Providing health services during a civil war: the experience of a garrison town in South Sudan

The impact of conflict, particularly conflict arising during civil wars, on the provision of healthcare is a subject that has not been widely considered in conflict‐related research. Combatants often target health services to weaken or to defeat the enemy, while attempts to maintain or improve health systems also can comprise part of counter‐insurgency ‘hearts‐and‐minds’ strategies. This paper describes the dynamics associated with the provision of health services in Malakal, an important garrison town in South Sudan, during the second Sudanese civil war (1983–2005). Drawing on the concepts of opportunity hoarding and exploitation, it explores the social and political dynamics of service provision in and around the town during the war. These concepts provide a useful lens with which to understand better how health services are affected by conflict, while the empirical case study presented in the paper illustrates dynamics that may be repeated in other contexts. The concepts and case study set out in this paper should prove useful to healthcare providers working in conflict zones, including humanitarian aid agencies and their employees, increasing their understanding of the social and political dynamics that they are likely to face during future conflict‐related complex emergencies.     

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.     

Community resilience and volcano hazard: the eruption of Tungurahua and evacuation of the faldas in Ecuador

Official response to explosive volcano hazards usually involves evacuation of local inhabitants to safe shelters. Enforcement is often difficult and problems can be exacerbated when major eruptions do not ensue. Families are deprived of livelihoods and pressure to return to hazardous areas builds. Concomitantly, prevailing socio-economic and political conditions limit activities and can influence vulnerability. This paper addresses these issues, examining an ongoing volcano hazard (Tungurahua) in Ecuador where contextual realities significantly constrain responses. Fieldwork involved interviewing government officials, selecting focus groups and conducting surveys of evacuees in four locations: a temporary shelter, a permanent resettlement, with returnees and with a control group. Differences in perceptions of risk and health conditions, and in the potential for economic recovery were found among groups with different evacuation experiences. The long-term goal is to develop a model of community resilience in long-term stress environments.     

Forced migration, processes of return and livelihood construction among pastoralists in northern Sudan

The Hawaweer, a nomadic, pastoralist group in northern Sudan, were seriously affected by the drought in the Sahel during the mid-1980s. Their experience illustrates the connection between internally displaced people, normal mobility, forced migration, dilemmas and opportunities of return and how new livelihoods can be successfully constructed based on traditional rights, strong local institutions and external resources. Some displaced Hawaweer got the chance to return to their homeland as new livelihood opportunities were established; others did not get this opportunity nor would they have returned if they had been given the chance. In both situations, the processes of displacement and return had an impact on the sense of belonging and identity.     

An Ethiopian refugee village in Sudan: the question of employment

Abstract— There are some 460,000 Eritrean and Tigrean political refugees in Sudan. The numbers have increased dramatically since the mid-1970s, and as yet there are no convincing signs of peace which would allow the prospect of a speedy return home. Sudan is thus faced with one of the Third World's largest populations of long term refugees, and the capacity of the economy to absorb such numbers into its labour force is an acute and potentially violent issue. Discussion and planning has been hindered by a lack of specific information on the proportion of refugees who are of urban or rural origin and the proportion of those who might undertake skilled or unskilled employment. The following report of a census and survey of a refugee village in eastern Sudan offers some insight into the problem and suggests steps towards its solution.     

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.     

Knowledge and Power: A Critique of an International Relief Operation

Exploring an alternative way to approach famine relief interventions, this paper draws on the work of French philosopher Michel Foucault and David Keen's recent work on south-west Sudan. It suggests that different discourses on 'famine' can lead to the dominance of certain kinds of institutional practices, and the prioritisation of special kinds of knowledge, at the expense of other modes of understanding and action. Using the case of the relief operation to Tigrayan refugees in eastern Sudan in 1984/5, the paper examines the specific ways in which 'power' was elaborated in the midst of the operation, and the manner in which institutional practices — designed to save as many lives as possible — influenced the reaction of international agencies to the spontaneous repatriation of the Tigrayans back to Ethiopia.     

