The Crisis Caravan What's Wrong with Humanitarian Aid?

Linda Polman is an Amsterdam-based journalist who for fifteen years has reported from war zones for a range of European radio stations and newspapers. She is the author of We Did Nothing, which was shortlisted for the Lettre Ulysses Award for the Art of Reportage. 

Introduction

The humane desire to lighten a little the torments of all these poor wretches . . . creates a kind of energy which gives one a positive craving to relieve as many as one can.
—Henri Dunant, humanitarian aid worker and founder of the International Committee of the Red Cross (ICRC)1

Imagine that you're an international humanitarian aid worker in a war zone and faithful to the principles of the Red Cross, as any good humanitarian should be. In other words, you're impartial, neutral, and independent. It's your responsibility to relieve human suffering, irrespective of the people involved and the situation on the ground. This time your mission has taken you to a refugee camp in Darfur. You do what you can for the victims, but soldiers exploit your efforts. They demand money for every well you dig and levy sky-high taxes, imposed on the spot, on all the sacks of rice and tents and medicines you arrange to have flown in. They consume a slice of your aid supplies and sell another slice. Among the items they buy with the proceeds are weapons, which they use to drive yet more people into your refugee camp or even to their deaths.

What do you do? Do you conclude that it is no longer possible to cling to the principles of the Red Cross, pack your bags, and leave to help war victims elsewhere? Or do you remain true to your convictions, believing that even if you save only one human life, some relief is better than none?

Leave, or continue providing aid at any price? It's a centuries-old dilemma. Two of the world's first international humanitarian aid workers, Florence Nightingale and Henri Dunant, fundamentally disagreed as to which would be the right choice. Nightingale was convinced that aid fails in its purpose if the warring parties use it to their own advantage. Dunant firmly believed in the duty to help no matter what.

Dunant, born into a Calvinist milieu in Switzerland, was a banker and businessman in Geneva. In 1859, he witnessed the Battle of Solferino during the war between Austria and the Franco-Sardinian Alliance. Of the three hundred thousand men and boys on the sixteen-mile front line in Lombardy, forty thousand were killed. Another forty thousand soldiers were wounded. They lay on the battlefield, where most were left to die.

In the book that Dunant published three years after this experience, Un Souvenir de Solferino (A Memory of Solferino), he describes the spectacle the morning after the engagement:

Bodies of men and horses covered the battlefield; corpses were strewn over roads, ditches, ravines, thickets and fields; the approaches to Solferino were literally thick with dead. The poor wounded men were ghostly pale and exhausted. . . . Some, who had gaping wounds already beginning to show infection, were almost crazed with suffering. They begged to be put out of their misery, and writhed with faces distorted in the grip of the death struggle. . . . In some quarters there was no water, and the thirst was so terrible that officers and men alike fell to drinking from muddy pools whose water was foul and filled with curdled blood. The men's wounds were covered with flies. The tunic, shirt, flesh and blood formed an indescribable mass, alive with vermin.

Wounded Austrian soldiers told Dunant that after a long, sweltering march they had been sent straight into battle, without a chance to rest and without being given anything to eat or drink, save a brandy ration. French soldiers, too, had marched for days on end to reach the front. On the morning of the battle they'd had nothing besides a mug of coffee.

For lack of sufficient army doctors, it was the inhabitants of the villages and small towns in the vicinity of Solferino who set about helping the wounded, with bandages and water. The volunteers carried surviving soldiers to stables, churches, and monasteries, where they helped a handful of village doctors amputate limbs. In the circumstances, little other medical help could be given.

"The convoys brought a fresh contingent of wounded men . . . every quarter of an hour, and the shortage of assistants, orderlies and helpers was cruelly felt," wrote Dunant. He gathered together a group of volunteers, mainly women. "Nearly five hundred soldiers were there, piled in the church, and a hundred more lay outside on straw in front of the church, with strips of canvas to protect them from the sun. The women . . . went from one man to another with jars and canteens full of pure water to quench their thirst and moisten their wounds."

Dunant arranged for cauldrons of soup to be prepared, and he supplied the volunteers with large bales of lint for cleaning wounds. From a town some distance away he had medicines, shirts, oranges, and tobacco brought in at his own expense.

