Mortality and morbidity in refugee camps in eastern Sudan: 1985-90

Civil war has disrupted life in Ethiopia since the 1960s and many people have sought refuge in Eastern Sudan, particularly during the famine emergency of 1984–85. UNHCR has provided the main financial support for the refugee programme, but began scaling down operations in 1990. Nearly 300,000 refugees still live in camps and benefit from food and health programmes. Health services are co-ordinated by the Sudanese Refugee Health Unit which operates a centralised health and nutrition surveillance system with the co-operation of the NGOs responsible for health care in the camps. A revision of the monthly reporting system and the establishment of a computer database in 1990 provided an opportunity to review the situation in the camps over the five years since the emergency. Child death rates for example, appear to have been reduced to levels below those expected in rural Africa. Patterns of mortality, morbidity, and nutritional status are outlined here and point to the general effectiveness of the health care programme. The surveillance system can, however, be used to identify those camps which have persistent problems, while monthly comparisons with the situation in previous years can provide early warning of deteriorating conditions.     

Prisoners of armed conflict: Nicaragua an ICRC survey

This paper examinee the role of the medical delegate of the ICRC. Part I outlines the diseases and conditions found during a survey of three Nicaraguan rural prisoner of war camps. This information should enable medical delegates to formulate better plans for the treatment of prisoners in future. Part II suggests an alternative health care system which relies on the use of medical kits and manuals In the hands of medical auxiliaries. Dividing responsibility in this way would leave the medical delegate free to perform tasks which make more use of his more sophisticated skills.     

Disaster study of war

In the first part of this article I argue that war should be considered as a disaster. A brief historical review of the relationship of the field of disaster studies to military concerns is presented in an effort to demonstrate that, in fact, war has been a familiar subject in the field. I then consider definitions of disaster and conclude that war is easily accommodated by them. In the main section of the article I attempt to uncover distinctive characteristics of war by submitting war to analysis within well known sociological frameworks for disasters. Finally, some methodological considerations for the study of war disasters are presented.     

Childhood Immunisation in Rural Afghanistan: The EPI Programme, 1987-91

A decade of outright war followed by civil strife and conflict has hindered the development of health care services for the population of rural Afghanistan. Despite the absence of a functional health care system and the fragmentation of the Afghan resistance, and despite widely held views to the contrary, it has proved possible to set up a technically valid and politically acceptable Expanded Programme of Immunisation (EPI). This paper discusses some of its technical and programmatic aspects and the rationale behind some of the very unusual choices made – such as the use of DPTP, the inclusion of girls 3–14 years old for TT immunisation, a vertical programme structure and a predominance of mobile and outreach strategies. The paper argues against the mindless use of global or handbook recipes. The keys to success have been strategic vision, intimate knowledge of the local context and pragmatic choices for options that are simple and effective.     

Privatisation and outsourcing in wartime: the humanitarian challenges

The tendency today to privatise many activities hitherto considered the exclusive preserve of the state has given rise to sharp debate. The specific nature of humanitarian emergencies elucidates in particularly stark contrast some of the main challenges connected to the privatisation and outsourcing of essential public services, such as the provision of drinking water and health care. Privatising the realms of defence and security, which are at the very core of state prerogative, raises several legal and humanitarian concerns. This article focuses on the roles and responsibilities of the various parties involved in armed conflicts, especially those of private companies engaged in security, intelligence and interrogation work, and in the provision of water supply and health services. It highlights the need for humanitarian and development actors to grasp better the potential risks and opportunities related to privatisation and outsourcing with a view to supplying effective protection and assistance to communities affected by war.     

Are non‐poor households always less vulnerable? The case of households exposed to protracted civil war in Southern Sudan

Civil wars in Africa are now the leading contributory cause of vulnerability of rural communities. Understanding vulnerability during civil war is critical for humanitarian response and post-conflict rehabilitation planning. The lack of understanding of vulnerability has led existing studies to make sweeping generalizations, either by equating the dynamics of vulnerability during civil wars with vulnerability in other risk events, or by projecting people in the 'war zones' as unable to cope and subsequently becoming vulnerable. This paper is an attempt to gain a more nuanced understanding of the dynamics of vulnerability during protracted civil war. It shows that during civil war the non-poor are not necessarily less vulnerable than poor households. The idea that people caught up in civil war are all vulnerable is not supported by the findings of this paper. It shows that the 'standard' pattern of vulnerability to drought is similar to that during exogenous counter-insurgency warfare, while a different pattern of vulnerability to endogenous shocks is identified.     

A comparison of health provision and status in ban napho refugee cAMP and nakhon phanom province, northeastern Thailand

Health care provision and health status in Ban Napho Refugee Camp is compared with that of the surrounding Nakhon Phanom Province for the year 1988. Records for the period 1984–88 were also examined to compare trends in health status. Personal experience of health services in the Camp and visits made to local schools and health facilities were also used in the comparison. Although direct comparison was difficult (because of the mobile nature of the camp population and problems to do with the interpretation of statistics), it was found that health care for refugees was more comprehensive, at a primary level, than for the Thai population of the surrounding Province. Access to primary health care facilities in the Camp was, moreover, easier and free of charge. This may explain the higher use of health facilities in the Camp but, despite this, health and nutritional status appeared to be worse in the Camp than in the Province. Possible reasons for the difference in reported health status and the use of facilities are discussed.     

