humanitarian actors further their ability to compromise needs conduct objective assessments and implement efficient programmes The humanitarian environment The humanitarian environment Shortly hit, political and humanitarian after the cyclone startedWest to speak about many thousands actors in the of impending deaths amongst the survivors and the need to open a humanitarian corridor for victims, while at the machines. A fundraising same time engaging their own organisation one non-governmental from release press killed in the stated: ‘With the likelihood of 100,000 or more for a all the factors are there cyclone up to which could multiply that death toll by catastrophe on the 15 times in the coming period’. Political pressure ensued, culminating in the of Myanmar government positioning of US warships off the coast of the aggressive the Delta, along with talk of putting into practice to Protect’‘Responsibility concept for the first time. and its external relations frozen In the context of Myanmar’s of this the objectives internal policies of self-reliance, the first four months. The primary need identified by MSF primary need identified by The the first four months. of villages hundreds was for the distribution of basic items to health the flooded plains of the Delta. Mental over scattered interventions were evident, and psychological needs were found to be highly pertinent. HE41 crc 18/12/08 3:46 pm Page 11 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 12

Health: a chronic concern humanitarian organisations to run operations in Myanmar, In contrast to the short-term needs of the Nargis-affected due to a complex system of administrative constraints that population and their stable medical situation, the general limits humanitarian access and data collection. Mostly, population of Myanmar is affected by chronic health this means that project activities and related resources issues that sadly do not reach the front page of must be planned many months in advance. It takes eight newspapers, but nevertheless amount over time to a crisis months to import medicines and at least three months to of significant proportions. As with the Nargis cyclone, it is obtain a visa to enter the country. Taxes on NGOs are high; understandably difficult for an outsider to understand the for instance, to buy a vehicle attracts a 300% tax. Some reality of needs. According to the government, the health parts of the country are still off-limits to humanitarian situation is largely satisfactory, and the limited official organisations. MSF Switzerland has made six formal data available tends to back up this assertion, at least requests to assess areas of , without success. partially. By contrast, actors working outside the country, It has taken many years to reach the population in Kayah mostly on the Thai border, speak of a catastrophic State. This is not because the government wants to hide situation, and likewise have data to back up most of their atrocities along the eastern border areas of the country; assertions. Unfortunately, most of the actors working rather, it stems from a fear of foreign presence among inside the country, where a direct view of the situation is populations that may not be fully under the control of the largely possible, tend towards self-censorship, making a regime. This fear is unfounded, and traps the population in clear picture of the population’s health status elusive. a vulnerable and helpless situation.

Despite the difficulties of collecting data in the country, Insufficient funding some conclusions can be drawn. Even using official figures Despite overwhelming needs and a willingness among published by UN bodies with government permission, one humanitarian NGOs to respond, Myanmar receives the least can conclude that the health situation in Myanmar is one amount of per inhabitant ($3 per person of the worst in South-East Asia. Of the 11 countries in the per year, 15 times less than neighbouring ). Although region, it has the lowest life expectancy at birth and the this aid doubled in financial terms between 2000 and 2005 highest rates of neonatal and under-5 mortality.1 It has (from $75 million to $150m), there are still only a small among the highest rates of tuberculosis worldwide, with number of assistance projects. The Global Fund is not 97,000 new cases detected each year. Multi-drug resistant present in Myanmar. Limiting structural or development tuberculosis has jumped from 1.5% (1995) to 4.4% among assistance to the government is primarily a political choice new patients, and to 16% among previously treated made with the political logic of sanctions. This should not be patients in 2004. According to the government, HIV infects the case for humanitarian assistance, where the needs of 0.7% of women in Myanmar, meaning that approximately the people are acute. The direct and accountable delivery of 15,000 children will start their lives HIV-positive every assistance is possible with careful planning and well- year. The vast majority of people affected by late-stage designed projects, which can be effective and cost-efficient. AIDS have no possibility of the kind of treatment freely The distinction between humanitarian assistance directly to available in most countries today. Malaria is the largest the people of Myanmar and bilateral or multilateral killer: deaths from this treatable disease account for more assistance to the country’s government is important in this than half of those in South-East Asia. Whatever the polit- context. It is unfortunate that sanctions, strongly supported ical context, these problems amount to a humanitarian by the US government, are such a dominating influence on situation requiring an urgent response. the donor response.

This situation could be defended if humanitarian malaria accounts for more assistance was impossible, and if the political approach chosen by external actors had the potential to achieve a than half of deaths in rapid and more favourable outcome for the population. South-East Asia But this is not the case. Meanwhile, humanitarian assistance can be provided efficiently, under certain conditions. Even if delayed, the government’s decision to Responsibility for the health situation of Myanmar’s people open up humanitarian space after the Nargis cyclone was obviously lies first and foremost with the government of surprising, and an indication that all is not lost when it Myanmar, which according to World Health Organisation comes to external assistance for its people. figures spends just 0.3% of its GDP on health, the lowest proportion of public expenditure in the world. At just $4 per Without needing to be sensationalist, it is accurate to person per year, this is also the lowest absolute per capita state that humanitarian and medical needs in Myanmar figure in the world. The lack of strategic and financial are critical over the medium and long term for the majority commitment to health is remarkable – all the more so given of the population, and that the gaps in both the the resources available. government response and external assistance are large. Increased donor support is urgently required to alleviate Constraints to the humanitarian response Myanmar’s chronic humanitarian problems. The people of In addition to the scale of need and the limited Myanmar cannot afford to wait for their government to government response, it is difficult and complicated for respond, nor can we expect sanctions to change internal

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE 1 WHO, World Health Statistics 2008. political structures or policies to positively influence the

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humanitarian response. This does not excuse the censorship that often afflicts international actors in government of Myanmar of its responsibility to provide Myanmar. A transparent and accurate reporting of the better services for its own people, increasing its level of situation to the government and the international aid funding in the health sector and related strategic community can be highly constructive. Highlighting health imperatives. Fortunately, engagement with the govern- and humanitarian issues in this way is an essential ment internally on medical and humanitarian issues is responsibility of all actors in the country. increasingly showing fruitful results, especially when international agencies are effective in their humanitarian Dr Phillip Humphris is Program Manager for Médecins actions and perceived as not having a primarily political Sans Frontières Switzerland. His email address is: agenda. Such engagement should not include the self- [email protected].

Responding to Cyclone Nargis: key lessons from Merlin’s experience

Fiona Campbell, Muhammad Shafique and Paula Sansom, Merlin THE CYCLONE NARGIS RESPONSE IN MYANMAR

Cyclone Nargis presented the humani- tarian community with a number of challenges, particularly in relation to access. For many agencies, very limited access to the Delta area was a significant impediment to the response. Many staff remained stranded outside the country awaiting visas to enter, or in- country in Yangon, some distance from the disaster epicentre in Laputta. Agencies already present in Myanmar and with programmes and staff in the Delta were therefore perceived to be in a stronger position to respond immediately to the disaster. However, even for these ©Jacqueline Koch agencies the movement of international staff was restricted, highlighting once again the importance of local response.

Merlin in Laputta Participants in Merlin’s Primary Health Care project in Laputta Laputta Township comprises over 500 difficult-to-reach island villages housing a total population of some 350,000 people. Prior to Cyclone At the time of Cyclone Nargis, 540 CHWs in Laputta Nargis, Merlin had been working in Laputta for three years Township, covering all island villages, had been through a as part of the tsunami response, supporting a Primary 21-day training programme and had received quarterly Health Care project. The programme was implemented with supplies of seven essential drugs. The training covered the agreement of the Myanmar Ministry of Health. A referral and drug management, hygiene education and complementary programme was also under way aimed at prevention of STIs and HIV, with a primary focus on improving access to safe drinking water and sanitation. maternal and child health care, and basic first aid. All training was conducted in conjunction with the Ministry of A primary goal of the programme was to reduce Health and using Ministry of Health training manuals. vulnerability to future shocks by strengthening the health system. The project addressed poor access to health care in Figure 1 (page 14) is a diagrammatic representation of the the area through the renovation and refurbishment of structure at community level, also showing links with the health facilities and the supply of drugs and equipment, wider health system. training health staff in the integrated management of maternal and childhood illnesses and improving family The response to Cyclone Nargis health practices. A key component of the programme was Though the Delta area is prone to regular cyclones, the strengthening community-level institutions, including magnitude of Cyclone Nargis was far greater than previous Village Health Committees, Village Tract Health Committees experience and caused a level of destruction in excess of and Community Health Workers (CHWs). This latter group of that seen following the 2004 tsunami. Merlin’s efforts to volunteers is an established part of the national health reduce vulnerability had highlighted the need for specific system, providing first-line care at the village level, though disaster preparedness arrangements, and at the time of at the start of Merlin’s programme it was non-functioning. Nargis these preparations were at an early stage. All CHWs

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Figure 1: The health structure at community level

Township Township Medical Officer Health Committee (responsible for health at the township level)

Township Health Officer (responsible for public health issues)

Health Assistant 1 (responsible for supervising staff at the RHC level. Often fills in for THO post)

Village Tract Health Committee (Committee representing the whole RHC. Attends meetings at Health Assistant Rural Health Centre township level with TMO/THO (in charge at the RHC) (in-charge is HA) and HA1 on regular basis)

Lady Health Visitor (works with the MW to meet family health needs e.g. immunisation, ANC, delivery, post-natal care. Supervises staff at RHC along with HA)

Midwife (Works with the LHV to meet family health Sub Rural Health Centre needs. In charge at SRHC and supervises (in-charge is the MW) CHWs)

Community Health Worker (The CHWs are Village Health Committee volunteers. There is one (one VHC per village) CHW per village. The CHW sits on VHC. Supervised by the Midwife)

had received training in disaster preparedness, covering floods, earthquakes and storms, though not in any depth. Merlin’s efforts to reduce Merlin also had supplies of household water filters and chlorine solution in Laputta, which were available for vulnerability had highlighted the immediate use following the cyclone, though not tanks, need for specific disaster bladders or mass chlorination facilities. preparedness arrangements Merlin staff in Laputta and Yangon (both national and international) were able to respond immediately. With the destruction of existing health facilities, the team in agencies encountered in getting approval for staff to enter Laputta set up a first aid point which saw approximately Myanmar, perhaps because the organisation was already 250 people a day. The majority of cases were trauma- known to the authorities. related, including head wounds and bruising, and skin damage related to hail and wind exposure. The Merlin With the arrival of the MRT, preparations to scale up the Response Team (MRT) arrived in the country a week after response were put in hand. These included plans for the

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE the cyclone. Merlin did not experience the delays other distribution of non-food items including water filters and

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purification solution, and in some areas water and food. and village rehabilitation all received Sphere training. All Doctors and other health staff were recruited to expand medical teams were provided with treatment protocols the coverage of health services. Merlin’s national staff and prescriptions were reviewed by supervisors to ensure increased four-fold, from 44 to 160. There were problems rational drug use. All Merlin assessments were designed in recruiting experienced staff: only two senior doctors to identify community priorities, and teams were asked to could be recruited in-country and the majority were develop selection criteria for their respective sectors. The recently qualified without the level of experience with programme also began to develop tools for patient which Merlin usually works. Clinics were set up in temples accountability. These initiatives are being taken further in and pagodas, which were being used as IDP camps, and the on-going programme. gradually expanded across the Delta, ultimately providing six fixed clinics and ten mobile clinics, using boats, across What we have learnt Laputta Township. Over the following six weeks, health The on-going programme in Laputta was clearly critical to teams visited more than 350 villages. Merlin’s response, providing the community structures and staff on which to build and guaranteeing a high level of Merlin was able to import supplies and clear them through acceptance for Merlin’s work within the Delta. At the same customs without problems, though this was not the case for time, however, access restrictions for international staff

all agencies. Again this was probably due to Merlin’s highlighted the importance of a locally prepared workforce THE CYCLONE NARGIS RESPONSE IN MYANMAR previous presence in the country and the fact that it had an with response systems and structures in place. The fact that established Memorandum of Understanding (MoU) with the national staff and local people were able to respond and Ministry of Health. However, only two expatriates were utilise the skills and equipment available to them presents allowed access to the Delta area, and they did not have the a strong case for making capacity-building and institutional freedom to travel beyond Laputta. As a result, Merlin strengthening in disaster response key components of on- implemented a ‘remote management’ arrangement, where- going programmes in this and other contexts. by MRT staff coordinated national teams in the villages, providing financial and logistical management in Laputta. Merlin’s experience from a number of countries, including National staff members and local people thus undertook all Ethiopia and Somalia, suggests that the health impact of the assessment and distribution activities in the affected disasters can be substantially reduced if national and local area outside Laputta. The level of responsibility and trust authorities in high-risk areas are well-prepared, such as developed within the programme between Merlin’s local through strengthened disease surveillance and effective staff and community health workers before the cyclone epidemic preparedness. This also includes training health ensured a degree of confidence that would not have been workers and enabling critical infrastructure such as health possible in a solely short-term response. facilities to remain functional. However, in many resource- or governance-poor settings, disaster risk reduction may not be considered a priority by local authorities. While a community health workers number of donors and NGOs are increasingly viewing this area as an important aspect of work, more needs to be became a central part of the done to actively promote this, especially with the response effort predicted increase in disasters in the future. For Merlin, Nargis has highlighted areas that the programme can strengthen immediately. These include an Mobile teams deployed from Laputta to the villages expanded role for CHWs, with more detailed and specific reported that communities were immediately assisted by training in disaster response management (to be their CHWs using the basic skills and supplies they had to conducted with the Myanmar Red Cross), and greater hand. Of the 540 CHWs trained and functional on 2 May, availability of supplies. A new training module on psycho- 94 lost their lives in the cyclone. Many of the surviving social support skills conducted by the Myanmar Red Cross CHWs had to deal with their own family situations has been built into the new programme. including the loss of shelter and psychological trauma. Despite this, over the days following the disaster CHWs None of this precludes the need for an effective and timely made their way to the Merlin office in Laputta, while international response to disasters such as Nargis. The others were contacted by Merlin staff. These CHWs fact that Merlin had only two MRT staff in Laputta not only became a central part of the response effort, assessing the meant that a considerable burden was placed on these needs of dispersed communities and ensuring the individuals in terms of administrative obligations, but also effective and equitable distribution of aid based on their that they were unable to provide the usual front-line local knowledge and positions within their communities. inputs into the response outside the town. Anecdotal evidence suggests that communities considered the CHWs’ response effective, though no Lessons for the wider humanitarian formal assessment has as yet been done. community In terms of lessons for the wider humanitarian community, it Issues of quality and accountability within the programme seems clear that the capacity to respond in Myanmar was were considered at an early stage. At the start of the scale- based on the ability to employ or engage those already on up response the teams covering food security, livelihoods the ground. In Merlin’s case, this predominately involved

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Merlin staff and CHWs previously trained by Merlin. In advocate for the humanitarian space to ensure the addition, however, Merlin needed to employ local medical international support needed to scale up, save lives and and other specialist staff. This was challenging, both in ensure every individual’s right to assistance, while at the terms of the quantity and quality of staff available. Problems same time emphasising support to and strengthening of were compounded by the lack of back-up from specialist the local systems and structures vital to the response. internationals able to quickly skill-up recruits. Fiona Campbell is Head of Policy at Merlin. Muhammad Given the restrictions on travel outside Laputta, remote Shafique is Behaviour Change Communication Specialist, management approaches were needed, in terms of the Merlin Myanmar. Paula Sansom is Emergency Response coordination of national staff and ‘community partnership Manager (Health), Merlin. The authors acknowledge the arrangements’. This proved effective, utilising the considerable inputs to this article from Jacob Asens and Dr combined inputs of international and national players and Panna Erasmus, Health Advisers, Merlin, Yves-Kim Creac’h, ensuring that supplies were distributed effectively within Merlin Response Team Manager, and Dr Paul Sender, the Delta region. However, the speed of the scale up was Country Director, Merlin Myanmar. Correspondence on this undoubtedly reduced. For this reason, Merlin continues to article should be sent to: [email protected].

HAP and Sphere focal points in Myanmar: early lessons Erik Johnson, DanChurchAid

The Sphere Project was developed by thousands of Emergencies (INEE minimum standards), with a view to stakeholders over the course of several years, starting in mutual learning and sharing of resources as the early 1990s. It has one aim: to increase the quality of appropriate. humanitarian assistance based on a set of agreed •To identify the most appropriate ways to establish principles and standards. More recently, the Humanitarian longer-term support, and the funding and personnel Accountability Partnership (HAP) has been launched to try that would be required to achieve this. to tackle another outstanding challenge in the provision of •To use this experience to advise on lessons learned, humanitarian aid, that of ensuring that disaster-affected and how to improve the provision of similar support in people have a right to speak and be heard about the future emergencies. assistance they may be receiving. HAP is perhaps the best known amongst several initiatives explicitly trying to Whilst both the political environment and the cultural address this problem in the humanitarian sphere. context (which may predispose people not to give feedback) have militated against work to support the use of the Sphere Following the massive earthquake in in 2005, and HAP tools, there are nevertheless a number of dynamic Church World Service (CWS) hosted a ‘Sphere focal point’ actors and agencies in Myanmar that have helped to get the in the affected area. This project aimed to raise awareness project off the ground quickly and multiply its output. These of Sphere standards and promote their implementation. have included a full-time NGO Liaison person, who had When Cyclone Nargis struck Myanmar in May 2008, CWS established an Accountability and Learning Working Group again offered to support a Sphere focal point, this time to (ALWG) prior to the arrival of the HAP and Sphere be jointly implemented with a HAP focal point, hosted by consultants, as well as a unique locally based Centre Save the Children. This article discusses this important established after Nargis, initiated by international NGOs to project, documents some of the early lessons and poses support Myanmar NGOs and Community Based further questions which will require investigation as the Organisations, including promoting their accountability. The project develops. CBOs include a range of local ‘NGO-like’ organisations, as well as faith-based groups and informal affiliations of Background interested individuals. They have played a huge role in the The initial objectives of the project have been: Cyclone response. It is difficult to determine exactly how much of the early success can be attributed to this project, •To work in collaboration with national and international as it is clear that it has played a supporting role to many agencies to determine the most appropriate ways to others’ efforts to promote quality and accountability, with a raise awareness of Sphere and HAP and train agencies handful of international NGOs playing a key role in their own on their effective use. operations’ accountability and quality approaches, lessons •To deliver that support, with the aim of improving the which they have documented and shared with others. quality and accountability of the response. •To work in close collaboration with others (such as the But despite the presence of the ALWG and other local NGO Liaison Officer, UN Clusters, INGOs, local NGOs resources, the initial informal surveys conducted by the and any other ‘quality and accountability’ initiatives consultants on behalf of the Sphere and HAP focal point

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE such as the Inter-Agency Network for Education in project found a wide range of prior knowledge and

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ensuring that translations were of high quality and that documents were faithfully reproduced. Mean- while, initial proposals that the ALWG should have a compliance enforcement role were dropped in favour of a learning model, which appears to have been instru- mental in its success and well- suited to the wide range of com- petencies and an atmosphere where agency staff were already under great pressure to deliver.

