Introduction
Nowadays, every large-scale disaster generates an international humanitarian response. Many groups, such as the Red Cross, the UN-backed agencies, the international non-governmental organizations, and various state institutions are quick to respond to these threats by sending supplies, medicaments, resources and volunteers to the afflicted areas around the globe (Gilman & Noyes, 2013). Despite the actions being noble, altruistic, and humanitarian in nature, many systematic networks such as ALNAP report the staggering inefficiency of most of these initiatives, which leads to wasted resources, lower recovery rates, and as a result, more lives lost (Clark & Darcy, 2014).
One of the major reasons for these humanitarian failures is the lack of proper evidence generation and implementation mechanisms. The recent cascade failures of the current humanitarian system are demonstrated by its inability to prevent chain-famines in the Sub-Saharan areas of Africa, despite the early warning systems being in place (Broadbent, 2012). This highlights the problem that the organizations are not only unable to properly generate evidence, but use it as well, even if quality evidence is ample and available.
The evidence is crucial to humanitarian action, just as much as proper logistics and funding. Without it, the humanitarian effort is often ineffective, unethical and unaccountable. All three are paramount to the success of the intervention. How does evidence affect these three criteria, upon which it will be judged? Evidence, or lack of it, directly influences the effectiveness of a humanitarian effort, as without information the participating organizations cannot devise a coherent and adequate strategy, which would address the critical aspects of a situation (Ashdown, 2011).
An action based on insufficient evidence cannot be considered ethical. One of the core principles of humanitarian actions is impartiality. Impartiality suggests analysing the entire spectre of available choices and picking the best one, avoiding as much bias as it is humanly possible. Without evidence, this goal becomes unachievable, as the entirety of available choices is not available to the decision-maker. In addition, actions based on insufficient evidence are ineffective at best, or harmful at worst (Dijkzeu, 2013).
The last issue is accountability. This has a lot to do with finances, fund-raisings and money spending. The majority of humanitarian organizations are funded by independent donors, governments, societies, or exist on taxpayer money. This makes the organizations accountable to a great number of people. They have to provide reasons why, how, and how effectively the money is spent. Without evidence, it becomes hard to justify these expenses or prove that the interventions were indeed effective (Tan & Schreeb, 2015).
In order to improve the situation, a shift towards evidence-based practices is required. Evidence-based practices are widely implemented in medicine and nursing. In the past 20 years, evidence-based medicine made huge leaps in both quality and effectiveness of its applications (Stevens, 2013). It is strange that while the modern medical effort is thoroughly evidence-based, the actions of the humanitarian movement as a whole are often based on poor and inconclusive evidence and are “anecdote, rather than evidence, driven.” Politics and personal convictions often play an important part in determining the course of a humanitarian action even when the information is present.
While certain efforts were made to renovate and enforce evidence-based practices in planning and analysis of humanitarian actions, the current system of evidence generation, implementation, and accountability still requires a lot of improvement. The paper will support this thesis by highlighting the problems with quality evidence-gathering and NGO accountability, assessing the effectiveness of the latest humanitarian efforts, addressing the role of nurses in the process, and providing a set of recommendations to improve the situation.
What is Evidence?
While there are many definitions of the word, in the scope of a large humanitarian effort, the term has a strictly scientific and empirical connotation. The evidence is data that allows us to understand whether certain statements are true or false. This information indicates the presence or absence of a problem, such as a mass epidemic or famine, which can be verified using various research techniques (Clark & Darcy, 2014). The current approach to evidence is too broad, however. Instead of compartmentalizing the evidence and presenting a differentiated picture of reality, many humanitarian propositions tend to generalize and homogenize the problem, often ignoring conflicting information. The accuracy of the overall picture suffers as a result. With many different types of information present, it is necessary to consider its value when formulating and supporting different courses of action (Polastro, 2014).
Humanitarian action requires two basic types of information in order to be effective. The first type of information, or Type A, talks about the kind of needs that arise as the results of humanitarian crises. Such needs include the need for food, water, shelter, supplies, medicaments, etc. The second type, or Type B, identifies the actions that could be taken in order to effectively deal with the crisis. These two large groups are divided into many subgroups, which cover every aspect of any problems or actions. Different kinds of evidence are required to support them (Clark & Darcy, 2014).
Problems with Evidence Quality
While many humanitarian organizations would prefer to have good evidence on which they could base their actions, it must be understood that gathering and assessing information is a lot more difficult than it initially seems. Many of these difficulties are related to the nature of the crisis. Wars, natural disasters that lead to mass casualties, and other incidents that call for humanitarian aid often leave local governments debilitated. When it happens, even basic data becomes increasingly hard to obtain. Humanitarian organizations rely a lot on governmental cooperation in order to generate data that could be used for analysis. Any information obtained prior to the event is useful only during the first stages of the emergency, after which the mounting casualties and population movements severely diminish its value (Hilhorst, 2003).