Women at risk: gender and AIDS in Africa

AIDS in Africa is a gender, development and rights issue involving power and differential access to resources. The risk situations for women in stressed development contexts of war, destabilisation and displacement, and the many contexts of transactional sex, are poorly understood by policy makers and the medical community. The dominant epidemiological paradigm has focused on female 'prostitutes' in a number of African cities. The limitations of this approach are discussed, as are the different contextualised meanings of sexual exchange. The importance of women's experience of sexually transmitted diseases and HIV and their perceptions of risk are stressed, as is the need for non-judgmental services linked to primary and comprehensive health care, and for sensitive, qualitative research. It is argued that all women who engage in unprotected penetrative sex are at risk. Most health promotion messages, however, construct an image of women as prostitutes ('Avoid prostitutes') or seek to mobilise women as carers and educators of families and communities.     

The functions of social service workers at a time of war against a civilian population

This article identifies the nature of functions that social service workers employed by municipal organisations have to perform during a community disaster and subsequent reorganisation at a time of war. The article also explores to what extent the functions of workers change as a result of the transition from a peacetime routine to a war situation. Using focus groups the study assesses the knowledge of social service workers and ordinary citizens who had direct experience of the second Lebanese war in Israel (2006). Eight major functions needed at a time of disaster are distinguished among various employees. The article discusses the significance of these functions, and the need to make changes in the network of functions at a time of disaster.     

Research in the War Zones of Eritrea and Northern Ethiopia

The paper engages in the discussion of conducting research in war zones, initiated in Disasters by Barakat and Ellis. It looks specifically at possibilities for research in the war zones of Eritrea and Northern Ethiopia during the 1980s, and notes the ways in which this context differs from wars in the former Yugoslavia to which Barakat and Ellis mainly refer. The authors suggest that the unique context of every internal war, and the institutional actors that converge around this context, create both the potential and the demand for particular kinds of information, especially when humanitarian programmes involving international donors are under way. De-contexualising research in war zones from the specific context in which it occurs, in order to derive general guidelines, can thus be problematic.     

War and Food Security in Eritrea and Ethiopia, 1998–2000

This paper examines the 1998–2000 'border' war between Eritrea and Ethiopia and its continuing legacies from the perspective of food security.¹ Focusing on the food crisis that hit both countries during the same period and was allowed to develop into a famine in southeast Ethiopia, it argues that this was linked with the war in more ways than hitherto recognised. Such connections can be appreciated only by taking a longer-term view of the decline of the rural economy of which this food crisis was part, factoring in the role played by this and other conflicts that have flared up in the region. An analysis of this kind might have helped donors and aid agencies to respond more effectively both to short-term humanitarian needs in the midst of an inter-state war and to the need for longer-term support for food security in a region beset by endemic conflict.     

Repatriation of 150,000 sudanese refugees from ethiopia: the manipulation of civilians in a situation of civil conflict

This paper outlines the dramatic return to Sudan of 150,000 men, women and children from Itang Refugee Camp in Ethiopia in June 1991. These people were pawns in Sudan's civil war, manipulated by governments, military forces and the media – a state of affairs that the international community failed to deal with effectively. At the time of the return to Sudan, ICRC and the United Nations were working to assist the returnees in two different areas and each had a different access agreement and thus a different impact on the survival of the returnees. The paper focuses on the role of political awareness and negotiation in the protection of refugees and in the organisation of relief in the context of a civil war.     

Anatomy of an ambush: security risks facing international humanitarian assistance

The 2003 war with Iraq has generated security concerns that present unique challenges to the practice of providing international humanitarian assistance during war and conflict. Objective research studies on security management are lacking. However, case studies have proven to be an important education and training tool to advance situational awareness of security risks. These challenges are illustrated by an analysis of the events surrounding the first ambush of, and assassination attempt on, a senior US aid official in Baghdad. Before deployment to conflict areas, especially those characterised by insurgent activity, humanitarian providers must realistically assess the threats to life and to the mission. They must obtain pre-deployment situational awareness education, security training and optimal protective equipment and vehicles.     

Arts as a vehicle for community building and post‐disaster development

Use of the arts in international aid is common in an ad hoc form, but it has not been systematically theorised or evaluated. The arts have the potential to be a culturally contextualised and sustainable intervention for adults and children in the aftermath of war or disaster. On the micro level, the arts are a method to enable the retrieval and reprocessing of traumatic memories that are often encoded in images rather than in words. On a macro level, they can help to reconstruct a group narrative of a disaster as well as mobilise people back into control of their lives. This paper researches a long‐term project using arts in Sri Lanka following the civil war and tsunami. A central finding is the need to understand arts within their cultural context, and their usefulness in strengthening the voices and problem‐solving capacities of the victims of the disaster.     

