The health sector gap in the southern Africa crisis in 2002/2003

The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to address the underlying problem of the health sector gap, a long-term strategy to ensure improved and sustainable health sector performance can only be accomplished with truly adequate resources. This will require renewed efforts on part of governments, donors and the international community. Public health interventions, complementing those addressing food insecurity, were and are still needed to reduce the impact of the crisis, and to allow people to re-establish their livelihoods. These will increase the population's resilience to prevent or mitigate future disasters.     

Aid in the midst of plenty: oil wealth, misery and advocacy in Angola

This paper examines advocacy initiatives by humanitarian and human rights organisations to address problems of governance in resource-rich and conflict-affected countries, focussing on the case of Angola. Humanitarian principles preclude the use of indiscriminate conditionality and point towards a cautious approach to advocacy aimed at assisting vulnerable populations. Furthermore, the relatively insignificant amount of aid supplied to resource-rich local authorities means that individual agencies have precious little leverage, especially when commercial interests rather than humanitarian or 'good governance' principles influence the priorities of bilateral donors. A context of resource wealth calls for: high levels of coordination and cooperation between human rights groups, aid agencies and donors; balanced use of conditionality, based on the drawing, by donors, of a clear distinction between emergency and development-oriented assistance; and a sustained effort to highlight the responsibilities of local authorities, foreign governments and businesses in meeting humanitarian and development objectives.     

Between international donors and local faith communities: Intermediaries in humanitarian assistance to Syrian refugees in Jordan and Lebanon

This paper explores the crucial part that faith‐based organisations (FBOs) play in acting as intermediaries between international donors and local faith communities (LFCs) implementing humanitarian relief projects for Syrian refugees. Humanitarian responses to the mounting Syrian refugee crisis have coincided with greater collaboration between international donors and LFCs. This cooperation often is facilitated by a complex web of non‐state intermediaries at the international, national, and local level. This study probes the breadth of roles of these intermediaries, drawing on primary data from case studies of two Christian intermediaries supporting Christian LFCs as they deliver aid primarily to Muslim Syrian refugees in Jordan and Lebanon. The results of the study are connected to the wider literature on LFCs in humanitarian response, revealing how intermediaries address issues of accountability, capacity‐building, impartiality, neutrality, and professionalism. The paper concludes by offering suggestions for further research on intermediaries as key actors in the localisation of humanitarian assistance.     

Citizen feedback in a fragile setting: social accountability interventions in the primary healthcare sector in Sierra Leone

Fragile and conflict‐affected states are frequently characterised by their inability to fulfil three core governance functions: provision of security, effective delivery of basic public goods and services, and managing political participation and accountability. This article explores the utility of social accountability interventions in fragile environments. Successful social accountability interventions can lead to joint examinations of public service standards by service‐users and providers, resulting in collaborative improvement efforts. The few available studies of such interventions implemented in fragile or conflict‐affected states show reasons for optimism as well as challenges. This article advocates the continued use of social accountability methods in fragile settings and provides examples of social accountability interventions in the health sector in Sierra Leone. The study suggests that social accountability can improve interaction between citizens and public service providers. Successful social accountability interventions can also lead to better quality and more accessible public services, which, in turn, can enhance state legitimacy.     

Beyond performance and protocols: early responders' experiences of multiple accountability demands in the response to the 2015 Nepal earthquake

Critics have long questioned the push for professionalised and performance‐driven accountability in the humanitarian sector, yet the matter is largely treated as a ‘back office’ issue of standards, guidelines, and processes. Scant attention is paid to the accountability demands experienced by early responders to disasters. Set in the contested climate of the emergency response to the earthquake in Nepal on 25 April 2015, and drawing on interviews with 15 early responders, this paper reveals three forms of accountability demands: (i) accountability as compliance; (ii) accountability as the object of government regulation; and (iii) accountability as public opposition and interrogation. Beyond the performance‐centric, non‐governmental organisation‐driven understanding of accountability, early responders to the earthquake experienced multidirectional accountability demands, not only from donors and beneficiaries, but also from the national government and wider public. Engaging with public criticism is a significant feature of early responders' responsibility that warrants further consideration by the humanitarian community.     

