The future of humanitarian medicine

Humanitarian medicine aims to provide essential relief to those destabilized by crises. This concept, the humanitarian imperative, expands the principles of humanity to include, as a right, the provision of aid to those suffering the consequences of war, natural disaster, epidemic or endemic diseases, or displacement.

Providing assistance to those in crises is a premise as old as human society and is one that is embedded in religious scriptures and social norms. Modern secular humanitarianism, however, originates in the mid-19th century with the first Geneva Convention and the formation of the International Committee Red Cross. Most humanitarian organizations continue to adhere to the original humanitarian principles of impartiality, neutrality, and independence. Expanded over the years, humanitarian providers now have the benefit of established international humanitarian law, which provides a legal framework for negotiation and access.

While over the years there have been steady increases in humanitarian need and presence globally, the previous decade has been marked by unprecedented expansion. As demonstrated in the trends in the financial appeals to meet the global humanitarian needs (an admittedly imperfect approximation to the size of humanitarian needs and operations), in 1992, the first inter-agency humanitarian appeal requested US$2.7 billion to meet the global needs, and by 2007, this figure rose to $5.5 billion.   A little more than one decade later, in a 2019 report, the UN required funding reached $24.88 billion, of which only $13.87 billion (56%) were received in 2018. Those covered needs in 41 countries. This explosive increase in global humanitarian needs, with recognition of an equally expanding scope of operations, shows no signs of waning.

The principle cause of the human suffering that leads to a humanitarian response is closely linked to conflict and its resultant displacement, and conflicts today have a changing profile. Today, complex wars, such as the one in Yemen, and protracted conflicts, including those in Syria, Democratic Republic of Congo, and South Sudan have become the unfortunate norm. In its 2018 Global Humanitarian Assistance report, Development Initiatives estimated that in 2017 conflicts and disasters around the world left 201 million people in need of assistance.  In addition to this, forced displacement continues to climb and in 2017 reached the highest level since World War II. Over the long term additional factors, such as climate change, are expected to make the situation even worse due to extreme weather, destruction of resources, and famine. The Institute for Environment and Human Security of the United Nations University has forecasted between 25 million and one billion environmental migrants by 2050. Most prognoses foresee 200 million. A displacement at this scale will dwarf anything previously seen.

The human suffering associated with such increases in conflict and displacement is pronounced, and the costs associated with the provision of humanitarian relief are significant.  In a 2018 report, the United Nations Office for the Coordination of Humanitarian Affairs estimated the total requirements are approximately $25.2 billion, of which only $15.2 million was received.  Significantly, this 40% gap in funding is not equally distributed among countries in need however, as although Iraq received over 90% of the requested $568 million in 2018, Haiti received only 13% of its $250 million request.  This suggests that funding to relieve suffering is often tied to political interest and affected by media presence and trade interests, rather than based on need alone.

This changing context has brought both an increase in humanitarian need and an increased risk for those providing such relief.  The changing profiles of war have led to erosion of respect for International Humanitarian Law, with increased violations, generally without repercussions.   The peril for those practicing humanitarian medicine has never been greater.  In 2017, 158 major incidents of violence against humanitarians were documented in 22 countries and affected 313 aid workers.

This is a transformative time both globally and within the humanitarian community.  While conflicts continue to claim lives in so many areas in the world, a form of humanitarian action that still adheres to principles of impartiality and independence remains critical. Those committed to practicing humanitarian medicine are upholding the noble principles established over a century and a half ago to help alleviate the suffering in their fellow men.  This practice goes beyond simply the clinical and exerts solidarity with those in need and touches on the core of what humanity entails. How both the humanitarian sector and the global community navigates these challenges is crucial.

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