The problem with the quality of evidence lies in the fact that even basic data is hard to obtain and monitor effectively. Population figures are always fluctuating as people die and flee from afflicted areas, malnutrition levels depend not only on these variables but also on the amounts of food distributed to the populace. Information regarding shelter determines the direction of forced migrations, especially during military conflicts. Constant monitoring is required to make sure the evidence is up-to-date. This is not always possible, as the areas afflicted by disasters and conflicts often have limited access. The situation is even worse when racial, territorial, and political aspects come into play, as they cast a shadow of bias upon any information received from third sources or informants (Poole & Primrose, 2010).
The denominators that are required for making accurate humanitarian propositions are notoriously basic. The organizations need to know the number of people affected by the disaster and the number of people that have received aid. Normally, the census serves as a starting point for data collection. When it is unavailable, the humanitarian organizations are forced to use much less accurate means of estimation, such as on-site calculations, counting the number of houses in the area, mathematical estimations based on old data, and so on. The problem of all these methods, aside from obvious inaccuracies, is that they tend to homogenize the population. There is no differentiation by race, gender or age, which makes planning an effective strategy even more difficult than it already is (Mazuran, 2011).
Problems with Accountability
As a rule, humanitarian organizations and NGOs do not seek to cause any harm. They only want to help as many people as possible. However, there were numerous instances when good intentions often ended in disastrous results. Tracking how the money is spent by the organizations is relatively easy due to the extensive nomenclature that they are forced to keep in order to remain accountable for the expenses. Holding them accountable for poor decisions, however, is a lot more difficult (Roddy, Strange, & Taithe, 2015).
Burkle’s framework and methodology for navigating disaster identifies two key reasons for oversight committed by the humanitarian organizations. The first one is the lack of reliable information, which leads to poor decision-making. This one is understandable – if the decision-makers do not have abundant and reliable data, they do not have an accurate picture of the situation. Their choices, while appearing valid and logical from the perspective of available evidence, often turn out to be flawed when facing reality (Chan & Burkle, 2013).
The second scenario involves failure to act upon the provided information. While this seems like a more serious offense that deserves a retribution of some sort, many factors may influence decision-making into committing to a wrong course of action. When facing a large-scale disaster such as a hurricane, a drought, or famine, many different organizations join forces in order to counteract the devastating effects of the cataclysm. Organizing the group effort is extremely difficult as there is no centralized “command structure” present. While many NGOs and international agencies cooperate deeply with one another, the overall level of the organization remains relatively low. This causes the efforts in some areas being duplicated by multiple agents, while other areas remain neglected (Cooley & Ron, 2002).
One of the problems with NGO accountability is the very idea of trying to make them accountable for anything. Many of the NGOs present themselves as independent organizations without any affiliations to a singular country or political block. Making humanitarian organizations accountable takes away their independence, and some fear that doing so would force them to become tools in political games. As it stands right now, however, there are very few legal frameworks through which an NGO could be held accountable for wrongful decisions that caused harm or waste of valuable resources (Featherstone, 2013).
Role of Nurses in Evidence-Gathering
Most if not all crises and disasters have a direct impact on the population’s health. Due to this, medical interventions usually form the widest front of a humanitarian effort. Whether managing mass-casualty incidents, recovering from a storm or an earthquake, or sustaining the populace during a drought or famine, the nurses form the majority of the agents involved in working with the population. The role they play is very important, as it involves far more than simply offering direct assistance to the afflicted populace. Nurses also act as information gatherers for the organizations they represent, allowing them to receive a more accurate picture of the situation at hand (Hernando, 1998).
As it was mentioned before, the two basic types of information necessary for facilitation of effective humanitarian strategies are the number of people afflicted and the number of beneficiaries received by the populace. Nurses provide direct data about the number of people that received professional help and are able to receive valuable primary information from their patients about the number, location, and composition. This data is very important as it allows coordinating humanitarian efforts on a local scale with increased precision. In addition, nurses are capable of seeing the effectiveness of the overarching effort first-hand, providing the organizations with the type B data, describing the effectiveness of the implemented measures and strategies. Lastly, due to the evidence-based nature of modern nursing practices, nurses are more than capable of adjusting and generating new methods of treatment that are best-suited to a particular emergency scenario (Clark & Darcy, 2014).
Nurses contribute to the information-gathering effort through filing activity reports and compiling lists of persons that have received beneficiaries. However, there are certain circumstances under which the nurses are unable to provide information. These include mass-casualty events during which the number of available medical personnel is low and a number of patients in need of assistance – high. Triage protocols advice spending less time on nomenclature and more time on helping patients, meaning that the activity reports received are sketchy at best (Coyle & Meier, 2009).