"Tutti fratelli" was Dunant's conviction. We are all brothers. He successfully persuaded the volunteers to help all wounded men, Austrians included. In the days that followed, "noble philanthropists" and "ladies' auxiliary committees" established for the occasion each made it a point of honor to care for wounded soldiers, irrespective of nationality.

Every house for miles around was turned into a clinic. People doled out soup, wrote farewell letters to families on behalf of dying soldiers, and patted blood-encrusted hands comfortingly. They meant well, Dunant wrote, but the volunteers were and remained "isolated enthusiasts" making "dispersed efforts." The food delivered by injudicious townspeople to the churches and hospitals was often unsuitable for wounded men, and eventually the doors had to be shut to them. "The consequence was that many, who would have been willing to spend an hour or two with the patients, would not be bothered when it became necessary to have an authorization and go and ask for it. . . . There was no time for those who knew their business to give the needful advice and guidance, and most of those who brought their own goodwill to the task lacked the necessary knowledge and experience, so that their efforts were inadequate and often ineffective."

Although they had started out in real earnest, within a week the enthusiasm of the volunteers began to ebb. They became exhausted.

"Oh," sighed Dunant, "how valuable it would have been in those Lombardy towns to have had a hundred experienced and qualified voluntary orderlies and nurses! Such a group would have formed a nucleus around which could have been rallied the scanty help and dispersed efforts which needed competent guidance."

Back in Switzerland he lobbied for just such a private initiative. In a proposal sent to potential donors he argued that the work of the new organization would not only be humane and Christian, it would benefit the national treasury. "By reducing the number of cripples, a saving would be effected in the expenses of a Government which has to provide pensions for disabled soldiers," he wrote.

This last point was precisely the reason why the other great humanitarian of the period, British nurse Florence Nightingale, rejected Dunant's plan out of hand. The higher the costs of a war, the sooner it would end, she argued. Voluntary efforts, which reduced the expense faced by war ministries, merely made it easier for governments to engage in wars more often and for longer.

In 1854, five years before Dunant's experiences at the Battle of Solferino, Nightingale, then thirty-four, had responded to a request from the War Office to assist the sick and wounded British troops of the Crimean War. The War Office was under fire in the British press over the inadequate care being given to the men.

Along with a team of thirty-eight professional nurses, whom she selected herself, Nightingale traveled to the British barracks at Scutari in Istanbul, on the Asian shore of the Bosporus. Stinking wards with leaking roofs, filled to bursting, were all that was available in the way of an army hospital there. Unwashed soldiers still wearing their soiled uniforms lay dying in agony in beds without sheets or blankets. There were not enough medicines, bandages, soap, or food. The medical staff refused to order further supplies, afraid that commanding officers would take it as personal criticism.

"Patients were left in the care of drunken orderlies who were often malingering soldiers, thieves avid for the savings of the dying, or pensioners who had foolishly volunteered to come out of retirement to accompany the army and who were rapidly succumbing to disease and delirium tremens," writes British author Hugh Small in his book Florence Nightingale: Avenging Angel.2

Conditions at other British military hospitals in the East were similarly abominable. The Crimean War lasted from October 1853 to February 1856. A total of eighteen thousand men died, out of an army theoretically twenty-five thousand strong. Five out of every six deaths were caused by cholera, dysentery, typhus, and other infections.

Dead animals littered the site of Nightingale's hospital, the yards outside the buildings were unpaved and poorly drained, and water stood stagnant in the sewers running under the unventilated buildings. Only after a visit from a Sanitary Commission sent from London were the medical staff ordered, at the commission's insistence, to reduce the double rows of beds in each corridor to one, and to have orderlies empty the rubbish bins and urine containers.

The death rate was highest in wards where the consequences of poor hygiene were exacerbated by overcrowding. The most deadly place of all, where five thousand men succumbed in a single winter, was Nightingale's own hospital. She was managing not a hospital but a death camp. In letters home she placed the responsibility for this wholesale "killing" on British officers of the "incompetent and heartless" army high command, who were, in her words, "sordid exploiters of human misery."

