May 1, 2004
Humanitarian Action Under Attack: Reflections on the Iraq War (page 2)

Published in Harvard Human Rights Journal / Vol. 17
Nicolas de Torrente*
Continued from page 1

4. After Saddam Hussein's Fall: Humanitarian Organizations Struggle To Address Failings of the Occupation

   Paradoxically, the toppling of Saddam Hussein's government did not lead to a decrease of humanitarian needs in Iraq. On the contrary, the failure of U.S. forces to prevent widespread looting in Baghdad contributed to the collapse of public health services, resulting in heightened difficulties for Iraqis in accessing medical care. In recent months, as the United States has faced violent opposition that has affected reconstruction efforts in the central part of the country, humanitarian organizations have struggled to provide immediate assistance, particularly as they have increasingly come under direct attack.71

   1. Essential Services Collapse After the War

      In the immediate aftermath of the conflict, the United States failed to live up to the expectations it generated and to its obligations as an Occupying Power under the Geneva Conventions.72 This failure was not only the unfortunate result of an unexpectedly rapid military success; a lack of leadership and confused actions by the United States as the new political authority also contributed to the situation. General Garner, the head of ORHA, did not arrive in Baghdad for two weeks after the end of the war and the medical DART tasked to immediately follow the troops did not arrive in Baghdad for three weeks after the war.73 This situation left important initial decisions to the discretion of the U.S. military.

      The provision of basic medical care in Iraq, like other services, crumbled after the war. The collapse of security following the U.S. military victory led to widespread looting, particularly in Baghdad.74 Hospitals and other health facilities were not protected by U.S. troops, despite the pleas of ICRC and other humanitarian organizations.75 Many health facilities were completely stripped of their medication, beds, furniture, and others amenities.76 As a result, many war-wounded patients were forced to discontinue their treatment. In Baghdad's al-Kindi Hospital, 120 war-wounded patients were taken home by relatives as anarchy engulfed the premises.77

      In the chaos after the war, access to essential health care was badly compromised.78 As public transportation ground to a halt, medical staff were no longer able to reach their posts. The removal of Saddam Hussein's government created a vacuum of power, spreading uncertainty and tension about leadership arrangements throughout the public health care system. Many hospitals were paralyzed by internal political struggles that mirrored those of wider Iraqi society.79 In smaller cities, self-organization was easier, and in Shia areas, religious community leadership stepped in to fill the void and services managed to restart.80 Yet there was still no adequately functioning hospital in Baghdad one month after the demise of Saddam Hussein's regime.81

      Rather than focusing on the provision of urgently required medical care, the United States concentrated its efforts on reestablishing the functioning of institutions such as the Ministry of Health. But its initial efforts to recreate these institutions were stymied by varying statements and policy decisions regarding the continued eligibility of Baath party members for public service positions.82 This focus on reconstruction also came at the expense of ensuring immediate life-saving assistance in hospitals. Emergency medical assistance was quite obviously not a priority for the military. For example, when Al-Wasiti Hospital, one of the only hospitals to remain open immediately after the war, converted its lobby into an emergency room to deal with the huge influx of patients, U.S. soldiers provided little or no assistance although they occupied nearly half of the hospital.83 The involvement of NGOs in the provision of services was also stalled. In the first chaotic weeks, when hardly any health services were available, interim and changing Iraqi hospital administrators indicated to MSF teams that any help beyond providing medical supplies would not be accepted.84 They reported that U.S. military officials had told them to wait until policies for cooperation with NGOs were in place.85

   2. The United States Orients Aid Organizations To Support Its Agenda

      From the beginning, the intentions of the U.S. government were clear: its policy was to incorporate aid agencies into its overall strategy. The U.S.-led coalition, however, did not deliberately block or overtly direct assistance efforts during and in the immediate aftermath of the conflict, contrary to some fears, voiced for instance in a statement by French organizations.86 Rather, the United States was respectful of MSF's presence in Baghdad during the war and did not interfere with the wartime convoys of medical supplies from Jordan.87 MSF staff also entered Iraq without any U.S.- or U.N.- issued identification in the immediate aftermath of the war.88

      In the wake of the Iraqi regime's collapse, U.S. forces were not in a position to establish basic security, let alone provide much assistance or manage the activities of NGOs. This disconnect between U.S. pronouncements of massive help before the war and the lack of preparations and leadership to restore basic services after the fall of Saddam Hussein's government is particularly striking. A likely explanation for the disjuncture is that the United States assumed that liberation from Saddam Hussein's rule would be so popular among Iraqis that provision of essential services could take a back seat in its planned efforts to win over the population. In addition, the massive looting was not foreseen and the United States wrongly assumed that the removal of top regime officials would leave the public service machinery of the state intact.89 It appears that emergency relief assistance was not planned because it was not anticipated to be necessary.