Governing sexual behaviour through humanitarian codes of conduct

Since 2001, there has been a growing consensus that sexual exploitation and abuse of intended beneficiaries by humanitarian workers is a real and widespread problem that requires governance. Codes of conduct have been promoted as a key mechanism for governing the sexual behaviour of humanitarian workers and, ultimately, preventing sexual exploitation and abuse (PSEA). This article presents a systematic study of PSEA codes of conduct adopted by humanitarian non‐governmental organisations (NGOs) and how they govern the sexual behaviour of humanitarian workers. It draws on Foucault's analytics of governance and speech act theory to examine the findings of a survey of references to codes of conduct made on the websites of 100 humanitarian NGOs, and to analyse some features of the organisation‐specific PSEA codes identified.     

Selling displaced people? A multi‐method study of the public communication strategies of international refugee organisations

The world has seen a major increase in forced displacement since 2011. As a growing number of states implement restrictive refugee policies, public communication has become essential for refugee organisations. This study analysed, therefore, three international refugee organisations’ discursive strategies towards the recent Syrian crisis, as well as their production and the social context. A critical discourse analysis of international press releases (N=122) and six semi‐structured interviews with press and regional officers revealed that the observed actors largely dehumanise displaced people and subordinate them to the ‘Western self’ and state interests; displaced people hardly ever acquire their own voice. The study found that the medium characteristics of press releases and the importance of media attention result in a depersonalising humanitarian discourse. In addition, there were indications of a post‐humanitarian discourse that reproduced the humanitarian sector's ‘marketisation’. Finally, the examined organisations use the political realist cross‐issue persuasion strategy, displaying displaced people as resettlement objects.     

Rethinking access: how humanitarian technology governance blurs control and care

Surprisingly little attention is paid to the role of digital technology and related forms of data production, storage, processing, and sharing in humanitarian governance. This paper uses Michael Barnett's ( 2013 ) conceptualisation of humanitarian governance when arguing for a better accounting of technology in literature on humanitarian governance. Specifically, it proposes a two‐fold alertness to governance of (a) the uses of new technology and (b) that which is produced by digital technologies. This elucidates important issues, including that of access to digitalised data collected from humanitarian subjects, with implications for their (in)security. The paper concludes by suggesting that access is no longer ‘only’ about challenges of gaining access to vulnerable populations, but also about challenges of preventing access to vulnerable digital bodies and their use for aggressive purposes. In short, access and protection acquire a new dimension and analyses of humanitarian governance must be more attentive to the role of digital technology.     

A world in turmoil: governing risk,establishing order in humanitarian crises

This special issue of Disasters on humanitarian governance focuses on risk and order. Its contributions show the tensions between humanitarian normative ideals and practical consequences, as many of the ordering effects are associated with either intended or unintended consequences. This introduction offers a conceptual framing of humanitarian governance. Defining humanitarian governance as a subset of global governance, the paper shows how humanitarians have attempted to improve the consequences of their work by fighting instrumentalisation and instituting rationalisation processes. It adapts four questions, originally formulated by Michael Barnett ( 2013 ), to examine the ways in which humanitarian governance functions in more detail: what kind of world is being imagined and produced through the specific concern with order and risk? Who governs? How is this a form of humanitarian governance and how is it organised? And finally, what are the principal techniques of such governance? The conclusion summarises the main findings and sets an agenda for further research.     

Mental and social health in disasters: the Sphere standards and post‐tsunami psychosocial interventions in Asia

The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project's Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long‐term humanitarian psychosocial programmes in different countries in post‐tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long‐term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long‐term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication.     