The demand for training was enormous, and the consultants from both HAP and Sphere began THE CYCLONE NARGIS RESPONSE IN MYANMAR offering training as soon as they arrived, in July, to both local and international organisations, as well as a government ministry. This overwhelming demand for A relief distribution after Cyclone Nargis training is particularly interesting given the number of anecdotal awareness of quality and accountability initiatives, reports of ‘training fatigue’; following the cyclone there was although overall the level of awareness was surprisingly a large and diffuse effort to build the capacity of response low. Even field staff from one of the most established agencies, with both Myanmar and international NGOs torn international NGOs had no awareness of the Sphere between the desire to gain new competencies relevant to Project or the use of standards in humanitarian response. disaster response – and perhaps please their donors – and This begs the question why this was so, given that to simply get out there and do the work. Sphere training Myanmar had experienced a number of disasters in the aside, this is perhaps another area that merits further past ten years and could arguably be said to have been in enquiry; in the early days of a sudden-onset disaster, how a chronic crisis. It may be argued that this was the first can we support actors’ responses through capacity-building ‘emergency’ officially declared by the government, and that is directly related to the task at hand, rather than therefore agencies seized the opportunity to introduce providing stand-alone ‘training’ that is likely to be a brief Sphere. However, this alone may not fully explain why the pause from the actual response work? A related challenge majority of agencies present were so behind in rolling out lies in trying to move from a training-focused approach to Sphere prior to Nargis. one that promotes the implementation of Sphere and accountability methodologies throughout the project cycle. As agencies struggled to expand and respond in the early days after the cyclone, many ‘new’ actors emerged, and many of the organisations and individuals providing ‘It’s not about complaints, it’s assistance had little or no prior experience in relief. The urgent need to respond superseded many development about feedback; giving people agencies’ desire to ‘take time out’ to train and gain new the opportunity to comment in competencies relevant to disaster relief. Gaining common understanding of humanitarian concepts between field a context that’s safe and workers and managers in Yangon has also proved difficult. appropriate’ More senior staff in Yangon have sometimes been unable to share these new tools and ways of working with their field staff and partners, while many agencies have Together with the ALWG, the HAP and Sphere consultants operated by ‘remote control’, with little or no capacity to also established a national resource team, or Core directly monitor work in the field. Support Group, on Quality and Accountability. This group of approximately 15 Burmese nominated by the ALWG and By the time the full-time consultants arrived in July, things other appropriate agencies will provide continuing had improved considerably, due in large part to increased support to their own and other agencies. The ALWG has access from mid-June. The ALWG had met several times, and also established accountability indicators for the IASC many agencies had undertaken initiatives to translate the Integrated Monitoring Matrix, and continues to document Code of Conduct and other key documents into Burmese. agencies’ experiences and share them with others. Indeed, one of the early lessons concerned the importance of coordinating translations of key documents – all It appears that the integration of the HAP and Sphere focal documents, HAP and Sphere ones – into national languages, points has been widely perceived as a good idea; too

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many initiatives at the same time, especially amongst a Lost in translation population not previously exposed to the plethora of While translating the rhetoric of rights-based approaches quality and accountability initiatives currently available, into a practical implementation methodology is difficult in can be confusing and counterproductive. However, many contexts, in Myanmar the challenges to creating an adequate resourcing and continuity are also crucial, and environment conducive to open and honest feedback are the potential benefits of synergy can only be captured if especially acute. When feedback is gathered, some the two initiatives closely coordinate their planning and agencies have found it difficult to determine who it should staffing. In the next phase, a more integrated plan will be attributed to, and whether vulnerable groups have ensure continuity and promote synergy, and enable a been represented. Furthermore, methodologies that work clearer interface with the Accountability and Learning with one community may not work with another. And, as in Working Group. Pakistan, promoting awareness of quality and accountability amongst government authorities on any Some have also drawn a correlation between the size of level can be very difficult. In this regard the only lessons agencies’ programmes and their ability to effectively that the Pakistan project can recommend are that implement accountability mechanisms, with smaller persistence and patience are required. programmes better able to more quickly roll out accountability mechanisms. The Core Support Group is ‘Accountability’ is a simple yet subtle concept, and likewise an area where there are some lessons to learn. translating it into the local context has proved as difficult in CWS concluded from its work in Pakistan that establishing Myanmar as it has elsewhere. But one key lesson is clear: a national training and knowledge resource was essential. terminology is important. As in many other languages, the However, exactly how this should be done, who should be term ‘accountability’ is untranslatable. ‘Complaint’ is a included, when it is appropriate and how it needs to be loaded term, and ‘feedback’ is likewise problematic in supported merit further analysis. Burmese. Some have opted for the imperfect ‘suggestion’, which also requires a degree of explanation in order to Promoting accountability in a culture of foster the right kind of feedback. The point is that good assent bilingual interlocutors are required, and a set of key terms Feedback is a difficult area. The political context – where should be decided on and consistently followed. This has Burmese people are not used to giving feedback to those now been done, and a Red Cross/Red Crescent Glossary of with greater power and authority – is compounded by a Terms has been helpful. cultural context where many may not find it appropriate to ‘complain’ about the aid that they are receiving. Yet Next steps despite the myriad difficulties in communication in While it is too early to deem these efforts a success, there Myanmar, agencies are successfully using complaints has been an enormous amount of progress. Whilst there boxes, megaphones, radio, telephone complaints lines are many ways of translating the rhetoric of rights into an and mobile notice boards, amongst other tools. The operational methodology, it is clear that the Sphere outcome of all of these attempts remains unclear, but standards, the Code of Conduct and the principle of there is a lot of sharing about the efficacy of various accountability are linked to a rights-based approach. approaches, both at the ALWG and in Clusters. Likewise, Those who have worked in Myanmar over a longer period an early pilot project to assess the feedback mechanisms can attest to the fact that many of the discussions about a being employed by some agencies had itself received rights-based approach would have been unheard of mixed responses, with some finding the lack of clarity, merely a year ago, when ideas of ‘feedback’ and ‘rights’ preparation and sensitivity disappointing. CBOs and were deemed far too dangerous or controversial. For now, local NGOs show promise as potential interlocutors at least, it appears that these concepts and terminologies between communities and INGOs. Communities appear are being tolerated, if only within the narrow confines of to be more willing to share complaints amongst the Nargis response. One of the recommendations of the themselves and then have them communicated to ALNAP‘Lessons for Operational Agencies’ paper international organisations. published in 2008 was that the ‘lack of certainty of access in Myanmar, and how it may continue, challenges the kind Many seasoned aid workers have remarked how of accountability frameworks that can be practically ‘unspoiled’ the affected populations are relative to other established’. However, in light of recent positive disasters they have worked in, where the ‘aid industry’ experiences with promoting accountability and quality, the has succeeded in creating a steady expectation of Nargis response agencies may have an even more crucial assistance amongst the ‘consumers’ of aid. It remains to responsibility to promote accountability and quality, be seen how long this will last; the use of instrument- exploiting this unique opportunity. based rather than solution-based assistance, as well as the continued reduction of beneficiary caseloads, will Perhaps the most compelling question of all remains doubtless have a negative impact. But perhaps the unanswered: what is the impact of all of this? Have the degree to which agencies are able to promote and Sphere and HAP focal points – and the various other like- respond to constructive feedback will also help shape minded initiatives – made any difference? This is a the post-Nargis relationship between agencies and question that deserves to be answered on at least two

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE villages in the Delta. levels: the level of impact on practitioners’ awareness, and

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the degree to which any increased awareness has led to in Africa and Asia for over ten years. His e-mail address is: improved quality and accountability for affected [email protected]. Special thanks to Kerren Hedland and Anne populations. Whilst it will probably be impossible to Lloyd for their important contributions to this article, as well establish an accurate and quantitative baseline for as to the staff of DanChurchAid, the Humanitarian awareness amongst different staff groups and Accountability Partnership, the Sphere project, Save the populations, some actors will be able to comment on the Children and Church World Service for proofreading. degree to which they have witnessed a change. References and further reading Save the Children has secured funding from DFID and will take the reins from CWS to provide six months of further Marc Purcell, Axe-handles or Willing Minions? Inter- support in Sphere standards and HAP for three key groups national NGOs in Burma, Australian Council for Overseas of stakeholders: intensive coaching with eight INGOs and Aid, 5 December 1997. one Myanmar NGO network on designing and implementing Kelly Wooster, Report – Sphere Response to Cyclone a Quality Management System, further training and on-the- Nargis, July 2008. job practical assistance for agencies and the Core Support Team, and general guidance and ad hoc work in response to Celestine Nyamu-Musembi and Andrea Cornwall, What THE CYCLONE NARGIS RESPONSE IN MYANMAR requests from the broader community through the ALWG. Is the ‘Rights-based Approach’ All About? Perspectives The next chapter of the Sphere and HAP project, and the from International Development Agencies, IDS Working ultimate implications of the wider Nargis response, promise Paper 234 (Brighton: Institute of Development Studies, to be just as interesting as the first. 2004). ALNAP, Cyclone Nargis: Lessons for Operational Agencies, Erik Johnson has worked in disaster relief for IRC, Merlin, 2008. Oxfam GB and DanChurchAid (a member of the ACT Alliance)

Support to local initiatives in the Nargis response: a fringe versus mainstream approach Kerren Hedlund and Daw Myint Su

In 1997, a noted author on Myanmar said that civil society international community do to facilitate or reinforce what in the country was dead.1 Since then he has dared to was decidedly a ‘surge’ of a local nature? correct himself. In the wake of Cyclone Nargis, the remarkable civil society response has clearly and Sharing information and coordination undeniably proved that it is alive, and capable of doing On the fringe … great things against all odds. While measuring the full On 8 May, a group of interested agencies (donors, scope of the local response is impossible, the fact that at international and national NGOs and capacity-building least $40 million (over $120m if the Red Cross is included) projects) came together to discuss how to help civil society was provided by the international community to local contribute to the Nargis response. As a result of that organisations in the first four months after the cyclone is a discussion, a Local Resource Centre was established to: significant indication of both the scale of the response and the existence of previously unrecognised local capacity. • link local organisations to donor funds and technical expertise; In the wake of a catastrophic disaster there is a strong •provide support to local NGOs in proposal writing, and sometimes necessary tendency for the international reporting and procuring supplies; humanitarian community to rapidly mobilise all its •facilitate information exchange between the IASC resources. There is also an ongoing struggle to find the coordinating bodies and local NGOs and other civil right balance between international and national efforts, society groups; and to make international efforts more inclusive of • advocate to ensure that the work of local organisations national ones. However, given the reluctance of was acknowledged and understood; Myanmar’s government to allow significant direct foreign •provide local NGOs with information and training on assistance in the first month after Nargis, the instinct of principles of disaster relief including codes of conduct, the international community to ‘surge’ could not be accountability (HAP) and minimum standards (Sphere); realised. In the first months of the response, what did the and 1 David I. Steinberg, A Void in Myanmar: Civil Society in Burma, Paper •monitor funded activities. presented at the conference Strengthening Civil Society in Burma: Possibilities and Dilemmas for International NGOs, Royal Tropical Building on a pre-existing project called the Capacity Institute, Amsterdam, 4–5 December 1997. Building Initiative (CBI), which provided coordination and

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training to local and international NGOs, the LRC provided this was not recognised and these actors were not training in various areas, including financial management, engaged with from the start. organisational development, reporting and monitoring and evaluation. It also offered technical training in key In general, the international community restricted itself to sectors such as health and water and sanitation. With the the Yangon UN compound, which required participants to arrival of HAP and Sphere consultants in July (see the provide legal identification to enter, and then later a five-star preceding article by Erik Johnson), Sphere and HAP hotel nearby. After two weeks the UN provided identification training has been targeted to local groups through the cards to all who requested them, but fewer than 20 out of LRC. The LRC facilitated weekly meetings with local more than 300 were issued to representatives of local NGOs. organisations, often exceeding 50 people from 40 different Cluster meetings, minutes and technical and strategic organisations. In July, these local organisations initiated documents were almost all in English, and translations were their own network, and dedicated staff to Cluster rare. At the time of writing, the Post-Nargis Joint Assessment meetings, the IASC and other information and decision- (PONJA) document has yet to be translated. In October, it making fora, such as the Technical and Strategic Advisory became mandatory that Cluster meetings at township level Groups of the Periodic Review. (where the ratio of nationals to internationals is never less than 10 to 1) are held in Burmese. More than 500 local NGOs and CBOs were supported in the Nargis response, albeit in an ad hoc and usually insufficient The Humanitarian Information Centre website is in English, way. A new grant has been made available for over $1 and there is no link to a Burmese-language page where million for 15 Myanmar NGOs and 50 CBOs to implement Burmese-language documents could easily be found. It livelihoods recovery projects. The LRC and collaborators would be very difficult for someone who does not speak have also trained nearly 100 local organisations, or 800 English to find basic translated documents such as the people, in ten topics. Sphere and HAP have trained an NGO/Red Cross Movement Code of Conduct and the INEE additional 70 local NGO staff. It remains to be seen to what minimum standards in education. In short, the inclusion of extent new initiatives by INGOs, such as the Disaster local actors remains largely a ‘fringe’ activity. Resilience Response and Learning Project (DRRLP), will reinforce ongoing capacity-building initiatives such as those Protecting the space for and encouraging of the newly formed Capacity Development Support Group, national response which includes CBI and the LRC. ‘There is no civil society in Myanmar’ – international There are certainly limitations to parallel information and aid worker, , September 2008. coordination structures. Coordination of local response has remained fettered by concerns about publishing too ‘Half of all villages surveyed reported having self- widely the names and activities of local NGOs for fear of reliance groups, one third women’s and/or youth damaging their access to communities. Yet, coordination associations and one-fourth religious associations’ – of local response has limited utility unless the Post-Nargis Joint Assessment, June 2008. international response subsequently recognises the local NGO contribution and their ‘space’, and attempts to Given the constraints to direct implementation by INGOs, reinforce it or at least protect it. Nargis was the perfect opportunity for agencies to change their way of working, even if only on a small scale, by supporting local initiatives through or alongside their own participation by local NGOs operations. In the end, those few who normally work with was severely limited given the partners did so, while those who directly implement stuck as far as possible to their standard operating procedures. language, location and attitudes of main players in the On the fringe … Supporting the spontaneous development of self-help international response groups A number of small programmes run by donors and INGOs provided grants, largely under $5,000, to hundreds of self- In the mainstream … help groups, spontaneously organised in response to the Standard practice in a humanitarian catastrophe is to cyclone. Not only saving lives, these grants were responsive, ensure leadership through a humanitarian coordinator, cost-efficient and some argue catalytic with regard to coordination through the Cluster approach and promoting dignity, self-reliance and recovery. These grants information through a humanitarian information centre. provided an important indicator of what local communities But one wonders, for whom? In Myanmar, participation by were not getting from international humanitarian agencies, local NGOs was severely limited given the language, seeking livelihoods inputs weeks before they were included location and attitudes of main players in the international in the distribution of INGO/UN programmes and filling food response. It is surprising that, after decades of pipeline breaks. humanitarian response, this remains a common criticism. It is particularly disappointing given that, in Myanmar, Limitations included being unable to ensure 100%

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE where the early response was largely by national actors, coverage of villages or equitable needs-based targeting,

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the risks of giving too much money to new groups unused Implementation through local ‘service providers’ to managing grants, potentially encouraging false appli- Some 40 INGOs sought to operate in Myanmar post-Nargis cations for grants and corruption, and at one time the without official agreement or while awaiting approval. The inability to operate the project itself due to the ‘aggressive majority of INGOs sought out legitimate (or registered) recruitment policies’ of INGOs, which left several local Myanmar NGOs that were apolitical, secular and with organisations including one small grants project without existing capacity to implement 50,000-plus beneficiary adequate staff. Note that all of these limitations are also programmes. Local capacity was quickly exhausted. Under reported from time to time by INGO programmes, or cited pressure to demonstrate outputs, some local organisations in donors’ evaluations. may have sacrificed downwards accountability (as do some INGOs under similar pressure). With some exceptions, the Reinforcing existing networks, federations and local INGOs that used this approach admit that their commitment development organisations was overtly to the ‘project’ and not to the ‘partner’, largely Prior to Nargis there existed a handful of INGOs in order to meet donor commitments. operating in-country whose mandate and philosophy was to reinforce existing civil society structures. By and Between the self-help community groups and the large, these were the same organisations that con- registered Myanmar NGOs, hundreds of smaller civil tributed to the start up of the LRC, seconding experi- society groups sprang into life. All mobilised their own THE CYCLONE NARGIS RESPONSE IN MYANMAR enced staff to the Centre in the first two months. By resources, and some were partially funded by small grants reinforcing existing capacity, this not only achieved an programmes. Many had the potential to do much more. important and otherwise unattainable degree of However, INGOs and donors felt that it was too great a risk coverage early on in the crisis, but also contributed to a to themselves (not the civil society group) to directly longer-term resilience to disasters, with relatively little engage, as these groups were operating in a sensitive expatriate input. The Red Cross and Church networks ‘grey area’. At a meeting of donors and INGOs in early June also fall into this category, together reaching over 1 it was announced that 30 such groups had been identified million beneficiaries. At the peak of the crisis, the Red and were looking for partners and funding. There was Cross response was supported by 20–25 expatriates at silence in the room. any one time, while national volunteers numbered in the thousands. Perhaps the biggest limitation of this Direct implementation approach was that very few agencies operating in The majority of INGOs chose direct implementation, waiting Myanmar had existing relationships with or had prev- for permission to operate and then scaling up rapidly (see iously explored how to work with Myanmar civil society Figure 1). There were many reasons for this, not least an to implement joint programmes. unclear understanding of what local capacity did exist, and a

Figure 1: Number of beneficiaries reported by the four largest providers of Nargis relief assistance

1,800,000

1,600,000

1,400,000

1,200,000

1,000,000

800,000 Beneficiaries

600,000

400,000

200,000

0 May 2008 June 2008 July 2008 August 2008

Date

MRCS CARE WV SC

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clear humanitarian imperative to intervene. Under intense pressure from headquarters, amid ‘sensationalist’ descrip- no one can any longer deny that tions of humanitarian conditions and with fantastically successful fundraising, at least early on in the crisis (the first there is an active and capable Flash Appeal was funded at 96%, though it is worth civil society in Myanmar remembering that there had not been a disaster of this magnitude since 2003 and in 2008 some agencies were not meeting their ‘growth’ objectives), demands to demonstrate govern relief aid. On the other hand, there are plenty of and report on outputs were immense. This barely left room examples of CBOs implementing ‘best practice’ without for staff to notice what communities were already doing for ever being trained. themselves, or to implement even the most basic measures of downwards accountability. Few distribution committees Taking the plunge and deciding to work with Myanmar civil were answerable to communities. Few INGOs provided society organisations may have carried some risks. But by information to communities on their agency and their and large the INGOs, donors and projects that took those (planned or actual) intervention, or systematic feedback and risks have been rewarded with the knowledge that not only response mechanisms, let alone participatory approaches. did they contribute significantly to the relief response, but Local NGOs often reported feeling let down by the national they also supported a remarkable blossoming of civil staff of international organisations, who could be dismissive society that Myanmar has not before known – a civil society of local capacity. One local NGO working in Ngapudaw since which had been prematurely consigned to the grave by the 2000 was told ‘they could stop now that [the INGO] was outside world. here’. Working with local partners was felt to be idealistic, not pragmatic. Lessons learnt (?) International relief agencies have long been accused of Obviously, given the magnitude of the catastrophe a overestimating their capacity to respond and under- combination of approaches was necessary to meet the estimating the capacities of affected communities. This is needs of the survivors. It is difficult to say if the right unlikely to change until the international community leaves balance was achieved. However, it is clear that civil society the attitude behind that working with local populations and had a lot more capacity than the international community partners is not pragmatic, or worse, the view that ‘if we are gave it credit for. The lack of existing knowledge and not doing it ourselves then it’s not being done’. The experience of working with civil society in Myanmar before international community could start by reflecting on the Nargis was an impediment to working with it after Nargis. messages it is sending and the approach it is using at And the inflexible approach used by most agencies largely community level. Make an effort to find civil society groups, precluded a response ‘led’ by local communities and in the villages, in their offices and businesses, creating space existing organisations. for regular dialogue. As for direct implementation versus a partnership approach, it is not either/or but both/and, and Strengths, weaknesses, opportunities – and agencies can start making explicit links, even experimental threats ones. A little trust and humility would go a long way. When asked, many INGOs expressed their concern about working with civil society actors in Myanmar as follows: Nargis destroyed much, but it also revealed much as well. No one can any longer deny that there is an active and • Given pre-Nargis restrictions on Myanmar NGOs, it was capable civil society in Myanmar, one that made an not always clear whether an NGO had links to the regime. immeasurable life-saving contribution with minimum •Myanmar culture is hierarchical and bottom-up support from international agencies. Imagine what would approaches to development (let alone relief) are still have happened if the international community had done it the exception, with Myanmar NGOs normally taking a differently, had had more experience of working with civil very charity-oriented approach. society, had engaged from the beginning, had consulted • There was a risk that aid would be biased towards a formal and informal coordination and decision-making particular constituency (religious, ethnic, political, mechanisms, had taken a community-led approach both even livelihood group). with villages and local organisations. What impact could this have had on longer-term recovery and development in An international advisor for Danish Church Aid and CWS Myanmar? The proposition here is not to ‘mainstream’, candidly admits violations of the Code of Conduct by like a river absorbing a new current. The proposition here local organisations: ‘almost naively they report using is to change the colour of the water. funds to provide aid to ten believers, coffee for the church meeting, guitars and bibles’. However, he went Kerren Hedlund is NGO liaison for ICVA. Daw Myint Su is on to state that these risks can only be mitigated by Programme Manager of the Local Resource Centre. This working with these groups. An unavoidable first step is article reflects the opinions of the authors and does not to learn if and why communities trust these CBOs and necessarily represent the views of the organisations they local NGOs, and explaining the basic principles that work for. THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE

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Helping the heroes: practical lessons from an attempt to support a civil society emergency response after Nargis ATP staff