      The United States was, however, intent on orienting assistance to support its effort to win over "hearts and minds." For instance, U.S. sanctions barring humanitarian assistance were kept in place for a month after the Iraqi government was toppled.90 With these sanctions in place, only programs funded by the U.S. government were legally authorized, and only in "liberated" areas prior to and during the war.91 This, in effect, kept any independent humanitarian assistance originating from the United States out of Iraq, and only organizations with an international operational base like MSF were able to avoid these interdictions. Through the "Humanitarian Operations Center" in Kuwait, U.S. officials also strongly encouraged the United Nations and NGOs to enter Iraq only when a "permissive security environment" had been established.92 This delayed the efforts of those organizations that sought U.S. military clearance or did not challenge its guidance.93 Ironically, the few weeks following the collapse of Saddam Hussein's regime were among the safest for aid organizations to travel around the country in order to assess and respond to needs.94

   3. Aid Organizations Equivocate in the Face of U.S. Efforts at Assimilation

      Faced with the U.S. government's intention of bringing aid organizations under its umbrella, U.S. NGOs found themselves in a quandary: they recognized the peril of close relations with the U.S. military for the perception of their activities by the local population, yet the U.S. government was a major source of their funding. In response, they essentially argued that they could have it both ways: they invoked loyalty to the humanitarian principles of neutrality and impartiality guiding their efforts while opting to work with the U.S. government.95 They focused on drawing a line in the sand: they accepted large amounts of U.S. government funding but refused direct military control over their activities, agreeing instead to work with U.S. civilian authorities such as OFDA and USAID.96 Supporting this stance, InterAction publicly backed the State Department and USAID in their power struggle with the Pentagon over control of aid efforts and called for more coordination by the United Nations.97

      While OFDA and DARTs have significantly more expertise than military officials in carrying out relief operations, ultimately U.S. NGOs were attempting to square the circle. Their "solution" chose to ignore the basic fact that all U.S. agencies are part of the same government waging war and exercising military occupation. USAID Administrator Natsios exposed the futility of attempting to draw subtle distinctions in May 2003 when he told NGOs attending the InterAction annual forum that by receiving U.S. government money for their activities, they were in effect "an arm of the U.S. government."98 He challenged them to either make the U.S. government origin of their funding explicit to beneficiaries, like private contractors do, or else he threatened to personally tear up their contracts and find new partners.99

      Had the U.S.-led coalition's rosy predictions of a quick and seamless transition from war to relief, rehabilitation, and reconstruction under an uncontested political authority been realized, the failure of the U.S. NGOs to counter the U.S. government's strategy of assimilation could have gone unnoticed. Indeed, it would not be problematic for those organizations choosing to work in such a context to be associated with the Occupying Power leading the reconstruction effort, particularly if they decided to take its funding.

      But the situation in Iraq is far different from what was predicted. Conflicts between U.S. forces and insurgents have intensified and reconstruction efforts have struggled, particularly in the central parts of the country. In this environment, an explicit distinction between the United States, an active belligerent, and humanitarian organizations is essential.

   4. As Security Deteriorates, Reconstruction Is Stalled and Aid Workers Are Attacked

      The complete overhaul of the ORHA team on May 6, with Ambassador L. Paul Bremer replacing Jay Garner as the highest U.S. official in Iraq, was an indication that initial efforts at relief, rehabilitation, and reconstruction were struggling.100 In the months since the reorganization, the provision of basic services, such as electricity, water, and health care, has been on the mend.101 This improvement stems from the injection of massive financial resources, the return of the U.N. agencies and others who have restored the pre-war food ration distribution system, the arrival of NGOs and private contractors, and the relief efforts of the U.S. military.

