Between war and peace: humanitarian assistance in violent urban settings

Cities are fast becoming new territories of violence. 1 The humanitarian consequences of many criminally violent urban settings are comparable to those of more traditional wars, yet despite the intensity of the needs, humanitarian aid to such settings is limited. The way in which humanitarian needs are typically defined, fails to address the problems of these contexts, the suffering they produce and the populations affected. Distinctions between formal armed conflicts, regulated by international humanitarian law, and other violent settings, as well as those between emergency and developmental assistance, can lead to the neglect of populations in distress. It can take a lot of time and effort to access vulnerable communities and implement programmes in urban settings, but experience shows that it is possible to provide humanitarian assistance with a significant focus on the direct and indirect health consequences of violence outside a traditional conflict setting. This paper considers the situation of Port‐au‐Prince (Haiti), Rio de Janeiro (Brazil) and Guatemala City (Guatemala).     

The ethical contours of research in crisis settings: five practical considerations for academic institutional review boards and researchers

The number of research studies in the humanitarian field is rising. It is imperative, therefore, that institutional review boards (IRBs) consider carefully the additional risks present in crisis contexts to ensure that the highest ethical standards are upheld. Ethical guidelines should represent better the specific issues inherent to research among populations grappling with armed conflict, disasters triggered by natural hazards, or health‐related emergencies. This paper seeks to describe five issues particular to humanitarian settings that IRBs should deliberate and on which they should provide recommendations to overcome associated challenges: staged reviews of protocols in acute emergencies; flexible reviews of modification requests; addressing violence and the traumatic experiences of participants; difficulties in attaining meaningful informed consent among populations dependent on aid; and ensuring reviews are knowledgeable of populations' needs. Considering these matters when reviewing protocols will yield more ethically sound research in humanitarian settings and hold researchers accountable to appropriate ethical standards.     

HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action

Conflict, displacement, food insecurity and poverty make affected populations more vulnerable to HIV transmission. However, the common assumption that this vulnerability necessarily translates into more HIV infections and consequently fuels the HIV/AIDS epidemic is not supported by data. Whether or not conflict and displacement affect HIV transmission depends upon numerous competing and interacting factors. This paper explores and explains the epidemiology of HIV/AIDS in conflict and addresses the unique characteristics that must be addressed when planning and implementing HIV/AIDS interventions among populations affected by conflict as compared with those in resource-poor settings. These include targeting at-risk groups, protection, programming strategies, coordination and integration and monitoring and evaluation. Areas for future HIV/AIDS operational research in conflict are discussed.     

Questionable accountability: MSF and Sphere in 2003

This article examines the relationship between Médecins Sans Frontières (MSF) and the Sphere Project. Prior to revisiting the concerns MSF had with the project, it looks at factors that give rise to differences between NGOs and cites some reasons for why an organisation such as MSF would not embrace such a project and clarifies some key elements of MSF-style humanitarianism. The author revisits the original concerns and arguments presented by MSF when it decided not to participate beyond assisting with the establishment of technical standards and key indicators for the handbook. This is followed by a critical discussion examining these concerns and counter-criticism with reference to experiences a few years after the inception of Sphere. It concludes with MSF's perceptions and stance regarding Sphere and accountability in 2003.     

Ecological stress and political coercion in the Sudan

This article outlines the impact of state intervention on ecological relations in the Sudan. The establishment of large-scale mechanised agricultural schemes; population and livestock concentration around water sources; and the evolution of large urban centres with high demands for firewood and charcoal have all contributed to ecological degradation. These effects have been coupled with the use of coercive measures to displace traditional farmers and pastoralists from their lands in favour of large-scale farming schemes. The objectives of government policy have suffered a double retreat – from development to crisis management and from crisis management to the bare maintenance of compliance and order. The inability of the state to intervene on behalf of the victims of drought and famine has led to the use of coercion as the only means to legitimise its hold on power.     

