Broken Humanitarian System: Recommendations for Future Action

1. The Humanitarian System is Not Just Broke, but Broken:recommendations for future humanitarian action Paul B. Spiegel MD, MPH Professor, International Health, Johns Hopkins Bloomberg School of Public Health Director, Center for Humanitarian Health, Johns Hopkins University

2. Magnitude and Cost of Forced Displacement

3. Figures for Forced Displacement (end of 2016)

4. Refugees (end of 2016)

5. Internally Displaced Persons (IDPs – end of 2016)

6. Funding for Humanitarian Assistance (end of 2016)

7. Funding for Humanitarian Assistance (end of 2016)

8. Humanitarian Norms and Current Trends

9. The Humanitarian ‘Norm’ was… (and still is) • Low income countries in Sub-Saharan Africa Corinne Baker/MSF, 2013 South Sudanese refugees in Kenya Mandel Ngan, 2013 Za’atri refugee camp, Jordan

10. The Humanitarian ‘Norm’ was… (and still is) • Low income countries in Sub-Saharan Africa • Persons in refugee camps Corinne Baker/MSF, 2013 South Sudanese refugees in Kenya Mandel Ngan, 2013 Za’atri refugee camp, Jordan

11. The Humanitarian ‘Norm’ was… (and still is) • Low income countries in Sub-Saharan Africa • Persons in refugee camps • Weak governments and few functioning national NGOs Corinne Baker/MSF, 2013 South Sudanese refugees in Kenya Mandel Ngan, 2013 Za’atri refugee camp, Jordan

12. The Humanitarian ‘Norm’ was… (and still is) • Low income countries in Sub-Saharan Africa • Persons in refugee camps • Weak governments and few functioning national NGOs • Communicable diseases Corinne Baker/MSF, 2013 South Sudanese refugees in Kenya Mandel Ngan, 2013 Za’atri refugee camp, Jordan

13. Current Trends Prolonged crises >90% of countries with humanitarian crises had humanit. appeals for >3 years

14. Current Trends Prolonged crises >90% of countries with humanitarian crises had humanit. appeals for >3 years UN and Int’l NGOs receive funds UN agencies and largest INGOs received 81% of humanit. assistance (2009-2013) Local and national NGOs directly received just 0.2% of total humanit. assistance (2014)

15. Current Trends Prolonged crises >90% of countries with humanitarian crises had humanit. appeals for >3 years UN and Int’l NGOs receive funds UN agencies and largest INGOs received 81% of humanit. assistance (2009-2013) Local and national NGOs directly received just 0.2% of total humanit. assistance (2014) Increasing, new and complex mix of actors Increasing number with varying competence National gov’ts and local NGOs taking lead Middle East gov’ts, Islamic agencies, and priv. sector

16. Syria

21. Recommendations for Future Humanitarian Action

22. Recommendations for Future HumanitarianAction • Operationalise concept of ‘centrality of protection’ • Integrate affected persons into national health systems by addressing humanitarian-development nexus • Remake not simply revise leadership and coordination • Make interventions more efficient, effective and sustainable Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017; (Series: Health in Humanitarian Crises): 45-52.

23. Recommendations: • Interpret centrality of protection in inclusive manner • Operationalise concept of ‘centrality of protection’

24. Recommendations: • Interpret centrality of protection in inclusive manner • Translate resolutions and laws into concrete actions including sanctions • Operationalise concept of ‘centrality of protection’

25. Recommendations: • Interpret centrality of protection in inclusive manner • Translate resolutions and laws into concrete actions including sanctions • Do not restrict pop. movements nor undertake mandatory testing in humanit. emergencies except under exceptional circumstances • Operationalise concept of ‘centrality of protection’

26. Recommendations: • Take into account existing development health strategies • Integrate affected persons into national health systems by addressing the humanitarian-development nexus

27. Recommendations: • Take into account existing development health strategies • Integrate affected pop. into national health systems; avoid parallel health services • Integrate affected persons into national health systems by addressing the humanitarian-development nexus

28. Recommendations: • Take into account existing development health strategies • Integrate affected pop. into national health systems; avoid parallel health services • Compensate for temporary disruption of national cost-recovery systems • Integrate affected persons into national health systems by addressing the humanitarian-development nexus

29. Recommendations: • Take into account existing development health strategies • Integrate affected pop. into national health systems; avoid parallel health services • Compensate for temporary disruption of national cost-recovery systems • Equitable access to quality health services should be available to all persons in specific area regardless of status • Integrate affected persons into national health systems by addressing the humanitarian-development nexus

30. Recommendations: • Undertake wholesale reform of humanitarian leadership and coordination • More customised approach • Fewer UN and int’l operational agencies • Prioritisation of key interventions by leader with sufficient authority • Remake not simply revise leadership and coordination Rebecca Blum, Haiti, 2010

31. Recommendations: • Undertake wholesale reform of humanitarian leadership and coordination • More customised approach • Fewer UN and international operational agencies • Prioritisation of key interventions by a leader with sufficient authority • Monitor closely • UN and INGOs who must relinquish influence and authority • Monitor closely WHO’s humanitarian reform process to ensure fundamental changes are made • Remake not simply revise leadership and coordination Rebecca Blum, Haiti, 2010

32. Recommendations: • Provide upfront investment by donors in health and WASH infrastructure • Make interventions more efficient, effective and sustainable

33. Recommendations: • Provide upfront investment by donors in health and WASH infrastructure • Initiate multi-year funding • Make interventions more efficient, effective and sustainable

34. Recommendations: • Provide upfront investment by donors in health and WASH infrastructure • Initiate multi-year funding • Actively and systematically scale up cash-based transfers • Make interventions more efficient, effective and sustainable

35. Recommendations: • Provide upfront investment by donors in health and WASH infrastructure • Initiate multi-year funding • Actively and systematically scale up cash-based transfers • Explore different health financing models • Provide guidance on prioritisation • Make interventions more efficient, effective and sustainable

36. Summary Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

37. Summary Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

38. Summary Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

39. Summary Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

40. Forgotten Emergencies

41. Forgotten Emergencies South Sudan

42. Forgotten Emergencies Central African Republic South Sudan

43. Forgotten Emergencies Rohingyha conflict in Myanmar South Sudan Central African Republic • Khin Maung Win, AP, 2012

44. Vision To pursue new knowledge and disseminate this learning to save lives and reduce human suffering and the consequences of humanitarian emergencies and disasters HopkinsHumanitarianHealth.org @Humanit_Health HopkinsHumanitarianHealth