      Although the efforts in Iraq have progressed, the U.S. government has faced criticism about the pace of reconstruction. In response, U.S. officials have argued that thirty years of neglect under Saddam Hussein's regime is to blame for the poor state of the country and that insufficient credit has been given to important reconstruction achievements, such as the repair and reopening of schools.102 It is clear that the situation of the civilian population in Iraq had deteriorated markedly in recent history, particularly after the 1991 war, as a result of both Iraqi government policies and international sanctions.103 This did not, however, relieve the United States, as the Occupying Power, from its responsibility to reestablish services that were disrupted during and in the immediate aftermath of the war; many Iraqis pointed the finger at the coalition forces for shortcomings and delays.104

      The deterioration of the security situation, particularly in the central part of the country, is critical in this regard. Not only is reestablishing security a key obligation of the Occupying Power, it is also the linchpin for the revival of economic activity and the restitution of public services. The increase in attacks and counterattacks between U.S. forces and opponents of the U.S. occupation has had striking implications for humanitarian organizations, revealing an apparent and deeply troubling paradox. On the one hand, by directly harming an increasing number of Iraqi civilians and delaying the restoration of public services, the fighting and general insecurity suggest an increased need for immediate, life-saving services.105 On the other hand, the violence, insecurity, and particularly the direct attacks against civilians and aid workers have made it increasingly difficult for international aid organizations to provide help and to complement the efforts of Iraqis.106

   5. Aid Organizations Reflect on Their Vulnerability to Attack

      The attacks on the United Nations, NGOs, and the ICRC not only sent a clear signal that the United States had not secured Iraq, but also conveyed the message that all organizations providing assistance were now considered targets, and that international staff were not welcome in Iraq. The initial response of aid organizations to the attacks and to the persistent security threat has been to minimize direct exposure by scaling back programs and staff presence. This reaction is being complemented by reflection on what led the organizations into this predicament and how it can be escaped.

      The attack on the U.N. compound in Baghdad and other serious security incidents seem part of a strategy by extremists to sharpen divisions and intimidate anyone not espousing their cause—the reverse application of President Bush's famous warning: "Either you are with us or with the terrorists."107 It is also clear, however, that the politicization of aid before and during the war, and the resulting absence of clear distinctions between the U.S. government and aid organizations, including those distinctively focused on independent humanitarian action, has created the perception that all assistance is part of the U.S. agenda. As Oxfam spokesman Brendan Cox stated, "The boundaries between the occupying force and the U.N. and the humanitarian community in Iraq is the most blurred it's ever been, anywhere we've worked."108 This perceived unity has increased the vulnerability of all organizations, irrespective of their position or actions. In effect, the bombings and threats indicate that all humanitarian aid groups are being viewed, according to Natsios's pronouncement, as an "arm of the U.S. government."109

      Given a charged history, drawing clear distinctions between humanitarian organizations and politics is not easy. The U.N. relief agencies, in particular, have to contend with a long legacy of being intertwined with the political agenda of the Security Council. The independent panel investigating the August 19 attack on U.N. headquarters, while underscoring serious lapses in security procedures, also emphasized that the "history of the U.N. engagement in Iraq in the eyes of the Iraqi population" was an important additional risk factor. The panel noted:

      the U.N. system is viewed by many to be at the origins of the imposition of the longest and most stringent sanctions regime ever, the deployment of the most invasive weapons inspection programmes and the conduct of the oil-for-food programme, where for over a decade the U.N. system controlled much of the oil production of Iraq. This cumulative experience is now coming up as a liability as the Organization is redefining its role in the country.110

      In the same vein, internal discussions among the staff of the United Nations High Commissioner for Refugees (UNHCR) raised critical questions: "How do humanitarian agencies, including UNHCR and its partners, avoid being too closely identified with resisted political and military interventions, as in Iraq," and "[h]ow do we balance the need for a secure political and military environment—essential for our operations—without being seen as humanitarian cover for strenuously contested political action?"111

