Humanitarian Relief, 'Pit Latrines and Politics'

Author: Andrea Gissing

"You get an amazing sense of satisfaction when someone's child is brought in to you suffering from cholera, to see them running around playing soccer after receiving simple rehydration treatment," said Dr. Michael Curtis during his discussion entitled "Politics and Pit Latrines: Dilemmas in Humanitarian Relief." Curtis, an urologist and a member of the Surgery Department at Dartmouth College Medical School, has worked extensively with Médecins Sans Frontières, or Doctors Without Borders (MSF), helping in humanitarian relief efforts in Bosnia, Macedonia and Bangladesh.

MSF began in the early 1970s when three French physicians serving with the Red Cross in Nigeria refused to leave the rebel camps they were working at when the Nigerian government requested the withdrawal of the humanitarian group. This action led to the formation of the group, an organization based on need rather than politics. It is now the largest independent emergency relief organization in the world.

In Curtis' first project with MSF, he was a member of a team working with Burmese refugees in Bangladesh. There, practicing tropical medicine in a refugee camp of a quarter of a million, the emphasis was on public health. "Unlike a lot of health care in the country," remarked Curtis, "in situations like this public health has to be focused on. You know that there is a lot more that can be done to address the health needs of the individuals, but that would be detrimental to the whole group, especially in terms of time and resources."

When providing emergency humanitarian relief, curative health care in camp is one of the least important things. Issues such as getting adequate drinking water, shelters, solving sanitation problems and providing food are far more important. "The people there have to believe in the system. They have to survive, and therefore they need the things that will enable them to survive." Getting people in the camp involved with the work is one way to ensure survival. According to Curtis, it is important that people try to establish a sense of normalcy in their lives. Depression and other psychological issues are major concerns in the camp. "Landmines and war-related injuries and issues get a lot of attention in the media," said Curtis. "However, preexisting conditions and mental health issues are big problems in the camps. MSF is now realizing the growing importance of psychological care, that it should be a part of the first care and not an afterthought," he said. MSF and other non-governmental organizations are addressing these concerns by employing refugees from the camp and by recruiting members of the local communities to work in the camp distributing food, working as physicians or helping to supply the camp with needed materials and services. This helps the people establish connections with locals and gives the refugees some control over their own lives, helping to restore some self-respect.

Using slides taken while working in Macedonia to illustrate his points, Curtis discussed several important considerations that must be addressed when delivering humanitarian aid. "Be aware of the political context in which you're working. If you don't, you could be taken advantage of. If you do, you can do a world of good." While MSF's goal is to provide humanitarian relief to those who need it, they have to take into consideration the effect their work has on the political situation. To a government, the ultimate threat is that the humanitarian relief group will pull out from the camp as a result of the government's actions, or perhaps inactions, thus embarrassing the government in the international view. However, the humanitarian relief group must also remain credible in the eyes of the local government and the world. They have to recognize and show that they are impartial, especially when there is military involvement in the relief project, it may be difficult for outside parties to distinguish if the work being done geared toward relief or if it is serving some other purpose. For example, MSF was forced to withdraw from Afghanistan in September 2001 because they were accused of being agents of Western powers.

One issue that Curtis stressed during his talk was the importance of the individual volunteers. "It's all about the individuals," he said, looking at a slide of a smiling woman. "They are amazingly resilient. Life is ongoing during the crisis phase, and they adjust so that they can survive." He concluded, "Our presence in places like these can bring hope, a connection with the outside world. Just being there, caring enough to come and help, can make a difference in itself."