Getting Humanitarian Aid Right

Back in March judges at the International Criminal Court refused to support chief prosecutor Luis Moreno-Ocampo’s call for Sudan President Omar al-Bashir to be indicted on charges of genocide. They said there was insufficient evidence. On Monday Ocampo lodged an appeal against the ruling, but as far as one can tell submitted no new evidence.

The problem of evidence, what to gather, how to gather it and how to interpret it is going to increasingly plague the humanitarian business. The crisis in the making is similar to that which plagued the medical profession up to the 1970s. Until then, although there were clinical trials and massive community wide surveys, there was no profession-wide recognition of the need for a rigorous understanding of what constituted good evidence, or the need for best practice to be based on evidence. Until then, trial and error, experience, wisdom passed on from the old hands and write-ups of practices that gave positive results constituted the bulk of the body that guided medical practice.

And that pretty much describes where humanitarian assistance is today.

For medicine, Archie Cochrane’s 1972 book Effectiveness and Efficiency: Random Reflections on Health Services, captured the massive change in approach which now dominate medicine. The Cochrane Collaboration, named after him, defines the evidence approach thus: “Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors.”

In The U.S., the Preventive Services Task Force (USPSTF) has used this approach to come up with two scales, one for rating the value of evidence and the other for rating the worth of a clinical service. Again, think of the parallels (or maybe absence of them) with humanitarian service.

On the USPSTF evidence scale, level I evidence is the best, level III the least reliable. • Level I: Evidence obtained from at least one properly designed randomized controlled trial.

• Level II-1: Evidence obtained from well-designed controlled trials without randomization.

• Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

• Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

• Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

If we are honest, where do most humanitarian studies sit? Level three and occasionally the bottom end of level two?

When it comes to clinical practice, or in our parlance relief interventions, it’s all about the balance between knowable benefits and probably risks. The USPSTF provides a five point scale to grade “magnitude of net benefit” .

The humanitarian profession, sadly, is a million miles away from this sort of systematic international discipline, and yet we too deal in life and death issues.

Here are the top five sins of insufficient evidence we regularly practice.

The sin of induction. We can’t help it. We view the present by comparing it to the past. We look for pattern in the past and assume similar pattern in the present means similar things. The science philosopher Karl Popper did a great job of showing the pernicious nature of this natural way of thinking. (You can read some of his original writings on this at http://dieoff.org/page126.htm). We then compound the sin by refusing to let go of it!

So, after the US invasion of Afghanistan, it looked like a post-conflict situation, so it got modeled thus, and the model was clung to, even though today, if you had known nothing about the past and were looking at Afghanistan with impartial eyes, it would patently be a country caught up in war. But we cling to the model and so program for post-conflict, channeling most of our aid in support of the central government, because that’s what you do post conflict to rebuild. Yet, to the skeptic, it looks like the aid business (supposed to be impartial and neutral) has chosen to back one side in the conflict.

It’s the same in Darfur (Aggressive Arab war crime committers pitted against victimized African farmers.) That’s the dominant model yet all our research shows this is a wild distortion and only a small part of what is going on.

In Nepal, the development community, Kathmandu based, programmed as though there was no conflict in the country.

conclusion one: The initial models upon which we base our programming assumptions are often wrong, and even though they are wrong they are desperately hard to shake off.

The sin of “all other things being equal”. Economists use this really irritating turn of phrase when they want to prove the predictive power of their models. The problem of course is that reality does not behave. All other things are not equal. “If funding is not provided/aid agencies do not have access/ people are not allowed to move/medical supplies are not let through, then XXX,XXX people are in danger of dying.” These sorts of predictions are only true if nothing else changes. In reality though the predictions rarely come true, because people take steps to help themselves, others step in, local communities or agencies provide help. I.e. the international aid machine is not the font of all salvation.

Conclusion two: Crises are dynamic. Predictions based on aid agencies centrality are of little value.

The sin of cherry picking: This is a well intentioned but distorting sin. We tend to quote the data that supports our case. Human rights reports cite incidents of human rights violations, a sub-set of the sample as it were. What about the incidence of human rights being upheld or not violated? We selectively quote the case studies and reports that support the case we want to build, thus confusing advocacy and evidence. We over report our successes and under report failure.