      Minimizing the safety risks of humanitarian workers in Iraq is difficult. Beyond improving security procedures and adapting operational approaches such as working with and through national staff to lessen visibility, there are few available solutions. As in any conflict, gaining and maintaining the trust and support of the civilian population is critical since humanitarian aid and the presence of international humanitarian workers cannot be imposed.112 Even beyond the specific links between political agenda and assistance that the U.N. Security Council and the U.S. coalition have promoted, it may be that the predominately Western nature of most aid organizations, as evidenced by their history, their headquarters' locations, their funding bases, and most of their international staff, is a uniting feature that makes them vulnerable to attack in contexts where there is radical opposition to Western military and political objectives.113

      It is clear, however, that without a much more vigorous defense of the specifi- city and relevance of independent humanitarian action in both statements and actions, the perception that humanitarian aid is part of the U.S. coalition's political and military strategy will continue to gain the upper hand.114 Given the determination of the most violent opponents to the U.S. presence in Iraq, this will likely make aid organizations increasingly vulnerable to threats and attacks.

   6. U.S. Violations of IHL Strengthen the Need for Humanitarian Independence

      The fact that the United States is an active belligerent makes the need for humanitarian organizations to establish their independence all the more pressing. When armed force is used and when violations of IHL are committed, association with a warring party can have damaging security implications for humanitarian organizations. However, security risks are not the only potential negative result of humanitarian organizations failing to distinguish themselves from a belligerent. Humanitarian action is concerned with the well-being of the civilian population, which entails far more than the provision of material assistance. Humanitarian organizations typically contribute to the protection of non-combatants from undue violence through advocacy, calling attention to and raising concerns about witnessed abuses. Close ties with any belligerent can impede humanitarian organizations from scrutinizing and, where appropriate, criticizing the belligerent's actions, thereby adversely affecting its ability to serv the interests of the civilian population.115

      Despite the widely reported assurances of the United States that it took maximum precautions to spare civilians, violations of IHL leading to the death or injury of non-combatants occurred during the war, and continue to occur in post-war Iraq.116 If anything, concerns about U.S. violations of IHL have become more pressing since the removal of Saddam Hussein, as coalition forces are required to ensure public safety, a task far different than waging open war. With attacks on U.S. soldiers mounting, and force protection a key concern as a result of the growing number of U.S. casualties, the U.S. military is taking no chances. U.S. troops are authorized to use overwhelming force on any entity considered hostile, even if it does not represent an immediate threat and is near civilians.117 Ordinary civilians are being killed and injured at checkpoints, during raids, in response to ambushes, and in riot control actions.118 The number of civilian casualties are unknown because they are not being counted or ecorded by U.S. military or political authorities.119 Media reports provide the only source of information regarding civilian casualties, but tend to focus on the most visible occurrences and do not present a comprehensive picture.120 Only a few investigations of suspected IHL violations have taken place, and the results have generally not been disclosed.121 Human Rights Watch, in a recent report, highlighted this lack of accountability of U.S. soldiers and officers, observing that U.S. forces presently operate with "virtual impunity" in Iraq.122

      Of course, the coalition forces are not alone in committing violations of IHL. Reported Iraqi violations during the war include feigning surrender, converting protected infrastructure such as hospitals into military staging areas, and hiding active combatants among civilians. Since the war, opponents of the U.S. occupation have deliberately targeted civilians in deadly attacks, such as the bombings of the ICRC, U.N. headquarters, and the Imam Ali mosque in Najaf on August 29, and numerous other incidents.123 Such attacks are war crimes.124 Yet this fact does not release the United States from its obligations to respect IHL fully in its military operations.125

      The ongoing post-war fighting in Iraq strengthens the necessity for the United States to fulfill its obligations under IHL in a straightforward and systematic manner instead of viewing the conduct of warfare and provision of assistance primarily through the prism of a "hearts and minds" agenda. It also increases the need for humanitarian organizations to dissociate themselves clearly from the United States as they would from any belligerent, despite its benevolent pronouncements.

5. Iraq as an Extreme Instance of "Coherence" Between Political Objectives and Humanitarian Response

   In many ways, Iraq is an extreme example of broader trends in the international response to crises. For years, the United Nations and powerful donor governments have promoted the virtues of an "integrated approach" or "coherence." They have sought to ensure that all international aid and interventions in a particular crisis are directed towards a common objective: to make, maintain, or build peace and security based on justice, democracy, and sustainable development.126 As such, military interventions to bring stability, political efforts to introduce democracy, human rights attempts to prevent impunity, and humanitarian endeavors to save lives are to be managed in harmony.