Several months prior to Cyclone Nargis, a loose mobile teams in the worst-affected townships in the Delta. consortium of international NGOs initiated a three-year Each team had a grant manager and 2–5 field monitors. pilot to provide long-term capacity-building support to Minimal training and orientation was given (ranging from CSOs engaged in community development and service one day to three hours) by ATP’s existing core team of delivery. Known by its Burmese name of Athauk Apun three. In Yangon, known local NGOs were contacted and (ATP), it aimed to link a micro-grant disbursal mechanism, informed of our approach, as were INGOs with local a mentorship service and action-oriented advocacy to partners and existing networks. In this way, several change the policy and practice of INGOs and donors. ATP hundred copies of the application were distributed. The had only just become operational when Nargis hit. Over three Delta-based teams made contact with the few local the next 60 days, some 350 grants worth over $700,000 in groups already known in the affected townships, and THE CYCLONE NARGIS RESPONSE IN MYANMAR cash (plus $200,000-worth of materials) were disbursed began visits to badly affected villages. Word of mouth did to 320 local NGOs, CBOs and self-help groups. Over the rest, and very quickly the teams were inundated with 350,000 survivors received emergency aid via ATP. requests for support. Meanwhile, a separate team was set up to offer additional (non-financial) services. While ATP represents only a small part of a far wider civil society response, it is clear that much more support for What happened next local responses could have been provided. With the right Initially, the flood of applicants represented the full range sort of assistance, a civil society relief response might not of civil society action: established NGOs already working only get there first, but also ‘go to scale’, while in social welfare, including Buddhist, Christian and Muslim contributing significantly to local capacity development organisations; newly formed volunteer groups full of for longer-term resilience – and all with lower transaction youthful, chaotic energy; thoughtful groups of writers, costs than incurred by INGOs. While such an approach teachers, academics and retired professionals – often with cannot completely replace direct implementation, it personal contacts in the Delta – seeking to help particular deserves much more serious attention from INGOs, villages; and private sector workers coming together to donors and governments. prise support from their employers. Very quickly, however, self-help groups formed by Nargis survivors from the villages began to predominate. Whether from affected with the right sort of assistance, areas in and around Yangon or from further afield in the a civil society relief response Delta, all had harrowing stories to tell. might not only get there first, but Most grants disbursed during the first two months were for also ‘go to scale’ around $3,000, with a range from $100 to $10,000. The majority (80%) included food items. Over 50% also sought non-food items, all of which were purchased locally. A month after the storm, we saw an increasing number of How it started proposals seeking livelihood support: rice seed, rotivators, Immediately after Nargis hit, ATP’s procedures and systems diesel, boats, fishing hooks, lines and nets. About 10% of were adapted to enable a much more rapid response. The proposals were rejected. most important step was reducing the turn-around time for grant proposals from about six weeks to a maximum three For the first month the teams worked around the clock, days. A working strategy was developed for rapid seven days a week. We were inefficient, inexperienced and fundraising, and a simplified, four-page emergency appli- understaffed, learning as we went along but enormously cation format was prepared. Written in Burmese, this inspired by those leading this indigenous relief effort – explained how ATP worked, how to contact us, and the especially the many self-help groups from the villages. By application information required (a brief profile of the early July, three months after the night of the storm, applicant group or organisation, details of proposed everyone was exhausted. Many communities were no activities, the target group and how the applicant would be longer in a life-threatening situation, and we needed to accountable to them), and a space for the contract signa- learn how our approach was working in practice. tories. No minimum grant size was indicated, but the local currency equivalent of about $6,500 was given as a Challenges maximum. An initial 500 copies of the forms were printed. Cash flow was a major problem, even in Yangon, but especially in the offices in the Delta. Fundraising, while Four teams were set up to process proposals, sign necessary and time-consuming (at our busiest we were contracts, disburse grants, monitor expenditure and disbursing over $150,000 a week, and six donors were used receive reports. One was based in Yangon, with three to keep us solvent), was less problematic than actually

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accessing, storing and counting out the physical cash in local currency. (A grant of around $4,000 needs almost 5,000 Kyat notes, weighs over ten kilos and fills two extra-large shopping bags.) Security, however, was not an issue. Much time and effort also had to be spent in the accounts depart- ment of the INGO through which our funds were being channelled. Staffing became increasingly problematic as INGOs mounted massive recruitment drives.

Communication was also problematic – for many weeks phone landlines and cell phones were not working. Hiring ©REUTERS/Stringer four-wheel-drive vehicles was difficult and expensive. All transport to villages in the Delta had to be by boats, which were in short supply because of the storm, and the monsoon rains were Survivors of Cyclone Nargis wait for aid south of Yangon starting. Given the ‘cautious’ attitude of the authorities, we also had to be careful to maintain a Rapidity – with no need to spend time on mobilising and low, non-provocative profile. supporting large operational teams, aid started reaching distant communities in a matter of days. An additional worry at the time was trying to find the right disbursement rate. If we went too fast (by cutting back even Minimal logistic requirements – over a period of 30 days, a further already reduced processes to promote accountability sub-team of one grant manager and five field monitors, with and establish legitimacy) we ran the risk of grant abuse, minimal facilities, can disburse (and subsequently monitor) promoting bad practice and fuelling corruption. If on the over 150 grants to 150 SHGs, in turn providing lifesaving other hand we raised the bar sufficiently high to be certain in relief to at least 120,000 people. A national director, a advance that we were only funding legitimate groups, the finance manager and two database/admin/finance assis- extra delays might result in more deaths. All our findings to tants can support four such teams. Add in some safes and date reveal humbling levels of integrity and honesty. calculators, laptops and printers, a couple of hire cars and some back-up for fundraising, reporting and donor Gauging impact management, and costs are about $30,000 a month, for an After the first two months or so of frenetic disbursement, operation that can help half a million people receive $2 the team began monitoring visits to the villages where million of highly responsive aid in about six weeks. CBOs were active. To date about 250 grants have been followed up (two field monitors can monitor up to 12 Efficiency – the total indirect cost of $30,000 a month villages per week), allowing us to draw some initial, incurred by ATP included the 7% overhead paid to head tentative conclusions. offices. The indirect costs incurred by the CSOs themselves were usually very small and often non-existent. In all, some Responsiveness – especially for proposals coming directly 83% of the funds provided by donors was spent locally on from SHGs formed by survivors, the approach was buying the relief items directly received by beneficiaries. undoubtedly highly responsive, allowing survivors to specify exactly what they wanted to prioritise. Of the first Accountability – so far only one case of misappropriation 350 interventions funded, 270 were qualitatively different has been encountered. Such remarkably high levels of depending on the particular needs of each village. Simply integrity may decrease with time, but it does seem that by looking at the changing nature of proposals, we were many humanitarian agencies could be far more trusting able to observe changing priorities far more accurately than they currently believe possible. Our experience has than many INGO needs assessments. also demonstrated how a small team of experienced, national community-development practitioners can, with Flexibility – the CSOs were able to rapidly adjust the assis- simple procedures, identify most (if not all) illegitimate or tance they provided, as opportunities or needs arose. spurious proposals at the application stage. To date, SPC Thus, while evaluations revealed minimal misuse of funds, has funded some 360 groups; it has rejected over 30. over 25% of action plans were changed after grant disbursal (e.g. from food to non-food items, or from seed Catalytic – many SHGs described the ATP approach as a purchase to diesel, or from nets to hooks and lines), either motivation for local action. In some of the more due to market changes or unexpected distributions from traumatised villages, there were alarming signs of lethargy

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE other agencies. and depression, and several survivors spoke openly of

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being close to suicide. Seeing or hearing about the • the risks of doing harm by providing too much money activities of groups that had accessed ATP grants seems to too quickly to SHGs with low levels of capacity and have had an important galvanising effect. experience in handling grants; and • the risks of provoking a deluge of illegitimate appli- Longer-term self-reliance and resilience – recipients are cations that become hard to separate from genuine interested in taking a larger role in on-going recovery and proposals (the fact that this has not happened to date is longer-term development. They also express a strong desire probably a reflection of the integrity of Myanmar culture to learn how to be better prepared for storms and floods in as a whole and of the level of compassion the scale of the future. Even if only 30% of the SHGs assisted to date the tragedy evoked). actually sustain themselves, this approach will have played a key role in helping over 100 CBOs come into being. What next? Over the next 15 months, using multiple grant cycles, mentoring and other capacity-building initiatives, ATP many humanitarian agencies aims to work with 240 SHGs and CBOs, largely drawn from groups already funded, contributing to livelihood recovery and DRR and strengthening their potential for driving

could be far more trusting than THE CYCLONE NARGIS RESPONSE IN MYANMAR they currently believe possible longer-term development. Given the high levels of poverty in the Delta before Nargis, there is a huge amount that a larger, more confident and better networked civil society could achieve. Efforts are also needed to help improve Weaknesses and limitations relations between state and non-state actors. One core lesson of the ATP experience is that civil society often achieved much despite our efforts, not because of Last thoughts them. We still have much to get right about application Because of the nature of its unusual organisation (a pilot procedures, grant disbursal and grant size, coordinating process answerable to a Consortium of INGOs through an and channelling information, and ensuring our own overstretched Board), from the outset ATP has functioned capacity to provide support. It is also clear that ATP only somewhat autonomously. The team raised all its own provided a small proportion (probably less than 5%) of the funds in-country and remained largely outside the kind of total funding that enabled the massive civil society corporate influence within which many INGO relief response to Nargis – with much coming through religious responses operate. Because of the complexity of the institutions, local donations, the private sector and INGOs working environment, it has also had to maintain as low a and donors working through local partnerships. However, profile as possible – definitely no flags, signs or press even with considerably more support and improvement, it releases (and we shall have to see whether indulging in seems unlikely that this approach could ever replace the the vanity of writing this article will be justified or not). kind of response a well-organised INGO or the UN can provide. Limitations of the approach include: Undoubtedly, these institutional peculiarities led to the emergence of an ATP sub-culture that forced us to remain as •difficulties in ensuring 100% coverage of all villages humble, client-led, adaptable, risk-taking, autonomous and and equitable or need-based targeting within them; team-managed as possible. Most importantly, it forced us to • dependence on local supplies of relief goods and view the target group as the initiators and managers of their transport; own relief interventions, not as helpless victims needing • the lack of potential for generating new ideas or massive outside help. What the victims of Nargis really technical solutions, or challenging local norms (this needed was for us to trust them – to trust them as the approach would not, for instance, generate a demand decision-makers and implementers of their own relief and for child friendly spaces or gender-sensitive responses); recovery response. Perhaps all of us, but especially inter- •low levels of participation or inclusiveness and the national agencies, need to re-examine our organisational difficulties in promoting good practice; cultures against the criteria of trust and humility.

Livestock, livelihoods and humanitarian response: the Livestock Emergency Guidelines and Standards Cathy Watson and Andy Catley Network Paper 64, December 2008

This Network Paper discusses livelihoods-based livestock programming and its role in humanitarian emergency response. It highlights the importance of taking livelihood assets, in particular livestock, into account in responding to emergencies and describes how the Livestock Emergency Guidelines and Standards (LEGS) Project has been developed to support this process.

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HIV programming in Myanmar Population Services International Myanmar, Save the Children and the UN Joint Team on AIDS in Myanmar1

Myanmar has one of the most serious HIV epidemics in significant number of married women are thought to be Asia. Contrary to many perceptions, the response to the infected from their husbands, amounting to approximately epidemic is expanding. Funding for the response has one-third of those living with HIV in Myanmar. gradually increased over recent years. However, coverage remains unacceptably low, donors seem largely unwilling Expanding service delivery to inject the resources needed to meet health needs and The number of people in Myanmar accessing HIV services the government itself significantly under-invests in health. has increased significantly since the beginning of the decade. The number of patients receiving ART quadrupled, The National Strategic Plan on AIDS 2006–2010 issued by from roughly 2,500 in 2005 to 10,500 in 2007; the number the Ministry of Health provides the reference framework for of sex workers, drug users and men who have sex with men the response. Despite what might be expected given the reached by outreach or peer education services has environment, the Plan was developed in a participatory increased, to the levels presented in Table 1. In many areas fashion, is multi-sectoral and up to date and prioritises of HIV work, the number of townships where programmes service provision for the most at-risk populations. It is have been initiated is growing: 132 townships with supported by a government-led, inclusive technical coordin- prevention of mother-to-child transmission services (2008), ation group. However, significant barriers to service 273 townships with sex worker outreach or peer education provision exist. These include constraining administrative programmes (2005), 24 townships with HIV programmes for procedures, controlled access, limited research and a highly drug users (2006) and 170 townships with government- politicised context. Nevertheless, the results demonstrate promoted 100% Targeted Condom Programmes (2006). A that persistent negotiation can yield agreements resulting in growing number of self-help groups of people living with increased services for those in need. Nearly 40 international HIV are emerging across the country, and they are beginning and national NGOs are implementing successful activities in to organise themselves into State/Division-level networks. Myanmar, alongside government efforts and with UN Most partners are able to undertake service provision using support. participatory approaches at community level, through techniques emphasising peer education and support for Present estimates of people needing services community-based organisations. In August 2007, government staff, the UN and NGO stakeholders held a workshop to apply international tools Most of this service expansion has been delivered by to estimate the extent of the HIV epidemic in Myanmar. The NGOs, especially for peer education work for vulnerable results were that 242,000 adults and children would be groups, community-oriented prevention, care and support living with HIV at the end of 2007 (or 0.67% of the activities and anti-retroviral treatment. The government, population, within a range of 0.5% to 0.9%), and that the with international assistance, is also providing services, epidemic peaked in 2000. Some NGO providers of anti- including anti-retroviral treatment (roughly 1,800 retroviral treatment (ART), calculating backwards using patients), treatment of sexually transmitted infections, estimated population numbers, have raised concerns that targeted condom promotion, prevention of mother-to- prevalence might be higher, and this question requires more child transmission, some support for harm reduction research. Prevalence remains high amongst sex workers activities and life-skills education in schools. and injecting drug users, and is believed to be high among men who have sex with men. As elsewhere in Asia, a However, even for those services where expansion has 1 The UN Joint Team on AIDS in Myanmar comprises UNHCR, UNICEF, been possible, the reach is still alarmingly low. Currently WFP, UNDP, UNFPA, UNODC, ILO, WHO, IOM, FAO, UNIC, UNOPS and roughly only 15% of people living with HIV (PLHIV) who UNAIDS.

Table 1: Coverage of interventions in selected areas of HIV prevention in 2006 Number reached by services or Estimated reference population Coverage HIV prevention programmes Female sex workers 26,000–36,000 (2006) 60,000 43%–60% Injecting drug users 21,000 (2006) 75,000 28% Men who have sex with men 28,000 (2006) 240,000 11.6% Pregnant women Receiving pre-test counselling 182,000 (2006) 1,200,000 15% Mother-baby pairs 969 (2006) 5,190 18.6% PLHIV receiving ART 10,500 (2007) 75,000 14% THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE

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13 Getting On-Line in Emergencies: A Guide and Directory to the Internet for Agencies involved in Relief and Rehabilitation by L. Aris, P. Gee and M. Perkins (1996) 14 The Impact of War and Atrocity on Civilian Populations: Basic Principles for NGO Interventions and a Critique of Psychosocial Trauma Projects by D. Summerfield (1996) 15 Cost-effectiveness Analysis: A Useful Tool for the Assessment and Evaluation of Relief Operations? by A. Hallam (1996) 16 The Joint Evaluation of Emergency Assistance to Rwanda: Study III ed. J. Borton (1996) 17 Monetisation: Linkages to Food Security? by J. Cekan, A. MacNeil and S. Loegering (1996) 18 Beyond Working in Conflict: Understanding Conflict and Building Peace (The CODEP Workshop Report), by J. Bennett and M. Kayitesi Blewitt (1996) 19 Human Rights and International Legal Standards: what relief workers need to know by J. Darcy (1997) 20 People in Aid Code of Best Practice in the Management and Support of Aid Personnel ed. S. Davidson (1997) 21 Humanitarian Principles: The Southern Sudan Experience by I. Levine (1997) 22 The War Economy in Liberia: A Political Analysis by P. A tkinson (1997) 23 The Coordination of Humanitarian Action: the case of by K. Van Brabant (1997) 24 Reproductive Health for Displaced Populations by C. Palmer (1998) 25 Humanitarian Action in Protracted Crises: the new relief ‘agenda’ and its limits by D. Hendrickson (1998) 26 The Food Economy Approach: a framework for understanding rural livelihoods by T. Boudreau (1998) 27 Between Relief and Development: targeting food aid for disaster prevention in Ethiopia by K. Sharp (1998) 28 North Korea: The Politics of Food Aid by J. Bennett (1999) 29 Participatory Review in Chronic Instability: The Experience of the IKAFE Refugee Settlement Programme, Uganda by K. Neefjes (1999) 30 Protection in Practice: Field Level Strategies for Protecting Civilians from Deliberate Harm by D. Paul (1999) 31 The Impact of Economic Sanctions on Health and Well-being by R. Garfield (1999) 32 Humanitarian Mine Action: The First Decade of a New Sector in Humanitarian Aid by C. Horwood (2000) 33 The Political Economy of War: What Relief Agencies Need to Know by P. Le Billon (2000) 34 NGO Responses to Hurricane Mitch: Evaluations for Accountability and Learning by F. Grunewald, V. de Geoffroy & S. Lister (2000) 35 Cash Transfers in Emergencies: Evaluating Benefits and Assessing Risks by D. Peppiatt, J. Mitchell and P. Holzmann (2001) 36 Food-security Assessments in Emergencies: A Livelihoods Approach by H. Young, S. Jaspars, R. Brown, J. Frize and H. Khogali (2001) 37 A Bridge Too Far: Aid Agencies and the Military in Humanitarian Response by J. Barry with A. Jefferys (2002) 38 HIV/AIDS and Emergencies: Analysis and Recommendations for Practice by A. Smith (2002) 39 Reconsidering the tools of war: small arms and humanitarian action by R. Muggah with M. Griffiths (2002) 40 Drought, Livestock and Livelihoods: Lessons from the 1999-2001 Emergency Response in the Pastoral Sector in Kenya by Yacob Aklilu and Mike Wekesa (2002) 41 Politically Informed Humanitarian Programming: Using a Political Economy Approach by Sarah Collinson (2002) 42 The Role of Education in Protecting Children in Conflict by Susan Nicolai and Carl Triplehorn (2003) 43 Housing Reconstruction after Conflict and Disaster by Sultan Barakat and Rebecca Roberts (2003) 44 Livelihoods and Protection: Displacement and Vulnerable Communities in Kismaayo, Southern Somalia by Simon Narbeth and Calum McLean (2003) 45 Reproductive health for conflict-affected people: policies, research and Programmes by Therese McGinn, Sara Casey, Susan Purdin and Mendy Marsh (2004) 46 Humanitarian futures: practical policy perspectives by Randolph Kent (2004) 47 Missing the point: an analysis of food security interventions in the Great Lakes by Simon Levine and Claire Chastre (2004)

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48 Community-based therapeutic care: a new paradigm for selective feeding in nutritional crises by Steve Collins (2004) 49 Disaster preparedness programmes in India: a cost benefit analysis by Courtenay Cabot Venton and Paul Venton (2004) 50 Cash relief in a contested area: lessons from Somalia by Degan Ali, Fanta Toure, Tilleke Kiewied (2005) 51 Humanitarian engagement with non-state armed actors: the parameters of negotiated armed access by Max Glaser (2005) 52 Interpreting and using mortaility data in humanitarian emergencies: a primer by Francesco Checchi and Les Roberts (2005) 53 Protecting and assisting older people in emergencies by Jo Wells (2005) 54 Housing reconstruction in post-earthquake Gujarat: a comparative analysis by Jennifer Duyne Barenstein (2006) 55 Understanding and addressing staff turnover in humanitarian agencies by David Loquercio, Mark Hammersley and Ben Emmens (2006) 56 The meaning and measurement of acute malnutrition in emergencies: a primer for decision-makers by Helen Young and Susanne Jaspars (2006) 57 Standards put to the test: implementing the INEE Minimum Standards for Education in Emergencies, Chronic Crisis and Early Reconstruction by Allison Anderson et al. (2006) 58 Concerning the accountability of humanitarian action by Austen Davis (2007) 59 Contingency planning and humanitarian action: a review of practice by Richard Choularton (2007) 60 Mobile Health Units in emergency operation: a methodological approach by Stéphane Du Mortier and Rudi Coninx (2007) 61 Public health in crisis-affected populations: A practical guide for decision-makers by Francesco Checchi, Michelle Gayer, Rebecca Freeman Grais and Edward J. Mills (2007) 62 Full of promise: how the UN’s Monitoring and Reporting Mechanism can better protect children by Katy Barnett and Anna Jefferys (2008) 63 Measuring the effectiveness of Supplementary Feeding Programmes in emergencies by Carlos Navarro-Colorado, Frances Mason and Jeremy Shoham (2008) 64 Livelihoods, livestock and humanitarian response: the Livestock Emergency Guidelines and Standards by Cathy Watson and Andy Catley (2008) Good Practice Reviews Good Practice Reviews are major, peer-reviewed contributions to humanitarian practice. They are produced periodically. 1 Water and Sanitation in Emergencies by A. Chalinder (1994) 2 Emergency Supplementary Feeding Programmes by J. Shoham (1994) 3 General Food Distribution in Emergencies: from Nutritional Needs to Political Priorities by S. Jaspars and H. Young (1996) 4 Seed Provision During and After Emergencies by the ODI Seeds and Biodiversity Programme (1996) 5 Counting and Identification of Beneficiary Populations in Emergency Operations: Registration and its Alternatives by J. Telford (1997) 6 Temporary Human Settlement Planning for Displaced Populations in Emergencies by A. Chalinder (1998) 7 The Evaluation of Humanitarian Assistance Programmes in Complex Emergencies by A. Hallam (1998) 8 Operational Security Management in Violent Environments by K. Van Brabant (2000) 9 Disaster Risk Reduction: Mitigation and Preparedness in Development and Emergency Programming by John Twigg (2004) 10 Emergency food security interventions, by Daniel Maxwell, Kate Sadler, Amanda Sim, Mercy Mutonyi, Rebecca Egan and Mackinnon Webster (2008) To order any of these publications, please complete the form overleaf and return it to: Publications, Overseas Development Institute, 111 Westminster Bridge Road, London SE1 7JD, UK. Tel: +44 (0)20 7922 0331/74. Fax: +44 (0)20 7922 0399. Email: [email protected] Or place an order via our website: www.odihpn.org

