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: http://www.msf.org/sites/msf.org/files/msf-whereiseveryone_-def-lr_-_july.pdf [44 pages]
-interactive: http://www.flipsnack.com/9666CCC7C6F/fun8r599

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.