From emergency to sustainable dev’t work: a shift in the humanitarian sector

The World Humanitarian Day (August 19) was originally established to commemorate the UN and other humanitarian staff who were killed in devastating bomb blast in Baghdad. It has since developed into a social media campaign where people globally can express their solidarity with humanitarian work around the world. Paul Emes is country director of the International Medical Corps, one of the leading humanitarian organizations in Ethiopia heavily involved in the healthcare and refugee sectors. Emes is a British citizen who has accumulated an immense wealth of experience in the humanitarian sectors for close 30 years. With professional training in education, human resources and modern languages, Emes has worked with Save the Children, Red Cross and International Medical Corps for many years. He has held leadership position at various country offices for these organizations that include Georgia, Serbia and Montenegro (in the former Yugoslavia), Sri Lanka and he was posted at Red Cross Middle East office at the start of the Syrian crisis in the region. He worked in Ethiopia for three years working with Save the children before taking over as the country director three months ago. Asrat Seyoum of The Reporter sat down with Emes last week to discuss issues ranging from the refugee situation in Ethiopia to overall humanitarian work in the country. Excerpts:     

The Reporter: Just to start off, can you give us a synopsis of what you have been up to in Ethiopia since 2003?

Paul Emes: We are an international NGO with headquarters in London and Washington. We basically focus on first response on emergency situation and humanitarian programming. Currently, we have programs worth between 10 and 25 million dollars a year in Ethiopia. The big programs are in Dalo and Gambella refugee camps where we work on water and sanitation, health, nutrition, protection of refugees from danger-based violence, sexual reproduction health programming and mental health programming. We also have long-term programs such as the USAID-funded program which  look into the nutritional impact of improved livestock programming on the health of mothers and children, in four regions. We are also working in concert with European Union funded programming which looks at resilience in Wolaita. Program sectors there are nutrition, water sanitation and livelihood. We also respond to emergency situations and natural disasters outside of the refugee context. So, we particularly work with emergency nutrition situations in Amhara and eatern Hararghe areas. And we are currently about to start an emergency nutrition program stretching from eastern Hararge down to the shashemene area.

As you have mentioned it, you have both long-term and short-term programs in Ethiopia. But, in terms of balancing the two, which one outweighs the other: emergency response or long-term development programming?

If you look at our operation in Ethiopia generally the majority of our activity is in long-term development programming. However, for the International Medical Corps, the majority of our activities are in the emergency and refugee programming because that is what we are good at. Globally, we focus on emergency and very rapid response on health and nutrition humanitarian crisis. But we are eager to use our experience in health, water sanitation, nutrition, livelihood and resilience to add value in long-term programming as well. Basically, we are planning to build on that expertise we have on emergency programming and expand that to long-term resilience and livelihood programming in Ethiopia and elsewhere. Generally, we expect the balance to shift in Ethiopia to more long-term programming alongside the emergency and refugee programs.

In the refugee context, is your focus solely on emergency response?

Refugee programming tends to be emergency by nature. Being in a refugee situation can never be a sustainable situation. Although the refugees in Dalo or Gambella have settled there for many years now, neither the government nor the refugees there prefer to stay there for ever. So, in the refugee context, the best one can do is to improve their lives while they are at the refugee camps and equip them with skills and experience to help them so that when they do finally go home or resettle in another country they can have improved livelihood. So, we, together with other international organizations, are doing some technical and vocational training in the refugee camps so that in an event of them going back to their home and another country they can build sustainable livelihoods.

In terms of facilities, how do you see the two refugee camps: one in Somali region and the other in Gambella Region? What are the conditions of the refugee camps?

Life in refugee camps is always tough. I have seen a lot of refugee camps and it is always heartbreaking to see women and children separated from their loved ones while away from home. So it is never easy when you talk about refugee and refugee camps. With regard to the refugee camps in Ethiopia, I can say two things.  For one thing, I was greatly impressed by the welcome that is extended by the government of Ethiopia and the host communities. I think it is extremely generous and impressive of the government to follow an open border policy which has welcomed what must now be some 600,000 refugees in Ethiopia. I am British and I wish my government can have a similar approach although the context in Europe is much different from Africa. The welcoming of the host community in Gambella and Somali region has been extraordinary although it was not without some tension. In terms of the camps themselves, of course the condition of Gambella camp is much better since there is better rainfall in the area. So it is a lot easier for the refugees to grow crops. If you go to the Gambella camps, a lot of the refugees grow maize in their backyard, which is great as it is a nutritional supplement and it helps to diversify the diet. If you go to the new camps in Gembella, for instance, environmental protection is remarkable since they make a point of keeping the trees there and using them as a shade and shelter. In both Gambella and Dolo (Somali Region) there is an effort to move people out of tents and into semi-permanent and permanent settlements. You still do see tents in these camps, especially in the new arrival areas. Of course, the conditions in the border areas of Gambella are a bit rough as people are still sleeping in big tents. The Pugnido II camp is opening up now and it will allow refugees to have a more permanent and better accommodation. The Dolo camp has been there for quite some time now and very few people live in tents there. We are working hard in Dolo to provide families with facilities like latrines, showers and accommodations that are more sustainable for families; and that seems to be going very well.

