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Books, Journals, New Media
January 14, 2004

Humanitarian Aid

Author Affiliations
 

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor.

JAMA. 2004;291(2):249-250. doi:10.1001/jama.291.2.249
Basics of International Humanitarian Missions

The field of humanitarian assistance has developed rapidly over the past decade.1 It has been professionalized and has become a recognized health discipline, with its own standards, literature, and research base. Consequently, new and updated books and resource materials for humanitarian practitioners, as well as policymakers and students, are needed.

Basics of International Humanitarian Missions is the first book in a series on international humanitarian assistance by Fordham University's Institute of International Humanitarian Affairs. Its primary objective is to "introduce the essential issues facing humanitarian workers." Although not specifically stated, it is assumed that these refer to the key principles, concepts, players, and policies of humanitarian assistance. It contains 350 pages consisting of four parts and 10 chapters with appendixes and index. Emergency Relief Operations, the second book in the series, has 386 pages, four parts, and 11 chapters with appendixes and index. Its main objective is to be a "practical guide to planning and managing relief operations." The targeted audience for these texts includes students, teachers, practitioners, policymakers, journalists, and other professionals.

The publication of these books is an ambitious attempt to provide updated primers on the basics of humanitarian principles, policies, and technical response. However, despite some very insightful chapters from respected leaders in the field, these books do not meet their stated objectives. While clearly a great deal of effort was invested, they suffer from structural design flaws, gaps, repetition, and some inaccuracies. Rather than providing the basics in a structured and coherent manner, the books read more like a mixed anthology of humanitarian concepts and action over the past three decades.

In Basics of International Humanitarian Missions, concepts and topics among the chapters and sections repeat, overlap, and sometimes contradict each other. For instance, data on the number of persons affected by humanitarian emergencies and the amounts of funding for them vary between two well-researched chapters by Ibrahim Osman and Joelle Tanguy. Similarly, the effects of funding and politics on the ability of nongovernmental organizations (NGOs) to follow humanitarian principles are mentioned repeatedly throughout numerous chapters, often with different interpretations. Another example is the use of different definitions for the same terms by contributors throughout the two books. This occurs despite a chapter by S. W. A. Gunn emphasizing the importance of a common language in disaster response and providing clear definitions of humanitarian assistance terms. I counted at least four different definitions for the term complex emergency in Basics of International Humanitarian Missions alone.

This book could be improved by better conceptualization and structure, with chapters containing specific topics placed in appropriate sections. For example, chapters on internally displaced persons (IDPs) and the military, currently in Emergency Relief Operations, might have been more appropriately placed in a section that included key players and affected persons in Basics of International Humanitarian Missions. Descriptions of different and evolving scenarios of humanitarian emergencies (eg, emergency, postemergency, "chronic emergency"; comparisons of situations involving refugees, IDPs, and nondisplaced persons; camp vs non-camp settings; urban vs rural settings) are missing. Also absent is a brief history of modern humanitarian assistance, from Biafra to Kosovo to Afghanistan, and how these events shaped policies and priorities in humanitarian assistance. Key policy issues, such as NGO independence and neutrality, engagement and exit strategies, "do no harm," transition from relief to development, and coordination are scattered throughout the two books; they should have been addressed more coherently in the first volume.

The chapter on training appears to be a promotion for the International Diploma in Humanitarian Assistance course rather than a comprehensive overview of the evolution of and existing avenues for training in this burgeoning field. There are numerous other short courses—at least one of which offers a university diploma, others situated in developing countries—that provide quality education with practical case studies. All these different training opportunities, including those offered by NGOs to their employees and master's degree programs, could have been discussed along with their advantages and disadvantages. Although teamwork is an important issue in humanitarian response, it is disproportionately represented in the book, comprising almost 20% of the 10 chapters. A shorter and more practical version would have been more appropriately placed in Emergency Relief Operations.

Some examples of inaccuracies in this book include the statement that the Office of the United Nations High Commissioner for Refugees was established between the two world wars in 1921; it was established on December 14, 1950. Another is the claim that European humanitarian NGOs receive more aid from government and religious sources than from private donations as compared with their US counterparts. In most cases, the opposite is true.