Conclusion three: Advocacy becomes self deluding. We start to confuse our advocates world with reality, distorting urgency, scale, depth and horror of crisis.

The sin of classification: We like cutoff points to help simplify our decision making, but the sin is believing that cutoff point matters. Mortality rates of more than 1/10,000/day mean you have a crisis on your hands, but why 1/10,000, why not 2 or 0.5? In reality the rate is an artificial cut off. In nutrition, difference organizations propose different cut offs for severe and acute malnutrition. And the interpretation of those malnutrition rates is highly dependent on the methodology used to measure malnutrition.

Conclusion four: Our fixing of and interpretation of cut off points, severity scales and standards, belies our lack of true understanding of how the complex processes at work in a crisis actually effect survive chances.

The sin of causality. This comes in two versions. In the fist we interpret statistical correlations as proven cause and effect. In the second we assume that cause and effect follow a simple relationship.

Economists are raving about eh beneficial effects cell phone ownership has on economic growth in the south. As cell phone penetration into the market goes up, so to does GDP. So what, which causes which or are they both caused by deeper underlying processes. There is a wonderful negative correlation, until the early 2000s between the number of pirates operating on the high seas and the average global temperature, but this does not mean countering pirates increases global warming.

Secondly, we like simple models. The more malnourished a person is the more at risk of death they are. Sounds plausible, but as Helen Young and Suzanne Jaspars have shown, its more complex than that. There is actually far les correlation than people expect because malnutrition is the end point of so many different livelihood and public health scenarios.

Conclusion five: Beware correlations, always seek to prove causality.

In sum, our hypotheses and conceptual models of what happens in a crisis are still far to poorly developed to allow us to be truly evidence based. As a result of this we do not know enough yet about what to measure, to diagnose, and proscribe in a crisis. We do not know how best to measure and we do not know how to fully interpret these measurements.

In short, humanitarian assistance needs its own evidence based revolution, just as medicine did. The good news is that, as Archie Cochrane and his successors showed, it can be done and once adopted it makes a significant difference to the outcomes.

Humanitarianism now has its first true international studies association.

Fifteen years ago, when the humanitarian Code of Conduct and the Sphere Standards, were being conceived, they were part of a logic which asserted that humanitarianism needed to “get more professional”. Well this week, one of the key elements in becoming a profession has fallen into place.

Professions - law, medicine, engineering, etc all share a set of common attributes. They all:

• Utilize knowledge in an altruistic fashion

• Have a monopoly on specialized knowledge

• Therefore have autonomy to self regulate

• Are responsive to the users of the profession

• And have a responsibility to expand the Knowledge

If we think about the developments of the last fifteen years we can see how the field of humanitarian practice is moving closer to this model. Structures like the Active Learning Network on Accountability and performance (ALNAP) and the Humanitarian Accountability Project International are making practitioners more responsive to their clients. The issue of autonomy to self regulate has been highlighted and reasserted by the pressure put on agencies, particularly American ones, to conform to foreign policy in Afghanistan and Iraq. Older developments, like the seven Fundamental Principles of the Red Cross and Red Crescent, speak to the altruistic utilization of knowledge and the many coordinating and cooperating associations and funding agreements predicated upon proven competence speak to the monopoly on specialize knowledge.

But until now the reasonability to expand that knowledge has been a rather defuse notion.
Most professions are structured with a body of practitioners who have an ethical code to abide by, a body of knowledge to apply in the service of others and a set of regulations to control that service. Downstream are their clients and upstream is their academy: Law Schools, Medical Faulty, Engineering departments, with their associated specialized journals, conferences, professional degrees and academic associations.

In Groningen (Netherlands) this week we had the world’s first ever full scale academic conference devoted to humanitarian studies. Over 500 hundred academics and practitioners came together, 50 panels, 400 plus papers, and out of the conference has come the launching of the first full academic study associating devoted to humanitarian issues. The International Humanitarian Studies Association. This association, open to academics and reflective practitioners world wide will promote humanitarian studies, organize an international bi-annual conference and launch a peer reviewed journal for the association. The next conference is already planned for June 2011 to be hosted by Tufts University, Boston, USA.

