MSF Report: Where is everyone? Responding to emergencies in the most difficult places

MSF Report: Where is everyone? Responding to emergencies in the most difficult places
July 2014
-pdf: [44 pages]

Foreword [by Dr. Joanne Liu, MSF International President]
The international humanitarian aid system has more means and resources at its disposal and greater know-how than ever before. But, on the ground, whether in Syria, DRC, South Sudan or the Central African Republic, MSF teams have repeatedly seen that:
:: Humanitarian responses are slow and cumbersome, and lack impact.
:: UN agencies and INGOs are increasingly absent from field locations, especially when there are any kind of significant security or logistical issues.
:: In acute emergencies, when assistance is most needed, international staff of humanitarian agencies are rapidly evacuated or go into hibernation, and programmes downgrade to skeleton staff or are suspended.
:: Many agencies are concentrating only on the easiest-to-reach populations and ignoring the more difficult places.
:: Many humanitarian actors are now working at arm’s length through local NGOs or government authorities, acting more as technical experts, intermediaries or donors than field actors.
:: These local organisations have enormous burdens placed on them to respond, but often do not have the skills and experience required to conduct technically difficult interventions; further, it can be difficult for them to operate in contested areas and to be seen as neutral and impartial.
:: Some humanitarian agencies simply wait until the emergency passes to continue their usual, long-term programmes.
:: Technical capacity in sectors such as water and sanitation or health also seems to be declining in emergency settings.

The result of all of this is that people in desperate need of lifesaving assistance are not getting it – because of the internal failings of humanitarian aid system. The findings in this report are based on research into three major displacement emergencies of recent years, but are also corroborated by our field staff all over the world. We are seeing these conclusions reinforced in the major crises of the day. In the Philippines response to Typhoon Haiyan, for example, where there is good access, funding and visibility, the UN and INGO community has deployed a massive response which has been largely effective, although very costly. Yet in the
Central African Republic and South Sudan, countries with considerable security and logistical challenges, persistent problems remain with the scale up of the UN and INGO response, which is characterised by bureaucracy and risk aversion. What assistance there is in these contexts is largely concentrated on the capital cities and/or in a small number of very large, officially recognised refugee camps; very little reaches the periphery.

In this report we level criticism at the UN for its lack of flexibility and effectiveness. In particular, we highlight the way the current UN system inhibits good decision-making, in particular in displacement crises where a number of UN agencies have a responsibility to respond.

We also put the choices made by INGOs, our peers, in the spotlight: to profile themselves as emergency responders, but without building the technical and human capacity to respond quickly and effectively; to work as implementers for the UN agencies, and become trapped in their bureaucracies; to avoid risk to the extent that they won’t work where people most need them; and to become dependent on the geopolitical interests in play in various conflicts and crises.

Donors should also examine their contribution to the atrophy of the humanitarian system, in particular their funding systems which are slow, inflexible and not suited to emergency situations. The “value for money” of a late, badly targeted and ineffective response is surely close to zero.

Some of the problems identified in this research are also challenges for MSF. In some conflicts and emergencies, our emergency medical capacities can be almost monopolistic. In camp settings we can be too focused on hospital care and not do enough community outreach. We are reviewing our approach to vulnerability.

We will undertake a review of our own emergency response capacity, and continue to examine the evidence of the system’s response in key contexts such as the Central African Republic and South Sudan. We also will engage with donors, and take a special look at how to improve our engagement with Emerging Actors.

Although we keep our distance from the formal institutions of the UN, MSF is part of the humanitarian aid system. And for all of its ‘smartness’ and wealth, it is not able to respond to the needs of the most vulnerable people affected.

For MSF this poses a huge challenge; in places like CAR and South Sudan our operations have grown enormously to respond to the massive needs caused by the crisis. We risk being the de facto substitute for the Ministry of Health. This exposes our teams in areas where there is great insecurity and we are the only health care providers. It also makes it a real challenge to scale down and to exit. Should we encourage or enable others to scale up? Or should we increase even more to fill the gaps? Presently, we are stuck with a strategy which vacillates between the two.

We put our conclusions forward at a time when the humanitarian system is taking the opportunity to review how it functions, in the lead up to the World Humanitarian Summit in Istanbul in 2016. We hope that this will be a time of reflection leading to changes, rather than a reaffirmation of the status quo. MSF is ready to contribute to making these changes.