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HUMANITARIAN PRACTICE NETWORK THE CYCLONE NARGIS RESPONSE IN MYANMAR 27 umber 41 • December 2008 umber 41 • December N a budgeted Operational Plan. Its development involved Plan. Its development a budgeted Operational ely permanently withdrawn. ely permanently withdrawn. und 3 AIDS grant, terminated in 2005, provides an und 3 AIDS provides terminated in 2005, grant,

r IV/AIDS in Myanmar. IV/AIDS in Myanmar. ears), the Minister of Health now also chairs a more ears), the Minister of Health now esearch to be disseminated in-country should have prior should have disseminated in-country to be esearch move from Yangon to Nay Pyi Taw has only increased these only increased has Taw to Nay Pyi Yangon from move any (in principle controlled is tightly Research barriers. r and advocacy inhibiting approval), governmental strategies. and programme about social issues discussion which all partners upon health infrastructure, The public under- due to chronic is weak degrees, varying depend to donors by itself and the government by funding both in Myanmar. in health systems unwilling to invest the political risks for context raises The highly politicised investment. and thus discourages potential donors, political actors inside and by closely scrutinised are Grants might not who in other circumstances outside the country, of HIVpay attention to details Fund The Global funding. Ro effort.The newer failed large-scale example of such a negotiated with was carefully which Diseases Fund, Three partnersof the country during its inside and outside has so far year, entering its second design and is now stable. Partners cautiously more in-country are proved a new these experiences, optimistic that, learning from effort will be successful. to access the Global Fund highly is on the whole environment The operating While prohibitive. being entirely far from yet constraining, once organisations often protracted, negotiations are able to implement generally they are an agreement have is to implement programmes and permission projects ra Coordination and planning Coordination serviceAccompanying the expansion in delivery, participative for coordination, and planning structures Early efforts forward. likewise moved monitoring have opportunities for partnersprovided to experiment with Such environment. ways to engage despite the politicised efforts into the country of a few included the early entry and the process proposal NGOs, the first Global Fund a Country Coordinating initial experience of organising on AIDS Joint Programme Mechanism, and the UN’s for 2003–2005, with the accompanying multi-donor Fund H a multi-sectoral In 2006, the Ministry of Health developed participatory using a more than strategy process Plan on AIDS National Strategic The Myanmar previously. and prioritised plan for the 2006–2010 is a targeted totality of HIV supported actors in the response, work by by the government, the UN,of the government, and representatives NGOs include a basis for affected communities. Advances (for example prisons, involvement multi-sectoral greater the police, the uniformed services, the transport sector and the judicial sector); a focus on the most at-risk populations, including sex workers and clients, drug users sex with men; a participatoryand men who have to human and explicit references structure; coordination governmental rights. In addition to the exclusively National AIDS Committee (which has not met in several y and Body for AIDS,Tuberculosis Coordinating inclusive ategic Plan, and have been helpfully highlighted in been helpfully highlighted ategic Plan, and have ogrammes must operate in a highly constrained must operate ogrammes r ogramme of 2006, the review of the 100% Targeted of the 100% of 2006, the review ogramme eviews such as the external review of the National AIDS of the eviews such as the external review In addition to insufficient coverage of those services which coverage In addition to insufficient other are there to some extent, at least being delivered are major gaps in the HIV example, programmes For response. nearly non-existent. as prisons are in closed settings such the police engaged unwilling to have The authorities seem manner; programmes in HIV large-scale in a programmes for uniformed services they occur at all, minimal and, if are undertakenThe situation of orphans and are in isolation. and insufficiently is precarious children vulnerable use of mass media for is ineffective There addressed. for strategies While many globally promoted advocacy. National accepted in the are these and other areas St need ARTneed only in 2006 side, the paediatric it. On receive ART received children HIV-positive 317 of 1,495 out die estimated 20,000 people to be in need. An estimated These deaths are of AIDS-related year. causes each significantly expanded but doing so requires preventable, increased and support community, the international from sector the public health NGOs and within capacity among in other priority, coverage The low services.to deliver 1. Table in is presented areas active Gaps and constraints r Pr of the review (2005) or the programme Condom Promotion in programme of mother to child transmission prevention to the contrary It is negligent – and 2007, gaps remain. services of those who might benefit from interests – not to and negotiate with the authorities to expand advocate the public health NGOs and by both by services, delivered filled. sector so that these gaps are Pr costs and high transaction by characterised environment, negotiate their long delays. International NGOs must and in year (MOU) every of understanding memorandums to specific activities in individual down detail, considerable sites must project International staff visiting townships. a government and be accompanied by obtain prior approval for importing commodities is a official. Obtaining approval a lack of delays, compounded by Procurement process. slow funding, at times seriously curtailpredictable programme face limitations implementation. International organisations access, particularlyin geographical to ‘sensitive’ areas, critical mining sites. and some areas which include border importantly organisations More in the long run, Myanmar footing in establishing the legal face constraints themselves and unclear facing a protracted necessary to operate, levels. at multiple administrative to obtain approvals process Formal of unpredictability. is a high level And there instructions are guidelines, written letters and informal oral The requirement in practice. uncertain, and variable irregular is township, by case negotiation, often township for case by the only constant. both national and international Although improving, lack sufficient opportunitiesorganisations for dialogue and in an programmes, about with the government mistrust and miscommunication are where environment physical significant obstacles the government’s already HE41 crc 18/12/08 3:46 pm Page 27 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 28

Figure 1: Available resources, actual expenditures and planned resource needs

80 Minimum Universal Access point 76.4 Funding needed for universal coverage of ART, SW, MSM and IDU 70 62.3 60

50 41.7 Funding gap 40 34 35.4 Millions US$ 30 25 30.8 31.2 27.2 20 20

Global Fund FHAM ends 3DF 10 Phase-out ends begins

0 2004 2005 2006 2007 2008

Planned expansion per National AIDS 3-year Operational Plan Current pledges Actual expenditures

Malaria, and the Department of Health chairs Technical and 2008, while there are gaps for both prevention and care and Strategy Groups (TSGs) for AIDS, tuberculosis and malaria, treatment components, expected resources fall seriously for which UN agencies serve as the secretariats. The TSG for short of what is needed to provide life-saving treatment. AIDS has 25 members including representatives from the government, the UN, national and international NGOs and Myanmar does not currently access resources from the people living with HIV. Global Fund, the World Bank or the Asian Development Bank. The contribution of the government of Myanmar to These structures have already led to some improvements. the national response to AIDS is estimated at A forum at least now exists for international and national approximately $0.2m per year. Government health partners, including nascent networks of people living with expenditures in 2005 were reported to be $0.37 per HIV, to raise issues, even if the meetings are not as person, which is grossly insufficient and disproportionate frequent or as efficient as might be hoped. Planning and to the wealth of the country. The Three Diseases Fund reporting documents are now prepared in a more (3DF) provides roughly 40% of the available funding, and participatory way, such as national Progress Reports for while this finances critical services, the 3DF has 2005 and 2006 (issued by the National AIDS Programme insufficient funds currently to fuel the needed scaling-up. but reflective of inputs and outputs from all partners). In 2007, the TSG produced the first agreed set of priority Considering its development profile, Myanmar receives a townships (forthcoming) for sex work, drug use, mobility very low level of financial support from the international and burden of care. The Operational Plan 2006–2008 is community. With roughly comparable epidemics, the being updated using the TSG and inclusive working group people of Cambodia receive nearly eight times more structure, and is trying to establish credible but ambitious funding per capita for AIDS than the people of Myanmar targets to raise funds to increase service delivery. These (Figure 2). Cambodia receives more assistance per capita structures and activities represent an important rehearsal for AIDS than the people of Myanmar receive for all of participatory practice which could serve as a basis for a development assistance combined (Figure 3). revitalised Country Coordinating Mechanism providing harmonised coordination efforts for the whole national Conclusion response in the fight against AIDS, TB and malaria. Despite the politicised atmosphere, actors both inside and outside the country have demonstrated that negotiated Financial analysis agreements on HIV programming and corresponding Sufficient and predictable resource flows are critical for delivery of services are possible. HIV services have planning and service delivery. In 2006, $27.2 million was expanded as a result of advocacy by internal and external spent on the national response to AIDS. For 2008, the actors, increased recognition of HIV by the Ministry of

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE expected available funds have risen to $35m (Figure 1). For Health, incremental increases in international funding and

HUMANITARIAN 28 exchange HE41 crc 18/12/08 3:46 pm Page 29

Figure 2: Per capita financing for AIDS (US$)

4.00

3.50 Cambodia 3.00

2.50

US$ 2.00

1.50

1.00 Myanmar 0.50

0.00 2005 2006 2007 THE CYCLONE NARGIS RESPONSE IN MYANMAR

Figure 3: ODA per capita (US$)

60

49.9 50

40 38.2

US$ 30 23 20

10 2.9 0 Year 2005

Myanmar Cambodia Laos

the establishment and expansion of services by NGOs, the services for people in need and facilitate the evolution of UN and the government. The National Strategic Plan HIV policies. International donors should recognise the reflects international best practice, highlights the most at- evidence of increased coverage possibilities by increasing risk populations and was developed in a more commitments. Without more investment from the participatory manner than any preceding plan. Funding Myanmar government and international sources, the road and expenditures have slowly increased each year. to universal access to HIV prevention and care will be long, Programme output data demonstrates that increased preventable deaths will occur and individuals’ rights to resources and policy engagement can result in increased health care will remain unmet.

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Number 41 • December 2008 29 HE41 crc 18/12/08 3:46 pm Page 30

Protracted crisis in eastern Burma Thailand Burma Border Consortium

Twenty years after the Burmese junta suppressed pro- abandoned in eastern Burma between 1996 and 2007. democracy protesters, violations of human rights and Such field reports have been corroborated by high- humanitarian law in eastern Burma are more widespread resolution commercial imagery of villages before and systematic than ever. Ten years after the Guiding and after the displacement occurred. During the past year, Principles on Internal Displacement were submitted, the community organisations have documented the forced international response in eastern Burma remains largely displacement of a further 142 villages and hiding sites. ineffective in dealing with a predatory governing regime. However, displacement is more commonly caused by The Thailand Burma Border Consortium (TBBC) has been coercive factors at the household level. The imposition of collaborating with ethnic community-based organisations forced labour, extortion, land confiscation, agricultural to document the characteristics of internal displacement production quotas and restrictions on access to fields and in eastern Burma since 2002. During this period there has markets has a devastating effect on household incomes and been increasing debate about whether violations of a destabilising impact on populations. During the past year, human rights and humanitarian law in eastern Burma this has been exacerbated by hydroelectric projects in Shan constitute an international crime. So, aside from updating and Karen states, mining projects in Shan and Karenni information about the scale and distribution of internal states and Pegu Division, a gas pipeline in and displacement, the most recent survey compiles abuses commercial agriculture and road construction in general. reported during 2008 in relation to the legal framework for .1 While the total number of internally displaced persons in eastern Burma is likely to be well over half a million, at The scale and characteristics of displacement least 451,000 people are estimated to be displaced in rural Conflict-induced displacement remains most concentrated areas alone. The population includes approximately in the northern Karen areas, where armed skirmishes 224,000 people currently in the temporary settlements of between the Burmese army and the Karen National Union ceasefire areas administered by ethnic nationalities. (KNU) continued in the first six months of 2008. While the However, the most vulnerable group is an estimated wet season was previously a time of respite from Burmese 101,000 civilians who are hiding in areas most affected by army patrols, intensified troop deployments during the military skirmishes, followed by approximately 126,000 past couple of years mean that the occupation is now villagers who have been forcibly evicted by the Burmese sustained all year. This has led to the displacement of army into designated relocation sites. An estimated 27,000 villagers in the four affected townships during the 66,000 people were forced to leave their homes as a result past year. The prevalence of attacks targeting civilians has of, or in order to avoid, the effects of armed conflict and slightly decreased since the junta’s offensive in 2006. human rights abuses during the past year alone. However, the harassment of villagers perceived as sympathetic to the armed opposition has continued. Vulnerability assessment Household surveys conducted since 2005 indicate that threats to personal safety and security have increased. conflict-induced displacement This is particularly significant in regards to the incidence of arbitrary arrest or detention and forced conscription to remains most concentrated in the porter military supplies, reflecting increased troop northern Karen areas deployments to outposts along the border. When disaggregated by surroundings, the dangers of military patrols, landmines and artillery attack are especially acute The four townships surrounding Laikha in southern Shan for households hiding in the most contested areas. State are of particular concern. Armed skirmishes and Villagers in government-controlled relocation sites are at Burmese army deployments have escalated in this area greater risk of arbitrary arrest or detention, torture or since a former battalion commander with the Shan State beatings and forced conscription as porters and landmine Army – South surrendered in 2006. The Burmese army is sweepers. These findings support the assessments of attempting to assert its supremacy in the area by breaking human rights groups that government troops and communication links between the armed opposition to the administrative authorities are the primary perpetrators of south and ceasefire groups to the north. Over 13,000 violence and abuse against civilians. civilians are estimated to have been displaced from their homes in this area during the past 12 months. Despite the severity of threats to personal safety and security, the prevalence of threats to livelihoods is more TBBC has previously reported that more than 3,200 settle- significant. Restrictions on civilian movement to fields and ments were destroyed, forcibly relocated or otherwise markets have increased markedly during the past two 1 TBBC, Internal Displacement and International Law in Eastern Burma, years. The survey findings indicate that this is now the

THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE 2008, www.tbbc.org. most pervasive human rights abuse, followed by forced

HUMANITARIAN 30 exchange THE CYCLONE NARGIS RESPONSE IN MYANMAR 31 23% eviction 15% umber 41 • December 2008 umber 41 • December N 15% 10% insurgency strategy, which deliberately targets civilians targets which deliberately strategy, insurgency and deprivation. impoverishment through to quantify been utilised Assessments of malnutrition have In 2007, acute malnutrition was the extent of vulnerability. detected amongst 9.5% of internally displaced children, according on a serious public health problem which borders This compares standards. Health Organisation World to which indicate poorly to the latest national baseline figures, 14% 13% 17% taxation of food items housing or forced 2005 2007 2005 2007 Military attack or beatings Torture or detention arrest Arbitary portering Forced 16% xtortion or arbitary labour Forced restrictions Travel Destruction or theft of Destruction E

5 0 5 0

15 10 15 10 40 35 30 25 20 25 20

% Households % % Households % igure 2: Threats to livelihoods (2005–07) 2: Threats igure igure 1: Threats to safety and security to safety 1: Threats (2005–07) igure F F labour and extortion or arbitrary taxation. The proportionlabour and extortion taxation. or arbitrary these patterns of abuse was of households affected by sites, and relocation areas administration highest in mixed conditions associated of the oppressive which is indicative to the Burmese army. with living in close proximity the destruction or confiscation of food Conversely, eviction from, or forced supplies and the destruction of, villagers hiding in the most housing primarily targeted counter- the government’s This reflects contested areas. HE41 crc 18/12/08 3:46 pm Page 31 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 32

that 7.4% of children are acutely malnourished. Given that a third of children are chronically malnourished nationwide, it can be speculated that close to half the children in internally displaced communities suffer from stunting.

In terms of coping strategies, the significance of traders and other civilians as a source of early warning about approaching troop movements appears to have decreased during the past few years. Civilians have become more dependent on their own village

security guards as a result of ©Brennon Jones/IRIN increased restrictions on movement weakening broader economic and social networks. However, accessing loans and aid from neighbours remain key mechanisms for coping with A Burmese refugee family at the Mai La camp on the Thai border shocks to livelihoods. This highlights the continued importance of social capital within and between local communities for the acts such as murder, enslavement, forcible transfer of development of a protective environment. population, torture and rape when related to a state policy. This definition reflects customary international law Humanitarian action and the Responsibility binding on all states, including Burma. to Protect Despite concessions made in the Irrawaddy Delta after Sceptics argue that raising allegations about crimes Cyclone Nargis, the junta’s restrictions on humanitarian against humanity will merely frustrate the promotion of access continue to obstruct aid workers elsewhere in Burma, political dialogue. However, just as the provision of particularly in conflict-affected areas. Indeed, the junta humanitarian assistance should not be dependent upon categorically ‘rejects the assertion of the presence of a large political reform, humanitarian protection and the number of internally displaced persons’ in eastern Burma.2 administration of justice should not be sacrificed to The large scale of displacement and the obstruction of relief expedite political dialogue. The reality is that ‘the efforts are indicative of ongoing violations of human rights authorities have consistently refused to enter into a and humanitarian law in eastern Burma. serious discussion of these abuses with a view to putting a stop to them’.4 The threat of prosecution may actually Agencies based inside the country can reach more stable increase the leverage of the diplomatic community and areas, including some internally displaced communities in provide an incentive for the governing regime to end the government-controlled relocation sites and ethnic ceasefire climate of impunity. zones, but the scale of this assistance remains limited. Cross-border aid is vital in order to access and assist the Given the impunity with which violations have been most vulnerable communities. In 2007, approximately $7 committed, and the Burmese junta’s failure to implement million was channelled into cross-border initiatives recommendations formulated by relevant United Nations’ supporting livelihoods, health care, education, human bodies,5 the responsibility to protect shifts to the inter- rights, environmental protection, independent media and national community. The challenge remaining for the community rehabilitation. international community is to operationalise this responsi- bility in Burma and hold the junta to account. The evidence cited in TBBC’s latest report appears to strengthen ’s assessment that the The Thailand Burma Border Consortium (www.tbbc.org) is violations in eastern Burma meet the legal threshold to an alliance of 11 international NGOs providing food, shelter constitute crimes against humanity.3 International law and non-food items to refugees and displaced people from recognises crimes against humanity as acts committed as Burma. The Displacement Research team can be emailed part of a widespread or systematic attack against any at: [email protected]. civilian population. Attacks on civilians refer not only to 4 International Committee of the Red Cross, Press Release: ICRC military assaults but also to the multiple commission of Denounces Major and Repeated Violations of International 2 U Nyunt Maung Shein, Myanmar Permanent Representative to Humanitarian Law, Yangon/Geneva, 29 June 2007. Geneva, UN Human Rights Council, 27 September 2007. 5 Paulo Sergio Pinheiro, Report of the Special Rapporteur on the 3 Amnesty International, Crimes Against Humanity in Eastern Burma, Situation of Human Rights in Myanmar, UN Human Rights Council, ASA 16/011/2008, 5 June 2008. A/HRC/7/18, 7 March 2008, para. 89. THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE

HUMANITARIAN 32 exchange THE CYCLONE NARGIS RESPONSE IN MYANMAR 33 , a newspaper issued umber 41 • December 2008 umber 41 • December N New Light of Myanmar eturning to their native villages eturning to their native mines are allegedly used by the mines are army to dissuade people from r after a forced eviction during campaigns counter-insurgency the , reported 107 people killed or injured landmines, all of them civilian. Most incidents occurred

ported seeing some indicators of mine danger, such as such ported some indicators of mine danger, seeing Some Karen villages in Pa-an District have had to move District have in Pa-an villages Some Karen settlement was burned times after each previous three able to identify villagers were and mined. In those areas, types of mine. Out of 30 heads of households six different all male, could state only five, assembled for interview, though the entire even that they knew the danger areas, and for foraging visited mined areas village regularly warned that all 2002, villagers were farming. In mid-March mined to prevent were the motor road paths except attacking a military base within the town. from insurgents In 2007, the combatants, but also their own troops, civilians and troops, own but also their combatants, animals. Interview that more with mine survivors reveal Army mine Liberation National Karen than 40% of the lifting or self-inflicted (while laying, casualties were stepping on combatants’ mines or those of their own takes place areas Some marking of mined comrades). also Survivors mine incident have of a within the country. re partsdead bodies and Although of mines and wires. to the International stated repeatedly combatants have (ICBL)Campaign to Ban Landmines and others that they warnings’ ‘verbal give which to civilians living near areas they mine, no civilian mine survivor interviewed the by ICBL has mentioned or reported such warnings. the of civilian activity by laid close to areas Mines are the army to allegedly used by Mines are Burmese army. villages after to their native returning dissuade people from campaigns. eviction during counter-insurgency a forced than that more Interview survivors with mine show records of a of the centre within half a kilometre injured 14% are village, while 63% of civilian survivors had been to the area they stepped on mines. An NGO worker before frequently with public health who visited villages in Hpa-an District pointed out to him were officials stated that mined areas the villages visited. walk of all within a five-minute by for food, while to forage forests when people entered to neighbouring villages or hunting or during travel plots. agricultural by have suffered have 1 Impact of Landmines Hillsides around the Lawpita Hillsides around 2 , 25 September 2002, KHRG #2002-U5. See , Nonviolence International. This data has been , Nonviolence International. , 7 September 2002, KHRG #2002-U4; and Consolidation of Control: The SPDC and the DKBA in Pa’an Consolidation of Control: enni State has experienced heavy use of landmines by enni State r bels and Burmese army units, both of whom maintain yawaddi and areas in the Dooplaya District of Karen in the Dooplaya District yawaddi and areas Operation Than L’Yet: Forced Displacement, Massacres and Forced Displacement, Massacres Forced Than L’Yet: Operation eshua Moser-Puangsuwan, International Campaign to Ban Landmines Campaign International eshua Moser-Puangsuwan, tate bordering Thailand. tate bordering ayah/Karen, Kayin/Karenni, Tanintharyi/Tenasserim, Kayin/Karenni, ayah/Karen, angon/Rangoon, Ayeyaraddy/Irrawaddy and Rakhine/Arakan. Ayeyaraddy/Irrawaddy angon/Rangoon, ersial dam on the Salween river opposite Mae Hong Son river ersial dam on the Salween Anti-personnel landmines in Myanmar: a cause of displacement of displacement cause a Anti-personnel landmines in Myanmar: return obstacle to and an Y in Burma 2002 interviews direct collected through with 192 landmine victims from 1999–2002. Nonviolence International between Burma by 1 Shortly after seizing power, the military junta renamed the country, the the military junta renamed 1 Shortly after seizing power, and governments Divisions and cities. Several as some States, as well the name do not recognise organisations many non-governmental (junta/former): Bago/Pegu, They are the junta. changes applied by K Y 2 Labor in Dooplaya District also District hydroelectric power station in central Karenni State have State Karenni station in central power hydroelectric the station from minefields to secure by been surrounded Mountain in central Yadana The groups. rebel sabotage by Ka re gem mines on the mountain. forces both government Anti-personnel mines planted by and kill not only enemy injure and ethnic armed groups Mines have been laid extensively in eastern Bago Division, been laid extensively Mines have near areas range, as the Dawana mountain as well M S The scale of the problem Mine warfare has taken place in Myanmar for more than two for more in Myanmar has taken place Mine warfare both the formal used by mines are decades. Anti-personnel Council and Development Peace of the State military forces opposing the junta. Landmine (SPDC) armed groups and by anti-personnel mine contamin- Monitor has documented and Divisions, mostly 14 States ation in ten of the country’s maintain groups opposition armed where areas in border of and the eastern areas States and Kayah their bases. Kayin Divisions (Tenasserim) Tanintharyi Bago and the most contamination by anti-personnel mines, and it is no anti-personnel by the most contamination of the majority also the source are surprise that these areas Thai side of the border. in camps on the living of the refugees no humanitarian demining are As of mid-2008, there country. within the programmes contamination will Official indicators of the impact landmine are or resettlement on any post-conflict development have the Myanmar from cause for deep concern. A mission for sites proposed Ministry of Home Affairs sent to inspect that the with the news returned development area border clearance with landmines and extensive was saturated area The plans were would be needed prior to any development. to work on a contro- hired Thai contractors quietly shelved. v moving from prohibited Thailand reportedly were in province due to mine infestation, and an border the equipment across was authority power state-owned Thailand’s of employee site. dam while inspecting a future a landmine killed by HE41 crc 18/12/08 3:46 pm Page 33 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 34

Mined areas and the return of refugees and why some people have chosen to remain internally the internally displaced displaced rather than go into refuge in a neighbouring Eventually conditions will be such that the armed conflict country. Although they may know where the mines are will end. To enable the safe return to their home areas of near their current location, they will leave that location up to three million displaced people, some activities and most likely will leave no mark of where the mines are. should be done now, or prepared for. There will be many casualties, and they will swiftly overwhelm the paltry health services currently available in First, prior to any future resettlement programme, all those areas. When this tragedy occurs, word of it will concerned organisations must lobby and demand that all probably halt any movement by people in refugee combatants within the country unambiguously mark all settlements in neighbouring countries. mined areas under their control. A condition of future ceasefires must be the surrender of maps of mined areas. Without this, movement by advance teams, let eventually conditions will be alone returnees, will be extreme risky. Marking of mined areas should be achieved prior to the date of such that the armed conflict commencement of any cessation of hostilities pact will end between the SPDC and ethnic armed organisations, which includes or allows for the relocation of internally displaced persons or refugees. It may be that the combatants have moved us past the point Second, once a cessation of hostilities agreement is in of avoiding this catastrophe. However, it can be minimised place, verification teams, preferably under the supervision by concerted action, and it is not too late for the United of the United Nations Mine Action Service, should Nations Country Team to develop contingency plans for commence the mapping and planned removal of all mines this foreseeable event. Relentless insistence that all areas which will directly affect the lives of returnees. Roadways, be marked, in a similar and unambiguous way, by all relocation villages and areas for schools, markets and combatants and those non-combatants with knowledge of religious buildings should be mine-free, as these will be mined areas of the country, must begin now. This will have key areas of activity and congregation by returned both a preventative and an awareness-raising effect. If displaced people and refugees. Prior to movement, a emphasised, in the same way by all concerned actors, it programme which educates refugees on the marking of would help reduce to the lowest possible level the number mine dangers must take place so that the marking method of casualties, while simultaneously making it more likely is recognised and the danger understood. that a system to care for the casualties is better suited to respond. Third, movement should only take place to designated mine- free areas, or areas where mines are clearly marked and Yeshua Moser-Puangsuwan is a researcher and editor for fenced off. All authorities in charge of movement should be the International Campaign to Ban Landmines’ annual briefed on this, and updated. No changes in the destination report, Landmine Monitor (see http://www.icbl.org/lm). of returnees should be made without consultation with He has co-authored the ICBL’s annual report on Myanmar those in charge of marking and clearance. since 1999. Information in this article comes from country reports on Myanmar between 1999 and 2007. Fourth, within mine-affected communities a programme of Mine Risk Education should continue until the mined area References and further reading is reduced to the point of no longer causing casualties. Focus after return should be on school children, though Chutimas Suksai, ‘Participatory Research on Sources of the community as a whole must be involved in order to Insecurity in Gho Kay Village, Karen Liberated Area’, in understand the localised activities which put people at Whose Security Counts?: Participatory Research on risk of mine victimisation. Armed Violence and Human Insecurity in Southeast Asia, Small Arms Survey, Geneva, 2002. To achieve these aims, humanitarian mine action organisations need to be involved within the country, Karen Human Rights Group reports, www.khrg.org. which the authorities currently have not authorised. Internal Displacement: Global Overview of Trends and Developments (Annual), Internal Displacement Monitor- Reality check ing Centre, www.internal-displacement.org. The sketch above sounds nice and orderly, but the reality is that thousands, if not hundreds of thousands, of Internal Displacement in Eastern Burma (Annual internally displaced people are going to return to their Surveys), Thailand Burma Border Consortium, www. home areas as soon as they think it may be safe to do so. tbbc.org. Many formerly inhabited areas are now ‘ownership free’ Landmine Monitor Report, International Campaign to due to the long armed conflict, and people will hurry back Ban Landmines, www.icbl.org/lm. in order to obtain the best lands. This is one of the reasons THE CYCLONE NARGIS RESPONSE IN MYANMAR NARGIS THE CYCLONE

HUMANITARIAN 34 exchange PRACTICE AND POLICY NOTES 35 2 + . , OCHA DRC, July 2008. severe food insecurity severe umber 41 • December 2008 umber 41 • December N † Comprehensive Food Security and Vulnerability Security and Food Comprehensive + ; Global Acute % of households in Malnutrition erall, experiencing similarly high levels of child mortality, high levels experiencing similarly erall, fugees, however, the boundaries of humani-tarian action fugees, however, ith the end of the war in many partsith the end of the war of the country and the Population Movements in Eastern DR Congo Population Movements Mortality of Congo Republic in the Democratic eturn of many internally displaced people (IDPs)eturn of many internally displaced and esponse is required. During the large-scale wars in the During the large-scale esponse is required. than the Sub- times higher five ebel-held territory nearly have become more difficult to draw. become more have 1 – that North Kivu, Table in – shown is evidence In fact, there is not, armed conflict has occurred, most of the recent where ov other partsmalnutrition and food insecurity as the of armed not been affected by that have Provinces country. levels far higher recorded have conflict for a number of years 2004 and between to the IRCof need. According survey, 2007 mortality 2.9/1,000/month to 2.6/ fell from rates (North Kivu, South 1,000/month in the eastern provinces Kivu, Oriental, Maniema and Northern while in Katanga), parts levels had been no conflict, there the country where of the same. of mortality roughly slightly or stayed either rose r was a straight- there 1996 and 2003, country between conflict and risk to armed between correlation forward period example, during the For human life and livelihoods. 1999–2001, the IRC survey found crude mortality in rates r a humanitarian This classic definition of average. Saharan war) served human suffering caused by crisis (i.e. death and cue to orient the effortsas a straightforward of aid agencies. W r re There are a number of caveats to this data. For example, to this data. For a number of caveats are There as a whole, while concern provinces presented the results 3 2 ** , , OCHA DRC, July 2008; **Percentage of children who die before their fifth birthday. Source: their fifth birthday. who die before of children , OCHA DRC, **Percentage July 2008; , Macro International, August 2008; †Percentage of children whose weight-for-height falls below whose weight-for-height of children International, August 2008; †Percentage , Macro Demographic and Health Survey of the DRCDemographic 2007 * ollowing the signing of peace the signing ollowing F 1 1% 17.9% 7.8% 6.0% (July 2008) 0%7%0%0%> 0%0% 21.9%0% 18.6%0% 18.5%0% 14.8%16% 15.8% 6.6% 15.4% 9.3% 10.2% 9.3% 15.4% 14.6% 16.8% 10.2% 13.7% 11.0% 12.2% 12.0% 10.6% 7.0% 6.7% 7.0% 10.1% 7.7% 6.0% 1.0% n/a 6.0% 2.0% 5.0% Population Movements in Eastern DR Congo Population Movements ince % of population displaced Child mortality ov PRACTICE AND AND PRACTICE POLICY NOTES argeting humanitarian assistance humanitarian argeting DRC in post-conflict asai Oriental asai Occidental atanga able 1: Provincial data on displacement, child mortality, and food insecurity malnutrition able 1: Provincial Mortality of Congo: An Ongoing Crisis Republic in the Democratic Pr Maniema South Kivu Bas-Congo K Orientale K K Kinshasa Bandundu Equateur North Kivu T Lilly and Alex BertramDamian T Notes: * 1 Committee, January 2008. International Rescue Where are the needs? are Where crisis in DRCWhile the existence of a humanitarian is not the need is where over disputed, debate is growing what kind of what is causing this need and greatest, The Democratic Republic of Congo (DRC) is often character- Republic The Democratic most – if not the most – neglected ised as one of the The often-cited Inter- in the world. humanitarian crises Committee (IRC)national Rescue mortality survey – August 1998 estimates that, between updated in 2008 – conflict and state collapse led to 5.4 and April 2007, armed deaths. million excess accords in 2003, a gradual shift from humanitarian relief to humanitarian relief shift from in 2003, a gradual accords of The resumption has occurred. post-conflict recovery to General loyal forces between armed conflict in 2007 in the (FARDC) Nkunda and the Congolese army Laurent of North Kivu, a conflict which escalated in province the has revealed October 2008 to international attention, the country With process. state of the transition fragile humanitarian war and peace, targeting stuck between While the difficult. assistance has become increasingly engaged in the humanitarian community has been actively North adequately the crisis, it has failed to address Kivu where humanitarian crisis in other parts of the country, to refused mortality and other indicators have levels end of conflict in these areas. despite the improve of funding have Humanitarian planning and the allocation systematic, This article for a more argues become skewed. action in DRC. to humanitarian approach data-driven Demographic and Health Survey of the DRCDemographic 2007 two standard deviations (Z-scores). Source: Source: deviations (Z-scores). two standard Analysis, WFP, July 2007 and February 2008. July 2007 and February WFP, Analysis, HE41 crc 18/12/08 3:46 pm Page 35 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 36

humanitarian action in North Kivu is predominately focused on the more than one million IDPs in the province who have been severely affected by the loss of livelihoods and could be in a worse position than the provincial average. Some of the data also predates some (but certainly not all) of the worst insecurity in North Kivu. Nevertheless, the data does seem to show that there is no obvious corre- lation between war-affected areas and humanitarian needs.

This is not to argue that humanitarian aid to eastern DRC is somehow misdirected. Far from it. Although there ©Damien Lilly is not sufficient data available, it would be reasonable to hypothesise that the massive response of the humanitarian community in North Kivu and other A destroyed school in Ituri, DRC places in the east has had a significant impact in addressing humanitarian need and has caused a reduction in human suffering and assisted. Taking a longer-term view though, and as Table 1 loss of life. What is of concern, however, is that many parts of again shows, many provinces are still experiencing DRC, where there is no armed conflict, are still experiencing significant humanitarian needs despite the fact that they levels of vulnerability that exceed emergency thresholds. In contain no IDPs. Furthermore, multisectoral assessments provinces such as Maniema, Katanga, Kasai Oriental and being undertaken by the UNICEF Programme of Expanded Kasai Occidental, for example, global acute malnutrition Assistance for Returnees (PEAR) in eastern DRC have shown rates still often surpass 10%, a widely accepted threshold for that, even a long time after IDPs have returned home, they humanitarian action. The Water and Sanitation Cluster has can still experience significant humanitarian problems, in found that 70% of all recorded cholera cases in DRC in recent some cases, beyond emergency thresholds.4 An analysis of years have occurred in Katanga, again a province that has the data collected has shown that the recentness of return not experienced major armed conflict since 2005. Katanga is not a very good predictor of vulnerability. That is to say, also probably has the largest concentration of mining IDPs that have returned home as long ago as a year are activities to exploit DRC’s copious natural resources, and is often as vulnerable as those that have come back more thought to be a relative economic success. Yet in early 2008 recently. Contextual factors, rather than the process of it suffered its worst cholera epidemic in years (even in large displacement and return itself, are probably more important towns such as Lubumbashi), killing hundreds of people. The in explaining humanitarian needs. Governor of the province has reportedly commented, albeit facetiously, that he would be well advised to organise a war Is a humanitarian response warranted? in order to secure humanitarian aid. It could be argued that, although the situation is clearly bad outside conflict-affected eastern DRC, it falls outside of the remit of humanitarian crises and therefore an the data seems to show that emergency response is not appropriate. The absence of there is no obvious correlation basic social services across the DRC is the best explan- ation of the deplorable situation of much of the between war-affected areas and population. State collapse over decades has decimated humanitarian needs the health structure, education system and water infra- structure. The wars in DRC between 1996 and 2003, and the insecurity that persists today, are but one part of the A similar conclusion can be drawn in terms of the impact of country’s downward trajectory, which started decades ago displacement on humanitarian need. According to the as a result of the catastrophic mismanagement of the Office for the Coordination of Humanitarian Affairs (OCHA) country under President Mobutu Sese Seko after there are, as of June 2008, 1.3m IDPs in the DRC.3 Clearly, independence in the 1960s. At the current growth rate, it is displacement renders populations more vulnerable and estimated that it will take until 2060 for the country to makes them key candidates for a humanitarian response. reach the level of GDP per capita it had in 1960.5 It would be difficult to argue that displacement does not 4 Quarterly Analytical Report: Humanitarian Situation in IDP Return cause humanitarian need on a large scale, at least in the Areas, January–March 2008, Programme of Expanded Assistance to acute phase as people are displaced and before they are returnees (PEAR), UNICEF. 3 Population Movements in Eastern DR Congo, OCHA DRC, July 2008.

PRACTICE AND PRACTICE POLICY NOTES 5 UN Country Assistance Feamework, DR Congo 1997.

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If state collapse is the real issue, then obviously more long- health, an infant mortality level of two deaths per 10,000 term developmental responses that address the structural – children per day meant that a remedial programme would rather than proximate – causes of the problem are required. be considered, regardless of where in the country this While this may be desirable, and is argued for by many humanitarian need may have been recorded. While the humanitarian actors and donors, there is little evidence that lack of available data is likely to skew such decisions, this the development aid that is flowing into the DRC is having a was at least an important effort to better direct assistance. significant impact on humanitarian needs in many parts of In addition, the two strategies for displacement and return the country. It is unlikely that the Congolese government, in the previous year’s HAP were expanded to five cross- even with donor support, will be in a position to respond sector strategies, which were not restricted necessarily to effectively for a very long time. Long-term, structural areas affected by conflict and displacement. assistance is essential to the country’s future, but its progress has to be measured in decades. In the meantime, As part of this new approach, geographical areas were there is a clear need for humanitarian action in the face of given a ranking according to key criteria, thereby wide-scale, immediate threats to human life. Even though decoupling the proxy causes of conflict and displacement they may only be able to provide temporary solutions to by introducing objective means of measuring humani- what are long-term problems, humanitarian actors should tarian need. However, the majority of humanitarian action retain their funding and mandate to respond to the terrible as defined in the 2008 HAP continued to be directed to the situation that many Congolese find themselves in. Many east the country, where there has been strong political humanitarian donors do not like the idea that their money pressure to support efforts to bring about peace in the may be paying for development, but this is an unavoidable region, particularly in North Kivu, where most humani- necessity. That total humanitarian funding for the DRC rose tarian action is still focused. While UN agencies, as part of from $137m in 2002 to $497m in 2007 would seem to the Integrated Mission of MONUC, have experienced this suggest that donors tacitly accept this. pressure in more explicit terms, NGOs face equally strong incentives from donors, the media and their own What does this mean for humanitarian headquarters to play a visible role in an increasingly planning? visible conflict. The planning of humanitarian programmes increasingly reflects this complex picture of what might be considered a humanitarian crisis in the DRC. The evolution of the NGOs face strong incentives to Humanitarian Action Plan (HAP) – the main strategic play a visible role in an framework for aid agencies in DRC – illustrates how

conceptions of the humanitarian crisis have changed over increasingly visible conflict NOTES POLICY PRACTICE AND time. The HAP in 2007 (as with the previous year) was framed around two key strategies: a) emergency response to crisis; and b) support to a return to self-sufficiency, i.e. Although still in draft form at the time of writing, the 2009 aimed at differentiating between the acute needs of IDPs HAP has retained the approach of thresholds and cross- and the reintegration needs of IDP returnees. The Mid- sector strategies. The assessment undertaken in preparation Term Review of the 2007 HAP, though, drew attention to for the 2009 HAP shows more clearly the dispersed nature of the protracted nature of the humanitarian crises in the the humanitarian crisis in DRC. One of the joint strategies DRC and the fact that they were not always located in also now focuses more explicitly on ‘early recovery’, areas affected by armed conflict. A strong push was made recognising that more long-term approaches are necessary to redirect humanitarian assistance to the west of the to address the many humanitarian problems in DRC. country. However, there are very few agencies in many of the western provinces and, despite funding being made Where is humanitarian financing being available, projects have not always been forthcoming. channelled? Despite these laudable initiatives within the HAP and This year, the data collected allow us to show that all of elsewhere to ensure the objective targeting of humanitarian the provinces have been affected by humanitarian crises. action in DRC, these efforts have not arguably affected The humanitarian map of the DRC has been sensibly decisions about how humanitarian financing is being corrected and the differentiation between east and west channelled. The Pooled Fund – with contributions from a no longer systematic. Our partners will be brought to range of donors – is the largest source of humanitarian reconsider their current deployment in the country in funding in DRC, providing more than $100m per year. The order to give themselves a greater mobility and allocation of Pooled Fund money is directly linked to the adequately access vulnerable populations. humanitarian needs identified in the HAP, and decisions about where money is spent are primarily decided within Ross Mountain, Humanitarian Coordinator, HAP 2008 the Clusters. In this way, humanitarian strategy and financing are inextricably linked. This is a very positive development and should theoretically be leading to better The HAP for 2008 went further by incorporating the notion targeting. However, as Table 2 shows, funds do not always of sector ‘thresholds’, beyond which a humanitarian seem to be channelled to the provinces with the greatest response should be launched. For example, in the area of amount of measurable humanitarian need.