II Murahaleen Raids on the Dinka, 1985-89

Successive Sudanese governments have used proxy forces, so-called militias, as an integral part of their war with the rebel Sudan People's Liberation Army (SPLA). The Rizeiqat and Misseriya of South Darfur and South Kordofan created armed bands, known as Murahaleen, in order to raid cattle from the Dinka to their south. Massive raids have depopulated swathes of territory south of the Bahr al-Arab, killing tens of thousands of people and leading to the destruction and displacement of unknown numbers of others. Famine in western Sudan fuelled the early raids, but the scale of the devastation wrought from 1985 onwards was the result of government complicity and assistance. More recently, since the coming to power of the current military government in Khartoum in June 1989, the relationship between the army and the Murahleen has been formalized through the creation of Popular Defence Forces.     

Ethical Codes in Humanitarian Emergencies: From Practice to Research?

Notable strides have been made in recent years to develop codes of conduct for humanitarian intervention in conflicts on the part of international NGOs and UN organisations. Yet engagement by the academic and broader research communities with humanitarian crises and ongoing complex political emergencies remains relatively ad hoc and unregulated beyond the basic ethical guidelines and norms developed within universities for research in general, and within the governing and representative bodies of particular academic disciplines. This paper draws on a case study of research on humanitarian assistance to Liberia during that country's civil war from 1989 to 1996. The difficulties faced by humanitarian agencies in Liberia led to the development of two key sets of ethical guidelines for humanitarian intervention: the Joint Policy of Operations (JPO) and Principles and Policies of Humanitarian Operations (PPHO). This paper seeks to address what lessons, if any, these ethical guidelines, together with different experiences of conducting research in war-torn Liberia, can provide in terms of the role of academic researchers--and research itself--in humanitarian crises.     

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.     

From emergency to social security in Sudan - part I: the problem

This is the first part of a two-part article which stresses the need to move away from short term emergency measures to a more general system of social security. A weakness in much of the thinking on food security in Sudan is its conception of a normally self-provisioning peasantry which is pushed into distress only as a consequence of exceptional external conditions. Food catastrophes are therefore seen as, essentially, temporary phenomena requiring emergency interventions. This article proposes a different view: that the commercial development of Sudan has engendered a crisis of subsistence synonymous with the collapse of indigenous support systems, the spread of absolute poverty and the erosion of the country's resource base. In the North this situation has come about through economic means and in the South through war. The spread of absolute poverty and the resulting vicious struggle for scarce resources cannot, however, be separated from the decay in governance. Part I of the article attempts to establish the interconnections between these elements and thereby to indicate the problems which a system of social security would have to overcome. Part II will examine the institutional consequences of the crisis, namely the imposition of a donor-led system of social security.     

Normalising the Crisis in Africa

Developmental relief has become the central doctrine of 'good practice' in humanitarian responses to complex political emergencies. This is despite the fact that a proliferation of such emergencies reflects a failure of development for people in those countries in crisis. Drawing on case study material from Sudan, Somalia, Rwanda and Uganda, this paper challenges assumptions made about the efficacy of developmental relief models in complex emergencies. The trend towards developmental relief practices coincides with an increasing acceptance of higher levels of humanitarian distress in Africa. Myths of aid dependency and the pursuit of sustainable programming in the midst of war are linked to a global reduction in aid. The mantra of 'local solutions to local problems' locates the causes of crises firmly within those societies in crisis. It provides a premise for international disengagement, and the denial of international responsibility for the genesis and prolongation of humanitarian crises in Africa. Assigning solutions to the poor, the marginalised and victimised through enhanced 'participation' and local financing of services sustains a myth that development is occurring, when in fact levels of distress are rising.     

From Emergency to Social Security in Sudan - Part II: The Donor Response

In the first part of this article I examined the crisis of subsistence in Sudan resulting from the commercial development of the North and the war in the South. An attempt was also made to relate the deepening impoverishment that this represents to a decay in governance. There is a tendency amongst donor and government officials, which is reflected in the literature, to regard the unfolding crisis as the transitory result of exceptional circumstances rather than as irreversible and therefore warranting a major revaluation of policy. As a consequence, social security and emergency planning has generally been of an emergency type. In this, the final part of the article, I examine the donor response in more detail. In particular, I argue that the decay of governance is so extensive that a donor-led system of social security has been imposed on Sudan. This system has a number of characteristics, the most important of which is that it exists in the absence of the political renewal and democratisation that would be necessary for the technical solutions it advocates to be implemented. The result is that donor-led security, which is typical of the Horn of Africa, proceeds in a relation of antagonism to the sovereign power, a situation which significantly reduces the efficiency of the measures undertaken.     