Humanitarian governance and resilience building: Ethiopia in comparative perspective

Humanitarian governance is usually understood according to the classic, Dunantist paradigm that accords central importance to international humanitarian agencies. However, this is increasingly paralleled by ‘resilience humanitarianism’ that focuses, among other things, on including national actors in humanitarian governance. This article views humanitarian governance as emerging through interactions between authorities, implementing agencies and communities. It is based on interactive ethnography in five countries by Partners for Resilience (PfR). Using the Theory of Change (ToC) tool, it analyses the various interpretations and priorities of actors involved in humanitarian problems, solutions and programme governance. For example, PfR had a ‘software’ focus, aiming to unlock communities’ potential for resilience, whereas communities and authorities preferred to receive tangible ‘hardware’ support. The findings highlight the crucial role of local authorities in shaping humanitarian aid. This is especially pertinent in view of the international agenda to localise aid, which requires the understanding and support of national actors in order to responsibly protect the vulnerable.     

The impact of the Gulf crisis on Qatar's humanitarian sector

The 2017 Gulf crisis is one of the most challenging episodes faced by Qatar since its independence in 1971, with major economic, social, and political impacts on the Arab Gulf nation. Its economic prognosis has been brought into doubt, the map of regional alliances has been redrawn, and any prospects of deeper regional integration have been dashed. This paper analyses the little-documented impact of the crisis on Qatar's humanitarian sector, which has unfolded as the small, gas-rich emirate has striven to become a major humanitarian donor. It concludes that while there have been disruptions to humanitarian operations and regional coordination, the Gulf crisis has triggered and in some cases accelerated already intended reforms across the Qatari humanitarian sector. In the long term, the reorganisation and adaptation implemented to weather the storm of the crisis may help Qatar to emerge from the crisis with a more sustainable and resilient humanitarian sector.     

The Protection of Civilians and ethics of humanitarian governance: beyond intervention and resilience

The principle of the Protection of Civilians (PoC) in armed conflict has ethical repercussions in various actions undertaken by states and international organisations, from humanitarian relief, development aid, and peacekeeping, to warfare and military intervention. While the ethics of humanitarian intervention are instructive in this regard, most PoC practices should be conceived rather as modes of humanitarian governance across borders—from interventionist to resilience‐oriented kinds. The consequences of this for the ethics of PoC are explored in this paper, highlighting questions of power, culture, and complicity. By relating these questions to the ethical strands of solidarist and pluralist internationalism, it positions the ethics of PoC within the broader field of the ethics of world politics. Examples are drawn from recent scholarly debate on PoC efforts in war‐torn countries such as South Sudan. This analysis of the ethics of PoC reconfigures central positions in the debate on humanitarian intervention to an era of global humanitarian governance.     

Humanitarian Crises: What Determines the Level of Emergency Assistance? Media Coverage,Donor Interests and the Aid Business

This paper proposes a basic hypothesis that the volume of emergency assistance any humanitarian crisis attracts is determined by three main factors working either in conjunction or individually. First, it depends on the intensity of media coverage. Second, it depends on the degree of political interest, particularly related to security, that donor governments have in a particular region. Third, the volume of emergency aid depends on strength of humanitarian NGOs and international organisations present in a specific country experiencing a humanitarian emergency. The empirical analysis of a number of emergency situations is carried out based on material that has never been published before. The paper concludes that only occasionally do the media play a decisive role in influencing donors. Rather, the security interests of Western donors are important together with the presence and strength of humanitarian stakeholders, such as NGOs and international organisations lobbying donor governments.     