What are the most challenging aspects of working in the refugee context in Ethiopia?

The most challenging thing both for us and other organizations working with refugees is funding. We have a duty to provide a minimum standard of services for the refugees and finding the money for that is usually difficult. In an emergency response, it is relatively easier to find the funding; if there is a big wave of refugees coming to Gambella, for instance, I would imagine that we, as an international community, should be able to raise the money for that. What gets really tough is when the refugees stay there for five or ten years; the donor would then move to a new crisis and the refugees would still be there in unsustainable states. So, basically, we are trying to provide the same amount of service with less money. For instance, in camps like Dolo it very difficult as the funding slowly goes down and we trying to sustain or even improve the level of services we provide there with less money. One thing I have noticed in both Dolo and camps in Gambella is that our work regarding mental health had revealed how resilient the refugee community is. Don’t get me wrong: mental trauma and stress is still quite a challenge in these communities but it is highly surprising to see how resilient these communities are and how strong their social network and structure is. Although in the majority of the cases, the male members of the community are absent, the female heads of the communities have managed to keep a strong social structure which has proven to be great asset to the Somali and South Sudan refugees in the two regions.

Apart from metal health, what is the most difficult health problem among the refugee community?

Actually, it depends on the refugee camps. In Gambella, for instance, Malaria is a big problem since the area is wet while it is not that much of an issue in Dolo. In any case, mental health is the very big problem as is case in many other refugee situations. I mean you would see a lot of health difficulties like epilepsy, trauma and depression are common. Another area we are working on is sexual and reproductive health issues and also sex-based violence. This might not be surprising in any dislocated society to see rise in the rate of sexual violence since they are away from their formal social structure and safetynet. But what is extremely distressing is to have to deal with sexual violence on the top of being a refugee. So, we are working with other organizations to help provide a safe environment for the refugees. In Gambella, for instance, we are providing women-friendly environments where the women can go there to share their worries and concern with one another. As I have said earlier, the men are absent  most in these situations. So, it is very important for the women to develop the sort solidarity and mutual protection and support. There is access to counseling for women who went through sexual violence or rape. We also make available medical services for victims of sexual violence which includes diagnosis and follow-up counseling. We also are running a very interesting program that focuses on preventing sexual abuse of refugees by the humanitarian workers themselves. I don’t know if you are aware of it but there was some sort of a scandal in West Africa a few  years ago where the humanitarian workers themselves abused refugees sexually; so we basically are trying to prevent something like that from happening. One of the things that we are trying to do is to distribute solar lamps because of darkness where the women are particularly unsafe. Furthermore, we are also trying to provide water access to the refugee communities closer to where they are so that they don’t have to go far away from their settlement.

So far you have been working extensively with Somali and South Sudan Refugees, but not with Eritrean refugees. Why is that?

Actually, we are in the process of preparing a proposal to work with Eritrean refuges. The situation of Eritrean refugees is actually very distressing. It is a situation that is being affected by a funding problem that I have mentioned earlier: the longer a humanitarian situation persists the more difficult it is to raise funds for it. Unfortunately, the Eritrean refugee camps in Northern Ethiopia are being affected by lack of funding more than any other camps in the country. Despite the fact that the UNHCR and the government of Ethiopia are pushing for funding to meant minimum standards, it is still a huge challenge in these camps. One thing which is different about the Eritrean refugees is that the government is allowing them to be integrated into the community and live in the urban areas. So, we are putting together an interesting proposal to see how we can improve the lives of Eritrean refugees in  urban context. As you know, a very large number of refugees who are struggling to get to Europe via deadly routes are Eritreans and we are trying to work with our partners and the government to help these refugees live here sustainably rather than making a hopeless and deadly dash to Europe, well, until such time that they want to go to their homeland.

We understand that the larger portion of your engagement with the local community is via the healthcare sector, which is a sector where the government of Ethiopia is said to have been making strides in recent years. So, what is your independent assessment of this sector?

