A world in turmoil: governing risk, establishing order in humanitarian crises

International humanitarian narratives of disasters, crises, and Indigeneity

Narratives are a means of making sense of disasters and crises. The humanitarian sector communicates stories widely, encompassing representations of peoples and events. Such communications have been critiqued for misrepresenting and/or silencing the root causes of disasters and crises, depoliticising them. What has not been researched is how such communications represent disasters and crises in Indigenous settings. This is important because processes such as colonisation are often at the origin but are typically masked in communications. A narrative analysis of humanitarian communications is employed here to identify and characterise narratives in humanitarian communications involving Indigenous Peoples. Narratives differ based upon how the humanitarians who produce them think that disasters and crises should be governed. The paper concludes that humanitarian communications reflect more about the relationship between the international humanitarian community and its audience than reality, and underlines that narratives mask global processes that link audiences of humanitarian communications with Indigenous Peoples.

Inferring the impact of humanitarian responses on population mortality: methodological problems and proposals

Reducing excess population mortality caused by crises due to armed conflict and natural disasters is an existential aim of humanitarian assistance, but the extent to which these deaths are averted in different humanitarian responses is mostly unknown. This information gap arguably weakens governance and accountability. This paper considers methodological challenges involved in making inferences about humanitarian assistance's effect on excess mortality, and outlines proposed approaches. Three possible measurement questions, each of which contributes some inferential evidence, are presented: (1) whether mortality has remained within an acceptable range during the crisis (for which different direct estimation options are presented); (2) whether the humanitarian response is sufficiently appropriate and performant to avert excess mortality (a type of contribution analysis requiring in-depth audits of the design of humanitarian services and of their actual availability, coverage and quality); and (3) the actual extent to which humanitarian assistance has reduced excess deaths (potentially the most complex question to answer, requiring application of causal thinking and careful specification of the exposure, and for which either quasi-experimental statistical modelling approaches or a combination of verbal and social autopsy methods are proposed). The paper concludes by considering possible 'packages' of the above methods that could be implemented at different stages of a humanitarian response, and calls for investment in improved methods and actual measurement.

Impediments to localization agenda: humanitarian space in the Rohingya response in Bangladesh

The article spotlights the impediments of the localization agenda in the Rohingya response in Bangladesh through the notion of humanitarian space. The Rohingyas rely entirely on material aid and humanitarian services in the camps, mainly stemming from international actors committed to the localization agenda, which, however, has not been effectively implemented. Drawing on the definition of humanitarian space as an arena, we investigate the main negotiations within humanitarian space in the Rohingya response and how they impede the realization of the localization agenda. We conducted secondary data analysis on reports published by organizations involved and validated the findings with ten telephone interviews with organizations in Bangladesh. We identified three main negotiations. First, negotiation on the nature of the partnership between local and international humanitarian actors, including the debates on the definition of "local"; second, negotiation concerning the characteristics and appreciation of local capacity; and third, the negotiation related to constraints within the operating environment for humanitarian actors in Cox's Bazar, Bangladesh. We conclude that the lens of humanitarian space is necessary for further understanding the dynamics impeding localization in the Rohingya response in particular and humanitarian action in general.

Healthcare governance during humanitarian responses: a survey of current practice among international humanitarian actors

BACKGROUND

Large international humanitarian actors support and directly deliver health services for millions of people in crises annually, and wield considerable power to decide which health services to provide, how and to whom, across a vast spectrum of health areas. Despite decades of reform aiming to improve accountability in the sector, public health practice among humanitarian actors is not heavily scrutinized in either the countries where they are headquartered or those where they provide healthcare. We surveyed current healthcare governance practice among large international humanitarian actors to better understand what organisations are doing to ensure oversight and accountability for health services in humanitarian responses.

METHODS

The term 'healthcare governance' was defined and categorised into seven domains: implementation of health management information systems (HMIS) and use of resulting data; professional development of health sector staff; audits of health service performance; management of clinical incidents; evidence-based practice; pharmaceutical supply; and beneficiary engagement. Senior health professionals at 32 leading international actors providing humanitarian health services were contacted between July and August 2019 to complete a 109-question online survey about their organisation's practice in these domains.

RESULTS

Respondents from 13 organisations completed the questionnaire. Healthcare governance practices were undertaken to varying degrees by all organisations but were often driven by donor requirements and external factors rather than improvement of programme performance. Common strengths were the inclusion of governance in organisational policies, high availability of technical guidelines, and close monitoring of pharmaceutical services. Recurring weaknesses were poor beneficiary engagement, inconsistent use of health information for decision making, unsystematic implementation of healthcare audits, inconsistent management of clinical incidents, and lack of training and professional development opportunities.

CONCLUSIONS

To our knowledge, this is the first study to describe healthcare governance practice among humanitarian actors. Leading international humanitarian healthcare providers are already implementing many healthcare governance activities; however, these are inconsistently applied and generally not reflective of systematic policies or earmarked organisational resources. There is a need for sector-wide consensus on how the humanitarian sector defines healthcare governance, the domains that constitute it, which actors in the humanitarian system are implicated, and how malpractice should be systematically addressed.