UN: Global Sustainable Development Report – Prototype

UN: Global Sustainable Development Report – Prototype
:: Global Sustainable Development Report – Prototype (PDF) [165 pages]
:: Summary (PDF) [27 pages]
Sustainability science emerged as a new inter-disciplinary endeavour around the year 2000. In 2012 alone, more than 40,000 authors from 2,200 cities around the world published some 150,000 articles on sustainable development – six times more than ten years before. However, to-date, there exists no global sustainable development report that comprehensively looks at global progress and the future outlook in a truly integrated way, taking into account the range of perspectives in different scientific communities across the world.

The Global Sustainable Development Report (GSDR), requested by Governments at Rio+20, is the first and only comprehensive, global report on sustainable development.

The present prototype global sustainable development report is the result of a collaborative effort of more than two thousand scientists and 50 staff from 20 UN entities from all world regions. The report illustrates a range of potential content and discusses potential overall directions for the Global Sustainable Development Report.

The report maps sustainable development assessments and related processes, and identifies key remaining challenges: to eliminate poverty and hunger; to feed, nurture, house, educate and employ the global population; to ensure peace, security and freedom; and to preserve the Earth’s basic life support systems.

The report sketches an alternative sustainable development pathway for the future. It shows that, if we significantly adjust our current patterns of consumption and production, we can help build a more sustainable world in 2050.

The report also identifies a range of estimates of total, global investment needs to achieve global goals and commitments.

The report identifies lessons learnt from national, regional and global case studies of the climate-land-energy-water development nexus. It takes an integrated approach that looks at clusters of issues and their inter-linkages rather than specific sectors or topics…

Summary [sample sections]
4. Review of progress from 1950 to 2013 [p.7]
The challenge is to eliminate poverty and hunger; feed, nurture, house, educate and employ more than nine billion people; secure peace, security and freedom; and preserve the Earth’s basic life support systems.

The report looks at three generations into the past (1950-2013) and two generations into the future (until 2050). The challenge is to learn from what we have tried in the past, in order to put our societies and economies firmly on the path to sustainable development by 2050. The report takes an integrated approach that looks at clusters of issues and their interlinkages rather than specific sectors or specific topics.

Sustainable development trends and progress
Historical progress towards sustainable development has been mixed. Some progress has been at the expense of worsening trends in other respects.

The world has managed to feed, nurture, house, educate and employ on the order of an additional 800 million people every decade from 1970 to 2000, and even 1.1 billion people in the 2000s. In the past 12 years alone, we have built cities for 770 million people (equivalent to 93 New York cities), more than in any decade before. These are enormous achievements.

Today’s world GDP is more than ten times larger than in 1950 and average per capita GDP is four times larger. Yet, we have not managed to employ our much greater wealth and technological capacity to eliminate poverty and hunger. 850 million people go hungry today, a number which has hardly changed over several decades. There are two hundred million more slum dwellers today than twenty years ago.

The unabated rise in the scale of materials consumption has increased global environmental, social and economic pressures. There is increasing evidence that we are jeopardizing several of the Earth’s basic life support systems. Countries and people trapped in persistent poverty have probably suffered most from these impacts. And future generations will most likely face much greater challenges to meet their own needs.

Progress has been mixed towards achievement of goals or commitments in 19 SDG-relevant focus areas [p.9]
Initial discussions of the UN Open Working Group (OWG) on Sustainable Development Goals (SDGs) considered 19 focus areas as potential areas for future SDGs. These have now been narrowed down to a fewer number of areas with a view to the OWG’s finalizing its report by the end of July 2014. An analysis of the initial 19 focus areas, a number of which build on the MDGs, suggests that progress towards goals or commitments in 11 of the 19 focus areas is off-track, in 4 shows limited or mixed progress, and in another 4 shows good progress or early achievement (poverty eradication; food security and sustainable agriculture; water and sanitation; and health). Clearly, the level of progress depends, inter alia, on the level of ambition of the goal or commitment in the first place. Early achievement of a goal might reflect faster than foreseen progress or an inadequately ambitious goal. For example, it is doubtful whether the target of improving the lives of 100 million slum dwellers was sufficiently ambitious, given the rate at which the population of slum dwellers has expanded since 1990.