Number 41 • December 2008 37 HE41 crc18/12/083:46pmPage38 38 PRACTICE AND POLICY NOTES continue tofocusontheeast. developing intheseareas, interventions andinstead we available from thePooledFund toaddress needsinthe that itisbetterdirected. While moneyisfrequently made isincreasingfinancing toDRC year by year, itisimportant ofthecountry.parts Atatimewhenhumanitarian noticeable impactonthehumanitariansituationinmany stated earlier, development aidisnotyet havinga provinces notexperiencingclassichumanitariancrisis.As not takeintoaccountdevelopment assistancetargeting at humanitarianfinancingfrom thePooledFund anddoes examples existforfoodsecurity. This analysisonlylooks Occidental received lessthan60centsperhead.Similar malnourished child,thenutritionclusterinKasai Kivunutritionclusterwasallocatedroughly $12per North Kivu,yet whilethe more thantwicethenumberinNorth than 170,000children sufferingfrom acutemalnutrition– foundmore survey Occidental, forexample,the2007DHS and foodsecurityshown by relevant InKasai surveys. humanitarian assistance,oftentargeting thesameareas. As approaches: development ontheonehand,butalso post-conflict transition mustincludeamixof inDRC least asbadtheeastofcountry, ifnotworse. The displacement are stillexperiencinghumanitarianneeds at ofthecountrynotaffectedby armedconflictand many parts assistance. According toobjective humanitarianindicators, do notalwaysspelltheendofneedforhumanitarian theendofconflictanddisplacement In thecontextofDRC, Conclusion by disparity between theamountsofmoneybeingallocated At leastfornutritionandfoodsecurity, there isalarge T Kinshasa Occidental K Bas-Congo South Kivu K Maniema K Equateur Orientale Bandundu Kivu North able 2:Provincial Pooled Fund allocationsfornutrition andfoodsecurity asai asai Oriental atanga

HUMANITARIAN stern andsouthernprovinces, agenciesare not the PooledFund andthelevel ofrecorded malnutrition exchange P p()Aueymlorse Poe udalcto, eeeyfo-neue Pooled Fund allocation, Severely food-insecure Pooled Fund allocation, Acutelymalnourished op (m) . 0618000–nana0– 0 – 0.49 n/a 142,000 0 n/a 292,000 2.96 0.61 7 399,000 – 1,530,000 21.47 6 8.27 207,000 517,000 – 7.62 338,000 12 0.84 1,245,000 0 0.59 7 58,000 1,183,000 36.11 2,172,000 143,000 0 4.1.4 1 381,000 285,000 118,000 2 102,000 5.16 2,889,000 454,000 6 10.6 80,000 172,000 677,000 6 52,000 0.95 13.7 5.6 4.64 5 9.3 164,000 1,198,000 4.93 9.3 6.3 232,000 12.72 226,000 14.6 2.8 768,000 12.29 237,000 8.8 676,000 166,000 12.2 8.0 1,181,000 137,000 10.1 1,001,000 93,000 7.8 9.7 81,000 6.7 8.2 7.7 8.8 6.9 5.3 . . 200150064 11100088000.77 818,000 1,100,000 11 6.49 145,000 22,000 6.6 1.7 hlrn(H,20)NtiinCutr 08hueod WP 07 F households(WFP, 2007) NutritionCluster, 2008 children 2007) (DHS, G M()Ttl oa U$ e %TtlTtl(S)Per food- Total (US$) Total % Per Total (US$) Total AM (%) anuihdinsecure malnourished expressed donotnecessarilyrepresent thoseoftheUN. been writteninapersonalcapacityandtheviews Nations Children’s has inDRC. This article Fund (UNICEF) Damian Lilly thisapproach. support assistance isbeingtargeted, usingalltheavailable datato translates intodecisionsaboutwhere fundingand planning, more needstobedoneensure thatthis implicit acceptanceofthisintermshumanitarian Although there isan major lossoflifeistobeaverted. humanitariancrises,ifthecontinued experiencing ‘classic’ to continuetargeting humanitarianassistanceinareas not hasargued, therethis article isahumanitarianimperative hl $ family(US$) child ($) E ID HumanitarianSituationin AnalyticalReport: Quarterly ment Comprehensive Food Securityand Vulnerability Assess- 2008. Ongoing Crisis intheDemocratic Republic ofCongo: An Mortality August 2008. Macro International,MinistriesofHealthandPlanning, 2007 Demographic oftheDRC andHealthSurvey Humanitarian Action to Need?NeedsAssessmentandDecision-Makingin James Darcy andCharlesAntoine-Hofmann, R xpanded Assistance to Returnees (PEAR), UNICEF.xpanded AssistancetoReturnees (PEAR), eferences and further reading eferences andfurther PR , , 2008. eturn Areas, January–March 2008 and , InternationalRescue Committee,January A lex Bertram , HPG Report 15,September2003. , HPGReport ood Security Cluster, 2008 work fortheUnited , Programme of According , PRACTICE AND POLICY NOTES 39 umber 41 • December 2008 umber 41 • December N RCAT/Eufor. RCAT/Eufor. umanitarian space umanitarian equires ‘humanitarian space’ ‘humanitarian equires humanitarian workers to allow INU ithin the wider humanitarian community, there was little there ithin the wider humanitarian community, ench Ministry of Foreign Affairs declared that the Affairs declared ench Ministry of Foreign space’ of respect other things, on the level depends, among H of victims within a crisis situation The efficient protection r its use aid and control needs, deliver to be able to assess humanitarian principles of the fundamental while respecting The extent of such and independence. neutrality impartiality, ‘ on the security to international humanitarian law and given if risk- Meanwhile, even to humanitarian workers. provided parttaking is an inevitable of humanitarian work, physical a worker is considered against a humanitarian aggression of In the event humanitarian law. violation of international concerned to it is up to the organisation such aggression, – or is considered consider whether the violence experienced in the ‘space’not – as a vital decrease necessary to carry out their operations. esponse of the humanitarian community in Chad is more esume operations in the Dar Sila district by October 2008. October the Dar Sila district by in esume operations meetings at coordination commemorations eaction beyond The local authorities launched an official investigation into The local authorities launched an official investigation This is not result. the attack, but so far with no concrete attacks unusual: it seems that none of the numerous of any against humanitarian workers has led to the arrest been suspects and no detailed official statements have the authorities concerning (supposedly) by put forward the French by ongoing enquiries. An investigation so far. no official result authorities has also produced the less than 24 hours after the killing of Pascal, However, Fr incident was most likely due to ‘carjackers’. its nutrition activities in Abéché and, pending funding, its nutrition activities in Abéché and, r SCUK that declared of November at the beginning However, to pull out of Chad completely. had decided the organisation W r Appeal Process and the dedication of the 2008 Consolidated A two-day suspension of non-lifesaving memory. to Pascal’s There a weekend. work had little impact as it coincided with consolidated protest. been no concrete, seems to have security for taken to improve Some steps were The number of UNhumanitarian workers. flights was started and Eufor increased, to communicate their patrol basis. Meanwhile, security on a regular itineraries within the humanitarian community continued coordination NGOs, UN meetings involving regular through agencies and M The limits of the humanitarian community in Chad of the national authorities and their The reaction international counterparts the was not surprising given The muted at stake. political and economic interests r killed and 107 security incidents involving esident Idriss Deby to members of his own clan, the to members of his own esident Idriss Deby

Pr re (at least officially) unknown assailants while travelling in travelling assailants while unknown (at least officially)

eactions to the killing of Pascal Marlinge eactions to the killing of Pascal ascal, Ramadan Djom, a driver of Chadian nationality Djom, a driver ascal, Ramadan ehicles in Abéché, the main town in Eastern Chad. ehicles in Abéché, the main town Does in Chad? exist space humanitarian Helle Garro an unarmed UN/NGO Sudanese border. close to the convoy ongoing, and to date the reason are Police investigations expect the Few unclear. remains was murdered why Pascal This is to become known. ever the killing truth surrounding conflicts deep ethnic marked by not surprising in a society a competent state-based independent and the absence of disputes and judge criminals. to resolve legal structure among the though, is the reluctance What is surprising, in Chad to present organisations humanitarian numerous on assassination and put pressure openly denounce the for the conditions donors and political actors to improve This articlehumanitarian interventions in Chad. explores a field point of view. as seen from for this, the reasons R death, SCUK temporarily In the hours after Pascal’s in Chad. A couple of days later, suspended all its operations to the Chadian Prime a formal complaint was presented an internal following months later, Two Minister. officially decided to continue the organisation investigation, The context in Eastern Chad began with an The humanitarian emergency of the escalating as a result influx of Sudanese refugees has grown, crisis in Darfur in 2003–2004. As the emergency interventionso the scale of the international humanitarian humanitarian 2006 and 2007, Between has increased. million to $187 funding for Chad almost doubled, from also in Chad has The international military presence $313m. of a UNintroduction with the increased MINURCAT, force, the former France, and an EU as Eufor. known contingent presence. military its own also maintains colonial power, unstable. It is very The political situation in the country is is granted favouritism that extensive widely acknowledged by less than 5% of the Zaghawas, a minority representing in February was nearly toppled The President population. Sudan with along the border groups 2008, and rebel The Chadian continue to mount attacks against the regime. supporting accuses Sudan of movements rebel government on its in Chad. Sudan in turn accuses Chad of backing rebels Humanitarian Meanwhile, banditry has increased. territory. to the UN, According easy targets. between workers are January and September 2008 six humanitarian workers we reported. SCUKhumanitarian staff were has been particularly prior to the killing of exposed: four weeks P working for SCUK, in the same area, was murdered a female attempt. In July, in a car-jacking presumably Cross the International Committee of the Red delegate from was badly wounded during an attack on two ICRC (ICRC) v On 1 May 2008, Pascal Marlinge, head of mission for Save head of mission Marlinge, 2008, Pascal On 1 May UKthe Children (SCUK) and killed Chad, was shot in Eastern by HE41 crc 18/12/08 3:46 pm Page 39 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 40

startling. Why did the murder of Pascal – an active and well-known humanitarian – not lead to con- certed demands for improve- ments in the security environment for humanitarian workers in Chad?

The UN system is, in theory, entitled to put pressure on the local authorities to tackle insecurity. So far, though, the only reaction has been the deployment of the MINURCAT mission. Although costly – $315 million for the period July 2008 to June 2009 – MINURCAT has had little effect, and UN agen- cies have no official political influence in Chad. A report published by Oxfam GB con- cludes that, for the UN to be able to provide security to the Local staff evacuated to Abéché the day after the death of Pascal Marlinge population of Eastern Chad, including for Sudanese refugees, ‘the UN Security Council disapproval and, if necessary, a suspension of non- must give the UN Special Representative of the Secretary lifesaving activities for more than just two days? A couple General in Chad a political mandate to promote and of weeks after the attack on Pascal, MSF Luxembourg develop an inclusive peace process’.1 Clearly, when suspended its operations in Iriba on the border with considering that the omnipresent impunity is deeply Sudan for three months following death threats against its rooted within the current political system, it will take expatriate staff. Why then did other NGOs operating in the serious and dedicated political will, both internally and same area not do the same? externally, to improve the situation. The obvious answer is: concern for beneficiaries. This argument, however, needs to be placed within the context of the difficulties NGOs experience in providing good-quality the reaction of the national relief in Chad. The reasons for this are many: short-term authorities and their financing of projects, high turnover of often inexperienced staff and frequent interruptions due to evacuations. Further- international counterparts was more, it is important to stress the lack of an overall coherent not surprising given the political and coordinated strategy among the various humanitarian and developmental interventions in Chad. Activities and economic interests at stake regularly overlap and the host population is often neglected, despite being as much in need as refugees and IDPs.

It is doubtful, however, that the UN system is sufficiently Another reason for the lack of a concerted reaction from independent to be able to put the required pressure on the NGOs is the impressive diversity that characterises the Chadian regime. Influential UN member states such as the organisations present in Chad. Despite the existence of the and France (both Permanent Members of the ‘Comité de Coordination des Ongs’ (the CCO) – a forum Security Council) may be unwilling to risk their relationship created in 2007 (following the initiative of, among others, with the Chadian government given their oil interests in the Pascal himself) to coordinate information and enable NGOs country and Chad’s geopolitical position. The fact that the to present a joint front to national authorities, donors and US and EU provide the lion’s share of financing for the UN’s UN agencies – it is difficult for NGOs to speak with one operations in Chad may make individual agencies reluctant voice, even on an issue of such pressing and shared to exert pressure on the Chadian government. importance as insecurity. While individual agencies, including Oxfam GB and several French NGOs as well as If the UN is constrained, what of NGOs, who should, ICRC and the MSF sections present in Chad have issued theoretically at least, be in a better position to denounce protests, these isolated efforts do not appear sufficient to impunity? What is holding them back? Why was the change the situation: attacks continue, often by armed immediate reaction following Pascal’s killing limited to a individuals in military uniforms, and impunity persists. timid ‘weekend protest’ rather than a loud outcry of 1 Oxfam, Mission Incomplete: Why Civilians Remain at Risk in Eastern The presence of Eufor is also likely to influence the attitude

PRACTICE AND PRACTICE POLICY NOTES Chad, Briefing Paper 119, September 2008. of NGOs. Organisations may be inclined to confront

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insecurity using a deterrence strategy, relying on the members of the humanitarian community will have the reassurance of Eufor protection, rather than adopting an capacity to coordinate a strong response. acceptance-based approach. This option, however, is obviously not a long-term solution and risks blurring the Is there sufficient humanitarian space line between the civilian and military sphere. While the in Chad? impact of impunity may be alleviated with the Eufor To the extent that no open war is currently preventing presence, it may also have reduced the need felt by NGOs to humanitarian organisations from reaching civilians and formulate a decisive complaint against insecurity. non-combatants in need of assistance, humanitarian space exists in Chad. However, the reality in eastern Chad The limitations of NGOs in Eastern Chad is that the basic principles of impartiality, independence We could of course ask a further question: what is holding and neutrality have become increasingly difficult to NGOs back from denouncing, jointly, the inefficiency of maintain: insecurity is seriously affecting the movements humanitarian relief in Chad? After all, if the (true?) of civilians and humanitarian workers; the majority of beneficiaries are not profiting from efficiently delivered NGOs in Chad show little independence in their relations humanitarian aid, and if the increasing climate of impunity with their donors; and it is becoming increasingly difficult allows anyone with the right ethnic background to loot and for the local population (including bandits, government kill humanitarian workers, then NGOs have a responsibility soldiers and armed rebels) to distinguish between all the to protest. And if verbal denunciation is not sufficient, the various military and civilian actors in the country. option remains of a consolidated and temporary, possibly partial, suspension of humanitarian activities. Such a move Based on these observations, coupled with the fact that would force all actors, including politicians within the many of the humanitarian organisations present in Chad international community, to step back and reconsider how (NGOs as well as UN agencies) have difficulties recruiting to approach the complex emergency in Chad. experienced staff (possibly partly due to the difficult context), there appears to be an urgent need to reconsider the current mode of humanitarian operations in Chad in what is holding NGOs back from order to improve the quality of relief work, and the security surrounding humanitarian workers and their beneficiaries. denouncing the inefficiency of While it is clearly not the job of NGOs to ‘solve’ the political humanitarian relief in Chad? crisis in Chad, it is their responsibility to react when humanitarian workers and beneficiaries become direct targets. This role is particularly important as long as the There are, I believe, two reasons why such moves are rarely UN agencies do not have the necessary mandate to exert

made. The first is that NGOs (perhaps particularly at HQ efficient, outspoken political pressure. NOTES POLICY PRACTICE AND level) tend to underestimate the extent of the mutual dependency between themselves and their donors: just as It is up to each organisation to decide whether humanitarian most NGOs are dependent on their donors for financing, so space is indeed sufficient in Chad today. It is however clear too those same donors need NGOs to carry out relief work in that this ‘space’ is proportional to the violence committed the field. Second, as mentioned above, the diversity among against humanitarian workers and their beneficiaries. If no NGOs clearly makes a coordinated approach very difficult. consistent political determination, nationally and inter- The fundamental concept of independence plays a vital role nationally, is mobilised to combat impunity, then a concerted in the relationship that each NGO has with all stakeholders – response by NGOs is crucial to ensure humanitarian space in including their fellow organisations. Therefore, each NGO Chad in the future. most often speaks with its own voice and according to internal priorities. If furthermore no firm and clear reaction is Helle Garro formerly worked for SCUK in Eastern Chad. given by the NGO directly concerned with the violence (in The opinions expressed here are the responsibility of the this case SCUK), it is even more unlikely that the other author only. Helle’s email address is: [email protected].

Aravanis: voiceless victims of the tsunami Chaman Pincha, gender researcher, and Hari Krishna, Oxfam America

Gender-just and rights-based humanitarian response, in conscious effort to take their existence, vulnerabilities and principle and in practice, should not discriminate between differing needs into account. In the tsunami response in majority and minority populations. However, the history of India, the Aravanis emerged as one such voiceless group. disaster responses worldwide – particularly in the aftermath of the tsunami – shows us that, for certain Gender equality and the Aravanis sections of the population, there is a high risk that their Gender equality posits equality between and among men conditions and needs may be ignored unless there is a and women. This leaves out Aravanis, whose gender

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category cannot be explained using a two-gender housing and livelihood support points to a degree of framework.1 Aravanis may be born inter-sex or apparently gender blindness even among agencies genuinely male, dress in feminine clothes and generally see committed to gender equality and human rights. Many themselves as neither women nor men. They are not men NGOs told us that the Aravanis were not deliberately trying to be women. excluded from relief and rehabilitation assistance; rather, they simply did not register as a marginalised group with Aravanis face serious gender discrimination. Although in particular needs. 2005 Indian passport applications were updated to include three gender options (male, female and eunuch), policies, Hasina’s story laws and institutions exclude Aravanis on the basis of both their sexual and their gender identity. Their absence from Hasina is 22 years old. Although a qualified plumber, she is definitions of gender and gender mainstreaming make this without a job and has been thrown out of the temporary group invisible, except in HIV/AIDS discourse. Although the shelter where she had been living. Lack of privacy and national census does not include Aravanis, unofficial data constricted space, coupled with the strong prejudice against suggests that there are approximately 150,000–200,000 Aravanis, left her on the streets. Living in the open is terri- living in . Since it is considered a stigma to be fying for her. She needs a job badly and does not want to beg born or grow up to become Aravani, most are rejected by any more. While living in the open, she has been raped mainstream social institutions, including their own families. several times, and sometimes gang raped. She believes that Hence, most prefer to join collectives, called Jamat. The a common shelter for Aravanis with basic amenities would systemic rejection of Aravanis pushes them into extreme give them a sense of security and mitigate the trauma she is poverty; they resort to begging, dancing and, in some cases, going through. prostitution. They are highly vulnerable to sexual abuse. Until recently, they were not covered systematically by any welfare schemes in India. Elderly Aravanis are not covered Communities in India are encouraged to live in caste-based by any pension scheme and have to continue begging into settlements. Aravanis feel that a settlement for them on the old age. same lines is essential for their protection and dignity, as well as enhancing their confidence and negotiating power. In Aravanis and the tsunami response a disaster situation it is all the more necessary that an Our field research reveals that five Aravanis died in the extremely vulnerable group like the Aravanis, who are tsunami, with an unknown number missing. These victims victims of mainstream prejudice and stigma, are protected are not recorded in official data. Neither family members from the majority, whose sheer numbers may deprive them nor the Aravani collectives received government of basic entitlements. Yet there has been hardly any research compensation. Survivors suffered injuries to their legs into the vulnerabilities they face. None of the Aravanis we while running for shelter from the tsunami, making them met had ration cards, as the process of applying for the card unable to beg or dance. Although they were treated in was a humiliation to them. Below is a typical set of questions government hospitals, they neither knew of nor were addressed to Aravanis applying for a ration card: provided with compensation for their injuries. Q: Are you a man or a woman? Kalyani’s story A: A man Q: You do not look like one. Kalyani is 40 years old. Married, she was accepted in her A: I am Aravani. spouse’s family, particularly by her mother-in-law, who Q: But you need to fill in this column asking for your sex, never taunted her. However, Kalayani’s spouse and mother- male or female. in-law died in the tsunami. The government compensation A: Then put me down as a woman. due to her on her spouse’s death was taken by her father-in- Q: Can you give birth? law, who also threw her out of the home. Against her A: No. wishes, Kalayani had to move to Mumbai to make a living. Q: Then go away, you are not eligible for something meant either for a man or a woman.

