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.     

Linking rights and standards: the process of developing "rights-based" minimum standards on food security, nutrition and food aid

This article examines the recent revision of the Sphere Minimum Standards in disaster response relating to food security, nutrition and food aid. It describes how the revision attempted to incorporate the principles of the Humanitarian Charter, as well as relevant human rights principles and values into the Sphere Minimum Standards. The initial aim of the revision was to ensure that the Sphere Minimum Standards better reflected the principles embodied in the Humanitarian Charter. This was later broadened to ensure that key legal standards and principles from human rights and humanitarian law were considered and also incorporated, in part to fill the "protection gap" within the existing standards. In relation to the food security, nutrition and food aid standards, it was agreed by participants in the process that the human right to adequate food and freedom from hunger should be incorporated. In relation to more general principles underlying the Humanitarian Charter, itself drawn largely from human rights and humanitarian law, it was agreed that there was a need to strengthen "protection" elements within the standards and a need to incorporate the basic principles of the right to life with dignity, non-discrimination, impartiality and participation, as well as to explore the relevance of the concept of the progressive realisation of the right to food. The questions raised in linking rights to operational standards required thought, on the one hand, about whether the technical standards reflected a deep understanding of the values expressed within the legal instruments, and whether the existing standards were adequate in relation to those legal rights. On the other hand, it also required reflection on how operational standards like Sphere could give concrete content to human rights, such as the right to food and the right to be free from hunger. However, there remain challenges in examining what a rights-based approach will mean in terms of the role of humanitarian agencies as duty-bearers of rights, given that the primary responsibility rests with state governments. It will also require reflection on the modes and mechanisms of accountability that are brought to bear in ensuring the implementation of the Minimum Standards.     

Locating responsibility: the Sphere Humanitarian Charter and its rationale

Criticised by some as a technical initiative that neglects core principles, Sphere was seen by its originators precisely as an articulation of principle. The Humanitarian Charter was the main vehicle through which this was expressed, but its relationship to the Minimum Standards has remained a matter of uncertainty. Specifically, it was unclear in the original (1999) edition of Sphere how the concept of rights informed the Minimum Standards. The revised (2004) edition goes some way to clarifying this in the way the standards are framed, yet the link between the standards and the charter remains unclear. The concern with the quality and accountability of humanitarian assistance, which motivated the attempt to establish system-wide standards through the Sphere Project, was accompanied by a desire to establish such actions in a wider framework of legal and political responsibility. In part, this reflects the conditional nature of the undertaking that agencies make when they adopt Sphere. This aspect of the charter has been neglected, but it is fundamental to an understanding of the standards and their application. This paper considers the rationale of the Sphere Humanitarian Charter and the conceptual model that underpins it. It discusses the relationship between the charter and the Minimum Standards, and the sense in which the latter are properly called "rights-based" (explored further in a related paper herein by Young and Taylor). The author was closely involved in the conception and drafting of the charter, and this paper attempts to convey some of the thinking that lay behind it.     

Nutritional response to the 1998 Bangladesh flood disaster: Sphere minimum standards in disaster response

In this study we use a cross-sectional survey to evaluate the nutritional response to the 1998 Bangladesh Flood Disaster by 15 relief agencies using standards developed by the Sphere Project. The Sphere Project is a recent attempt by agencies around the world to establish universal minimum standards for the purpose of ensuring quality and accountability in disaster response. The main outcomes measured were resources allocated to disaster relief types of relief activities and percentage of agencies meeting selected Sphere food aid and nutrition indicators. Although the process of nutritional response was measured, specific nutritional and health outcomes were not assessed. This review found that self-reported disaster and nutritional resources varied widely between implementing agencies, ranging from US $58,947 to $15,908,712. The percentage of resources these agencies allocated to food aid and nutritional response also varied, ranging from approximately 6 to 99 per cent of total resources. Agencies met between 8 and 83 per cent of the specific Sphere indicators which were assessed Areas in which performance was poor included preliminary nutritional analysis; beneficiary participation and feedback; disaster preparedness during non-emergency times; monitoring of local markets and impact assessment. Agencies were generally successful in areas of core humanitarian response, such as targeting the vulnerable (83 per cent) and monitoring and evaluating the process of disaster response (75 per cent). The results here identify both strengths and gaps in the quality of humanitarian response in developing nations such as Bangladesh. However, they also raise the question of implementing a rights-based approach to disaster response in nations without a commitment to meeting positive human rights in non-disaster times.     

