ABC of conflict and disaster: Humanitarian assistance: standards, skills, training, and experience

Standards for humanitarian agencies

The Sphere Project

Those affected by catastrophe and conflicts often lose basic human rights. Recognising this, a group of humanitarian non-governmental organisations and the Red Cross movement launched the Sphere Project in 1997. The aim of this project was to improve the quality of assistance and enhance the accountability of the humanitarian system in disaster response by developing a set of universal minimum standards in core areas and a humanitarian charter.

The charter, based on international treaties and conventions, emphasises the right of people affected by disaster to life with dignity. It identifies the protection of this right as a quality measure of humanitarian work and one for which humanitarian actors bear responsibilities.

The Sphere Project was launched in response to concern about inconsistencies in aid provided to people affected by disaster, and the frequent lack of accountability of humanitarian agencies to their beneficiaries, their membership, and their donors. The project attempts to identify and define the rights of populations affected by disasters in order to facilitate effective planning and implementation of humanitarian relief.

People in Aid: human resources management

People in Aid was founded with two main aims - to highlight the importance of human resources management in the effective achievement of an organisation's mission, and to offer support to humanitarian and development agencies wishing to improve human resources management.

After the Rwanda crisis, research showed that aid workers saw organisational and management issues as prime stressors in their work. From this research, the People in Aid Code of Good Practice was developed. The code focuses on the organisational decisions that affect aid workers - such as including human resources in plans and budgets, risk management, and communicating with staff on human resources issues. It helps agencies to assess their own human resources policies, practice, training, and monitoring. People in Aid awards "kite marks" (using the social auditing process) to those agencies that implement the code.

Gaining skills and experience

Training

Complex emergencies typically involve large numbers of refugees or internally displaced people, conflict or threat of conflict, a high risk of epidemics, and disruption of normal infrastructure. UK training as a nurse or a doctor is unlikely to prepare health workers adequately for such conditions. While each crisis scenario has unique problems, there are common themes that, if addressed through training, can prepare people to work effectively in any emergency situation.

Public health in emergencies course - Run by the International Health Exchange and Merlin, it uses trainers with field experience to give overviews of public health interventions. It includes sessions on communicable diseases, health centre management, nutrition, reproductive and mental health, and HIV infection and AIDS.

Liverpool School of Tropical Medicine diploma in humanitarian assistance - This is run in partnership with Liverpool University and leading non-governmental organisations. Core modules cover the political, economic, and legal context of humanitarian assistance and consider planning and management at all stages of humanitarian crises.

Catastrophes and conflict course - Run by the Society of Apothecaries of London, this modular course covers the spectrum of humanitarian intervention. Vivas and a dissertation lead to the diploma in the medical care of catastrophes.

Other courses - cover issues that are important for all aspects of humanitarian work. ActionAid has developed a set of training modules on the rights-based approach. Oxfam, in collaboration with the International Health Exchange, has developed a course on "gender issues in humanitarian assistance."

Gaining experience

Most agencies require two years' post-qualification experience. However, gaining primary field experience can be a "Catch 22" situation, as many agencies ask for experience overseas before they will consider a candidate. Language skills, experience of living abroad, and specific skills help.

DAVID GILES/PA/EMPICS

Helping out in Rwanda

The main thing is not to lose heart. The human resources departments of agencies are very busy and may not have time to reply. Join the register of a recruiting agency (such as the International Health Exchange, RedR), send your curriculum vitae to organisations and follow up by telephone, and keep an eye on job vacancies advertised in newspapers (such as the Wednesday Guardian) and the websites of aid organisations.

However keen you may be to get a job, ensure you ask about any key issues not already covered in the job description. Check terms and conditions, including arrangements for health care, and ask about the organisation's security policy where appropriate. The People in Aid code of conduct lays out a framework and minimum standards for human resource management in emergencies.

Get as much information as you can about where you are going before you go. Do not limit yourself to information specifically about your job; find out about the history of the country, the present political situation, cultural and social norms, and basic health information.

Be aware that the situation is dynamic and may change by the time you arrive. Often the most important aspect of what you manage to learn before you leave is that it prepares you for the right questions to ask. Potential sources of information include the internet (including academic, government, and agency websites), journals and books, aid agencies' reports, and embassy briefings.

Maintaining skills

The ever changing political landscape, ongoing research, and new strategies mean that in-service training is important for humanitarian workers. You can keep up to date in the field by reading journals and newsletters such as the International Health Exchange's Health Exchange magazine and those from the Overseas Development Institute and Healthlink Worldwide. The internet has made a huge difference, but, as with all subjects, information should be cross checked if it is not from a known and credible source. Take time off to attend courses, share experiences with others, and step back and think.

Two examples of areas where practice is changing quickly are nutrition and HIV/AIDS. Therapeutic feeding schedules are far more refined than they were, and special feeding products are readily available. Exciting new initiatives in home based feeding are being piloted. HIV/AIDS is by far the biggest recent challenge in health and has important implications for humanitarian assistance. Research into, for example, mother to child transmission and breast feeding is ongoing, and it is important to keep up with the latest developments.

Teams in the field

You will almost certainly be part of a team working closely alongside local agencies. Good coordination within your team is essential, and this should be based on a clear understanding of each other's roles and responsibilities, and how these contribute to the overall objectives. It must be clear who is responsible for security issues. Sufficient leave and breaks should be taken, as they will contribute to good relationships in the field.

Health and safety

Some areas are more hostile for humanitarian workers than they used to be. It is important that your organisation has a good understanding of the situation and briefs you well. Road traffic crashes are responsible for many injuries and deaths among aid workers. Sometimes the hardest thing is to follow rules about who should drive and when, especially out of normal working hours, but this is crucial for health and safety. RedR runs a range of security courses, details of which can be found on its website.

Taking care of your own health is essential; your agency should advise you on immunisations and malaria prophylaxis, what drugs to take, and arrangements for care and evacuation. Just as important as malaria prophylaxis is avoiding mosquito bites with insect repellents, impregnated mosquito nets, and suitable clothing. Travel clinics, the Department of Health, and organisations such as Interhealth offer clear guidance.

Cultural awareness

Remember that life didn't start for anyone when you got off the plane. Your intervention needs to fit into the local response to the crisis. You must be aware of what has already been done and find out from local people the most acceptable way to go about things. Pre-deployment reading will help you to understand local norms and practice. Remember that people will not expect you to know everything - if in doubt ask what is appropriate for you, as an outsider, to do.

In trying to understand local culture, you may find that you cannot agree with some part of it. If this has implications for your work you need to discuss this with your manager. When deciding whether to react, it can help to ask yourself what difference it is going to make to thos e you are trying to assist. What will be the likely end result for them?

Funding

The amount of funding for programmes and projects, and the way it is provided, has a great influence on their scope. Your organisation may have made a proposal to get specific funding for a particular disaster, it may use funds it already has, or it may issue a joint appeal for funds through a mechanism such as the Disasters Emergency Committee in Britain.

Training is funded in various ways. Your agency may pay as part of staff development. Grants are sometimes available. Many workers fund their own training, and courses such as those run by the International Health Exchange, Merlin, and RedR are subsidised to make this less difficult. (See also Editorials p 223.)

Marion Birch training manager at International Health Exchange/ RedR, London.

Simon Miller Parkes professor of preventive medicine, Army Medical Directorate, FASC, Camberley.


studentBMJ 2005;13:221-264 June ISSN 0966-6494