By Yibeltal Mekonnen, Key Correspondent for the Irish Forum for Global Health
The global health community is highly engaged with development aid and responding to humanitarian crises in many fragile states and conflict zones. However, interventions are often embroiled in the ideological confrontation as to where global health stands in the humanitarian-development nexus: whether the focus is predominantly development aid, or humanitarian response. Some organizations have tried to merge the two, and, in the end, to be truly successful, institutions and governments must address beneficiary communities’ needs and work together to identify and implement locally engineered and acceptable solutions to meet perceived needs. Three presentations during the second day of the Global Health Exchange conference this week in Dublin unpacked key issues around such challenges.
Speaking on effective partnerships and strategies to bridge the humanitarian-development nexus, Dr. Michael Ryan, the WHO’s Assistant Director of Emergency Preparedness and Response, stated that almost 80% epidemics arise in areas of conflict. In the current outbreak of Ebola in the Democratic Republic of the Congo (DRC), he reported there were 300 confirmed cases and 5500 suspected contacts as of 7th November 2018. Working with international partners such as MSF and GOAL the WHO set up 3 mobile clinics and vaccinated more than 24,000 people, including health care workers. He spoke of major challenges in tackling the outbreak. For example, contact tracing and preventive measures are difficult to implement due to ongoing conflict and where access to communities is limited. Weak infrastructure is unable to provide health facilities, clean water, and sanitation exacerbates the problems. For Michael Ryan, biodiversity in the region and disrupted development are other factors impacting on epidemic control.
He also reflected upon the role of community engagement in dealing with outbreaks in conflict zones, and why some countries in sub-Saharan Africa have more success. For Dr. Ryan, community surveillance networks in conflict zones are increasingly relied upon when a state’s apparatus is weak. Hence, community engagement and participation can have positive and significant implications for behaviour and community-based approaches He added, “Bad experience leaves an unforgettable lesson,” citing the successful control of Ebola in Uganda where, following an Ebola outbreak in 1990s, the country is better prepared and benefits from the strong institutions in the control of any new outbreaks. Most significantly, perhaps, he reiterated that in DRC;
“This is a man made catastrophe, not a virus. Without conflict it would be easier to control Ebola outbreaks.”
During the same conference session, David Wightwick described the role of UK-Med and other medical missions in emergency and humanitarian settings. He noted that medical missions are organised to respond in the short-term to emergencies as a lifesaving tool, but there was no involvement in long-term basic service delivery or recovery of institutions. Many emergency medical teams do not see themselves as humanitarian agents and they are more directed by, (and reliant on, official governments and institutions. They are, however, drivers of standards of service, and useful supplements to the existing sector, especially in fragile states.
Olive Moore, Head of Programmes at Trócaire, described the dilemma the organisation faces when working in developing contexts. Funding is mostly allocated for either humanitarian funds or development aid; not both. She said, ”We identify communities that need help but are forced to decide whether to provide humanitarian aid or development for their communities and institutions.” She also argued that dwindling funds drive NGOs to focus on ongoing successful interventions in some communities, sometimes leaving other communities in dire need behind. This presents an ethical issue and moral dilemma. Irish Aid, the biggest funder of Trócaire, has recognized the need for adaptive development humanitarian support for sustainability in countries it works in. In line with this her Trócaire has now started running programs that blend development aid with humanitarian assistance. She stressed the importance of adopting such an attitude to funding as communities benefiting from effective development may end up needing humanitarian relief mainly due to climate change.
The three presentations in this plenary shine a light on the future: the need for adaptive development- humanitarian joint programming as currently exercised by Trócaire, and Irish Aid. The global health community does need to work on coordination and the funding architecture, with communities in the driving seat and a focus on setting priorities, sustainability, and resilience. The key message to take away from these sessions is the clear need for a top down and bottom up approach engaging governments, NGOs, and institutions, utilising important platforms – perhaps such as the WHO’s World Health Assembly – to drive policy shift.
7th November 2018