The role of research institutions in seed-related disaster relief: Seeds of Hope experiences in Rwanda

The article describes the efforts of a coalition of agricultural research centres, Seeds of Hope (SOH) in the rebuilding, of Rwanda, after the genocide and war of 1994. Research involvement in emergency relief and rehabilitation was unusual at the time and SOH had to forge its unique complementary role. Focusing on crop and variety development and conservation it: provided technical advice to relief agencies on seed procurement; used its baseline ken to assess the effects of war on seed diversity and seed security; made preparations to restore specific germplasm (which, fortunately, proved unnecessary) and spent substantial effort on rebuilding human resource capacity in research as well as basic scientific facilities. The involvement of SOH highlighted the critical, yet very different, roles for research during emergency versus rehabilitation periods and demonstrated the cost effectiveness of building in a diagnostic component--before massive seed or germplasm distributions are programmed.     

Farming the battlefield: the meanings of war, cattle and soil in South Kivu, Democratic Republic of the Congo

Prior to 1996 and the Congolese wars, exploitative land policies pushed farmers in the eastern highlands of the Democratic Republic of the Congo (DRC) into a vulnerable position, with cattle manure sustaining intensive cultivation. This exposed households to a complete breakdown in mixed farming as cattle became targets of war. This study of villages in South Kivu offers an inside understanding of continuity and change in farming practices in a region where there are no easy solutions, and it assesses how the province lost its present and where farmers look when they glance to the future. For farmers, who hold a broad view of soil fertility, the casualties of war were not only people and cattle but also the land itself, which has enduring scars. Perceiving a rupture in tradition, South Kivu farmers are searching desperately for new livelihoods that are built on education instead of livestock, setting aside old ethnic signifiers to seek a future beyond protracted conflict.     

Images of war: using satellite images for human rights monitoring in Turkish Kurdistan

In areas of war and armed conflict it is difficult to get trustworthy and coherent information. Civil society and human rights groups often face problems of dealing with fragmented witness reports, disinformation of war propaganda, and difficult direct access to these areas. Turkish Kurdistan was used as a case study of armed conflict to evaluate the potential use of satellite images for verification of witness reports collected by human rights groups. The Turkish army was reported to be burning forests, fields and villages as a strategy in the conflict against guerrilla uprising. This paper concludes that satellite images are useful to validate witness reports of forest fires. Even though the use of this technology for human rights groups will depend on some feasibility factors such as prices, access and expertise, the images proved to be key for analysis of spatial aspects of conflict and valuable for reconstructing a more trustworthy picture.     

Aid in a city at war: the case of Mogadishu, Somalia

Mogadishu, the capital of Somalia, has been central to life, war, and peace in the country for almost two decades. Its urban characteristics, though, have been put to one side for the most part. In recent years, Mogadishu-related issues have been merged mostly into a global agenda for South and Central Somalia, resulting in the technical and coordination approaches employed in the city largely being reproductions of solutions utilised in refugee camps and rural areas. Unfortunately, urban problems require urban solutions. The aid system is just starting to discover how specific aid in cities at war should be, both from an organisational and a technical standpoint. The enhancement of aid practices in an urban setting implies, among other things, a more strategic approach to the specific spatial characteristics of the city, a more fine-tuned analysis of the technical requirements of the urban service delivery systems, and a better understanding of the role of urban institutions.     

Guatemala: violence in peacetime--a critical analysis of the armed conflict and the peace process

The recent history of Guatemala is interpreted here using an interdisciplinary approach inspired by recent development and conflict studies. The author reflects on his experience in peace-building activities and uses a combination of primary and secondary sources to present the Guatemalan war as a complex political emergency. The first part (a methodological introduction) proposes an analytical framework, taking into account both the root causes and the different functions of violence, in order to achieve a better understanding of contemporary conflicts. In the second and central part of the article, the integrated framework is applied to Guatemala, trying to understand causes and functions of war and negotiation and underlining the existence of structural obstacles to a lasting peace. The conclusions are dedicated to policy implications: if the signing of peace accords represents only a step towards negative peace, the condition for a lasting peace is a strategy for reconciliation and development based on social participation and social justice.     

Humanitarian War: A New Consensus?

The NATO bombing operation Allied Force against Yugoslavia in March-June 1999 represents the final disappearance of the narrowing divide between humanitarianism and politics: a war initiated and justified on humanitarian grounds. Although unlikely to be repeated any time soon, the Kosovo case appears to have cemented an ideological shift on the international right and even necessity of sing military force to protect civilians within sovereign states. Rather than humanitarians acknowledging the political context and consequences of their work, however, the case suggests the embrace of humanitarian principles of universality and neutrality by military organisations. This article discusses some consequences of the new consensus: neglect of the political context (both local and foreign) of such operations, interaction between the operational dynamics of relief operations and the logic of war and the political consequences of using the humanitarian legitimation and mission in such cases.