WHO: Progress on the health-related Millennium Development Goals (MDGs) Fact sheet N°290

WHO: Progress on the health-related Millennium Development Goals (MDGs)
Fact sheet N°290
Updated May 2014 [FULL REPORT: English ]
Key facts
:: Globally, the number of deaths of children under 5 years of age fell from 12.6 million in 1990 to 6.6 million in 2012.
:: In developing countries, the percentage of underweight children under 5 years old dropped from 25% in 1990 to 15% in 2012.
:: While the proportion of births attended by a skilled health worker has increased globally, fewer than 50% of births are attended in the WHO African Region.
:: Globally, new HIV infections declined by 33% between 2001 and 2012.
:: Existing cases of tuberculosis are declining, along with deaths among HIV-negative tuberculosis cases.
:: In 2010, the world met the United Nations Millennium Development Goals target on access to safe drinking-water, as measured by the proxy indicator of access to improved drinking-water sources, but more needs to be done to achieve the sanitation target.

Progress report on the health-related MDGs
While some countries have made impressive gains in achieving health-related targets, others are falling behind. Often the countries making the least progress are those affected by high levels of HIV/AIDS, economic hardship or conflict.
:: Millennium Development Goal 1: eradicate extreme poverty and hunger
Target 1.C. Halve, between 1990 and 2015, the proportion of people who suffer from hunger
Undernutrition which includes fetal growth restriction, stunting, wasting and deficienceies of vitamin A and zinc, along with suboptimal breastfeeding; is the underlying cause of death in an estimated 45% of all deaths among children under 5 years of age. The proportion of underweight children in developing countries has declined from 25% to 15% between 1990 and 2012. This rate of progress is close to the rate required to meet the MDG target, however improvements have been unevenly distributed between and within different regions.

:: Millennium Development Goal 4: reduce child mortality
Target 4.A. Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Globally, significant progress has been made in reducing mortality in children under 5 years of age. In 2012, 6.6 million children under 5 died, compared with 12.6 million in 1990. Between 1990 and 2012, under-5 mortality declined by 47%, from an estimated rate of 90 deaths per 1000 live births to 48. The global rate of decline has also accelerated in recent years – from 1.2% per annum during 1990–1995 to 3.9% during 2005–2012. Despite this improvement, the world is unlikely to achieve the MDG target of a two-thirds reduction in 1990 mortality levels by the year 2015.
More countries are now achieving high levels of immunization coverage; in 2012, 66% of Member States reached at least 90% coverage. In 2012, global measles immunization coverage was 84% among children aged 12–23 months. During 2000–2012, estimated measles deaths decreased by 78% from 562 000 to 122 000.

:: Millennium Development Goal 5: improve maternal health
Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Target 5.B. Achieve, by 2015, universal access to reproductive health
Despite a significant reduction in the number of maternal deaths – from an estimated 523 000 in 1990 to 289 000 in 2013 – the rate of decline is less than half of what is needed to achieve the MDG target of a three quarters reduction in the mortality ratio between 1990 and 2015.
To reduce the number of maternal deaths, women need access to good-quality reproductive health care and effective interventions. In 2011, 63% of women aged 15–49 years who were married or in a consensual union were using some form of contraception, while 12% wanted to stop or postpone childbearing but were not using contraception.
The proportion of women receiving antenatal care at least once during pregnancy was about 81% for the period 2006–2013, but for the recommended minimum of 4 visits or more the corresponding figure drops to around 56%.
The proportion of births attended by skilled personnel – crucial for reducing perinatal, neonatal and maternal deaths – is above 90% in 3 of the 6 WHO regions. However, increased coverage is needed in certain regions, such as the WHO African Region where the figure remains less than 50%.

