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Domeez refugee camp, Kurdistan, Iraq – 2013
The MSF (Médecins Sans Frontières / Doctors without Borders) clinic in Athens receives refugees who escaped war and crossed the sea only to get confined in freezing winter with no direction and little hope. Yet, the refugees in Athens are only one example where humanitarians attempt, and often fail, to remedy the wrongs done by war, disaster, and dirty politics.
Helping people restore their lives after a conflict is committing to human dignity and social justice, but even in our role as humanitarians managing crises, we are reluctant to acknowledge the changes that affect our work, environment, and the people we serve.
Greying veterans speak of classic humanitarian contexts, but such conditions scarcely exist anymore. Talking to senior managers in MSF, we found that a majority started in the early nineties in the Great Lakes, South Sudan, Burundi, Chechnya, Somalia, Liberia, Afghanistan, and Bosnia. Those conflicts of the 20th century involved ‘interstate tensions and one-off episodes of civil war’ where actors, sovereign states or clearly defined rebel movements, are known, and ‘if a dispute escalates and full-scale hostilities ensue, an eventual end to hostilities (either through victory and defeat or through a negotiated settlement) is followed by a short post-conflict phase leading back to peace’ (1). Those conflicts created large refugee camps such as Goma in the Democratic Republic of Congo or the Dadaab in Kenya.
Today’s conflicts are fought and concluded differently; the report quoted above describes ongoing ‘cycles of repeated violence’. This comes with changes in global governance and attitudes, technological advances, and increased political and economic fragility. Refugee camps are no longer the norm, and forced displacement has taken on a new shape and scale.
Changing conflicts
The siege of Aleppo has been likened to that of Sarajevo (1992-96). Yet, Aleppo, unlike Sarajevo, which was besieged by the regular Republika Srpska army, saw troops from half a dozen countries and militias and non-state armed groups fighting for it.
Wars are different today. Revisionist theories concerning ‘just wars’ argue against the conventional understanding of just war (jus ad bellum) and its appropriate conduct (jus in bello), arguing that ‘it is a mistake to think of war as a morally distinctive enterprise’ (2), and equating it to individual violence, hence blurring the lines between combatants and non-combatants (3).
Others maintain that there are New Wars (4) where actors, goals, methods, and finance are different. The 21st century wars are fought by a mix of ‘regular armed forces, private security contractors, mercenaries, jihadists, warlords, and paramilitaries, etc.’, replacing ideology by identity politics, and they are fought through displacement and control of population rather than decisive battles.
Moreover, great powers prefer to fight with zero casualties, chiefly using drones. This changes war, where fighters are liable to die in combat, into a ‘manhunt’ where one side suffers all the losses while the other is totally immune (5). This change is illustrated by the US dropping more than 26 thousand bombs in 2016 alone (6).
This contributes to the concept of Hybrid Warfare, which includes counterinsurgency and war on terror through unconventional means, ‘involving the convergence of combatants and non-combatants, kinetic and nonkinetic, physical and psychological weaponry’, and which seeks to incorporate ‘the aspirations and techniques of mainstream international development and humanitarianism in the battle space of war’ (7).
Changing actors and environment
Daesh, or ISIS (Islamic State in Iraq and Syria), a Jihadist group that occupied vast lands in Iraq and Syria in the past three years, has become a major item of news broadcasts and political debates. This is due to their military conquests as well as the terror attacks they perpetrated in the West.
Daesh is different from previous non-state actors in conflicts. They employ different methods, mixing guerrilla warfare, online fundraising and recruitment, and terror attacks far away from their stronghold. They don’t attempt to overthrow a government, to take its place, and become the legitimate rulers of their country. They are dismissing the borders of the nation-states and creating new borders with no concern for international norms and legitimacy.
Additionally, permanent members of the United Nations Security Council have shown very little ability to collaborate or put aside animosities to limit the devastation of conflicts like those of Syria or Yemen. On the contrary, they have all manipulated the UNSC to undermine the very peace and security it aims for in order to promote their own political interests.
The crisis in Syria reveals the shortcomings of the UNSC in stopping conflicts as well as those of the humanitarian system, including UN agencies, donors, and NGOs (8). The failure to mitigate attacks on medical facilities such as the one by the US Airforce on the MSF hospital in Kunduz and the many airstrikes on hospitals in Yemen and Syria are just a few examples of this.