The academic rigor, obsession with actions being evidence based and compulsion to share knowledge, embodied in such an association, has the potential to make a real difference to humanitarian practice and through that to the lives of those caught up in crisis.

This time of year, these ten days between the winter solstice with its associated add-on festivals, and the new year, has always made me feel uneasy, as though one was held in limbo. Of course in a rational world the New Year, 1st January, would happen on the day after the winter solstice, 22nd December, thus allowing for the logic of the year beginning with the change over from longer nights to longer days. But this 10 day period remains an anomaly, a wrinkle in rationality.

As such it is rather a neat metaphor for one of the biggest problems we continue to grapple with today, the struggle between reason and superstition, science and religion, the West and the Rest: pick your dualism

The Enlightenment, about which we think far too little today, from Rene Descartes though Newton to the Lunar Society and on to Franklin and Jefferson (not forgetting Voltaire and Robespierre) posited a world of three powers, God, religion and reason with reason dispelling the darkness of lives dominated by superstition, received unchanging “law” and rule by divine right. From the enlightenment came democracy, science, human rights, and ironically freedom of worship. The enlightenment spawned both the American and French republics, but took very different forms in those two new countries. In the USA it took a moderate form, one which did not deny religion and saw no problem with it continuing as a force alongside reason, democracy and science. Jefferson wrote it into the first sentence of the declaration of Independence and it’s there on every dollar bill. In France, and is essence across Europe, it took a more radical path. Until the French revolution was hijacked by one of its most successful generals, Napoleon, the church was banned and its buildings systematically destroyed. Across the rest of Europe the Church was, and largely still is, confined to a social welfare and folksy ceremonial role. We still see this split today. It is one of the reasons why Europeans find it so difficult to understand (and to tolerate) the role of religion in American politics. One could imagine an Atheist being president of France, Prime Minister of the UK, but President of the USA?

This dualism of religion and reason play out in the humanitarian world as well. Classically we think of it as the Dunantists, the ICRC’s of this world, in one track driven by humanity and reason, deliberately standing apart from politics and religion, and in the other, the faith driven agencies of the Hindu, Jewish, Christian and Islamic persuasions. Of course the scales are not balanced. Most aid is delivered and funded by organizations which are essentially secular and rationalist, if not to the pedantic and principled level of the ICRC.

And here comes the problem. It comes in two parts. Part one. The vast majority of people who receive humanitarian assistance are in nations where religion is a key part of people’s lives. For most humanitarian beneficiaries, spirituality is a given. It is an important part of their lives. Part two of the problem comes from science. We know, from research carried out with people recovering from alcoholism, or traumatic injuries that those with strong spiritual beliefs recover faster and in a more lasting way. We can prove, at least statistically, that spirituality alleviates suffering.

So if spirituality is a meaningful part of our clients’ lives and if spirituality aids recovery, what then should be the stance of humanitarian agencies, committed as they are to the impartial and rapid alleviation of suffering and to doing so in a way that does not express views on issues of a political racial or religious nature?

Part of the solution I think is to sidestep the mistake our forefathers made. They treated religion in a rather unenlightened way. They refused to study it with the same reason and empiricism as they did anatomy or astronomy, instead they locked in up in Pandora’s box as an object of suspicion to be avoided, much as their forefathers are written “here be sea monsters” on the edges of their maps.

Daniel Dennett in his superb book Breaking the Spell: Religion as a Natural Phenomenon does an excellent job in showing how religion can and should be studied and how it is possible to separate out issues of spirituality for the religious trappings that have been loaded onto them over the ages.

If we pursue this path, then spiritually becomes another intriguing facet of the human mind along with hope, empathy and love, all of which we have no problem supporting in humanitarian work. And if we in the humanitarian world can shown how reason can be used to describe and support spirituality to demonstrably reduce suffering, without recourse to religion, then we may also be contributing to addressing the far greater problem posed by this same challenge I the larger world.