Vulnerability to typhoon hazards in the coastal informal settlements of Metro Manila,the Philippines

In many low‐ and middle‐income countries informal communities—also termed slum and squatter areas—have become a dominant and distinct form of urban settlement, with ever increasing populations. Such communities are often located in areas of high hazard exposure and frequently affected by disasters. While often recognised as one of the highest ‘at risk’ populations, this paper will argue that informal settlers have been directly and indirectly excluded from many formal mechanisms, thereby increasing their vulnerability to disaster events. Household surveys were conducted across several frequently flooded informal coastal communities in Metro Manila, the Philippines, following a major typhoon and storm surge disaster. The study revealed a large level of diversity in socio‐economic vulnerability, although all households faced similar levels of physical exposure and physical vulnerability. Disaster risk reduction policies and responses need to better integrate informal settlement areas and recognise the diversity within these communities.     

Ensemble predictions and perceptions of risk, uncertainty, and error in flood forecasting

Under the auspices of the World Meteorological Organization, there are a number of international initiatives to promote the development and use of so-called ensemble prediction systems (EPS) for flood forecasting. The campaign to apply these meteorological techniques to flood forecasting raises important questions about how the probabilistic information these systems provide can be used for what in operational terms is typically a binary decision of whether or not to issue a flood warning. To explore these issues, we report on the results of a series of focus group discussions conducted with operational flood forecasters from across Europe on behalf of the European Flood Alert System. Working in small groups to simulate operational conditions, forecasters engaged in a series of carefully designed forecasting exercises using various different combinations of actual data from real events. Focus group data was supplemented by a follow-up questionnaire survey exploring how flood forecasters understand risk, uncertainty, and error. Results suggest that flood forecasters may not instinctively use ensemble predictions in the way that promoters of EPS perhaps think they should. The paper concludes by exploring the implications of these divergent ‘epistemic cultures’ for efforts to apply ensemble prediction techniques developed in the context of weather forecasting to the rather different one of flood forecasting.     

Partners under pressure: humanitarian action for the Syria crisis

Partnerships between organisations in humanitarian crisis situations generally are challenging, but at the apex are those established as part of remote management in a context of extreme insecurity. To date, little systematic research has been conducted on arrangements between local organisations that have access to crisis‐affected populations and international organisations that hold the purse strings. This paper presents the findings of nine months of qualitative research conducted with five Syrian local organisations and their international partners engaging in humanitarian action across the Turkey–Syria border, and presents insights into the components of successful partnerships. It redefines capacity along organisational and operational lines, and unpacks how monitoring and evaluation and donor requirements create tension and, at times, place local organisations at risk. The paper highlights the centrality of trust in successful partnerships, and describes the personalisation of the conflict by local organisations. Based on a historical case study of civil society in northern Iraq, it closes with some suggestions for long‐term sustainability.     

Jockeying for position in the humanitarian field: Iraqi refugees and faith-based organisations in Damascus

The rise in the number of interventions by faith-based organisations in the humanitarian field has reignited debate about the role of religion in the public sphere. This paper presents a nuanced examination of the part played by religious institutions and networks in the strategies of forced migrants in urban contexts. Furthermore, it considers how such organisations work to integrate displaced populations into their new surroundings. Drawing on two case studies and ethnographic fieldwork and in-depth interviews with Iraqi refugees and refugee service providers in Damascus, Syria, carried out between March 2010 and March 2011, it evaluates how Iraqi refugees, as active social agents, utilise religious institutions and networks in conjunction with established international humanitarian organisations to produce a distinctive geography of exile. In addition, it draws attention to how the Syrian state exerts influence over religious actors and how ultimately this affects the decision-making of forced migrants.     

From authoritarian enclave to deliberative space: governance logics in post‐disaster reconstruction

One would be hard‐pressed nowadays to find any practitioners and scholars in the field of post‐disaster reconstruction who would argue against the virtues of community participation. In practice, however, the legacy of community participation has been mixed. This paper pursues this line of inquiry by examining the manifestations of participation in three communities affected by Typhoon Haiyan that struck the Philippines on 8 November 2013. The findings suggest that different governance logics emerge in each of the three case studies: authoritarian; communitarian; and deliberative. These logics promote particular understandings of who should participate in the reconstruction process and the appropriate scope of action for citizens to express discontent, provide feedback, and perform democratic agency. The paper contends that design interventions in participatory procedures, as well as contingencies in wider social contexts, shape the character and legacies of community participation. It concludes by comparing the legacies of these three ‘governance enclaves’ and imagining possibilities for participatory politics in post‐disaster settings.     

