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.
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
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
Spiegel PB. Humanitarian Aid. JAMA. 2004;291(2):249-250. doi:10.1001/jama.291.2.249