10. Humanitarian Assistance and Disaster Relief (HADR)

Learning Objectives:

1. Describe HA/DR structures, processes and activities
2. Understand when the DoD engages
3. Differentiate HA and DR as distinct subcomponents of DoD GHE activities
4. Identify the disaster cycle and related opportunities for engagement

Lecture:

Humanitarian Assistance

UN definition: “Assistance that seeks to save lives and alleviate suffering…in accordance with the basic humanitarian principles.”

DoD definition: “DoD personnel planning, overseeing, conducting and evaluating specific humanitarian projects and activities including assistance to host nation civilian authorities.”

Why does the DoD engage in HA/DR activities?

Benefits to partner nation: provides needed assistance, command and control, resources available, and quickly deployable

Benefits to USG: builds partnerships, show of commitment to a partner nation, within government mandates and the humanitarian imperative, image of the USG/US military, consistent with American values, training opportunity, force health protection

HA Planning Process:

Authority – CCMD

Planned/executed by – service components, combined joint task Forces, civil affairs units, hospital ships Funding – ODHACA, HCA

• Identify the context for engagement
• Develop an understanding of the situation
• Identify opportunities to engage
• Develop a concept for operations/execution
• Develop a plan to monitor and evaluate the engagement

HA steady state activities: technical assistance and support, advice & selected training, assessments, manpower, equipment, security missions, dislocated civilian support

HA non-steady state activities (security missions): direct medical care projects, disease surveillance, cooperative threat reduction, health clinic construction, disaster preparedness, int’l avian influenza/pandemic Influenza preparedness

Disaster relief:

A rapid response to a crisis by supplying non-lethal equipment and/or supplies, transport of humanitarian assistance-related resources, and unique services to address urgent and critical humanitarian needs.

Context of a disaster:

• Disruption of the health system, increased medical demands, disproportionate effect on vulnerable populations, little confirmed information and a dynamic environment, impeded access to health services

Secondary effects of a disaster:

• Environmental exposure after the event, malnutrition after the event, mental health consequences, communicable disease outbreaks, excess NCD mortality

USAID requests DoD assistance based on:

• Scope of disaster, US national interest, host nation desires and will accept DoD assistance, verified requirements for DoD unique assets and capabilities (Oslo Guidelines), DoD mission clearly defined, force protection must be addressed
• DoD is rarely asked to assist; when asked, common DoD assistance requests include airlift/sealift, direct patient care, hospital support, field hospital deployment, evacuation of US civilians, other health activity (force health protection)
• In disasters >95% of the actors are NGOs; UN, military and other government actors make up <5% of the response…and the health component of the military’s response is usually a fraction of that 5%

Humanitarian Assistance Survey Teams: “The supported CCDR may also organize and deploy a humanitarian assistance survey team (HAST) to acquire information required for planning….. The HAST should include preventive medicine personnel that are trained to perform a detailed occupational and environmental health site assessment….” Ref: JP 3-29 (Foreign Humanitarian Assistance).

Key to Success:

COORDINATION & COMMUNCATION!

• Reach out to other stakeholders
• Respect humanitarian principles
• Use/establish forum – Civil Military Operations Cell (CMOC), etc.

The Sphere Handbook

Summary: The Sphere Handbook contains common principles and universal minimum standards for humanitarian response projects/programs. While initially developed by INGOs and the Red Cross, it has application for all entities involved in humanitarian assistance. As such, it has been endorsed and applied by governments, military and private sector actors, including the USG. The current version is the 2011 Handbook.

Where to access:

Electronic version: https://spherestandards.org/handbook-2018/

Key points:

1. It is a USG-approved, user-friendly resource to help plan/implement HA/DR projects. HA/DR is not the day job of most DoD personnel, so working on HA/DR projects usually means working outside of your area of expertise. This guide was designed for such a reality, and as such is an easy to use resource that works across all sizes and sectors of HA/DR engagements.

2. The most critical point to learn about the Sphere Handbook is how to use it correctly (and conversely, the dangers of using it incorrectly). It is a common planning mistake to go straight to the key indicators/guidance notes. Since those include suggested targets it seems like that would be an easy planning shortcut. But all disaster response experience (including some really botched US military humanitarian assistance) has shown that using the indicators separate from the Standards

Overview

The Sphere Project is a global initiative to improve the quality of humanitarian assistance and the accountability of humanitarian actors to their constituents, donors and affected populations.

The Sphere Handbook (the most visible products of the Sphere Project) is one of the most widely known and internationally recognized sets of common principles and universal minimum standards for the delivery of quality humanitarian projects. Specifically, the Handbook helps users in the field tasked with designing HA/DR engagements to do so in effectively and with few negative consequences. It is especially helpful for those new to HA/DR, and those working in unfamiliar sectors.

What is it?

The Sphere Handbook walks those with little experience in designing specific sector-related activities during disasters with a tool to guide them from start to finish. It focuses on outcomes, not inputs – a resource for you to create a project that will measurably achieve program objectives. In other words, a sector-specific tool to help you achieve your mission.

What the Handbook IS:

• It was designed for use in disaster/conflict situations. While it can inform steady state activities as well, there are additional important development considerations for stead state activities, and additional resources available to assist in that context.
• The Handbook covers planning, implementation and M&E during a disaster response.
• The Handbook is a practical tool, but only if used appropriately, which is why this cheat sheet is longer than a few reminder bullets.