The resurgence of religion as a political power, whether it is the evangelical right wing in the USA, the Islamist jihadists in Pakistan and Afghanistan, the Hindu nationalists in India or the Orthodox Church with the orthodox state in Russia, represents a clear and demonstrable challenge to the gifts of the enlightenment - democracy, tolerance, science and the necessity of doubt. We see from history that the full frontal attack of the French and Russian revolutions faltered, as has the accommodation strategy of the American revolution. Perhaps the answer lies not in the outright rejection of religion, nor in its unstudied acceptance, but rather in the continued use of reason to explore and enhance life. Why should the study and enhancement of spirituality be the exclusive domain of religion and theology? Perhaps, if we stopped being so frightened of the spiritual side of ourselves and sought to enhance it as we do our physical and intellectual sides, then we would truly have an answer to the threat of religious fundamentalism.

A year ago, a time which seems positively archeological now, we helped host a conference at Tufts University on Microcredit and its future. I, in my naivety, thought this was going to be a cozy chat amongst earnest development workers and community groups, but not a bit of it. Microcredit is big business these days. With deregulation in India it is the banks, not the aid agencies that provide the capital (well credit) to drive this multi-billion dollar enterprise. It is still the community groups who deliver the product and work with borrowers to manage their daily risks. In African, Banks, we were told, were starting to look longingly at the prospects of all those potential clients across the continent.

The phrase that really stuck in my mind came from one of these bankers. When asked to capture what he saw his role to be he was clear we are “blazing the trail for consumers of credit”. His point, and that of many in the room, was that there is nothing inherently wrong with linking the worlds purest two billion into the lower tiers of the global financial engine. Credit is credit, whether you borrow two dollars or two billion dollars, and it is what makes the economy go round, or rather forward. So, the bankers ask, do you want the world’s poorest to be part of this economy or do you want to exclude them from this hope (there term not mine).

That was eleven months ago. Now all has changed. Well actually no, all has not changed. Michael Balen in his wonderful book on the South Sea Bubble shows how the habit of talking up share prices, constructing make-believe realities and gambling away the future was alive and well in 1720. Then, stocks were traded at the coffee houses around London, the very same places where bets were made on the great horse races of the day. Money, greed, risk, adrenaline, all together in the same place Nothing has changed.

Today, those in Africa who have not been sucked into the great credit gamble, don’t seem so stupid. Elizabeth Blunt writing for the BBC paints a wonderful picture from Addis Abebe, where growth is fueled by remittances from relatives and from savings. OK it is slow, and if you have little to save it takes forever to move forward, but you are in the driving seat.

Savings groups, remittances transfers, the innovative use of cell phones and SMS to move cash around the country, these are the building blocks of an alternative way of doing business, and in small ways across Africa it is working.

In the early days of evolutionary theory, Darwin’s “bulldog” Thomas Huxley promoted evolution in the British middle call image, survival of the fittest, completion - nature red in tooth and claw. It is always good to feel that science, as well as God, is on your side. Half a world away in Siberia, Russian prince-turned-anarchist and biologist, Peter Kropotkin, saw it differently. He saw an environment in which survival was about collaboration not competition and in which making small savings in energy or food made all the difference between life and death. He did not see the massive competition and heady growth of the tropics with its consequential winner takes all.

So today, which political interpretation is right, competition (I’m sorry, it’s not personal, it’s just business) or cooperation?

Speaking in Paris this weekend Antonio Maria Costa, executive director of the United Nations Office on Drugs and Crime, urged NATO troops to bomb the drug factories in Afghanistan. Le Monde reports him as saying that "NATO troops are being killed with weapons bought from drug profits" and that the bombing of opium laboratories in Afghanistan could destroy 60% of the opium flow from that country and, as he points out "It's also cost-effective for us."

According to his CV , this top UN official has a degree in mathematical economics from Moscow State University, and a Ph.D. in economics from the University of California at Berkeley. He is not pencil pusher but a highly educated, well, practiced and worldly economist.

As an economist he must be aware that supply needs demand. Afghan and Pakistan officials have for some time being privately lobbying for a more sustained program to reduce demand, particularly in the USA, but they have not been lobby for a campaign to bomb the neighborhoods where heroin is used, or the houses of known drug dealers in New York, San Francisco or Los Angeles, despite that fact that there are at least 3.8 million Americans who have used heroin and an additional 106,000 users added in 2007, the last year for which we have statistics, all driving demand.