The dedication with which her team of nurses attempted to look after the men as they lay dying distracted attention from the causes of the disaster, Nightingale concluded later. The only way to save lives was to make costly investments in better hygiene and buildings. Civil servants at the War Office removed the most damaging passages from her report before it was presented to Parliament. The war was not yet over and Nightingale's charts, which laid bare the causes of sickness and death, would have made it even harder for the War Office to enlist new recruits and mercenaries.

Nightingale devoted the rest of her life to nominating and keeping on their toes the only people who could improve conditions for soldiers, and later for ordinary citizens as well: the legislative and executive authorities. When Henri Dunant in Switzerland began to lobby for an international volunteer organization to help wounded soldiers, and by doing so relieve the government of its responsibilities, Nightingale felt only anger and disgust. Dunant wrote to try to convince her that his initiative was crucial. He agreed that war ministries bore primary responsibility for the care of their own sick and wounded, but even in the best organized armies such care was inadequate. Nightingale answered tartly: "If the present Regulations are not sufficient to provide for the wounded they should be made so."

Although Dunant was a self-declared admirer of "Miss Nightingale," her disapproval left him undaunted. In 1863, nine years after the Crimean War and four years after Solferino, Dunant and other Genevan notables set up the International Committee of the Red Cross (ICRC), the forerunner of all Western humanitarian aid organizations in existence today. The "humanitarian" principles adopted by the ICRC became enshrined in the Geneva Conventions.

Humanitarianism is based on a presumed duty to ease human suffering unconditionally. Aid organizations endorsing the humanitarian principles of the Red Cross promise neutrality (no cooperation with one side in preference to the other), impartiality (the giving of aid purely according to need), and independence (from geopolitical, military, or other interests). Humanitarian aid workers help wherever, whenever, and whomever they can. Tutti fratelli.

"I need hardly say that I think its views most absurd," Nightingale continued to complain, "just such as would originate in a little state like Geneva, which never can see war."

With signatures by Nauru and Montenegro in August 2006, the Geneva Conventions have now been accepted by all 194 countries in the world. Never before have the principles of the Red Cross been so universally embraced. And never have there been so many humanitarian aid organizations. They are known as NGOs, nongovernmental organizations, or INGOs if they work internationally: independent and neutral organizations not tied to governments. Together they make up the "humanitarian community" that operates in "humanitarian territories," places conceived as enclaves in war zones where the provision of aid to victims transcends all military and political imperatives. Victims are victims, irrespective of cause and effect.

In the century and a half that has passed since the ICRC was established, its principles have remained the same while wars and humanitarian territories have changed utterly. In Dunant's time wars were still fought on battlefields, and almost all the dead and wounded were soldiers. A hundred years later, after the Second World War, the decision was made to declare Red Cross principles applicable to aid offered to civilians in wartime. Civilians had become military targets; they were bombed in their cities and towns, persecuted, and made the target of extermination programs. The Second World War claimed roughly equal numbers of military and civilian victims. In our own time, as many as 90 percent of war fatalities are civilians, and almost all wars are civil wars, fought not by the armies of belligerent nations but by people's militias, separatist movements, insurgents, and rebels within the war-torn country itself. A government army, if involved at all, is merely one of the parties to a conflict, of which there are usually several.

Today's humanitarian territories, in which the humanitarian community attempts to reduce human suffering, are found in countries such as Iraq and Afghanistan, where the fighting is messy and long drawn out, and in the Democratic Republic of Congo, Somalia, Sierra Leone, Ethiopia, and Sudan, hellish places where one of the main goals of the warring factions is to slaughter as many civilians as possible and drive all the survivors out of house and home. Humanitarian territories and battlefields are often one and the same, since civilians gather there, clustered around the aid organizations.

Humanitarian aid workers still help wherever, whenever, and whomever they can, as a matter of principle, but by doing so they are at the mercy of the belligerents and become subject to their whims. The tragedy of the admirable Red Cross rules is that they are unenforceable. "In this kind of war, calling on, or expecting the parties to respect humanitarian principles is like calling on a gang of armed muggers to fight by the rules of boxing; it's not just laughable, it's irrelevant," said researchers from the University of Utrecht and Cordaid in Afghanistan.3

Should INGOs carry on, doggedly providing relief, if warring factions in humanitarian territories both use aid for their own benefit, to the detriment of their enemies, and to prolong the fighting? Or should they leave? Which option, in the long run, is more cruel?