Likewise, losses suffered by Aravanis did not feature in As one focus group complained: damage assessments carried out by the government and NGOs. Aravanis lost dancing costumes, small savings in No one came before to talk about food security, cash, make-up kits, jewels and tools. None figured in the housing and the basic necessities of life. People come list of affected people eligible for post-disaster support to us to talk about HIV/AIDS. Some of you think we are from the government, and did not receive immediate relief obsessed with sex and pollute society. We ate assistance in the form of food, clothes and bedding. Some leftovers thrown away by people living in the Aravanis in Veppanchery were surviving on the charity of temporary shelters during the tsunami. Not that we the local temple four years after the tsunami. The like it … but we know that no one would raise their exclusion of Aravanis from access to temporary shelter, voice for us. 1 Aravanis are also known as Hijras or Jogappa. We avoid the term ‘third gender’ as it implies a hierarchy of gender and raises the There is an urgent need to include Aravanis within the

PRACTICE AND PRACTICE POLICY NOTES question which is the first and which the second. definition of gender and gender mainstreaming so that

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their needs can be effectively addressed. We would argue institutions. Participatory capacity-building workshops that the ‘tyranny of numbers’ often violates the human focusing on ways to integrate their differing needs into rights of those from smaller groups. Coupled with their ongoing programmes could be made an integral part of minority status, the socio-cultural stigma that Aravanis the disaster preparedness agenda. carry with them makes this population extremely vulnerable in both developmental and disaster contexts. To mainstream the gender concerns of Aravanis, strong Gender-just disaster management would see that advocacy and lobbying with policy-makers is needed to Aravanis, the victims of gender discrimination, are helped facilitate access to their entitlements, encompassing both in an equitable manner, in all phases of disaster response. their practical and strategic gender needs. In this context, Sex- and gender-disaggregated data should take them a government order from 2006 safeguarding the interests into account, and their differing needs, capacities and of Aravanis needs to be properly analysed and widely aspirations should be recognised. disseminated, both to stakeholders and to Aravanis themselves. Giving the order practical effect remains a challenging task for all actors concerned. Finally, there is a need for donor agencies to channel funds for the ‘when we pray we always say: empowerment of Aravanis through specific programmes, “Let us be the last Aravanis on ensuring them a life of dignity and an existence free of earth”’ – Padma and Uma, Nagai violence, discrimination and stigma. and Cuddlalore, Tamil Nadu Chaman Pincha is a freelance writer and researcher based in Chennai. Her e-mail address is: pincha.chaman@ gmail.com. Hari Krishna is a Humanitarian Representative, India, with Oxfam America based in Chennai. His e-mail The needs of Aravanis for safe housing, access to address is: [email protected]. citizenship documents, secure livelihoods, including access to credit and training for alternative livelihoods, their inclusion in the job market and recognition of their This article is an edited extract from a research study capacities and of the Jamat as a legitimate body are some entitled Indian Ocean Tsunami Through the Gender of the areas interventions can seek to address. Such Lens: Insights from Tamil Nadu, India, supported by gender-sensitive needs assessment will require a process Oxfam America. The book can be downloaded from of reflection and a conscious effort to tackle entrenched www.beyondboundaries.org. The views presented in biases and gender blindness, constant interaction with this article are those of the researchers, and do not

Aravanis themselves and a deliberate effort to counter the necessarily represent the views of Oxfam. NOTES POLICY PRACTICE AND negative perceptions of Aravanis within mainstream

Including chronic disease care in emergency responses Emily Y. Y. Chan and Egbert Sondorp

Although acute physical injuries are the leading cause of The burden of chronic disease human mortality and morbidity in natural disasters, a Table 1 (page 44) highlights the burden of chronic disease significant proportion of deaths are a result of poor in selected countries frequently affected by natural hygiene and sanitation, inadequate nutrition as well as disasters. The absence or disruption of treatment for insufficient health care services due to the destruction of chronic diseases (like diabetes, high blood pressure, healthcare structures and resources to cope with the mental illness and HIV/AIDS) is not only life-threatening diseases prevalent in the affected area. Whilst the for vulnerable groups, but may also give rise to provision of basic care following disasters usually focuses complications (e.g. diabetes retinopathy, stroke) resulting on the treatment of acute conditions like injuries, in a reduction in quality of life and potentially impaired diarrhoea and respiratory infections, as well as more livelihoods, due to the costs of complication treatments recently on psychosocial and mental health services, the and avoidable deaths. provision of care for chronic diseases is rarely seen as a priority. For the twenty-first century, the aging of most To act or not to act populations around the world, in combination with an Typically, a emergency health response increase of non-communicable, often chronic, diseases, would include treatment for injuries, basic care for common calls for a rethink.1 diseases, surveillance and emergency preparedness for 1 E. Y. Y. Chan and E. Sondorp, ‘Medical Interventions Following Natural disease outbreaks. Management of non-communicable Disasters: Missing Out on Chronic Medical Needs’, Asia Pacific Journal chronic disease is usually left out. There are a number of of Public Health, vol. 19, Special Issue 2007. questions that need to be considered when deciding to

Number 41 • December 2008 43 HE41 crc18/12/083:46pmPage44 44 PRACTICE AND POLICY NOTES * Asprojected in2005**Asprojected in2002 disaster-statistics-50top-countries.pdf. andhttp://www.emdat.be/Database/Trends/trends.html. Centrechronic_disease_report/en/; ofResearch http://www.unisdr.org/disaster-statistics/p onEpidemiologyofDisaster(EMDAT), chronic diseasemanagementasapriorityduring trauma. couldbeperformedfortheir physical interventions surgicalexisting chronic medicalconditionsbefore further neededclinicalmanagementoftheirpre-survivors 2008, frontline medicalteamsfoundthatupto38%of r of theneedtomanagechronic diseasesduringemergency and awareness amongrelief agenciesandhealthworkers key gapatthefieldlevel seemstobethelackofmandate treatments toadoptinemergency settingsare absent. The manage, indicatorsformonitoringorguidelineson guidelines intermsofdecidingwhichconditionsto issue ofchronic medicalconditionmanagement,but disasters. The Sphere MinimumStandards highlightthe management ofchronic medicalconditionsafternatural noguidelinesregardingThere are the virtually Gaps inresponses 2 outlinessomeoftheseissues. countries duringmedicalrelief afternatural disasters. Table provide forchronic diseasesindeveloping medicalservices Sources: WHO, T T thelancet.com/journals/lancet/article/PIIS0140673608611411/fulltext. Lancet 2 E. Y. Y. UntoldStories Chan,‘The oftheSichuanEarthquake’, onr Total number Country know-how) W Sustainability/continuity becauseofavailable localpartnership T T Humanitarian imperative (emergency/lifesaving forpatients) Operational mandate R Capacity ofrelief agenciesversus localcapacity Invitation ofthelocalauthorities Pr Demand from recipient population Population need Affected population To ni 6 8878253 79 61 2 1 3 8 8 11 7 17 7 8 20 12 28 33 28 160 P 235 Indonesia* 133 India * * elief operations. After the Sichuan earthquake inMay elief operations. AftertheSichuanearthquake able 2: Issues toconsider able 2:Issues (2000–2008) able 1:Burdenofchronic countries andnaturaldisasters inselected disease echnical capacityandexperience echnical challenges ksa* 12 42 1 8 5 6 22 61 akistan** esources (medication,humanresources, equipment) illingness toaccepttechnicaltransfer (ofknowledge and e-existing structure/availability ofresources andcapacity HUMANITARIAN

c Nottoact act , vol. 372,359–362, no. 9636,2August2008,http://www. 2 exchange Only ahandfulofrelief groups hadidentified Pr vnigCrncDsae ia netet World HealthOrganization GlobalReport eventing Chronic Disease:A Vital Investment, 2000–2008 disasters of natural disease Cardiovascular Cancer % deathsbychronic diseasecausedinthecountry The disease Chronic respiratory L Concern formanagementcontinuityandsustainability Unwillingness orlackofcooperation from stakeholders Lack ofguidelines/standards Lack oftechnicalcapacity/competency Lack ofoperational mandateforhealth-related issues Competing medicalpriorities Political pressure from theauthoritiesnottotackleissue Pr threatened) financialincentive isbeing Competition (localphysicians’ understanding oftheproblem areas donotexist. where pre-disaster healthservices To care shouldbeprovided forchronically illpeoplelivingin whethermedical management post-disastersconcerns The majorfielddebateregarding chronic disease a result ofalackmedication. andminorstroke as needs, suchasunstablehypertension number ofpatientsseekingcare fornon-disasterhealth patient profile changesasthere willbeanincreasing addition, immediatelyaftertheinitialacutephase, instance unstableglucosecontrol fordiabetes).In treated becauseoftheirpoorclinicalcondition(for trauma werepatients withorthopaedic notsurgically appropriate drugsupplieswere available, manyolder emergency medicalrelief work.Even whensurgeons and ocal populationresistance duetodifferent cultural ioritisation ofothermedicalconditionsfortreatment operations during emergency medicalfield too significantaburden toignore medical conditionswillbecome in thedecadestocome,chronic te hoi Diabetes diseases Other chronic , 2005,http://www.who.int/chp/ r (among total disease deaths % chronic eported deaths) eported df/isdr- PRACTICE AND POLICY NOTES 45 is a member of tocol for -disaster service ypes of treatment T eatment: lifesaving esources (relief)esources – eferral system (clinical) eferral (technical esources ommitment/duration ommitment/duration tage of disaster ossible partnership opulation beliefs and opulation beliefs re ro r ocal technical capacity ocal technical eceptivity r availability financial/material of involvement Goals of intervention Set-up/setting capacity) only Opportunistic management – Diagnosis – Management plan Offer follow-up Offer associated services •P •L •R •C •P •S • • •R •R •P •T • •P • • umber 41 • December 2008 umber 41 • December Egbert Sondorp N ([email protected]) works in the ([email protected]) + opical Medicine. elevant services and clinical management supportelevant are medical conditions during efusing to manage chronic the Health Policy Unit at the London School of Hygiene of School of Hygiene the Health Policy Unit at the London Tr as heart diseases, stroke and cancer, but health advice as heart and cancer, diseases, stroke Even consumption. spending on cigarette may also reduce disease treatment, chronic if it is decided not to provide support. example, For still ways to provide are there options, where agencies could try to identify referral r least, they At the very and facilitate referral. provided, disease might consider documenting the key chronic population so as to among the disaster-affected burdens highlight health gaps that need to be addressed. In the decades to come, non-communicable chronic to medical conditions will become too significant a burden It is medical field operations. during emergency ignore important medical missions do not that emergency substitute for local systems, and issues of sustainability of assessed. Nevertheless, should be carefully treatment r mortality in the very may result and operations emergency intends to minimise. operation morbidity which the relief Chan Y. Emily Y. The Chinese of Medicine, Health, Faculty School of Public of Hong Kong. University Action e-existing Assessment Pr circumstances — Ignore completely Ignore Documentation only to refer to on the issue to refer Identify relevant groups groups Identify relevant source availability in terms of finances and materials, availability source igure 1: Proposed conceptual model for decision-making on whether or not to provide chronic medical services medical for decision-making model conceptual chronic 1: Proposed provide or not to whether on igure egardless of the decision, it is importantegardless to highlight that eferral system and the technical capacity of relief eferral F countries developing in post-disaster help decision-making on whether or not to include care for to include care help decision-making on whether or not a present we disaster, diseases after a natural chronic 1. conceptual model in Figure It is important to understand the pre-existing location before the disaster-affected in circumstances pre- making decisions. Population beliefs and receptivity, local technical capacity, disaster service availability, re of the of involvement the commitment and duration intervening possible partnerships agency and should all During the assessment, the timing of the be considered. interventionof the stage of the disaster), its (in terms of a the availability set up, are operations goals, where r to be examined. agencies all have R a spectrum of conditions involves management of chronic to services disease prevention/protection from ranging rehabilitation diagnosis, treatment, health promotion, Some of these care. and palliative (‘tertiary prevention’) services, such as health advice, would incur no cost but long-term implications for disease potentially, have, only can smoking cessation instance, not For prevention. clinical outcomes such potential adverse advice prevent HE41 crc 18/12/08 3:46 pm Page 45 Page pm 3:46 18/12/08 crc HE41 HE41 crc18/12/083:46pmPage46 46 PRACTICE AND POLICY NOTES challenges offield-basedmedicalhumanitarianwork. needs tobedeveloped, reflecting thereality andthe into thisissuewiththeconvictionthataspecificapproach published andpresented in2007,MSFhaslooked atODI report, become aglobalbuzzword. SinceAustenDavis’ about whatandforpurpose.Accountabilityhas accountability isneeded. The issueisrather towhom, lack oftransparency aboutresults obtained,thatfarmore debatable, given theoftenpoorresponse tocrisesandthe work theydoandtheresources theyuse.Norisit forthechoicestheymake, and ‘beinganswerable’ must beaccountable,bothinthesenseof‘giving account’ There isnoquestionthathumanitarianorganisations oriented management’ and the certification of(humani- andthecertification oriented management’ the corporate sectorandintroduces conceptslike‘results- Conduct andSphere. The secondcategoryhasitsoriginsin setting general ortechnicalstandards, suchastheCodeof different strands canbeidentified. The firstfocuseson organisations toimprove theiraccountability. Atleastthree the backdrop togrowing callsforhumanitarian organisations andanincrease inavailable funding,provides international response tocrises,arisingnumberofaid heightenedpoliticalprofile inthe ‘humanitarian sector’s’ nature ofNGOs, compoundedby the This ‘unregulated’ tax-exempt status. related totheir for instancemandatoryfinancialreporting subjecttoformalaccountabilitymechanisms, only partly transnationally across different jurisdictions,NGOsare stakeholders occursinmanyways,yet operating donors andthegeneral public.Responsiveness tothese constituencies, from localauthoritiesandcommunitiesto ofabroad range of acceptance, andatbestthesupport, ‘ achieve andhow theyintendtodoit.Incarryingouttheir agreed goal,theydefinethemselves by whatthey aimto Constituted by peoplewhocometogetherinpursuitofan NGOs likeMSFare by definition‘self-mandating’. challenging an‘unquestionablygoodidea’ Pr MSF’s present practice withregard toaccountability. describesthisapproach, aswell aspresentingThis article Accountability ofHumanitarianNGOs’, 3 Dorothea Hilhorst,‘BeingGoodatDoingGood?Qualityand Discussion paperforMSF, March 2006. Unquestionably GoodIdea.For Radical Reform? OrUtilitarian Takeover? 2 AustenDavis, Network Paper 58(London: 2007). ODI, 1 AustenDavis, 203–204. Eric Stobbaerts andNicolasde Eric Stobbaerts Torrenté, MSF solutions MSF andaccountability:from globalbuzzwordstospecific social mission’, theyare dependentonatminimumthe need tobegood. by from thedarknessoutsideandwithin They constantlytrytoescape HUMANITARIAN oliferation ofaccountabilityefforts:

dreaming ofsystemssoperfectthatnoonewill exchange Concerning AccountabilityofHumanitarianAction Accountability inHumanitarianAction–An 3 Disasters T.

S. Eliot, , 2002,26(3),pp. The Rock , 2 , 1 2005. 7 SallyBibb, Accountability 6 Pierre Perrin, ‘Accountability: AFramework’, no. 2,2004. Integration’s False Promise’, 5 SeeforinstanceNicolasde Torrenté, ‘HumanitarianismSacrificed: October 2007,pp. 18–20. and UN HumanitarianReforms’, and UN Katharine4 EricStobbaerts, ‘Integration Derderian andSarah Martin, seem ill-advised.However, by definingaccountabilityin ably goodidea’, challenginginitiatives to improve itmay As humanitarianaccountabilityisseenas‘an unquestion- to account. which theyare expectedtoholdhumanitarianorganisations may beprevented from exercising thevery rightsthrough r for advocacy purposes.Rights-basedapproaches alsofailto presence needs orthevalue ofhumanitarianorganisations’ such astherelevance oftheaidprovided topeople’s actual aspects ofhumanitarianactionthatare harder toquantify, mayunderplay measurable indicators,whileimportant, which humanitarianactiontakesplace. in thevolatile, politicallycharged andviolentcontextsin humanitarian organisations andthechallengesencountered responsibilities of space forunderstandingtheparticular approaches toaccountability. These provide little solutions’ or‘global The secondconcernrelates to‘one size fitsall’ broader internationalagendas. of humanitarianorganisations andstrengthen theirlinksto toincrease thecoordination closely associatedwithefforts for management,monitoringandevaluation. fail tocreate innovative andadaptedorganisational models T ficiaries’). towards thosetheyaimtohelp(‘accountability tobene- humanitarian organisations have obligations,particularly centres onthe‘rights-basedapproach’, positingthat exemplified by theHumanitarianAccountabilityProject, processes, suchastheOne World Trust. The third, tarian) organisations whichcomply withsetnormsand r r to ofacomprehensiveintegral internationaleffort part ations. Increasingly, humanitarianactionisviewed asan tarian assistanceandtherole ofhumanitarianorganis- main concerns. The firstrelates tothedefinition ofhumani- elements,MSFhastwo include promising andimportant donor-driven toimprove effort accountability. Althoughthey ecognise thatindividualssubjectedtoviolenceandneglect espond tocrises,contributingpeace,state-buildingand econstruction. ogether, theseinitiatives constituteasignificant,largely ‘ NGOs are bydefinition self-mandating’ The Stone Age Company , ICRC, 2002,pp. 12–16. 4 Calls forincreased accountabilityare Ethics andInternationalAffairs Fo r ced Migration Review 5 , MarshallCavendish Business, 6 FORUM: Warand FORUM: Similarly, theyoften 7 Insistence on , no. 29, , vol. 18, PRACTICE AND POLICY NOTES 47 (New York: Civilians Under Fire – Civilians Under Fire have learned firsthand have

The ‘accountability to The ‘accountability hermore, the notion that hermore, We rt 8 9 Fu pecific areas of focus areas pecific umber 41 • December 2008 umber 41 • December The Practical Guide to Humanitarian The Practical Beneficiaries, patients and Beneficiaries, patients communities ‘Downstream’ to accountability is the most intended beneficiaries the hardest difficult to define and As a medical organi- to achieve. the are sation, medical ethics starting point in our relationship ethics also with patients. Medical reference useful points of provide in highlighting instances where patients’ should take interests policy or legis- over precedence ethics do medical lation. However, not constitute a clear guideline. ethical different there Not only are S on three focusing currently MSF is of accountability: specific areas and to donors to ‘beneficiaries’; public; and ‘mutual’ the general within different accountability parts of the organisation. N 10 ©François Dumont, MSF, 2008 failed for years to detect and treat sexual violence, a sexual to detect and treat failed for years (Oxford: Rowman and Littlefield, 2007). Rowman (Oxford:

equire arbitration. Finally, medical ethics only address Finally, arbitration. equire health-related matters, whereas humanitarian catastrophes whereas matters, health-related lives. entire engulf people’s our those to whom than patients are group A broader assistance is addressed. approaches, but different ethical values often clash and ethical values but different approaches, r critical yet largely invisible need if women are not actively not invisible need if women are largely critical yet participation are and consultation sought out. However, not always feasible. Particularly in conflicts, the means that victims seriousness of their predicament cannot simply be equated with ‘clients’ in or patients in international humanitarian law stable settings. Inherent is the notion that the ‘powerlessness’ of victims is and the what entitles them to protection precisely of assistance. provision that not listening to those caught up in conflict can result that not listening to those caught up in that fits our preconceived response in a stereotypical notions of the ‘ideal victim’ and our organisational instance, needs. For than actual, pressing priorities, rather we beneficiaries’ consultation with or emphasises approach the participation of assistance, who are of the recipients defined as ‘rights-holders’. vulnerable crisis-affected people are able to articulate crisis-affected people are vulnerable not only ignores aid organisations from what they require that within societies but also the benefits relations power the aid local leaders often intend to obtain from 8 Rather than ‘beneficiaries’, which presupposes that the people than ‘beneficiaries’, which presupposes 8 Rather help do indeed benefit, it would be to strive whom aid organisations to call them ‘addressees’ appropriate more of assistance. Rony personal communication. Brauman, of Affect the Quality Images of Adversity ‘How 9 Jean-Herve Bradol, Salignon (eds), and Pierre Pape Le Aid’, in Marc 2003). MSF, Bouchet-Saulnier, 10 Francoise Law Humanitarian Practices in the Congo Republic 1998–2000 in the Congo Republic Humanitarian Practices Aid recipients in Ethiopia Aid recipients by defining accountability in by defining accountability is a risk terms there such general a merely that it will remain end in or become an buzzword itself consider that we are accountable for what we set out to accountable for what we are consider that we