:: Millennium Development Goal 6: combat HIV/AIDS, malaria and other diseases
Target 6A. Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 6B. Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it.
In 2012, an estimated 2.3 million people were newly infected with HIV – 33% less than the 3.4 million people newly infected in 2001. Sub-Saharan Africa accounted for 70% of all the people who acquired HIV infection globally.
There were an estimated 35 million people living with HIV in 2012, an increase from previous years. As access to antiretroviral therapy in low- and middle-income countries improves (around 9.7 million people in low- and middle-income countries received treatment in 2012), the population living with HIV will continue to grow since fewer people are dying from AIDS-related causes.
Target 6C. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
About half the world’s population is at risk of malaria, and an estimated 207 million cases in 2012 led to approximately 627 000 deaths – most of these in children under the age of 5 living in Africa.
During the period 2000–2012, malaria incidence and mortality rates of population at risk have both fallen globally, 29% and 42% respectively. An estimated 3.3 million lives were saved as a result of scaling-up malaria interventions during the same period.
The coverage of interventions such as the distribution of insecticide-treated nets and indoor residual spraying has greatly increased, and will need to be sustained in order to prevent the resurgence of disease and deaths caused by malaria.
The annual global number of new cases of tuberculosis has been slowly falling for a decade thus achieving MDG target 6.C to reverse the spread of the disease by 2015. In 2012, there were an estimated 8.6 million new cases and 1.3 million deaths (including 320 000 deaths among HIV-positive people).
Globally, treatment success rates have been sustained at high levels since 2007, at or above the target of 85%. Between 1995 and 2012, 56 million people were successfully treated for tuberculosis and 22 million lives were saved. However, multi-drug resistant tuberculosis (MDR-TB), which emerged primarily as a result of inadequate treatment, continues to pose problems.
Other diseases
Neglected tropical diseases are a medically diverse group of infections caused by a variety of pathogens such as viruses, bacteria, protozoa and helminths.
The 17 diseases prioritized by WHO are found in 149 countries and can cause multiple infections in one person and are almost always associated with poverty.
Leprosy has now been eliminated as a public health problem in 119 out of the 122 countries where it was previously endemic. Dracunculiasis (also known as guinea-worm) is a crippling parasitic disease on verge of eradication, with only 148 cases reported in 2013.
In addition, 728 million people worldwide were treated for at least 1 NTD through preventive chemotherapy in 2011.
However, neglected tropical diseases still affect more than 1 billion people worldwide.
Despite renewed momentum characterized by unprecedented progress, some neglected tropical diseases (like dengue) remain a significant obstacle to health, making it harder to achieve the Millennium Development Goals, and pose an ongoing impediment to poverty reduction and overall socio-economic development.

:: Millennium Development Goal 7: ensure environmental sustainability
Target 7C: By 2015, halve the proportion of people without sustainable access to safe drinking water and basic sanitation
The world has now met the MDG target relating to access to safe drinking-water. In 2012, 90% of the population used an improved source of drinking-water compared with 76% in 1990. Progress has however been uneven across different regions, between urban and rural areas, and between rich and poor.
With regard to basic sanitation, current rates of progress are too slow for the MDG target to be met globally. In 2012, 2.5 billion people did not have access to improved sanitation facilities, with 1 billion these people still practicing open defecation. The number of people living in urban areas without access to improved sanitation is increasing because of rapid growth in the size of urban populations.

:: Millennium Development Goal 8: develop a global partnership for development
Target 8E. In cooperation with pharmaceutical companies, provide access to affordable essential medicines in developing countries
Many people continue to face a scarcity of medicines in the public sector, forcing them to the private sector where prices can be substantially higher. Surveys undertaken from 2007-2012 show the average availability of selected generic medicines in low- and middle-income countries was only 57% in the public sector. Patient prices of lowest priced generics in the private sector averaged 5 times international reference prices, ranging up to about 16 times higher in some countries.
Even the lowest-priced generics can put common treatments beyond the reach of low-income households in developing countries. The greatest price is paid by patients suffering chronic diseases. Effective treatments for the majority of the global chronic disease burden exist, yet universal access remains out-of-reach.

WHO response
WHO works with partners to support national efforts to achieve the health-related MDGs. WHO’s activities include:
:: setting prevention and treatment guidelines and other global norms and standards;
:: providing technical support to countries to implement guidelines;
:: analysing social and economic factors and highlighting the broader risks and opportunities for health.
WHO assists national authorities as they develop health policies and plans, and helps governments work with development partners to align external assistance with domestic priorities. WHO also collects and disseminates data on health so countries can plan health spending and track progress.

UN: World Urbanization Prospects – The 2014 Revision

UN: World Urbanization Prospects – The 2014 Revision
Department of Economic and Social Affairs
July 2014
Excerpt from Press Release
…The 2014 revision of the World Urbanization Prospects produced by the UN Population Division of the Department of Economic and Social Affairs notes that the largest urban growth will take place in India, China and Nigeria. These three countries will account for 37 per cent of the projected growth of the world’s urban population between 2014 and 2050. By 2050, India is projected to add 404 million urban dwellers, China 292 million and Nigeria 212 million.