Only a month ago Costa was reporting a decline of 20% in poppy cultivation over last year and praising the fact that the province of Nangarhar, the traditional heartland of the opium business was, this year, totally free from poppy cultivation. The reasons he gave for this turnaround? That local governors with the help of the local shuras and religious leaders were able to convince the farmers not to cultivate opium. He went on to say that “Only a very small amount of land was eradicated, only 5,000 hectares at a very high human cost - 77 people died, half of them civilian and half of them policemen - and also at a very high economic cost. We are therefore making a change towards our policy regarding eradication.”

One is sometimes staggered by the thoughtlessness of remarks made by those with power and influence, but one is more staggered that a UN official, could throw aside principles of due legal process, basic human rights and simple pragmatism to make such an incredible statement. One wonders whether, in his economic models, the life of an Afghan drug producer is somehow of less worth than that of an American drug user?

The use of the term victim to describe the people aid agencies seek to assist has rather gone out of vogue. In the 90’s in was viewed as politically incorrect. It had connotations of helplessness and dependency. We started to talk about beneficiaries or even clients, and on occasion partners.

But I would like to make a plea for us to worry less about our own feelings of correctness and more about reality. Researching a little paper on the food aid crisis recently set me off thinking about how and why people end up in crisis, and to be honest the term victim is the right one to use.

In many of the brutal conflicts agencies work in; think Iraq, Afghanistan, Darfur, N. Uganda, citizens are either victimized or are the innocent victims caught in the middle, particularly women and children.

As climate change tips marginal environments and livelihoods towards destitution, those who sufferer are not those who caused global warming, they are the victims of someone else’s actions.

The food price hikes we have seen across the global south, and the shift to supermarket food-selling which excludes local producers from the market, are driven by forces outside of the immediate control of those slipping into malnutrition.

The global panic around failing banks and insurance companies this week, which will result in smaller aid budgets and less loans available for Southern states and business, will reduce employment opportunities in the South and remittances from the north; more victims.

Victims can still be partners, or clients and beneficiaries. They can also be agitators, reformers and leaders, but that does not detract from the reality that they have been victimized.

Sometimes you come across an initiative in the humanitarian world which hits you like a breath of fresh air. The New Partnership for African Red Cross and Red Crescent Societies http://www.neparcafrica.org/ is just such an initiative.

Second class partners

For decades Africa’s Red Cross and Red Crescent Societies have been the work-horse of the humanitarian world. In Sudan, Ethiopia, Malawi, Mozambique and many many other countries they provide the bulk of volunteers on the ground in times of conflict and disaster, whether working with the ICRC, the Federation or as partners with UN agencies and International NGOs. But to be brutally honest, for years Northern agencies “we” have not totally trusted our African partners “them”. The funds flow from Northern government to International NGO or Northern Red Cross Society then thence down to the Africans. Using a military analogy, Northern agencies are the officers and Africans the troops; occasionally the non-commissioned officers. Yet time and time again Africa’s Red Cross and Red Crescent Societies ran and delivered large and effective aid operations, for refugees in Malawi in the 90s, for flooding in Mozambique, for famine victims in Ethiopia and Sudan. NEPARC was born out of this frustration; the frustration of always being seen as the junior partner, the second class citizen, not quite in the tent. The accepted wisdom of the donors and Northern based agencies was that African Societies did not have the management and accounting systems to enable them to mange funds, programming and reporting directly, yet Northern agencies has spent decades running and funding innumerable trainings for these ground troops.

Striking back

In 2003 a small group of Red Cross and Red Crescent leaders in Africa, lead by Abbas Gullet, the newly appointed Secretary General of the Kenyan Red Cross, decided to challenged the received wisdom. Fed up of being treated as untrustworthy partners they formed a self help grouping to devise internationally recognized standards to which they would be held accountable, by themselves. Working with the Fritz Institute http://www.fritzinstitute.org , KPMG-Kenya and SGS the big Swiss based international inspection outfit, they devised a set of bench-marking audits which SGS would carry out independently on the Societies http://www.ngobenchmarking.sgs.com/.Societies would receive an audit report and a grading for their accountability, transparency, financial competence and financial sustainability. Societies are given a time span in which to come up to spec and if they do not, they are expelled from NEPARC. But African societies are meeting the standards, and now want to go further. Their next move it to develop and use standards and audits for program impact (not process, not output, but true impact). Again these will be administered both by outside organizations and in a peer review system. (There is a good write up of this process in Forced Migration Review http://www.fritzinstitute.org/PDFs/FMR18/FMR28.pdf?type=F) The point of this little homily is that NEPARC has achieved in 5 year what decades of top down funding and training never achieved. Africa’s Red Cross Societies are asserting their right to be treated with dignity and as professional, equal partners. Of course things won’t change overnight and some societies won’t make the graded, but then I wonder how many of the country operations of the big international NGOs would? The final hurdle still remains though, and that is for the traditional donors into the humanitarian system, the OECD states’ aid ministries, to fund the African Societies directly rather than via Northern based Societies and NGOs.