Ensemble predictions and perceptions of risk,uncertainty, and error in flood forecasting

Under the auspices of the World Meteorological Organization, there are a number of international initiatives to promote the development and use of so-called ensemble prediction systems (EPS) for flood forecasting. The campaign to apply these meteorological techniques to flood forecasting raises important questions about how the probabilistic information these systems provide can be used for what in operational terms is typically a binary decision of whether or not to issue a flood warning. To explore these issues, we report on the results of a series of focus group discussions conducted with operational flood forecasters from across Europe on behalf of the European Flood Alert System. Working in small groups to simulate operational conditions, forecasters engaged in a series of carefully designed forecasting exercises using various different combinations of actual data from real events. Focus group data was supplemented by a follow-up questionnaire survey exploring how flood forecasters understand risk, uncertainty, and error. Results suggest that flood forecasters may not instinctively use ensemble predictions in the way that promoters of EPS perhaps think they should. The paper concludes by exploring the implications of these divergent ‘epistemic cultures’ for efforts to apply ensemble prediction techniques developed in the context of weather forecasting to the rather different one of flood forecasting.     

Measuring disaster recovery: bouncing back or reaching the counterfactual state?

How should one measure the recovery of a locale from a disaster? The measurement is crucial from a public policy and administration standpoint to determine which places should receive disaster assistance, and it affects the performance evaluation of disaster recovery programmes. This paper compares two approaches to measuring recovery: (i) bouncing back to pre‐disaster conditions; and (ii) attaining the counterfactual state. The former centres on returning to normalcy following disaster‐induced losses, whereas the latter focuses on attaining the state, using quasi‐experimental design, which would have existed if the disaster had not occurred. Both are employed here to assess two housing recovery indicators (total new units and their valuations) in Hurricane Katrina‐affected counties (rural and urban). The examination reveals significantly different outcomes for the two approaches: counties have not returned to their pre‐disaster housing conditions, but they do exhibit counterfactual recovery. Moreover, rural counties may not be as vulnerable as assumed in the disaster recovery literature.     

Protecting people in cities: the disturbing case of Haiti

Humanitarian actors have sought increasingly not only to assist people affected by natural disasters but also to protect them. This paper examines the efforts of international humanitarian actors to protect Haitians affected by the devastating earthquake of 12 January 2010. It begins with an analysis of the particular difficulties of conceptualising and operationalising protection in an urban environment and traces the efforts of international actors on the ground to develop appropriate protection strategies. The particular difficulties of working with camps and spontaneous settlements in urban areas are explored as are the challenges that stemmed from working with different levels of governmental authorities and a multitude of humanitarian actors. The paper concludes by highlighting some of the lessons learned from the successes and failures of international protection efforts in Haiti. It is hoped that these may assist future efforts to protect people living in urban environments.     

HIV risk and prevention in emergency-affected populations: a review

While basic guidelines on HIV prevention in emergencies have been available for several years, international agencies involved in the provision of health services have not placed sufficient priority on the prevention of the human immune deficiency virus (HIV) and other sexually transmitted infections (STIs) in complex emergencies. This paper reviews the factors that may increase the risk of HIV transmission in populations affected by complex emergencies and outlines recommendations for research and programmes. Research into the most appropriate methods of carrying out HIV surveillance and interventions in these settings is needed. In the post-emergency phase programmes need to be far more extensive than those offered under the Minimal Initial Services Package (MISP). While the potential for stigmatization represents an important constraint, there is a need to prioritize HIV/STI interventions in order to prevent HIV transmission in emergency-affected populations themselves, as well as to contribute to regional control of the epidemic.     