The urban population of the world has grown rapidly from 746 million in 1950 to 3.9 billion in 2014. Asia, despite its lower level of urbanization, is home to 53 per cent of the world’s urban population, followed by Europe with 14 per cent and Latin America and the Caribbean with 13 per cent.

The world’s urban population is expected to surpass six billion by 2045. Much of the expected urban growth will take place in countries of the developing regions, particularly Africa. As a result, these countries will face numerous challenges in meeting the needs of their growing urban populations, including for housing, infrastructure, transportation, energy and employment, as well as for basic services such as education and health care.

“Managing urban areas has become one of the most important development challenges of the 21st century. Our success or failure in building sustainable cities will be a major factor in the success of the post-2015 UN development agenda,” said John Wilmoth, Director of the Population Division in the UN’s Department of Economic and Social Affairs…

Amref Health Africa [to 12 July 2014]

Amref Health Africa [to 12 July 2014]

Amref Health Africa and Partners hold Cross-Border Meeting on Eradicating Polio
07 July 2014
Amref Health Africa, with support from the Core Group-funded Polio Eradication Project in South Sudan and the Ministry of Health Central Equatorial State, held a cross-border collaborative meeting to discuss eradicating polio. The cross-border meeting took, place in Kaya County and was attended by representatives from neighbouring districts of Koboko and Arua in the Democratic Republic of Congo and Uganda respectively.

In his remarks to officially open the meeting, Morobo Commissioner Hon Moses Soro noted that “diseases have no borders”. He added that collaboration was important between South Sudan, Uganda and the DRC because people constantly moved across borders and it was impossible to control them.

The main objectives of the meeting were to share information between the bordering countries on the status of polio eradication activities; to identify migrant, mobile and hard-to-reach populations along the South Sudan-Uganda-DRC borders and agree on strategies of how they can be reached; to discuss mechanisms of strengthening surveillance and addressing population immunity gaps along the borders; and to strengthen advocacy, communication and social mobilisation for polio eradication along the border areas.

Following the discussions, a plan of action was agreed upon by the participating countries to strengthen implementation of synchronised immunisation activities and disease surveillance. The plan includes intensification of active case searches, particularly along the borders, and increased delivery of immunisation services to populations in hard-to-reach areas…

Amref Health Africa is the implementing partner for the Polio Eradication Project in Morobo. The project seeks to strengthen routine immunisation services in the county and improve case detection by strengthening community involvement.


Amref Health Africa @AMREFUSA • Jul 7
Our #eLearning program in #Uganda is exciting and saving lives!

Amref Health Africa @AMREFUSA • Jul 1
What’s new with us? See the latest in our eNews, including @USEmbassyKenya’s visit to one of our projects!

Aravind Eye Care System [to 12 July 2014]

Aravind Eye Care System [to 12 July 2014]

AravindEyeFdtn @AravindEye • Jul 2
Last month #Aravind nurses and doctors performed 29,266 surgeries and saw 246,441 patients! Thank you for eliminating needless #blindness

AravindEyeFdtn @AravindEye • Jul 1
Congrats to #Aravind’s Mr. L. Kirubanithi, who received the T. Mark Hodges International Service Award by the Medical Library Assc.

BRAC [to 12 July 2014]

BRAC [to 12 July 2014]

BRAC @BRACworld • Jul 11
BRAC’s dir of MF @Shameran on Client Protection, Balancing Credit/Savings & Evolving Inclusion Landscape @CFI_ACCION

Retweeted by BRAC
Susan Davis @SusanDavisBRAC • Jul 10
@BRACworld=@girleffect: Have you heard about #GirlEffectLive yet? Here’s everything you need to know: #girleffect

BRAC @BRACworld • Jul 8
Workshop on client protection in #microfinance by @SmartCampaign_ & @BRACworld underway!

BRAC @BRACworld • Jul 5
‘We believe women are the engines of development’ – BRAC Vice-Chair speaks to the @guardian @ElizaTalks #globaldev

BRAC @BRACworld • Jul 2
Subscribe to BRAC’s YouTube channel today and be the first to know when we release a new video!