Early Warning and Response: Why the International Community Failed to Prevent the Genocide

Western leadership … has proclaimed moral indifference to be its decent Christian right John le Carré (1995, p. 213).
The enormity of the genocide in Rwanda demands that it be subjected to searching enquiry and that members of the international community, collectively and individually, examine their own roles in the event.
This paper draws extensively on Study II of the Joint Evaluation, and examines the effectiveness of international monitoring (early warning) and management of the Rwanda conflict. It is not intended to explore all the factors which together contributed to the genocide that were or might have been amenable to modification by the international community. The focus is on warning and response beginning with the start of the civil war in 1990, and culminating in an analysis of the international response to the genocide in April–June 1994.     

Livelihood patterns of displaced households in greater khartoum

Members of impoverished households in Greater Khartoum, who have been displaced from their homelands by famine and civil war, gain a livelihood by utilising a wide variety of subsistence activities and sources. These include moonlighting, income diversification and pooling, exchange relations, scavenging, relief supplies from aid agencies and remittances from relatives working in other areas. This finding challenges the widely held view of the displaced as dependent and parasitic on the wider urban community. Several public policies are identified which have a detrimental effect on the livelihood of the displaced.     

The 1970 Bhola cyclone,nationalist politics,and the subsistence crisis contract in Bangladesh

The devastating Bhola cyclone in November 1970 is credited with having triggered the political events that led to the division of Pakistan and the creation of Bangladesh in 1971. A callous response to the disaster by the Pakistani regime resulted in a landslide electoral victory for Bengali nationalists, followed by a bitter and bloody civil war. Yet, despite its political momentousness, the Bhola cyclone has been the subject of little political analysis. This paper examines the events, arguing that its extraordinary political significance put disaster management on the nationalist agenda; the famine of 1974 confirmed its centrality, producing a social contract to protect the population against disasters and subsistence crises on which the country's acclaimed resilience to the effects of climate change rests. The Bhola cyclone also drew international attention to this neglected, little‐known region, and in general can be seen as foundational for the subsequent developmental achievements of Bangladesh.     

Conflict, the Continuum and Chronic Emergencies: A Critical Analysis of the Scope for Linking Relief, Rehabilitation and Development Planning in Sudan

The concept of the ‘relief-to-development continuum’ has been the subject of renewed interest in recent years. Concerned by the rise in relief budgets over the past decade and the absolute fall in development aid resources, support has been growing for the concept of developmental relief. In the context of complex political emergencies, it has been argued further that as effective development aid can reduce vulnerability to the impact of natural hazards, so it might also be used to contribute to a process of conflict prevention. In this way, the concept of the relief-development continuum has become entwined with broader discussions about the contribution of official development assistance to conflict management. Drawing on a Review of Operation Lifeline Sudan (OLS), this paper cautions against uncritical application of the concept of the continuum in complex political emergencies, and of rehabilitation in particular, in the current Sudanese context. It argues that in order to move legitimately from relief aid programming to development aid programming, three fundamental conditions must be in place: first, a minimum level of security, respect for human rights and humanitarian access. Second, empirical evidence from the field needs to demonstrate that the emergency is over. Finally, moving from relief to development aid programming is contingent on donor governments accepting the legitimacy of national governmental structures and of the rebel movements. In other words, for donor governments, moving along the continuum is in significant part determined by foreign policy considerations, not only technical ones. Consideration needs to be given to the actual and perceived legitimation of the different movements that a move to rehabilitation might be seen to imply. The paper argues that none of these conditions had been satisfied in Sudan by mid-1997. Instead of a process of normalisation paving the way to long-term development, the current situation in Sudan is better described as a chronic political emergency. In such a context, uncritical pursuit of developmental strategies may negatively affect the welfare of conflict-affected populations.     

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.     

基于振动的土木工程结构损伤诊断研究进展

评估土木工程结构的安全状况已成为当前国际上土木工程师十分关心的问题,也是当前国际上的研究热点.在综述近几年国内外有关结构损伤诊断研究进展的基础上,重点介绍了基于振动的结构损伤诊断方法的发展,并对相关问题进行了讨论和评述.最后对基于振动的结构损伤诊断的未来研究提出了几点建议与展望.