The limitations on traditional NGOs and other humanitarian actors in accessing such conflicts made it the norm for local entities, such as the self-organised civil defence in Syria as well as the local medical personnel there and in Iraq, to become the providers of whatever assistance is left.
An attempted takeover of the humanitarian space seems to be continuing, as we observed at the World Humanitarian Summit in 2016, where the Chair’s Summary (9) notes the attendance of ‘55 Heads of State and Government, hundreds of private sector representatives, and thousands of people from civil society and non-governmental organisations’. The sequence of actors here, like a Freudian slip, reveals a change in the perception of humanitarian actors with even private actors before NGOs.
Changing population
We also see a shift in the epidemiological profile of populations affected by conflicts, from infectious to non-infectious diseases, due to the increase in life expectancy in Sub-Saharan Africa and to more beneficiaries from middle-income countries in the Middle East and Ukraine.
The mental health consequences of crises are now better understood and are a priority that can no longer be ignored.
The high-profile wave of displacement across the Mediterranean over the past few years caused media attention to spike and describe it as the centre of the global migration crisis. This is misleading. The United Nations High Commissioner for Refugees’ report on Global Trends in Forced Displacement 2015 (10) shows the highest burden of the more than 65 million displaced persons in the world by far skewed towards receiving countries like Turkey, Pakistan, Lebanon, Iran, Ethiopia and Jordan. Most of the refugees and displaced populations in the world today are not in refugee camps but on the road or in host communities, sometimes in urban settings.
The people we serve have more access to information and have, as they should, higher expectations from humanitarian medical providers than has been the case in the past.
Implications for medical humanitarian assistance
The factors mentioned above make it more difficult to access, leverage, and provide humanitarian medical assistance.
Some humanitarian actors are part of the problem, while others have little willingness, funds, or capacity to intervene or don’t consider it a priority or a mandate. As a result, local organisations, diaspora groups, and regional donor networks end up filling the void (8).
As many NGOs depend on government donors, their choices are further limited by government policies. Only a few international NGOs have enough private funding to remain independent in their operational choices.
These trends may signal the end of the context that produced modern humanitarianism. With few traditional wars or battles, newer technologies, greater disregard for international humanitarian law, and crises such as the forced displacement of increasing numbers of refugees, it could become difficult for humanitarian actors to continue operating as they have done in the past decades.
Conclusion
We need a better understanding and in-depth debate about the realities of humanitarian emergencies and the future of medical humanitarianism. This debate should not take place primarily in summits where suited government officials, donors, corporate executives, and NGO bosses talk to each other, but within the context of a broader discussion held among field workers (both foreign and national), the public that supports humanitarian assistance with their donations, and above all with the people affected by emergencies. This will improve our understanding of the changes we are facing as well as the opportunities and pathways to the future in front of us.
When that is the case, borders get closed to humanitarian assistance, health facilities get bombed, and populations are pushed out of their homes and their countries – all with little or no ramifications or deterrence for the perpetrators.
In a truly humanitarian world, where we aim to reduce the impact of war and violence and retain a trace of human dignity in the face of destruction and massive forced displacement, we must start to consider when, within a humanitarian context, does the sovereignty of people trump that of states?
STATE SOVEREIGNTY AND NATIONAL POLITICS HAVE LONG BEEN PUT ABOVE THE NEEDS OF THE PEOPLE
References
- World Bank, 2011, World Development Report 2011.
- Frowe h. 2014. Defensive killing: An Essay on War and Self-Defense. Oxford University Press.
- Gratitude to Philippe Calaine for his research and insights on revisionist just war theories and their implications on humanitarian assistance.
- Kaldor, M. 2013. In defence of new wars. Stability 2(1).
- Chamayou, G. 2013. Drone Theory. Penguin Specials.
- Benjamin, M. 2017. America dropped 26,171 bombs in 2016, What a bloody end to Obama’s Reign. The Guardian.
- Bell, C. 2012. Hybrid Warfare and its Metaphors. Humanity.
- Abu Sa’Da, C. 2017. The Middle East: A mandatory re-turn to humanitarian action. Chapter 17 in Makdisi and Prashad (Eds) Land of the Blue Helmets, the United Nations and the Arab World. University of California Press.
- Chair’s Summary of World Humanitarian Summit. (http://reliefweb.int/sites/reliefweb.int/files/resources/Chairs%20Summary.pdf)
- UNHCR. 2016. Global Trends in Forced Displacement 2015. Geneva. (http://www.unhcr.org/576408cd7.pdf)