(Photo: UNICEF)

I was putting together a short note this week for a training session on humanitarian principles, and came across a couple of wonderful phrases on an ICRC website.

Referring to the principle of Humanity: Humanity is an "optimistic philosophy": the refusal to despair of mankind. Humanitarian work is difficult. Its greatest enemies may well be neither weapons nor disaster, but selfishness, indifference and discouragement.

And then on Impartiality: Impartiality in its true sense requires that subjective distinctions be set aside as well. It demands that an effort be made to overcome all prejudices, to reject the influence of personal factors, whether conscious or unconscious, and to make decisions on the basis of facts alone, in order to act without bias towards or against anyone.

As I watched the tragedy of the flooding in the Irrawaddy data unfold and here the rhetoric on all sides for and against more robust action, it came home to me just how difficult, and how essential it is to understand and practice the core values of humanity and impartiality.

Of course we all abhor the Generals in Yangon and their regime. They are sucking their country dry of hope and wealth, personally enriching themselves as they and their army exist in a fantasy state of private accommodation, schools and shops, well above the law. You could almost imagine them, like Marie-Antoinette , suggesting the poor eat pasta if they cannot get rice, except of course, the Generals cannot claim ignorance of lack of complicity.

What is clear though is that the temptation to make political capital out of the crisis is not all on one side. Reading official Myanmar websites about the flooding is just tragic. They paint a picture of concerned leaders rolling up their sleeves and personally distributing relief with the benevolence of a medieval minor prince.

But there is political capital being made by others. Bernard Kouchner, Frances new(ish) foreign minister sounded good, and made France sound good, when he invoked the right to protection and suggested the time was right for some form of armed intervention to provide relief to the people of the delta. But as Gareth Evans., one of the architects of the Right to Protection doctrine has said. “The point about "the responsibility to protect" as it was originally conceived, and eventually embraced at the world summit … is that it is not about human security generally, or protecting people from the impact of natural disasters, or the ravages of HIV-Aids or anything of that kind. Rather [it] is about protecting vulnerable populations from "genocide, war crimes, ethnic cleansing and crimes against humanity"

In other words by invoking the R2P doctrine Kouchner devalues its usefulness in those extreme situations for which is was designed.

Likewise members of the European Parliament, in accusing the Burmese authorities of “a crime against humanity," may be putting politics before people.

Their call to the U.N. Security Council to see if aid shipments to Myanmar "can be authorized even without the consent of the Burmese military junta" smacks more of seeking regime change than the neutral and impartial alleviation of suffering.

I am not arguing that regime change in Burma is not needed, it is. The Generals rule by force in a country that courageously voted them out of office and has since suffered the consequences of opposing such malevolent power. Whether the regime in changed now, or in six week or six months will make little difference to the future of Burma, but those six weeks have made a huge difference to the survival chances of tens of thousands of people in the delta.

We are back to that age old humanitarian dilemma, whether to seek the course most likely to alleviate suffering in the here and now, or to address root causes and seek political change in the hope of potentially alleviating a lot more suffering in the long run.

In the past few years, many states have faced the same choices over assistance to Darfur, balancing a more robust policy over aid delivery to Darfur against the cost of rocking the boat of the peace process in the south of Sudan.

This may be the stuff of foreign policy strategy, but it is so patently not the stuff of humanitarianism. We, the outsiders, simply do not have the moral right to trade off assistance now to save lives against possible longer term good.