The Sphere Project: The Implications of Making Humanitarian Principles and Codes Work

In 1996, in recognition of concerns about humanitarian response efforts, non- governmental organisations (NGOs) launched the Sphere Project, the first collaborative initiative to produce globally applicable minimum standards for humanitarian response. The aims of the Sphere Project are to improve the effectiveness of humanitarian efforts and to enhance the accountability of the humanitarian system, primarily to those people who have a right to protection and assistance in disasters, as well as to agency members and donors.
This paper discusses the purpose of the Sphere Project, the unique process that brought it about and the major concerns that have been raised about its practical application. Finally, the paper considers the implications of this for improving the impact of humanitarian response and for future initiatives given the process that Sphere has begun. It argues that improved accountability does not start and stop with NGOs. They are just one element of a wider humanitarian response effort and more needs to be done to improve the system as a whole.     

The Sphere Project: the implications of making humanitarian principles and codes work

In 1996, in recognition of concerns about humanitarian response efforts, non-governmental organisations (NGOs) launched the Sphere Project, the first collaborative initiative to produce globally applicable minimum standards for humanitarian response. The aims of the Sphere Project are to improve the effectiveness of humanitarian efforts and to enhance the accountability of the humanitarian system, primarily to those people who have a right to protection and assistance in disasters, as well as to agency members and donors. This paper discusses the purpose of the Sphere Project, the unique process that brought it about and the major concerns that have been raised about its practical application. Finally, the paper considers the implications of this for improving the impact of humanitarian response and for future initiatives given the process that Sphere has begun. It argues that improved accountability does not start and stop with NGOs. They are just one element of a wider humanitarian response effort and more needs to be done to improve the system as a whole.     

Towards a natural disaster intervention and recovery framework

Contemporary responses to facilitate long‐term recovery from large‐scale natural disasters juxtapose between those of humanitarian agencies and governments and those of the affected community. The extent to which these mechanisms articulate is crucial to the recovery propensity of the affected communities. This research examines such action by exploring the relationship between the scale of post‐disaster response interventions, the extent of community participation in them, and their impact on community recovery, using a community wealth capital framework. The investigation was applied to a study of the longer‐term community recovery of the island of Vilufushi, Republic of Maldives, which was almost completely destroyed by the Indian Ocean tsunami of 26 December 2004. Data were analysed through the employment of a pattern match technique and a holistic recovery network analysis. The research framework, informed by the case‐study results, other long‐term recovery evaluations, and existing resilience theory, is reconfigured as a testable roadmap for future post‐disaster interventions.     

Ocean waves and roadside spirits: Thai health service providers' post-tsunami psychosocial health

A massive earthquake off the west coast of Sumatra in Indonesia triggered a tsunami on 26 December 2004. At least five million people around the world were affected, and the total number of deaths exceeded 280,000. In Thailand, the tsunami struck six southern provinces, where the disaster's immediate impact was catastrophic. Based on ethnographic fieldwork in Phang Nga Province (2007), this paper provides an overview of the disaster's psychosocial consequences for Thai health service providers, the vast majority of whom were bypassed by regional post-tsunami mental health initiatives. The available tsunami literature only briefly attends to health providers' experience of professional 'burn-out', rather than explores the tsunami's wide spectrum of psychosocial effects. This research aims to remedy such oversights through 'critical medical' and 'interpretive phenomenological' analysis of the diverse and culturally-situated ways in which health providers' experienced the tsunami. The paper concludes by arguing for disaster-related psychosocial interventions to involve health providers explicitly.     

Revisiting Sphere: new standards of service delivery for new trends in protracted displacement

The proportion of people living in protracted displacement, as well as the duration of this displacement, is increasing. International humanitarian standards for services provided in protracted displacement are based on the Sphere Standards, which were formulated using evidence and experience from acute phase emergencies. However, the majority of protracted emergencies are in the post‐emergency phase. This paper discusses trends in displacement, outlines reasons why using the Sphere Standards as minimum standards of service provision in protracted displacement does not adequately meet the needs of these populations, and analyses areas where greater standards of service provision are necessary. An expansion of the evidence base regarding determinants of morbidity and mortality in protracted emergencies is needed. This, followed by a joint approach to designing new, effective standards focused on proactive policies, will allow the humanitarian community more appropriately to serve and enable the millions of people currently living in protracted displacement.     

The 2004 tsunami and mental health in Thailand: a longitudinal analysis of one‐and two‐year post‐disaster data

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36‐item Short Form Health Survey (SF‐36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long‐lasting ramifications for mental health, and that diverse losses may influence mental health differently.     

Rights,Standards and Quality in a Complex Humanitarian Space: Is Sphere the Right Tool?