Ambivalence towards discourse of disaster resilience

This paper investigates empirically how the international aid community (IAC)—donors and practitioners—considers and implements disaster resilience in a specific country setting, Nepal, and throughout the rest of the world. A key finding is that there is ambivalence about a concept that has become a discourse. On a global level, the IAC utilises the discourse of resilience in a cautiously positive manner as a bridging concept. On a national level, it is being used to influence the Government of Nepal, as well as serving as an operational tool of donors. The mythical resilient urban community is fashioned in the IAC's imaginary; understanding how people create communities and what type of linkages with government urban residents desire to develop their resilience strategies is missing, though, from the discussion. Disaster resilience can be viewed as another grand plan to enhance the lives of people. Yet, regrettably, an explicit focus on individuals and their communities is lost in the process.     

British disaster planning and management: an initial assessment

The unprecedented series of damaging events experienced by Britain since the early 1980s has focussed attention on the country's arrangements for disaster prevention, planning and management. Until very recently the focus had been on planning for wartime emergencies, with events of the kind responsible for the current anxiety receiving much less attention. This is now changing and, following a wide ranging review, the government has appointed a Civil Emergencies Advisor to assist the national effort. The paper reviews these changes and makes an initial assessment of British disaster planning and management. This is not done at the operational level; rather it proceeds in terms of key issues emerging from the literature and the government review: organisational structure; information flow; national policy or guidelines; and learning from disasters.     

Public Nutrition from an Approach to a Discipline: Concern's Nutrition Case Studies in Complex Emergencies

The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue – through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC – that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.     

Lessons from the 2006 Louisiana health and population survey

The 2005 hurricane season caused extensive damage and induced a mass migration of approximately 1.1 million people from southern Louisiana in the United States. Current and accurate estimates of population size and demographics and an assessment of the critical needs for public services were required to guide recovery efforts. Since forecasts using pre-hurricane data may produce inaccurate estimates of the post-hurricane population, a household survey in 18 hurricane-affected parishes was conducted to provide timely and credible information on the size of these populations, their demographics and their condition. This paper describes the methods used, the challenges encountered, and the key factors for successful implementation. This post-disaster survey was unique because it identified the needs of the people in the affected parishes and quantified the number of people with these needs. Consequently, this survey established new population and health indicator baselines that otherwise would have not been available to guide the relief and recovery efforts in southern Louisiana.     

Disaster preparedness in a complex urban system: the case of Kathmandu Valley,Nepal

The city is a growing centre of humanitarian concern. Yet, aid agencies, governments and donors are only beginning to comprehend the scale and, importantly, the complexity of the humanitarian challenge in urban areas. Using the case study of the Kathmandu Valley, Nepal, this paper examines the analytical utility of recent research on complex urban systems in strengthening scholarly understanding of urban disaster risk management, and outlines its operational relevance to disaster preparedness. Drawing on a literature review and 26 interviews with actors from across the Government of Nepal, the International Red Cross and Red Crescent Movement, non‐governmental organisations, United Nations agencies, and at‐risk communities, the study argues that complexity can be seen as a defining feature of urban systems and the risks that confront them. To manage risk in these systems effectively, preparedness efforts must be based on adaptive and agile approaches, incorporating the use of network analysis, partnerships, and new technologies.     

The consequences and policy implications of urban encroachment into flood-risk areas: the case of Ibadan

Urban encroachment on floodplains has exacerbated flood disasters owing to the reduction in the floodplain’s capacity to mitigate flooding, thereby bringing more settlements and people at flood risk. This study examined the consequences and policy implications of urban encroachment into Ibadan’s flood-risk areas. The survey-based study relied on primary and secondary data, with multistage sampling procedures selecting 15% of the flood-affected buildings in 2011, from which a structured questionnaire was administered to 402 households. The study revealed that the institutional arrangements with respect to responsibilities, regulations and control of urban floodplains were fragmented and non-participatory. At least 62% of all the affected buildings encroached into the statutory setbacks to rivers. Household property lost/damaged included domestic goods (75%), domestic animals and pets (60%), working instruments/machines (31%), the source of domestic water (34%) and vehicles (29%). Strong direct correlations were found between the urban and peri-urban communities in (1) the number of damaged/lost property and (2) the number of households that suffered health-related challenges. The paper recommends that the overall co-ordination of flood management activities be entrusted to an institution that can assume responsibility for legal, technical, administrative and financial matters related to urban planning and flood-risk management.