The International Federation of Red Cross and Red Crescent Societies, best known for its very visible work in short-term humanitarian disasters, has made a dramatic shift to the longer view - where disease is the great killer.
Releasing its latest annual report this week, the Societies say that the death toll from infectious diseases such as AIDS, malaria, respiratory diseases and diarrhoea is 160 times greater than the number killed in last year's natural disasters, including the massive earthquakes in Turkey, floods in Venezuela and cyclones in India.
According to Didier Cherpitel, Secretary General of the IFRC & RC, writing in the introduction to the report : "When disaster strikes... community care falters as families are torn apart. State systems crack, and the gap between needs and service delivery dramatically widens. Filling this gap in times of disaster, though, often means that as the threat of disaster recedes, emergency responders find themselves faced with a dilemma. To pull out, knowing that neither community nor state systems have re-established themselves. Or to stay and risk being caught in the open-ended commitment of welfare provision."
For example around Chernobyl, says the Societies' report, "cancer rates continue to rise, 14 years after the disaster, but screening, treatment and psychosocial support remain inadequate. In Kosovo, the health-care system has been irrevocably changed. Rebuilding it will require not just capital but completely rethinking the role of the state in providing care."
"I am convinced we must highlight some of the underlying causes of suffering and the long-term consequences of the crises to which we react" says Charpitel. "The days when disaster response meant 'quick in, quick out' are long gone. We cannot just pack up and go home after the disaster. But pumping inadequate resources into dysfunctional systems is equally flawed. Today we have to be smarter."
The International Federation was created in 1919 to respond to the post-war threat of epidemics in Europe. "Today, eight decades on, we remain committed to preparing for and responding to not only crises, but chronic threats to people's lives and dignity...." Charpitel says.
What caused this new emphasis on the long term at the Red Cross and Red Crescent? Some say it was the Societies' experience in Kosovo. According to the report, "agencies competed for media attention, made individual assessments, protected information and pursued their own priorities. By autumn 1999, around 400 international agencies in Pristina swamped local efforts to recover." Assessments and relief were duplicated, antagonizing beneficiaries. "It was a bit like a humanitarian Klondike [gold rush]," said t Folke Lampe of the International Committee of the Red Cross. [See below for Red Cross terminology.] Too much short-term aid hampered local efforts at recovery, the report says, concluding that "longer-term strategic vision and commitment of resources are needed to rehabilitate Kosovo's shattered health systems and society".
There may also be a degree of turf war with WHO. "Following field assessments in East Timor last year, WHO appealed for funds to rebuild health infrastructure, control infectious diseases and address mental and reproductive health" the Societies' report says. "But WHO's strengths may lie in analysis of data and guidelines for best practice, rather than front-line implementation."
So what can be done? "Investing in local capacities will mitigate the effects of ongoing public health crises and future disasters. Local people reach disaster zones long before international agencies arrive and remain long after they have left. Trained volunteers bridge the gap between disaster and rehabilitation - especially as regards psychological trauma. While international teams struggle to offer therapy in unfamiliar cultures, local capacity-building enables a longer-term response" says the report.
A new system of international disaster law, to curb the kind of chaos seen in Kosovo, is also sorely needed, the Societies say.
The IFRC & RC press release on this story is available here.The full report is regrettably not available on-line.
The structure of the Red Cross & Red Crescent Societies is somewhat complex. The Geneva-based International Federation, whose report is described here, promotes the humanitarian activities of 176 national Red Cross and Red Crescent Societies. It coordinates international disaster relief and encourages development. The Federation, National Societies and the International Committee of the Red Cross together, constitute the International Red Cross and Red Crescent Movement.