One Nurse At A Time modules are intended to help nurses understand processes that are uncommon in our work practices at home. They are intended to be practical guides and not exhaustive dissertations. Education is a dynamic, ongoing process. We value your input and comments on the content of this module. Please feel free to write to OneNurseAtATime@gmail.com.
HUMANITARIAN NURSING 101
ALPHABET SOUP: HOW THE HUMANITARIAN WORLD TURNS
The huge array of organizations working on the world stage can seem overwhelming. Believe it or not, there is a framework! Nearly everything is referred to with initials, and often the names have changed over time but initials remain the same. VERY briefly, here are some of the more important organizations and relationships:
Every country has a Ministry of Health (MoH). For example, in the US, it’s the Department of Health and Human Services. In Canada, it’s the Provincial Ministry of Health. The role of a national MoH is to provide health and medical services to all citizens of a country in normal and emergency circumstances. Usually, a MoH is responsible for (not an exhaustive list):
- Setting quality standards for medical services, practice and facilities. Often, the MoH also operates the health system and directly provides services – public hospitals, clinics, etc.
- Defining national treatment protocols for health services
- Credentialing and licensing health care providers
- Managing health insurance systems
- Overseeing quality of (and often provision of) medications, including family planning, blood products, vaccines, etc.
- Immunization standards and campaigns
- Running programs for public health diseases such as TB, HIV/AIDS, Leprosy, Filaria, etc.
Each country has its own series of laws governing health and medical issues. National Ministries of Health can be legally and politically charged, especially in key areas like Reproductive Health. Some countries frown on all methods of contraception; some countries encourage abortion as a means of family planning; some countries allow abortion if the mother’s life is at stake; and some impose criminal penalties for any elective termination of pregnancy.
As a guest in a foreign country, you will need to have authorization from the national Ministry of Health in order to work, including volunteering. After all, the US would never allow a foreign national to practice medicine without subjecting the individual to a rigorous approval process. Normally, your host organization will make these arrangements on your behalf and may request various documents prior to your departure. Most international organizations work with a national partner for easier navigation of these somewhat complicated processes.
In complex emergencies, there is normally a local area HAC – Humanitarian Affairs Coordinator, to whom you may also need to report activities. On shorter missions, you may not even become aware of the complexities involved.
The United Nations (UN) serves as broad international advisory body. The UN was formed in the wake of World War II to deal with international law, security, economic and social development, human rights and world peace. It is a political body with membership of every sovereign nation in the world. Since the UN is comprised of and funded by member nations, it is immune to the laws of countries where they operate.
There are five sections of the UN, but for the purposes of this module, we will only discuss section #5:
- Security Council
- Secretariat (headed by the Secretary General) for international peace and security
- International Court of Justice and International Criminal Court
- Economic and Social Council
- Specialized institutions to address particular issues: International Monetary Fund (IMF), World Bank, and various humanitarian arms to be discussed below: WHO, UNFPA, UNICEF, WFP, UNHCR, UNAIDS, UNOCHA and others.
All of these agencies are within the United Nations system. All provide guidance and direction, but work through national governments and not independently. They are not “NGO” or Non-Governmental Organizations. They are “INTER-governmental organizations.”
WHO – The World Health Organization holds coordinating authority for international public health. WHO is financed by member states and donors such as Non-Governmental Organizations, pharmaceutical companies, foundations and other UN agencies. WHO’s responsibilities include:
- oversight of disease outbreak control, prevention and treatment
- support of vaccines, drugs, and diagnostics
- provision of evidence-based tools: guidelines, norms and standards for health related topics
- setting international standards for healthcare
- conducting health related campaigns
- creating global initiatives
- conducting health research.
UNFPA – United Nations Population Fund works through governments and societies to provide services and supplies for reproductive health, including HIV/AIDS and sexually transmitted infections. Its goals are universal access to reproductive health services, primary education, decreased infant and maternal mortality and decreased HIV rates.
UNICEF – United Nations Children’s Fund is a long term humanitarian and developmental agency with a goal to assist mothers and children in developing countries. It is funded 2/3 by governments and 1/3 by the private sector. UNICEF:
- Deals with children’s rights
- Provides technical assistance and guidance to host governments
- Provides vaccines, Antiretroviral drugs (ARVs), nutritional supplements and guidance for their use
- Implements safe water and sanitation programs
- Provides emergency shelter and supplies
- Provides schools, books, teacher salaries and education for children.
WFP – World Food Programme is the food aid branch of the United Nations. It addresses hunger in vulnerable populations with a goal to eradicate hunger, malnutrition and micronutrient deficiencies. WFP is funded by governments, corporations and private parties.