sponse to acute needs in exceptional circumstances, sponse to acute needs in exceptional ealisable, taking account of the fact that, frequently, the ealisable, taking account of the fact that, frequently, and difficult approaches equiring risk-taking, innovative esponse to crises, potentially undermining the specific esponse to crises, potentially undermining Developing a specific approach Developing to accountability is based on four key approach MSF’s that a medical tenets. First is the specific responsibility assumes in carrying out its work. humanitarian organisation We Second, our employ. and the means that we achieve and to accountability aims to be realistic approach r we Third, work offer only bad choices. contexts in which we a of constituencies that have the diversity seek to recognise their stake in our medical humanitarian work and to address accountability is particular Finally, needs and interests. Mistakes will be made of as a learning process. conceived aid is a real-time as humanitarian will recur and failures re r judgments. such general terms there is a risk that it will remain merely is a risk that it will remain terms there such general Indeed, it is unclear an end in itself. or become a buzzword and quality of the in the relevance if any major improvement current has been obtained from humanitarian response their principal effect could accountability efforts. Ultimately, tie humani- mechanisms and be to expand bureaucratic coordinated closely to an increasingly tarian action more r can make for contribution that humanitarian assistance those most at risk. HE41 crc 18/12/08 3:46 pm Page 47 Page pm 3:46 18/12/08 crc HE41 HE41 crc18/12/083:46pmPage48 48 PRACTICE AND POLICY NOTES activity that would allow reporting, andbudgeting,based activity thatwouldallow reporting, r to programmes are therefore required. Rather thanrigid Measures thatefficientlyorienttheprovision ofresources national, non-profit andmission-specificnature ofourwork. likehospitalsare problematic given thetrans- ations’ organis- and comparisonswithothertypesof‘healthservice versuslevels fieldlevel atheadquarters donotreadily exist, ‘o ‘ instead ofby boatasaresult ofpoorplanning–improves the plane in thefield–forinstancesendingsuppliesby charter are considered positive, even inefficientspending expenses’ funding mayscore better. Andironically, asall‘programme that aidorganisations relying more heavilyongovernment than applyingforgrants from governments, whichmeans constitute more than85%ofMSF’s resources) ismore costly measure. For instance,raising private funds(which tration), thisisanimprecise andpotentiallymisleading to programme activitiesagainstfundraising andadminis- ‘ have limitations. While MSFcanboastafavorable 82% totheallocationanduseofresources efficiency pertaining fraud prevention andinternalcontrols, butmeasures of Financial accountabilityoftenfocusesonproper accounting, interdependent aidorganisations. something ofafirstforlarge network ofindependentyet MSF movement, by independentauditors. certified This is international combinedfinancialaccountsfortheentire transparency hasresulted intheestablishmentof pooled from different offices;acommitmenttoincreased MSF, programmes thefinancialresources are supporting hasreceived considerablein particular attention. Within public isamore developed area. Financialaccountability accountabilitytowards donorsandthegeneral ‘Upstream’ Donors andthepublic improvement. programmes, althoughthere remains significantroom for the rationale fordecisionsliketheopeningandclosure of ofactively explaining made usunderstandtheimportance approach oftentypicalinemergencies and the ‘top-down’ education andempowerment are key. This haschallenged r H inthisrespect, inparticular important particularly assist. MSF’s experienceinmore stablesettingshasbeen about thechoicesmadeandlimitsofourabilityto work shouldentailasmuchtransparency asfeasible,both define programmes andmaintainanacceptablespaceof negotiation whereby humanitarianactorsgainaccess, pointisthattheprocessto meetthem. of The starting empathetic assessmentofpeople’s needsandourability the aidwe provide basedonanopen-mindedand would rather assumeclearresponsibility fordetermining R help. frequently have littleinterest inthosewhomostneed r social mission’ ratio (the proportion ofresources ratio (theproportion allocated social mission’ social missionratio’. Beyond financialaccountability, atios, whatisneededameasure ofresources per elationship withpatientsandpatientgroups andpatient elationship. Those whospeakfor‘thecommunity’ ather than wish away these important limitations,we ather thanwishawaytheseimportant IV/AIDS treatment programmes,IV/AIDS where along-term r aiainlacutblt’indicatorscomparingstaffing ganisational accountability’ HUMANITARIAN exchange donors naturally respond tostoriesofsuccess. despite thetemptationtopromote one’s achievements as ofreality, trustisbuiltonanuancedportrayal supporter and informationtothegeneral public.MSFbelieves that commitment toopennessintodonormailings,websites due tointernalproblems. The intentionistointegrate this outcomes achieved, includingwhere underachievement is This includesbeingcriticalandreflective aboutthe andlimitsofmedicalhumanitarianwork. shortcomings MSF priority–greater transparency aboutthedifficulties, An increasing focusonresults iscloselylinkedtoanother additional burden ofworkforfieldteams. measuring outcomes,attributingcausalityandthe be expanded,takingintoaccounttheinherent difficultiesof nutrition andsurgery. should This typeofresults reporting malaria, number ofprogramme activitiessuchasHIV/AIDS, patient cure rates) are currently available foralimited but alsoofoutcomes. The results ofourmedicalwork(e.g. r Assessing theeffectiveness withwhichresources are used programme-wide ororganisation-wide basis. orforecast expendituresystematically usedtoreport ona much tobedonebefore thisapproach canbe ‘ toimplementsuch medicines, etc). While MSFhasstarted functional categoriescurrently used(staff, transport, on specificinput/outputratios rather thanthegeneral executives toaccount. operations are essentialforBoards tobeablehold highest body. Information-sharingandcriticalreviews of the 19sectionsformInternationalCouncil,MSF’s Board ofDirectors. Inturn,thePresidents oftheBoards of ‘o sections are organised as‘associations’, withmembers mation theyneedtodischarge theirduties.MSFnational and overseeing MSF’s workare provided withtheinfor- governance, whereby thosebodiescharged withguiding isalsocloselylinkedto Finally, ‘mutual accountability’ MSF’s advocacy andcommunicationswork. assessedis area whichshouldbefurther Another important in thefuture leadtotheinvolvement ofexternalauditors. parative assessments. This commitmenttoopennessmay definingamethodologyandcarryingoutcom- further MSF’s internationalofficehastherefore beentaskedwith and consofdifferent OCsworkinginthesamecontext. different strategies andtheiroutcomes,includingthepros must becomplementedby acommitmenttoevaluating structure withanoverarching authority. However, diversity operational centres (OCs).MSFhasoptedagainstapyramid approaches andoutcomesbetween thedifferent MSF isthecriticalreview ofoperational accountability’ T movement Governance andmutualaccountabilitywithintheMSF and progress canandmustbemade. The qualityand More accountabilityisrequired inthehumanitarianfield, Conclusion activity-based reporting andbudgeting’,there isstill activity-based reporting equires notjustadescriptionoraccountingofactivities, he third area offocusforMSFisprimarilyinternal.‘Mutual nn’theorganisation andelectingtheirpeerstothe wning’ HE41 crc 18/12/08 3:46 pm Page 49

extent of aid provided to people affected by acute crises is the twenty-first century, nor was treating malaria patients in frequently insufficient, and the trust and support required Africa with ACTs up to very recently. Adopting donor-driven by humanitarian operations on a number of levels need to accountability measures could end up binding humanitarian be actively nurtured. Confidence in humanitarian organis- organisations ever more closely to broader government ations and the values they claim to stand for has eroded in priorities and choices in crises, instead of improving the many parts of the world. Yet it is important to tie relevance and effectiveness of humanitarian work. And while discussions about accountability to the specific responsi- relevant concepts from the private sector are welcome, bilities of humanitarian organisations – our objectives, humanitarian aid is not a ‘market’ with ‘consumers’ and activities and the conditions in which we work. In our ‘service providers’. There is an inherent element of ‘field experience, a useful way forward centres on ongoing and craft’, even arbitrariness, in operational choices, and this has critical reflection about the responsibilities, limits and to be acknowledged and explained. meaning of humanitarian action in concrete situations.11 Developing a specific framework for accountability on this Ultimately, accountability is perhaps most significant as premise may be more productive than adopting overly an organisational state of mind – a willingness to ask broad or ambitious initiatives that risk becoming either difficult questions about one’s operations, to seek and empty slogans or burdensome bureaucratic processes. share the answers, and to learn from the process. Recent events in Myanmar are a good example of this état While we can learn from other sectors, the illusion that d’esprit: rather than foregone conclusions based on set humanitarian action will ever be perfectly ‘objective’, standards, critical questions were asked within MSF about governed by rules, standards and procedures, is dangerous. the risks posed by the denial of access for international This is particularly the case when these norms are set and staff to field sites, drawing upon previous work in the required by political entities. Humanitarian action by country and under other repressive regimes. Monitoring definition exists in tension with the ‘status quo’, with systems adapted to the situation of national staff mainstream political norms and the choices that have led, delivering the bulk of assistance were also put in place, and continue to lead, to the neglect and victimisation of large assuaging concerns that the restrictive operating parts of society. ARV therapy for people living with HIV/AIDS environment might lead to intolerable outcomes in terms was certainly not the international standard at the start of of aid delivery. The aim here, as in other situations that are 11 In that regard, MSF has a number of internal reflection units – by definition unacceptable, is constant progression rather notably the CRASH, ‘centre de recherché sur l’action et les savoirs than impossible perfection. humanitaires’, based in Paris, whose recent work has included a book on the Niger nutritional emergency of 2005. Jean-Hervé Jezequel and Nicolas de Torrenté is Executive Director, MSF-USA. Eric Xavier Crombe (eds), Niger: une catastrophe si naturelle (Paris: Karthala, 2007). Stobbaerts is General Director, MSF-. RCIEADPLC NOTES POLICY PRACTICE AND

In praise of dependency Maurice Herson

While welfare, such as free humanitarian aid, is arguably borrowing a concept from a field unrelated to humani- the sign of a civilised society, it is sometimes accused of tarianism, namely ‘dispersed dependencies’, an idea ‘creating dependency’, undermining sustainable self- formulated by the psychologist George Kelly.1 In 2005, Paul sufficiency and demeaning its recipients. The idea that Harvey and Jeremy Lind put the case that ‘the focus should dependency is a bad thing and that free assistance be, not how to avoid dependency, but how to provide … de facto creates dependency not only has long roots in the assistance so that those who most need it understand what history of humanitarianism, but also is nourished by the they are entitled to, and can rely on it as part of their own strongly held feelings of those who believe that relief too efforts to survive and recover from crisis’.2 Kelly – if I’ve should be in some way sustainable, linked maybe with a understood him right, although he did not address what we desire to move towards more developmental approaches. call humanitarian concerns himself – starts from the position that all humans have their various needs met Humanitarian agencies tend to look at the situations of through a set of dispersed dependencies. Self-sufficiency, people affected by disasters in terms of their needs and or independence, thus means having a full set of depen- rights. Assessments, for example, use these categories to dencies that can be reliably counted upon. describe their situation and to formulate responses. ‘Need’ too is a disputed idea: anyone who has done a 1 In Kelly’s field, it refers to the set of individuals’ relationships, where they have practical, emotional, social, physical, etc. dependencies. needs assessment will know that ‘need’ is hard to use in a Personal independence is about having a viable set of dispersed practical way. In itself, need or dependency are not on/off dependencies – dependency is neither a problem nor abnormal. (No or single-level, but vary in both intensity and over time. man is an island, as the poet said.) 2 Paul Harvey and Jeremy Lind, Dependency and Humanitarian Relief: This article suggests a new terminology and a new frame- A Critical Analysis, HPG Report 19, July 2005, www.odi.org.uk/hpg/ work. It seeks to add to the discussion on dependency by papers/hpgreport19.pdf.

Number 41 • December 2008 49 HE41 crc18/12/083:46pmPage50 50 PRACTICE AND POLICY NOTES natural oranthropogenic. Logically, behindtheconcerns place inthelives ofpeopleaffectedby disasters, whether First, itwillinduceahealthyhumilityinagenciesabouttheir problems ofhumanitarianactionwillbesolved. will increase thelikelihoodthatsomeofmore enduring provide bothaconceptualandpractical framework that things thathave notbeendonebefore. Buttheymight either beapanaceaorwillsuddenlymakeusdosetof imply thatthissuggestedterminologyandconceptwill dependencies ofdisaster-affected people. This isnotto programme plansthrough theperspective ofthedispersed crisis situations,doingtheassessmentsandmaking There seemtobeseveral potentialadvantages tolookingat Why ‘dispersed dependencies’? sustainable, thusenhancingcapabilities. thosethatarewhere theyare sustainable,orsupport work withinaframework thattransfers dependenciesto the setofdependenciesthatpeoplerequire, andcanthen impossible, thatisindependence,butitcanacttofillout idealised. Byitself, humanitarianaidcannotcreate the aid) are stigmatised;others(oncommunity)are valued or dependencies (forinstancedependencyonhumanitarian and insafety, andcontinueorrebuild theirlives. Some behealthy,water theyneedtosurvive, live withdignity items, spacetolive, remittance money, food,shelterand them theyget,ifare lucky, someorallofthematerial organisations, internationalagencies andmore. From family andneighbours,hosts,theirgovernment, local disasters depend,variously, onthemselves, theirfriends, informal –iswhatwe oftencallcoping.People affectedby through theirsetofdependencies–bothformaland which theycanpurchase orleverage care forthemselves economic resources attheircommand. The extentto P Dependency andcoping r complicated reality, andwhatthisimpliesinpractice in affected by disasterstobeseeninawaythatreflects their troubling. The value inthisideaisthatitenablesthose way astoofferthepossibilityofmakingthemless different perspective tothem,alterthemind-setinsucha troubling orcontentiousinadifferent way, applya agencies toapproach issuesandactivitiesthatare most inevitable but therefore dependencyshouldbeseennotonlyas such thingasindependenceintermsofsurvival, andthat The additionalpointbeingmadehere isthatthere isno to copewithahazard andrecover from itwhenstrikes’. vulnerability tothoserisks,andthecapacitiestheypossess that peoplefaceintheirlocality, theirdifferent levels of whichis‘designedespoused by toassesstherisks theIFRC, (VCA) idea isthatof‘Vulnerability andCapacityAssessment’ livelihoods, andhow thesechangeduringcrises’.Asimilar forms ofinterdependency thatmakeuppeople’s understand …therole thataidplayswithinthemultiple ofasimilarargument ‘to insupport ‘interdependency’ re Applied inthehumanitariansphere thisisnota esponding tothecrisesanddisasterspeopleface. eople’s abilitytoactisafunctionofthesocialand v HUMANITARIAN olutionary idea. Harvey andLindusetheconceptof olutionary idea.Harvey exchange as agoodthing . Taking thisviewwillenable (London: ALNAP, 2008),p. 214. P R 3 JohnCosgrave andMaurice Herson,‘Perceptions ofCrisisand involves matchingthescaleofresponse to the One oftheissuesinshapinganassessmentintoaresponse the setofdependenciesthosebeingassisted. commonly perceived setofcontributionstobemade agencies; therole ofeachwillbenaturally setwithina on. This willencourage coordination amongexternal seek roles toprovide somethingthatpeoplecandepend dencies, itwillprovide apicture withinwhichagenciescan external agenciestakeontheideaofdisperseddepen- any process suggestedtodate.Iseethepossibilitythat,if easily solved, ashasbeenproved by thelimitedsuccessof Likewise, theenduringproblem ofcoordination willnotbe performance inactionistobewelcomed. lacking. Anythingthataddstothepressure toimprove are oftenfoundinreviews andevaluations tobemissingor above isnewassuch,buttheyare amongthethingsthat To communities decidingtheirown pathtosurvival iscritical. taking place.Here, therole ofconsultationandlocal within theculture andpractice is inwhichtheintervention In addition,helpandassistancehave tomakesense changed, maintainedorstoppedaccordingly. affected peoplewillmakethisclear, andactioncanbe dependenciesofdisaster- looking atthevarious ‘dispersed’ r giving. Thereassistance worth isnosenseproviding a is;indeed,itiswhatmakes circumstances certainly the peoplebeingassisted. This maybetrue,andinsome ofthecopingstrategy of assistance formsasignificantpart about dependencycausedby assistanceistheideathatthis unavoidable partners andconstraints forus’. unavoidable partners work. Government andcommunityare simultaneously ability tocontrol orimprove, andwithwhichwe mustdoour ofthecontext‘thatisbeyond [humanitarianagencies’] part enough. For disaster-affected people,suchagenciesare something thathumanitarianactorsoftendonotwell agencies, whethergovernmental ornon-governmental, example, reinforce awareness oftheactualroles oflocal created inresponse toacrisisordisaster. This will,for r contributions thatare brought withthem,thatcanbe even ifonlythephysicalones–willenableustosee An analysisofthesetaffectedpeople’s dependencies– inthissamelight. design andmakeourinterventions the caseoflarge-scale disaster we humanitariansshould – theneedtoanchoryourself insomekindofcontinuity. In influenced by whatinessencemighthave stayed thesame such asbereavement orseriousillness,seemstobe Copingwithcatastrophicinterventions. personalchange, ensure thattheyare takenintoaccountinour matters, althoughtheyliebeyond ourremit, we cantryto and rituals.Ifwe askthemandourselves aboutthese re of and resources butforpeopleaffectedpart tosurvive, esource thatiseithermeaninglessorinappropriate. But eclaimed, thatpersistthrough thedisaster, andthatare akistan Earthquake’, in akistan Earthquake’, esponse: ASynthesis ofEvaluations oftheResponse tothe2005 building lifeafteradisasterinvolves communityactivity

some extentlifebecomesfocusedonphysicalneeds AL NA PR eview ofHumanitarianAction 3 None ofthe , 2008 PRACTICE AND POLICY NOTES 51 ced Migration Review ced Migration r Fo umber 41 • December 2008 umber 41 • December N is Editor of eople affected by disasters are suddenly faced with the disasters are eople affected by elationship between this idea and rights and the elationship between coping’ within that definition. implications for the protection approach. None of them approach. protection implications for the This is not at odds with to the idea. seems to me to be fatal disaster as a state or definition of a conventional the more the coping capacity of the people involved. beyond event of meaning and substance to the idea In fact, it gives ‘ P dependency shaking up of their habitual (dispersed) life-critical to make sometimes forced system and are into to deal with and incorporate decisions about how support possibly unfamiliar potential their strategies (the of the The role of the dependency idea). inverse humanitarian system should be to support them in doing choices’this and in the ‘difficult to make. that they have an essential but intangible aspect of humanitarian Dignity, to manage your aid, in part being allowed comes through being in the link between can break This dependencies. need of ‘aid’powerlessness, on the one hand, and incapacity and neediness on the other. Maurice Herson being looked at and looked for is fundamentally different fundamentally for is and looked looked at being in a and an emergency phase of the acute turmoil of in the This is on the cards. or rehabilitation recovery time when act as a assessment cannot the acute phase means that basing assessments. Again, later and ongoing baseline for of dispersed a framework assessment on the early at that will overcome enables a continuity dependencies and difficulty in justifying aspect of the least this assessment. repeated organising in terms of disaster would be to redefine effect The overall disrupting the patterns rapidly and its effects in radically dependencies that supportof existing (dispersed) people of course, not least the remain, in normal times. Questions r (http://www.fmreview.org). eview of R Good Practice Review 10, December 2008 Review Good Practice Emergency food security interventions Emergency . There is more than one problem is more There . Daniel Maxwell, Kate Sadler, Amanda Sim, Mercy Mutonyi, Rebecca Egan and Mackinnon Webster Egan and Mackinnon Mutonyi, Rebecca Amanda Sim, Mercy Sadler, Kate Daniel Maxwell, er timing and strategy for exiting from a programme. An a programme. for exiting from er timing and strategy Emergency food security interventions are evolving. In the past few years new ideas have emerged for protecting the for protecting emerged new ideas have In the past few years evolving. interventions food security are Emergency relevant, remain and crisis-affected people to adequate and nutritious food. Some old approaches access of disaster- understood. sometimes not well but are a concise overview It provides food security. emergency in practices programming explores Review This Good Practice in together with state-of-the-art practices of conceptual issues and analytical and planning approaches, programming Along with a brief description or crisis-affected groups. the food security of disaster- interventions designed to protect to the best topic- of the intervention, its application, management and monitoring, each chapter includes references available. tools and case studies currently specific overviews, officials and as government as well is intended primarily for humanitarian aid workers, managers and staff, This review It is intended in times of emergencies. that food security is protected donor agency personnel, whose task it is to ensure best suited to determine which are options and the means to of programmatic aid workers with a full range to provide situates the emergency this review broadly, While much has been written on food security more their circumstances. right to adequate food. people’s protecting element in the context of the wider debate on programming ecovery ears its head at two significant moments. At the ears its head at two significant ealistic meaning to the idea of self-sufficiency, and allows the idea of self-sufficiency, ealistic meaning to Humanitarian Action the idea by that can be addressed But one problem here. of what is nature of dispersed dependencies is that the Dispersed dependencies and the transition to and the transition Dispersed dependencies r is a theme that there response In the life of an emergency r an emergency beginning it appears as a claim that intervention and will undermine both self-sufficiency predicated which are programmes ongoing development In the later on self-sufficiency. on stimulating or relying an issue as it reappears to recovery phase of transition ov the idea that analysis based on original, and repeated, dispersed a set of ever-shifting have people naturally interventions to shifting dependencies can lead naturally to support to recovery. transitions to a one- assessment, as opposed The need for repeated has been off initial assessment and defined programme, Evaluation Tsunami out among other places in the brought Coalition Summary Report the ALNAP and perceived need. This is often felt to be supply- rather than rather be supply- felt to This is often need. perceived as a designed is it too rarely and demand-driven, the gaps An analysis of to meeting needs. contribution that can be dependencies totality of required among the a fully or partially an intervention by filled is able to provide of ‘packages’scale of size It background. a real against of ‘degrees’ a nuancing allows It does not of dependency. but assistance dependency, leading to imply assistance a dispersed dependencies. It gives within a context of r support previous choices in either rebuilding for ones. It looking for viable, possibly new, dependencies or in that will support but should ensure approach, a livelihoods of ‘self-sufficiency’ version is no extreme there implicit in planning and implementation. programme HE41 crc 18/12/08 3:46 pm Page 51 Page pm 3:46 18/12/08 crc HE41 HE41 crc 18/12/08 3:46 pm Page 52

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