Earthquake lessons The Chinese newspaper Nanfang Zhoumo recently asked me to pen some thoughts one what other countries and cities had learned from their earthquake response efforts. Since most of us do not read Mandarin, I thought it would be useful to republish the piece here.

Earthquakes occupy a special foreboding place in the family of disasters that afflict man. They are cataclysmic, they make no differentiation between rich and poor, political elite or worker, old or young. They also demonstrate that, despite the way our different countries have developed, the cultures and the histories of nations, people, when caught in such crises, behave in utterly similar ways.

The grief on the face of a mother in Sichuan province today, is no different from that of the mother in Bam, Iran in 2003, or Izmit, Turkey in 1999, Kobe, Japan in 1995, San Francisco in 1989 or Spitak in Armenia in 1988. In all these earthquakes we saw the heroism on local people digging through the night to help rescue trapped loved ones, and the dedication to duty of local officials who, despite loosing their own families, stayed in place to direct relief efforts. When all said and done, we have more that unites us than separates us.

Also, in these past decades we have learned much about how best to respond to earthquakes and, as importantly, what not to do. Here are some of the key lessons from previous earthquake relief and rehabilitation operations.

Search and Rescue People do not survive long trapped in collapsed buildings, particularly those built of concrete. The basic rule is that 95% of all those who will be rescued alive will be rescued in the first 48 hours. After that, loss of blood, toxins released by damaged tissue and dehydration will have killed most trapped people. This means that search and rescue teams need to be on the ground within hours of the quake striking. International search and rescue teams may be great gestures of solidarity and shared concern but they have little chance of getting to the disaster site in time to do any real good.

Hospital services Earthquakes place a massive rapid load on the emergency facilities of hospitals. Beds blood, surgery teams. In countries where the hospital service are centrally organized, either through the state or, in the case of Japan, through the Red Cross, coordinating the flow of casualties from the quakes sites to the various medical facilities and keeping track of who went where, is handled far quicker and more effectively than in privatized systems where each hospital operates independently.

Volunteers After every recent major televised earthquake, local volunteers have poured into the quake area to help. These numbers are always high if the quake takes place during one of the university and school vacation times when students are quick to volunteer. States that have ready structures for organizing this flow of sympathy fare better than those where volunteers are not organized.

Water and Sanitation People die fastest from dehydration and through infectious disease spread in unsanitary conditions. Getting a clean water supply up and running has always got to be the priority. Most well fed people can go quite a few days without food and although earthquake damage infrastructure and storage facilities for the most part they do not damage food production. Once transportation routes can be reopened, food can be brought in. But water normally comes to people’s houses and apartments in pipes, now damaged beyond use, so alternative systems of tankers, mobile tanks and water stations need to be installed.

Fear Earthquakes are truly terrifying events. In the immediate days after the quake people need reassurance and a constant flow of information. Often panic can set in around rumors. Rumors that an epidemic has broken out, or that another earthquake is predicted or that the local dams are going to burst and flood the town. Authorities need to be more open and more rapid in sharing information than they normally would, in order to reassure the population. Cell phone networks have proved invaluable for this, particularly the use of text message broadcasting. Text messages take up very little band width and can get through with little signal strength and to hones which are running low on power.

Shelter There is no such thing as temporary shelter! Experience after every major earthquake shows that where temporary housing is provided, much of it is still there and used years after the earthquake. In Kobe, Japan, authorities put up temporary housing in areas around the city and moved out people who had lost their homes. Three years later, people were still living in some of them. Those left in temporary housing tend to be those that have the hardest time coping. In the case of Japan, this was people who suffered from mental illness, and elderly people who had no immediate family to look after them. So temporary housing in the form of tents and mass accommodation in public buildings works in the short term. This should be replaced by housing which is meant to be permanent, not by some interim measure.

The second lesson, from all earthquakes is that people want to move back to their homes. They do not want to be relocated and do not want to see outsiders come in and redevelop their villages and communities. In some countries, planning authorities see the destruction of the earthquake as a chance to “wipe the slate clean”, to assume they can bulldoze the debris aside and take the opportunity to redevelop. Everywhere this has happened, those who suffered most in the earthquake have lost out. Where the affected community is deeply involved in the rebuilding process and gets to rebuild what they believe is right, the solution tends to be more durable and economically more sustainable in the long run.