Emergency Relief Operations has few practical chapters that would be useful to practitioners actually working in the field. Some notable exceptions are the technical chapters on health assessment, environmental health, protection, gender, and field security. These chapters provide a combination of indicators, checklists, and practical experience that may aid the field practitioner. There are some technical gaps in this book. The fundamentals of emergency relief—such as food aid and security, communicable disease control, establishment of a health infrastructure including referral hospitals and laboratories, essential drug lists, and monitoring and evaluation—are not included. Only the clinical presentation of nutrition, another essential component of relief, is discussed; surveillance for and diagnosis and treatment of acute malnutrition are not mentioned. During the past decade, reproductive health and mental health have become important priorities that had been neglected in previous relief operations; they are also missing from this book. More case studies from past emergencies would have been helpful to illustrate the points elucidated in the chapters.

Another essential aspect missing from the book is the prioritization of programs and interventions during complex emergencies. For instance, at the beginning of an emergency, defecation fields and trench latrines may be necessary. The former are not referred to in the environmental health chapter, and the latter are only briefly mentioned. Instead, too much space is provided on how to construct ventilated improved pit latrines and compost latrines, both rarely, if ever, used in emergencies. Similarly, measles vaccination campaigns, the number two priority intervention in the Médecins Sans Frontières book Refugee Health,2 are mentioned only once, in the chapter on health assessment.

The chapter by Ed Tsui on the initial response to disasters is well written but too focused on the United Nations Office for the Coordination of Humanitarian Affairs, of which he is the director. Both this chapter and "Concern Worldwide's Approach to Water and Sanitation and Shelter Needs in Emergencies" are too organization-focused. A book on the basics of relief operations should be more generic and focus solely on the key issues of the topics. Finally, absent from the book are future interventions and trends, such as the diagnosis and treatment of adult undernutrition, appropriate response to chronic disease in developed country complex emergencies, future use of insecticide-treated plastic sheeting and blankets, and the importance of HIV and AIDS in complex emergencies.

Some examples of inaccuracies in Emergency Relief Operations include the statement that the protocol for measles immunization during a complex emergency is to provide measles vaccination and vitamin A to all children from 1 through 6 years of age at the time of registration in the camp. In most circumstances, mass measles vaccination campaigns should be implemented immediately, regardless of registration, to all children from 6 months through 12 to 15 years.2,3 Children who received the vaccine at 6 through 8 months need to be revaccinated again at 9 months. The explanation of protein energy malnutrition and the description of a physician rather than a trained nutritionist managing cases of malnutrition are obsolete. Finally, the generally accepted minimum quantity of water per person per day in an emergency phase of a complex emergency is 15 liters or more.3 Other recommendations stated throughout the book, ranging from 20 to 40 liters, are confusing.

The editing of these books is uneven. The chapter notes and references are inconsistent throughout. Many of the notes sections contain references. Some of the references are incomplete or incorrect. The abbreviations and acronyms lists at the beginning of each book are incomplete and some acronyms, such as EMS and GIS, are not explained. Finally, the figures in the environmental health chapter are poorly reproduced and difficult to read.

Despite the problems with these books, there are some excellent individual chapters. Osman presents useful trend data on number of persons affected and estimated costs and actual assistance provided for natural, technological disasters and complex disasters. The data are disaggregated by year and continent and have been used to calculate percentage of needs covered and average amount of assistance per person. Roy Williams has written a thoughtful chapter on the interactions and challenges that NGOs face in humanitarian assistance. Tanguy's comprehensive piece covers a broad range of important issues, from the media and the military to NGO independence, neutrality, and accountability. Ted Gurr and Barbara Huff provide a clear explanation of early warning systems for humanitarian disasters and conclude with an analysis of countries in armed conflict in 2001 that are at increased risk of genocide and/or politicide. These and some of the other chapters in the two books would have made a wonderful anthology of essays on humanitarian assistance.

In conclusion, despite some well written and insightful chapters from some of the leading experts in humanitarian assistance, these books do not meet their stated objectives of being primers on the basics of humanitarian action.

References
1.
Waldman R, Martone G. Public health and complex emergencies: new issues, new conditions.  Am J Public Health.1999;89:1483-1485.PubMed
2.
Médecins Sans Frontières.  Refugee Health: An Approach to Emergency SituationsLondon, England: Macmillan Education Ltd; 1997.
3.
Steering Committee for Humanitarian Response.  The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. Geneva, Switzerland: Sphere Project; 1998.
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