The government of Ethiopia has made enormous strides in terms of meeting the Millennium Development Goals (MDGs) in the health sector. This, I think, is one of the reasons that Ethiopia is a biggest recipient of international development aid in recent years. Well, there are other factors too like Ethiopia generally having a good security compared to its neighbors. Also, Ethiopia benefits from having generally a  low level of corruption. Furthermore, the country has a development community and a government that is highly committed to uplifting the most vulnerable in both the urban and the rural areas. So, the success over the past ten or fifteen years has been very outstanding. But, still, there an enormous amount to do as we move to the Sustainable Development Goals. I think now the challenge is to get children to school in the developing regions of the country; it is to one thing to be able to get children to go to school in Addis or Bahir Dar but succeess in the developing regions is completely another challenge. So, generally the challenge of the coming years is to ensure quality of services in the high infrastructure areas and to improve access in developing regions like Somali and Gembella or Benishangul Gumuz regions. I have been in Ethiopia three years now. When I first came here I visited health care centers in SNNP Wolaita zone and I asked what percentage of the women gave birth in the health centers. The response was maybe up to 20 or so; but now this same question in the same region will be met with maybe 80 or 90 percent. So, even in three years the progress has been enormous. This is mainly due to the provision of ambulances, health extension systems and health personnel and the effort that has been put in by NGOs, local civil society and government health structure and health education. And one of the reasons for this, I think, is that the focus given to making the health centers family-friendly and homely so that the women would feel at home and prefer to give birth there.

But, globally the bulk of such humanitarian and development programs focus largely on public sensitization, awareness raising and offering trainings and the impact of such activities are said to be highly qualitative and are difficult to measure. How do you measure the impact of your programs objectively?

This  is a very important question. I think we are driven partly by our own desire for quality and the desire of our donor for quality of the programs we administer. And, indeed, the government desire for same quality, evidence and rigorous evaluation in that regard. Social and behavioral change is the key to changing peoples’ lifestyles. Changing peoples lifestyles is important if you want to change their health practices, nutrition, their willingness to send their children to school, willingness to abandon their harmful traditional practices and so on. The provision of these services is one thing but peoples’ willingness to use them is something else altogether. Now, to be able to measure the success of the provision of health or education services is relatively straight forward. You just need to measure the number of people who are using the series. What is much more difficult is to measure the quality of those services. It is good news to learn that 93 percent of the kids in Amhara region go to primary school, but do they learn anything? That would be an interesting question. Measuring if kids can read after two or five years of school is actually challenging. For instance, measuring if households are producing vegetables is quite easy while measuring if they sell the vegetables or cook them. If they do, who gets to eat the vegetables, does it have an impact on stunting are far more difficult to measure. Measuring stunting for instance is another issue since it is not always about physical development but cognitive growth as well. Sadly nutrition is highly liked to this. So, what you need to do is identify some key indicators to measure these impacts. Now, we as well as other organizations have in place a very well-developed monitoring and evaluation mechanism. It is about identifying some key indicators and collecting both qualitative and quantitative evidence to see if these key indicators have been met. Some of these indicators are in the MDGs while others are built into the logical framework of the project design. But, these indicators have to be agreeable for all stakeholders: donor and government and partners. So, each project has to be rigorously evaluated and audited and the findings have to be in the reports. So, each project would be evaluated against the key indicators that are built into the project proposal in the first place. All these indicators have to be integrated and have to be in agreement with the government’s own plans like the GTP and MDGs. It is complicated but we are absolutely committed to building evidence regarding the work that we do.

It seems that there is an over-emphasis given to short-term relief and emergency response when we talk about the humanitarian sector. Simply, what is humanitarian work for you?

I have been involved with this type of work for just about 30 year now. For me, personally, humanitarian work and emergency work are slightly different. Emergency work is what you do when there is a rapid onset of disaster: if there is an earthquake or flood or if there is a drought or a famine. If there is a war and if there is a rapid flow of refugees, what you do there is an emergency work. That then evolves into recovery work, resilience work and then eventually to development work. For me, humanitarian work is helping my fellow human beings whether that is an emergency or development work. I think it is unfortunate to mix up emergency work with development. I think of myself as a humanitarian worker whether it is through emergency or development worker. I think we have a duty as human beings to respond to the emergency need of our fellow humans. Having said that, emergency work is not a sustainable work. Although it is an evitable use of resources, it is not useful use of the resources to say the least. If I am a donor, I would rather prefer to use my resources on development than emergency response because it builds a sustainable livelihood and resilience. A classic emergency work in Ethiopia is water trucking (delivery of water via trucks for communities struck with emergency situation); everybody hates water trucking because it is really expensive and highly unsustainable. But, if you have communities who have no water and people and animals are dying because of it, then you have no choice. You would rather use that money to rehabilitate boreholes, dig shallow wells and develop water catchments. But, you have no choice. As an organization, the International Medical Corp is involved with both water trucking and more sustainable water development projects.

Can we say that world humanitarian sector is moving from water trucking to more sustainable development work, in a manner of speaking?

Definitely; and I think is a very welcomed move. Yes, we will still continue water trucking but everybody understands that we should invest our money in more sustainable solutions.