Humanitarian aid professionals strategize

The public and private agencies that respond to war and disasters sometimes respond disastrously — and it’s time to do something about it.

That was the basic message of a three-day Humanitarian Health Conference at Harvard Sept. 6-8, which drew more than 120 emergency physicians, epidemiologists, and professional aid workers from 68 organizations. It was a reprise of a conference held a year ago in Hanover, N.H., co-sponsored — as this one was — by the Harvard Humanitarian Initiative (HHI) and Dartmouth Medical School.

“There is really a need for an ongoing expert forum,” said HHI co-director Jennifer Leaning, professor of the practice of international health at the Harvard School of Public Health and an assistant professor of medicine at Harvard Medical School.

The conference lets senior staff in humanitarian aid agencies look at key critical issues in a setting “where everyone knows and trusts each other,” Leaning said. “They welcome the chance to search for answers with academic colleagues in the neutral and intellectually challenging space that Harvard can provide.”

HHI is an interdisciplinary, Harvard-wide research and academic center designed to improve humanitarian aid, educate responders, and instill human rights principles into the business of relief. It sponsors faculty research, especially on issues relating to the effect of war on civilians.

Recent projects have looked at forced migration, disease in displaced populations, infant mortality, sexual violence, and other disaster-related health and humanitarian issues.

Another Harvard-Dartmouth conference will take place a year from now, HHI officials said, and another the next year. Summary PowerPoint files from this year’s conference will be ready within a week, said organizers, and proceedings will be ready in a month — followed by policy briefs from working groups.

The conference was held at the Center for Government and International Studies. Most of those attending represented U.S.- and Europe-based private, government, intergovernmental, and United Nations aid groups, including AmeriCares, International Rescue Committee, and the U.N. Children’s Fund (UNICEF).

Many others were medical aid workers from locations closer to the refugee camps and simmering regional wars that draw humanitarian aid. They came from places like Kenya, Sudan, and Banda Aceh, the provincial capital in Indonesia leveled by the 2004 Indian Ocean tsunami.

Conference attendees share common problems, which emerged in outline over the three days as the subjects of high-level intensive working groups.

“Make sure the right people are in the room,” said refugee health expert James C. Strickler, dean emeritus of Dartmouth Medical School, commenting on the caliber of attendees. “We got the right people in the room.”

Human resources represent one set of common problems, including issues of training and staff shortages. “The standards of doing good are not there,” said Nan Buzard, senior director of international programs at the American Red Cross. And that’s true, she added, despite the Sphere Project, an NGO/Red Cross initiative in Geneva once directed by Buzard and intended to set common standards for humanitarian work. Still needed, she said, are clear career paths for aid workers and clear standards for an emerging “humanitarian health work force,” from physicians to paraprofessionals.

Improving human resources requires better executive leadership for managing crises, said Georgetown University professor Andrew Natsios, former administrator of USAID and now the White House’s Special Envoy to Sudan. He urged aid experts to professionalize health management responses — and even to create an educated core of interagency professionals modeled on the U.S. Foreign Service.

“To work real change will be very difficult,” said Natsios, a former Massachusetts state legislator. “You’ll have to break some crockery.”

Humanitarian aid veteran and former ambassador Peter W. Galbraith also addressed the conference. He’s now senior diplomatic fellow at the Center for Arms Control and Non-Proliferation and author of “The End of Iraq: How American Incompetence Created a War Without End.”

Iraq remains the best example of how to respond to a crisis badly, Galbraith contended. “It’s comic,” he said, “except it’s tragic.” He compared Iraq to relatively successful international interventions in the Balkans and East Timor.

“In nation-building, professional competence is essential,” he said — along with event diagnosis, planning, a grasp of history, operational flexibility, and a sense that interventions can be done at a reasonable cost.

Civilian protection, another issue humanitarian aid groups have in common, is at the core of turmoil in Iraq, for beleaguered NGOs as well as civilians. In the chaos of field conditions, protection for of those not bearing arms is often ill-defined. Clear standards are needed, along with new ways to measure and monitor civilian protection, said veteran aid worker Geoff Loane, who has field experience in some dicey locales, including the Balkans, the Middle East, and the Horn of Africa. Today he’s with the International Committee of the Red Cross (ICRC), and oversees humanitarian visits to detainees at Guantanamo Bay, Cuba.

Protection of civilians, said Loane, “is very much at the core of humanitarian activities,” especially in a world where distinctions between fighters and civilians are growing murky.

Information management is another common problem shared by humanitarian aid groups. Agencies often don’t share data. Add to that a lack of funding, surveillance standards, data reliability, technical support, and training. “We have a lot of work to do,” said Dr. Paul B. Spiegel, chief of the Public Health and HIV Section at the U.N. High Commissioner for Refugees in Geneva. He moderated the conference’s working group on health information and data management.

Sharing data and resources “is a massive change for so many people” in the world of humanitarian health aid, said Spiegel, who remains skeptical that change will come soon. “The jury is still out.”

Interagency cooperation – covered by the fourth working group – seemed to be the one common problem underlying all the others. Agencies providing aid “need to be inclusive” and cooperative, said Mary Pack, an executive with International Medical Corps. “Principles of partnership” are already emerging, thanks to an action plan from the 2006 conference, she said – but they need to be better defined.

Without collaboration among rival agencies, health humanitarian aid remains “an unregulated, uncoordinated environment” – more like “Brownian motion (than) forward motion,” said Dr. Ronald Waldman, who teaches at the Mailman School of Public Health at Columbia University. (Brownian motion is the cloudlike, seemingly random motion of particles suspended in a fluid.)

But during remarks in the closing minutes of the conference, Waldman remained optimistic about effecting change. “We’ve done a good job of taking stock of the problems, many of which have been around for a long time,” he said of the three-day gathering of experts. “It leaves us with a lot more possibilities than we had in the past.”