Effectiveness of Humanitarian Efforts
The ALNAP report is dissatisfied with the quality of humanitarian effort around the world and highlights major organizational problems that affect it. The recent failures in large-scale humanitarian efforts include the scandals around the restorative effort in Haiti after the disastrous earthquake that happened in 2010, and the East Africa Drought of 2011, which caused a chain famine, the aftereffects of which are felt even today. The two events represent two different failures on the part of humanitarian organizations – one being in information-gathering, and the other – in acting and making decisions based upon said information (Dijkzeul & Wakenge, 2010).
The protestors in Haiti accuse the NGOs of arrogance and lack of knowledge about the true state of affairs in the country (Jones, 2015). One of the key charges against the Red Cross and other groups involved in the process is that they refused to cooperate with Haitians on matters that require experience and knowledge with the natives. As a result, the protestors claim, the efforts were lacklustre, and much money and resources were misspent (Anderson, Brown, & Jean, 2012). This situation indicates a crucial mistake in the evidence-gathering strategy. While it is likely that extensive research was conducted during the first stages of dealing with the crisis, no evidence-gathering was made beyond that. Operating on old data caused major discrepancies between projected results and the real state of events. Of course, the Haitian crisis is multi-layered, with a plethora of reasons for failure, but the lack of timely and renewable evidence played its part too.
During the East Africa Drought of 2011 the situation was starkly different. Due to the slow and predictable nature of droughts and food shortages, the early warning systems provided the humanitarian organizations with plenty of information about the impending disaster. The early warning systems are, perhaps, one of the most effective tools currently available to humanitarian organizations – the system of analysis of weather patterns advanced greatly in the past 20 years, and the data provided by it usually scores high on relevance and timeliness (Majid, 2011). However, the data shows that no urgent action was taken at the beginning of the crisis. Additional action and funding were only allocated mid-2011 when the states officially declared the state of famine. While an argument could be made that in Somalia the local militant and political groups prevented the NGOs from effectively distributing supplies to the starving populace, the pattern repeated itself across the rest of eastern Africa. This indicates that the main reasons for the delayed action during this crisis were poor reaction times and decision-making.
Recommendations
The crises in Africa and Haiti showed the glaring flaws in the current evidence-collection and decision-making policies currently in place among the humanitarian organizations (Arroyo, 2014). Change is required, so that next time, under similar circumstances, the same mistakes would not be repeated again. The system could be significantly improved in three ways:
– The evidence-collection system could be improved by incorporating the local experts and officials into the planning and decision-making process. They would be able to provide information and additional insights that would help tailor the relief effort to conditions specific to a particular country. Haiti did not see this implemented in 6 years of the continuous relief effort, meaning that the problem is deep-seated and not just a singular oversight from the NGOs (Akl et al., 2015).
– The decision-making system must be streamlined and optimized to ensure the quickest response times to the rising challenges in the humanitarian sphere. The chain of mistakes made during the East Africa Drought of 2011 and the following famine had shown that the bureaucratic machines of the world’s largest NGOs and International organizations move too slowly. One of the possible reasons a united effort was not conducted sooner is the fact that every NGO tends to have its own sources and databases, which they do not share with others unless specifically requested to. This has the potential to significantly reduce the speed at which the humanitarian organizations react due to how to slow the information travels from one NGO to another. The creation of a unified database will be a significant step in the right direction (Buchanan-Smith & Cosgrave, 2013).
– The introduction of minimal standards. This idea was discussed and supported by the Sphere project (Scott, 2014). The idea behind these standards is to identify the minimum amount of evidence and data, which is required in order to justify taking a large-scale humanitarian effort. One of the reasons why the bureaucracy of humanitarian organizations moves so slowly is because of the difficulties with raising funds and mobilizing the effort, which has a chance of being disproportionate to the problem. This is one of the main underlying reasons why the effective response from the UN-backed international humanitarian organizations came only after a good portion of African countries declared a state of famine and pleaded to the international community for assistance (Coyle & Meier, 2009).
These measures are not conclusive, but they address the major problems presented in the current evidence-gathering and decision-making system. Large humanitarian crises such as earthquakes and famines often highlight the obvious gaps in strategies commonly applied during contemporary relief efforts. These lessons are costly and should not be ignored or taken lightly.
Conclusions
The topic of evidence-gathering, decision-making, and accountability is a multi-layered one. Many underlying conditions, trends, and issues affect the outcome. The process of gathering evidence in a timely manner is a challenging task, especially when faced with humanitarian crises that leave many people displaced. Wars and natural disasters cripple the state institutions. The ensuing chaos makes the situation in the afflicted areas fluid, unpredictable, and dangerous for the information-gatherers. This severely complicates the mission of NGOs and international humanitarian organizations operating in the area. It is understandable that obtaining perfect data and creating a perfect response plan is an impossible task. However, there is still plenty of room for improvement. According to ALNAP, the standards of information-gathering and decision-making should undergo significant changes in order to ensure an evidence-based and timely response to various challenges and crises. NGOs should be held to some degree of accountability for their actions. These measures, combined together, would improve the quality and effectiveness of assistance provided by humanitarian organizations around the world.
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