Preparedness and mitigation In the aftermath of every earthquake that has hit a rapidly developing city or town, it is found that local buildings and developers have cut corners and not built to the correct earthquake building codes. This is especially true for public buildings. A key lesson is that short term savings in construction costs lead to long term consequences in terms of loss of life, livelihoods and economic prosperity. In all cases authorities have needed to revise the way they police and administer building codes, usually becoming much stricter and introducing much harsher penalties for code violations.

At the household and social level, preparedness is often about behavior patterns. What history shows us is that in communities where earthquake preparedness and mitigation is practiced, losses are much lower. History also shows us that in communities where minor earthquakes are common, preparedness and mitigation is taken seriously but in communities where earthquakes are a risk but uncommon, preparedness and mitigation are easily forgotten. As an example, Tokyo suffers regularly from small tremors and earthquakes. Most people in Tokyo have earthquake insurance. Most people have bolted their furniture to the walls and their TVs to the tables, most people regular partake in earthquake evacuation drills. In Kobe, before the 1995 earthquake, very few people practiced these measures. Both are earthquake prone areas, but Kobe had not had a major earthquake in a generation.

Crises usually bring out the best in people. There is great suffering, but it is shared and the burden thus lessened. There are opportunities to rebuild to better standards, opportunities to retro-fit old buildings, particularly public buildings, to withstand the next shock, and opportunities to put in place preparedness measures to guard against future quakes. Where the authorities are invested in ensuring the safety and future of the population, the mistakes of the past can be learned from and a hopeful future created. Cities and people can live with earthquakes and can guard against them, but it takes long term investment, in infrastructure, research and people.

Some years ago when I first read Samantha Power’s book on genocide A Problem from Hell: America and the Age of Genocide I remember being so shocked, not just by the descriptions of appalling cruelty, apathy and duplicity but by the realization that many of the countries listed were ones I, as a humanitarian worker, had served in or worked with, and often during those periods of genocide. The shock was that I had been part of that history and at the time (apart from Rwanda) had not thought of the various “humanitarian crises” as theaters of genocide. Genocide was there and I was not cognizant of it.

That same uncomfortable shock came over me again when I read Naomi Klein’s The Shock Doctrine: The Rise of Disaster Capitalism. From Iraq to New Orleans to the tsunami hit coasts of Sri Lanka, the Maldives and Thailand, Klein shows how the fear and disruption that accompanies the suffering of crisis has been cynically exploited to push through the privatization of national assets and the corporate grab for real estate, profitable service provision and the extraction of wealth from already poor communities. Klein is not alone in uncovering this phenomena.

Gunewardana and Shuller do much the same in their edited volume Capitalizing on Catastrophe: Neoliberal Strategies in Disaster Reduction showing how crisis has been used to push through unwelcome policies and changes in Haiti, Guatemala and other countries.

According to Greg Berger and Ben Wisner, in a paper circulated on the internet this week, “victims of last year's massive flooding in Chiapas are being offered loans and grants by the Mexican government to resume their farming activities, but with a catch. They need to agree to stop growing corn and beans (their traditional crops) and replace them with African oil palm (Elaeis guineensis, native to West Africa), an important emerging source of biodiesel.” As they put it in the paper’s title, this is disaster capitalism moving into the blackmail business.

Earlier this week the New York times reported how fear around the present global crisis of food and fuel prices is being used to in Japan, Korea, the USA and some European countries to relax legislation allowing for more genetically modified crops to be planted.

The opportunism to profit, both financially and in terms of power grabs, from disaster is not new. When San Francisco was devastated in 1906 by earthquake and fire, the city rebuilt quickly, relaxing building and sanitation codes and grabbing land previously occupied by minority communities, but now viewed as prime real estimate. By the time of the Panama-Pacific International Exposition in 1915 the city was totally rebuilt, but for the city fathers and business sector, not the Chinese immigrant population for instance, most of who’s dead and displaced were simply not counted in the published statistics.

So the question is, now that these issues are out in the open, that they are being publicize in the popular press and not just the fringe media, will aid agencies, who bear witness to these economic crimes alongside human rights crimes, have the courage and competence to expose this dark side of disaster reconstruction?