What the Handbook IS NOT:

• Not prescriptive – Each actor responding to a disaster has its own mission, capacities and areas of focus. The Handbook was designed by the full range of disaster stakeholders, and therefore recognizes that all actors play their own unique roles in disaster response/recovery. Instead of telling you what you have to do, the Handbook is designed to show you things that need to be considered in order for your engagement to be successful.
• Not comprehensive – The Handbook is a tool, not a comprehensive list of all possible approaches and considerations.
• Not written in military lingo – While it was written to be accessible to all players (government, NGO, UN and military), the Handbook tries to avoid using actor-specific language. Which means it does not use language explicitly chosen by the US military for HA/DR engagements. Effective use of the handbook may require some examination of how the standards in the Handbook relate to DoD guidance, standards and terminology.
• Not an all or nothing resource – Because it is meant to be flexible and adaptable, adhering to all the standards is not required in order for your team to engage with the Sphere Handbook. Just because an actor can’t/won’t adhere to certain standards (and there are sometimes good reasons for not doing so), it does not mean that other parts of the Handbook aren’t useful.

Why does Sphere matter?

While civilian and military actors may use different language, and will not share all of the same goals and objectives, everyone wants the same thing – to achieve the desired end state with few negative unintended consequences. Internationally accepted principles and evidence-based standards help us to do that. You already know this from your medical training. Health services are provided based on key standards and science. Many of your standards/much of this science were developed by civilians, but that doesn’t make it less relevant to your work.

Why do these standards matter to the US military?

• The standards align with the DoD commitment to delivering on its mission and objectives.
• USAID uses this guide to inform its planning in disaster situations, and they are the lead federal agency assigning the role(s) of the US military
• Improves coordination with civilian partners by providing a common framework, a common language, which results in better collaboration and the reduction of gaps/overlaps.
• Smartly designed programs are more likely to result in the desired end state, thus ensuring appropriate and effective use of taxpayer dollars
• The Handbook format is easy for all to use, including those in austere environments, regardless of level of experience in designing projects in WASH, shelter, health food security, nutrition, and non-food items.
• Designed for use in all disaster situations, from small to large, across cultures and across hazards

Sections of the Handbook

Humanitarian Charter = Cornerstone of the handbook

Describes core principles that govern humanitarian action and asserts the rights of disaster-affected population. It provides the legal and ethical backdrop for the Protection Principles and all of the included standards (legal precedents includes human rights, IHL, refugees and humanitarian action, as well as existing standards such as IASC guidelines). Think of it as kind of a summary of the international community’s version of DODI’s – while military personnel on the ground may not be able to quote chapter and verse for DODD/DODIs, they know that there is official guidance for what they are doing and why.

Core Standards = Process

• General statements, broad enough to be applicable to all types of disasters that explain what needs to be in place in order to achieve the minimum standards.
• Meant to serve as guidance for entities designing a disaster response. They sound like lofty goals, but are incredibly practical. Sort of best practices for approaches and strategies.

Minimum standards = Activity level (suggested practical actions and indicators). These show how activities are developed, and how to increase their value and feasibility.

• Standards: Qualitative, specify the minimum level to be obtained. The health minimum standards are “evidence-based and represent sector-wide consensus on best practices in humanitarian response”.
• Actions: Recommended steps to take
• Key Indicators:
  • Quantitative, based on evidence
  • Validation – can be used to tell that the project has been designed smartly and is being implemented effectively
  • Do NOT use the indicators without the Core Standards, or you can be sure you are using them incorrectly, resulting in bad projects

Guidance notes = Context-specific points to consider

Context specific points to consider when aiming to achieve a particular standard or indicator, including guidance on tackling practical difficulties. This is NOT guidance on the HOW to implement particular activities. These can be quick lifesavers when trying to program outside of your normal area of expertise.

Protection principles = Safety, dignity and rights of people affected by disaster/conflict. Protection Principle #1 is the most relevant for DoD global health engagements in HA/DR. These three groups of protection activities are not hierarchical. They are interdependent and will often be carried out simultaneously.

Examples of protection activities would be:

• Responsive action: Monitoring, investigation, reporting, evacuation, tracing
• Remedial action: Family-reunification, resettlement, rehabilitation, promoting transitional justice, including justice for victims
• Environment building: Promotion of legislative reform, capacity building, training and dissemination

Cross-cutting themes = Issues that affect all sectors and therefore should be considered in all disaster response planning

The list of cross-cutting themes currently includes children, DRR, environment, gender, HIV/AIDS, the elderly, persons with disabilities and psychosocial support. It is not expected that every project would address every theme.

Supplemental Materials:

1. Oslo Guidelines – The Use of Foreign Military and Civil Defense Assets in Disaster Relief. UN Office for the Coordination of Humanitarian Affairs, 2007. [This is in the process of being updated and approved.]
2. The Sphere Handbook
3. DODD 5100.46 re Foreign Disaster Relief

After You Watch/Read/Engage:

1. Visit the Sakai discussion forums.
2. Join the live VTC on Thursday.
3. Complete the Quiz before Wednesday at 2355 EST.

Looking Ahead:

1. Next week we will discuss Ethical Considerations in DOD GHE.
2. The comprehensive final paper assignment (2000 words) is due May 13 at 2355 hours.