UNHCR – The United Nations High Commissioner for Refugees works to protect refugees and displaced populations, and to resolve their problems. Technically, a refugee is someone who crosses an international boundary. An Internally Displaced Person (IDP) remains within the boundaries of his/her country of origin. UNHCR provides voluntary repatriation, local integration or resettlement to another country.
UNHCR often works in tandem with IOM, the International Organization for Migration, which is an inter-governmental organization outside the UN system. IOM is dedicated to humane and orderly migration and provides humanitarian assistance to migrants in need.
UNAIDS – the United Nations agency working against HIV/AIDS through leadership, advocacy, funding, technical support, strategic partnerships and tracking the epidemic.
UNOCHA – the United Nations Office for Coordination of Humanitarian Affairs is an inter-agency body created to strengthen the UN’s response to complex emergencies and natural disasters. The UN “cluster system” divides needs into sectors and assigns a sector leader, which also serves as the agency of last resort. For example, WHO is the lead UN agency for health, UNICEF for water and sanitation, WFP for logistics, UNICEF for nutrition, etc. Some NGOs also participate in the UN “clusters.”
There are a few United States government agencies to also be aware of:
CDC – The US Centers for Disease Control and Prevention works for public health in the US, but contributes information to achieve the international goals of infectious disease prevention and treatment.
USAID – The United States Agency for International Development is the federal agency for civilian foreign aid focusing on economic, development and humanitarian assistance in support of US foreign policy goals.
Independent : ICRC – The International Committee of the Red Cross is neither an Non-Governmental nor Governmental Organization. It is the only institution named under international humanitarian law. It is a private humanitarian organization with a mandate to protect victims of international armed conflicts. This mandate covers the organization of nursing and care for wounded soldiers, war wounded, prisoners, refugees, civilians and other non-combatants. ICRC is exclusively humanitarian, independent, impartial, non-political and neutral in conflicts. Its work encompasses protection and care of civilians, prisoners of war, tracing missing persons and reuniting families, health promotion and message exchanges, among other activities. ICRC rarely speaks out publicly and all of its interactions are confidential.
ICRC was formed in the mid-19th century at the same time as the first Geneva Convention with legally binding rules guaranteeing neutrality and protection for soldiers, medical and humanitarian institutions. By the later part of the 19th century, it had become an international movement. Clara Barton worked to form the American Red Cross. National societies of Red Cross, Red Crescent (Muslim) and Red Crystal (in Israel) were accepted into the International Federation of Red Cross (IFRC) with the symbol of a red cross on a white background and motto “Amidst war, charity.”
Unfortunately, in the 1990s attacks began against humanitarian aid workers, including ICRC delegates. Since then, there has been a lack of respect for the rules of the Geneva Conventions and protection symbols resulting in dozens of aid workers being killed and kidnapped around the world.
Non-Governmental Organizations (NGO)
Tens of thousands of organizations around the world are considered international NGOs, meaning they operate independently from a government and have no government representatives as members. There are literally millions of national NGOs in existence. There is no universally accepted definition for NGO. For example, the US calls them “non-profit organizations.” The World Bank uses “private organizations that pursue activities to relieve suffering, promote the interests of the poor, protect the environment, provide basic social services, or undertake community development.”
Funding sources do not define NGOs. Most accept funds from churches, governments, the United Nations, private parties, foundations and/or corporate donors. Some of these donated funds carry specifications for use, and in order to qualify for funding, the organization must comply with donor demands. This can put the NGO in a position of altering its work to accommodate those restrictions.
One recent example is PEPFAR, the President’s Emergency Plan for AIDS Relief, started in 2003 by US President George W. Bush to provide antiretroviral/HIV drugs (ARVs) in resource-limited settings. The program was highly controversial and criticized as being socially insensitive for spending a portion of the funds on abstinence-until-marriage programs in receiving countries. Faith-based organizations were often funded by this United States government program. In 2008 these funding requirements were eliminated but the program continues.
NGOs carry on the tradition of Alphabet Soup – even One Nurse At A Time refers to itself as ONAAT at times! You will notice other entities referred to in “humanitarian speak”: GoSS, GoN, etc. (Government of South Sudan, Government of Nigeria, etc.), UNMIL, UNMIS (UN Mission in Liberia, UN Mission in Sudan) – even warring factions have initials: SPLA, LRA, JEM, FARC, MILF, AFP and hundreds of others. It’s a sort of shorthand you will become accustomed to in the international humanitarian world.
The structure and relationships between international, national and local governments and organizations can be complex and confusing. But understanding your role within that framework will help you avoid traps and pitfalls that can hamper your mission’s success.
Please continue to the next module in this series – HUMANITARIAN NURSING 102: THE ROLE OF THE NURSE IN THE DEVELOPING WORLD or HOW DO I FIT IN?