Emergencies in developed countries: are aid organisations ready to adapt?

Published Letter¹

A recent letter in the Lancet has called into question the appropriateness of aid organisations using developing country models for humanitarian response during complex emergencies in more developed countries. The authors assert that priorities and standards have arisen out of the hard learnt experiences of aid organisations responding to complex emergencies in developing countries, primarily Africa and Asia. Then came the crisis in the Balkans during the 1990s. Relatively healthy populations with demographic characteristics and epidemiological disease profiles similar to those of other Western countries were suddenly forced to flee en masse from their homes. This did not fit the standard definition of an acute complex emergency and the developing country model of humanitarian response should have been adapted for an emergency in a developed country.

Crude Mortality Rates among refugees displaced from Kosovo to Macedonia and Albania were relatively low, never reaching a daily rate of one death per 10,000. Few large epidemics of infectious diseases occurred in the Balkans. Due to the high incidence of rape and traumatic exposures, assessments for reproductive health and psychological morbidity were needed. Elderly people seemed to be more at risk of under-nutrition than young children yet they were rarely considered a vulnerable group.

Most aid organisations responded to the crisis in a predetermined manner and some did not adapt to the specific needs and characteristics of the situation. Organisations used pre-positioned medical kits, with some containing anti-malarial drugs and other inappropriate medication. Medication for treating chronic diseases was often lacking. Because children younger than 5 years were not found to have an increased prevalence of wasting, it was assumed, often incorrectly that under-nutrition was not present in the population.

The Balkan crisis underscored the importance of context-specific approaches to humanitarian assessments and programme implementation. New definitions for acute and post-emergency phases of complex emergencies must be developed taking into account variables other than mortality rates alone. The specific demographic characteristics and epidemiological disease profile of each displaced population must be considered and appropriate programmatic responses developed accordingly. The authors conclude that although the development of codified priorities and standards has been an important achievement in the field of humanitarian assistance, these should be seen for what they are; minimum standards which need to be adapted by aid organisations according to realities in the field.

¹Emergencies in developed countries; are aid organisations ready to adapt? Spiegel P. and Salama P., The Lancet, vol 357, pp714 March 3rd 2001.