Human Rights versus the Humanitarian Ideal: Sustainable Programming in Countries with Questionable Human Rights Records

The humanitarian assistance community is gradually forming a consensus that sustainable interventions should focus on building resilience in order to successfully address the ongoing effects of natural disasters and complex emergencies as well as to minimize the effects of new crises.[1] Such attempts often require working within local government institutions to build local capacity in health, education, food production, or any one of the many silos that fall under the sprawling UN Cluster System.

Ideally, these efforts strengthen the institutions of local and national governments which represent the interests of the communities they serve. But what happens when these efforts are undertaken in less than ideal circumstances, as they so often are? Even a cursory analysis of humanitarian aid financial allocations shows that there is significant overlap between the places where the largest amounts of humanitarian assistance are dispersed (Figure 1) and countries which are repeatedly rated as having an extreme risk for human rights abuses (Figure 2). Under these circumstances, it is unavoidable that humanitarian assistance and human rights advocacy will sometimes conflict with one another.

Reflections on Nepal

It’s hotter than I expected. Having never been to Nepal before, my imagination was dominated by photos of Sagarmāthā and its snowcapped reaches, but down here in Dhading Besi, the summer sun is unrelenting. We’ve been waiting on a hard-packed dirt field-turned-helicopter-landing-zone for a day and a half, awaiting our turn to be delivered via Indian Air Force helicopter to the furthest reaches of the district. The field looks like it serves as an intermittent parade ground for military formations, and the outpost off to the corner looks defensible. The bunkers are empty, but I recognize their sight lines are well-arrayed and the layers of concertina wire are carefully maintained, kept clear of debris and brush that might make them easier to leap over. I struggle to remember how long ago the insurgency had been and wonder what had happened to the Maoists. Asking some of the Nepali staff members what the result had been, they hesitantly say that they had been incorporated into the government. I remark that surely that meant they had truly been defeated, and I’m rewarded with a boisterous laugh among the normally quiet staff members. It was a good and heartfelt laugh, and I relax a bit while simultaneously berating myself internally for bringing up what could have been a very awkward and controversial subject. Reminding myself that a student intern is best seen and not heard, I continue to ponder the heat.

NYC Medics Coverage in the New Yorker!

NYC Medics, the organization that I went to Nepal with, has received some coverage in the latest version of the New Yorker! It was written by Nick, a journalist who embedded with us on the trip, and I think he did an excellent job cataloging the accomplishments, challenges, and frustrations we experienced during the mission. Check it out here!

. . . And We're Back!

Lots of things have been going here in the office and across the world. Summer was a busy mix of an emergency medical intervention in Nepal, which resulted in a mountain of data that had to be entered by hand, followed by having to return to San Diego to help care for a sick family member.

Now that things have stabilized a bit, I'm going to be trying to post regularly again, starting with a brief series on Nepal and what I thought went well and what didn't.

The Ebola Endgame in West Africa

            With the Ebola Virus Disease outbreak in West Africa nearing its end, we can now begin to step back and take stock of what went well and what went wrong. Failing to analyze the response from an objective and ex ante perspective runs the risk of failing to observe a "teachable moment," in global public health. I have already published my report on the Guinea Health Surveillance System below, but I think it deserves some further context:

• Health Systems: If the West African countries of Guinea, Sierra Leone, and Liberia had sufficient health systems, with adequate facilities and healthcare workers, the disease could have been managed mush more easily. Had there been an adequate infectious disease surveillance program, with lab facilities and a system capable of rapid response the outbreak could have been stomped out in its early stages. These are issues of poverty, but also of weak systems that are at risk of collapsing once the attention and aid money begin to subside. Capacity building must be the number one priority for aid agencies and it must begin now, before public attention shifts away. 
• Traditional Practices: There remains a significant cultural barrier to formal healthcare in West Africa. As much as 80% of those who seek medical attention due so from a traditional provider. Now there is certainly an access issue due to cost and maldistribution of facilities and physicians, but there is also a significant tradition component. This presents a decision, would it be better to discourage people from seeking traditional care? Or perhaps it would be better to utilize these traditional healers by providing them training and access to the formal health network? The latter approach might enable us to simultaneously address the underground nature of informal medicine and also to increase the number of healthcare workers in the region. Traditional burials also played a dramatic role in the outbreak, but knowledge of disease transmission had lead to a massive shift in cultural practices there.
• The World Health Organization: The problem here is two-fold, the slow initial response and the lack of willingness to step up and take leadership of the problem were a dramatic failure that played out in major newspapers around the world. I'll simply say here that concerns about undermining local ministries of health must come secondary in the context of an acute emergency that transcends national boundaries. Only the WHO has the prestige and capacity to act in such a situation. It must not hesitate to use it.

            It is too easy to lay the blame at the feet of the countries who suffered the outbreak. We must acknowledge that the root cause of their inability to act effectively remains a lack of economic and political power in the global system. While we can address specific measures as I attempt to do above, the underlying factors mean that the risk of some other new crisis erupting are present anywhere that structural inequalities persist.

What Went Wrong: An Autopsy of the Guinea Disease Surveillance System

            On March 23, 2013 the World Health Organization announced an outbreak of Ebola Virus Disease in the country of Guinea.^[1] Located in West Africa, the tiny country is home to nearly 11 million people and is ranked 179^th on the Human Development Index.^[2] The fact that it was the World Health Organization, and not the Guinea Ministry of Health, that made the announcement of the outbreak is telling in and of itself. Guinea had not detected the outbreak, it was only the coincidental presence of a Médecins Sans Frontieres team in the country to treat a Malaria outbreak that led to the discovery of what would become the largest Ebola outbreak in the history of the disease.^[3] This paper will analyze the health surveillance system of Guinea in an effort to understand how such an outbreak could have gone unnoticed, continuing to spread among the population and to neighboring countries for nearly three months before the WHO announcement.