The dilemma faced by Dunant and Nightingale is more pressing than ever.

After the Second World War, during the Cold War, conflict zones were more or less inaccessible to private humanitarian aid organizations. The world was divided into East and West, and the boundaries of war-torn areas were controlled by the two superpowers. INGOs did not usually get any closer to the seats of conflict than refugee camps on the peripheries of war zones.

After 1989 and the fall of the Berlin Wall, the nature of armed conflict changed and with it the position of aid organizations. In many areas, the superpowers withdrew. From then on it was the local warring parties themselves who decided when and on what conditions organizations would be given access to victims. The number of aid agencies in war zones has since vastly increased. In the 1980s, "only" around 40 INGOs were active in the camps set up for Cambodian refugees near the border with Thailand. Fifteen years later, in 1994-95, 250 came to the war in former Yugoslavia. Favored humanitarian territories can now bank on the arrival not only of INGOs but of an average of ten different UN relief agencies and literally countless local NGOs. The ICRC reckons that every major disaster now attracts, again on average, about a thousand national and international aid organizations. The presence of twice that number, as in Afghanistan in 2004, no longer surprises anyone. The United Nations Development Program (UNDP) estimates that the total number of INGOs exceeds thirty-seven thousand.

For developmental cooperation in general, donor governments that belong to the Organization for Economic Cooperation and Development (OECD) make a total of about $120 billion available annually. For emergency humanitarian relief—first aid, you might say, for wars and disasters—the sum reached $11.2 billion in 2008, not including incidental extras, for use in case of an event such as a tsunami, or for emergency assistance given by soldiers in frontline states in the War on Terror. Campaigns by churches, businesses, and clubs, plus door-to-door collections and all kinds of spontaneous, heartwarming local initiatives, add hundreds of millions of dollars to this total every year. An entire industry has grown up around humanitarian aid, with cavalcades of organizations following the flow of money and competing with each other in one humanitarian territory after another for the biggest achievable share of the billions.

To warring parties as well, money and supplies provided by humanitarian aid organizations represent a business opportunity. Aid has become a permanent feature of military strategy. Belligerents see to it that the enemy is given as little as possible while they themselves get hold of as much as they can.

No matter how often the Red Cross rules may be trampled underfoot by warlords, generals, rebel leaders, agitators, local chiefs, insurgents, heads of splinter groups, militia commanders, transnational terrorist leaders, regime bosses, mercenaries, freedom fighters, and national and international governments, the humanitarians persist in brandishing their Red Cross principles and accept no responsibility for the abuse of their aid.

Ranging from the huge, well-oiled humanitarian operations run by the ICRC in the sandy deserts and rocky wastes of the Horn of Africa and by the UN refugee organization UNHCR (Office of the United Nations High Commissioner for Refugees) beyond the Sahara, to a one-man aid mission on a backfiring moped in Rwanda, and from the rapid frontline interventions by Oxfam International in the craggy mountains of Afghanistan or by Médecins sans Frontières (Doctors Without Borders) in Ethiopia to the floating clinics of the Mercy Ships from Texas that drop anchor on the shores of West African civil wars in the name of the Redeemer, a caravansary of humanitarian aid organizations treks, apparently by common agreement, from one humanitarian territory to the next. In this book we travel with them, through overcrowded, stinking refugee camps, via food distribution points in famine zones to bombed and shelled villages and towns, and to homes for war orphans.

One question inevitably arises: If aid has become a strategic aspect of warfare, can the claim to neutrality made by humanitarian aid organizations still be justified? Imagine that it's 1943 and you're an international aid worker. You've been granted permission to deliver aid to the Mauthausen camp, but you know that the camp overseers will keep much of the supplies for themselves. What do you do? If you conform to the practices of the humanitarian aid industry, you of course deliver the aid.

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