The Sphere Project (consisting of both the Humanitarian Charter and Minimum Standards for Disaster Response) has made prominent contributions to the debates, thinking and work on the quality of assistance and accountability of aid agencies. However, since its inception in 1997, several agencies expressed concerns regarding Sphere's approach, many of which were confirmed by the Sphere evaluation (2002/3). The present article restates these concerns, and addresses more fundamental issues regarding Sphere's cornerstone. It questions the validity of Sphere's rights-based approach, which consists of a tenuous link between the rights of affected populations and standards for technical interventions. Sphere is founded on "the right to assistance", although this right does not exist in international law. Its elaboration would entail solving several complex legal and political issues, which Sphere fails to address. This article also questions the validity and usefulness of universal standards for technical performance in helping relief agencies provide adapted assistance to disaster-affected populations, in line with their mandates and principles. It suggests that Sphere's approach and content largely reflect the concerns, priorities and values of technical professionals in Northern agencies, leaving limited space to genuine "participation" by affected populations and partners from the South.     

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.     

Assessing the impact of microfinance programming on children: an evaluation from post‐tsunami Aceh

This paper presents an evaluation of the long‐term impact of microfinance programmes on Acehnese children during the post‐tsunami recovery. The study, conducted from June to August 2010, examined the impact of microfinance programming six years after the tsunami. The sample consisted of 185 microfinance participants, with a comparison group of 192 individuals who did not participate in microfinance programmes. All respondents were parents, interviewed through a structured survey. The study used four child protection indicators—diet, health, childcare and education—in contrast to traditional repayment rate indicators. The primary results were insignificant with respect to all four child protection indicators, suggesting that, with respect to these indicators, there was no long‐term difference between the impact of microfinance on beneficiaries' children and non‐beneficiaries' children. These findings signify a need for microfinance actors to move beyond traditional indicators of economic success to evaluate the social changes microfinance programmes are presumed to effect.     

Mental health in South Sudan: a case for community‐based support

This paper² provides a snapshot of the mental health situation in South Sudan between 2013 and 2016, taking account of the personal reflections of both authors who were engaged in mental health and psychosocial support (MHPSS)³ programming in the country at this time.⁴ It begins by presenting an overview of MHPSS activities from this period, including governmental and non‐governmental organisation (NGO) services, and relevant research and coordination mechanisms. It goes on to illustrate the challenges to the provision of support, as well as the overarching structural, governance, and human resource constraints faced by the sector. Finally, recommendations are put forward for improving services and care for people suffering from psychosocial and mental health issues, as well as suggestions for areas of focus in the future. The importance of an integrated, community‐based model is emphasised, and opportunities for organisations engaged in reconciliation efforts and mental health service provision to collaborate are proposed.     

Work‐related stress in a humanitarian context: a qualitative investigation

There is a paucity of research on the subjective stress‐related experiences of humanitarian aid workers. Most evaluations of stress among these individuals focus on trauma and related conditions or adopt a quantitative approach. This interview‐based study explored how 58 humanitarian aid workers employed by a United Nations‐aligned organisation perceived the transactional stress process. The thematic analysis revealed eight main topics of interest: an emergency culture was found where most employees felt compelled to offer an immediate response to humanitarian needs; employees identified strongly with humanitarian goals and reported a high level of engagement; the rewards of humanitarian work were perceived as motivating and meaningful; constant change and urgent demands resulted in work overload; and managing work–life boundaries and receiving positive support from colleagues and managers helped to buffer perceived stress, work overload, and negative health outcomes. The practical implications of the results are discussed and suggestions made in the light of current research and stress theory.     

Public nutrition in emergencies: an overview of debates, dilemmas and decision-making

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'. Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition. Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use. Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectorial working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.     

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.     

Public Nutrition in Emergencies: An Overview of Debates, Dilemmas and Decision-making

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'.
Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition.
Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use.
Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectoral working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.     

Understanding the security management practices of humanitarian organizations

Humanitarian organisations operate in increasingly hostile environments. Although authoritative statistics are scarce, anecdotal evidence suggests that aid workers face life-threatening risks that are exacerbated by the growing number of humanitarian organisations operating in the field, the diversity of their mandates, the lack of common professional security standards, and limited success in inter-agency security coordination. Despite broad acceptance of the need for better security management and coordination, many humanitarian organisations remain ambivalent about devoting increased resources to security management and security coordination. A critical lack of basic empirical knowledge of the field security environment hampers efforts to enhance security management practices. The absence of a systematic means of sharing incident data undermines the capacity of the humanitarian community to address proactively security threats. In discussions about humanitarian staff safety and security, the least common denominator remains cumulative anecdotal evidence provided by the many security personnel working for humanitarian organisations in the feld.