Coordination in theory,coordination in practice: the case of the Clusters

The atomised nature of the humanitarian system has led to frequent and repeated attempts to coordinate humanitarian activity. Since 2005, some of the best resourced, and arguably most successful, coordination mechanisms have been the humanitarian Clusters, groups of UN (United Nations) and non‐UN actors that engage in sectoral coordination of humanitarian response (such as the provision of healthcare and water) at the global and country level. Nevertheless, it is not clear exactly what ‘coordination’ means in the context of a Cluster. Formal guidance suggests that they should be aiming to create a single, joint strategy to guide the activities of members. Actual experience of the Clusters, however, indicates that looser forms of coordination are more effective. This finding resonates with organisational theory, and with the experience of emergency management professionals beyond the international humanitarian sector. To capitalise fully on the success of the Clusters, policymakers may need to rethink their attitudes to, and expectations of, coordination.     

Challenges in humanitarian information management and exchange: evidence from Haiti

There is a growing recognition of the critical role information management can play in shaping effective humanitarian response, coordination and decision‐making. Quality information, reaching more humanitarian actors, will result in better coordination and better decision‐making, thus improving the response to beneficiaries as well as accountability to donors. The humanitarian response to the 2010 Haiti earthquake marked a watershed moment for humanitarian information management. Yet the fragmented nature of the response and the use of hierarchical models of information management, along with other factors, have led some observers to label the Haiti response a failure. Using an analytical framework often found in humanitarian emergencies, this study analyses challenges to information flow in the Haiti case and the implications for effective humanitarian response. It concludes by offering possible paths for overcoming such challenges, and for restoring the value and utility of humanitarian information management and exchange in humanitarian relief settings.     

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.     

Participation,political economy and protection: food aid governance in Darfur,Sudan

Humanitarian food assistance aims to meet short‐term emergency needs, yet often it is sustained over many years and develops its own systems and infrastructure that interact with local governance and local communities. This paper explores the links between participation and local governance, as well as the implications for exclusion of certain groups, the dignity of those involved, and protection issues. The paper proposes a framework for reviewing the governance functions and capacities of local Food Relief Committees, based on the following criteria: accountability; gender equity; legitimacy and authority; representativeness; responsiveness; and transparency. A case study of the Darfur region reviews how local governance evolves as a result of both the wider conflict and of adapting to the international humanitarian system, itself a form of governance. The paper concludes by proposing three strategies for enhancing participation and applying lessons learned: improved analysis of participation; linking programming strategies and protection; and taking account of governance functions and capacities.     

Children and the Sphere standard on mental and social aspects of health

Most of the world's children live in resource-poor countries where people are at a relatively high risk of exposure to catastrophic situations arising from conflict and natural disasters.(6) Given the potential social, psychological and psychiatric consequences of exposure to disaster, mental health and psychosocial support programmes are increasingly part of humanitarian aid. A minimum standard on mental and social aspects of health is included in the recently revised Humanitarian Charter and Minimum Standards in Disaster Response (Sphere Handbook) (Sphere Project, 2004). Most recommendations for mental health and psychosocial interventions in guidance documents are based on expert opinion rather than research. Consequently, interventions are being implemented without full understanding of their potential benefit or harm. This paper offers a child-focused review of the evidence for each of the interventions described as indicators for the Sphere standard on mental and social aspects of health. It suggests some, but limited, support for each of them. However, the evidence base needs substantial strengthening.     

The moral sense of humanitarian actors: an empirical exploration

This paper examines humanitarianism's moral positioning above private and political interests to save lives and alleviate suffering. It does not aim to assess the legitimacy of this stance, but rather to probe the way in which humanitarian actors relate to this moral dimension in their everyday work. It investigates empirically humanitarian ethics from the perspective of humanitarian actors, drawing on interviews conducted in Beirut, Lebanon, in 2014. As it is exploratory, three key conceptual innovations were required. The first of these is the introduction of the tools developed to consider a neglected reality: humanitarian actors’ ‘moral sense’ vis‐à‐vis the humanitarian sector's ‘moral culture’. Second, the study shows how the sector's moral culture is structured around the notion of ‘concern for persons in need’. Third, it analyses the way in which the sector and its actors handle the asymmetrical relationships encountered daily. Ultimately this paper seeks to valorise humanitarian actors’ creativity in their common practices and explore potential challenges to it.