   Proponents of a "coherence" approach argue that it is critical to enhance the effectiveness of international interventions.127 Closer integration between aid and political responses considered necessary to address the root causes of conflicts, and to ensure that the provision of humanitarian aid does not fuel political tensions.128 Placing assistance within the pursuit of a higher goal, such as peace-building, is also intended to relieve "donor fatigue" derived from continually remedying the recurrent humanitarian consequences of protracted conflicts.129

   A number of NGOs have embraced the idea of enhancing the relevance of their relief work by placing it within a broader framework of resolving conflict and promoting human rights. The availability of donor funding for "coherence"- based activities has also played a key role in bringing about this change.130

   Since the terrorist attacks of September 11, 2001, the "coherence" agenda has been re-energized and refocused, as the pursuit of peace and security has assumed a new meaning for major Western powers, especially the United States. The "global war on terror" seeks to bring aid organizations into the fold by projecting the view that the Western world faces an existential threat and by arguing that fence-sitting is impossible and ultimately immoral.

   The "coherence" agenda challenges the essence of humanitarian action as a neutral and impartial endeavor. At its core, it implies that aid may be selectively allocated to certain groups of victims, or withheld from others, depending on their political usefulness, instead of being allocated according to, and proportionate to, needs alone.131 The primary concern for humanitarian organizations is that, when political objectives and humanitarian concerns conflict, the hierarchy of priorities inherent in the "coherence" agenda generally results in humanitarian interests being sacrificed in the name of a greater good. Moreover, by presenting aid organizations and governments as partners, the "coherence" approach weakens the ability of humanitarian organizations to hold governments accountable for fulfilling their political and legal responsibilities. Finally, by making aid organizations associates of Western political-military efforts, the "coherence" agenda may designate them as targets of violent opposition thereby hampering their access and ability to deliver assistance, as the current situation in both Afghanistan and Iraq illustrates.132

   A crucial indicator of how much assistance for Iraq served political purposes is its impact on governments' responses to other crises worldwide. To fund aid efforts in Iraq, attention and resources were diverted away from other, more pressing humanitarian needs.133 Once the war started, the U.N.'s emergency appeal for Iraq, the largest in its history at $2.2 billion, was easily funded by donor governments in stark contrast to the U.N.'s appeals for crises with much more significant humanitarian impact, such as those for Burundi, Sudan, or the Democratic Republic of Congo.134 Funding for the U.N.'s Iraq emergency appeal came out to seventy-four dollars per person compared to seventeen dollars per person for the U.N.'s Congo appeal, even though civilian needs were more acute and the U.N.'s programs more limited in the Congo than in Iraq.135 The consolidated U.N. appeal for Iraq was forty-three percent of the total 2003 worldwide appeal, and Iraq garnered fifty-six percent of the actual funding received by U.N. agencies in 2003.136 The United Kingdom's Department for International Development 2003 budget for Iraq assistance was nearly double its 2001 worldwide spending on humanitarian assistance.137 This political slanting of assistance by governments is neither a new phenomenon, nor specific to the Iraq crisis. 138 However, in Iraq, it has reached new and unprecedented heights.139

   Striving to protect and assist all victims according to need alone disturbs the designs of the powerful to abuse, exploit, or neglect. This necessarily places humanitarian actors in a tense relationship with political powers, including those who declare having benevolent intentions. It may be easier to eschew this tension and take a conciliatory approach by participating in what many view, overall, as a positive agenda promoted by Western states. Although this stance may well yield valuable services, effectively covering some of the needs of some populations, it is fundamentally the work of a service provider, not of a humanitarian actor. Instead of following donor governments' leads, humanitarian organizations should resist and contest them in the name of the equal worth of human life.

Conclusion

As we seek to review the ongoing Iraq conflict from a humanitarian perspective, it is essential to remember that humanitarian action is not a political project. It has a limited, modest, yet vitally important ambition to ensure that the most vulnerable are not sacrificed in times of conflict and crisis. The tested principles of neutrality, impartiality, and independence are designed to safeguard the ever-fragile access and security of humanitarian organizations in carrying out this endeavor in volatile, fragmented, and contested environments.

The well-being of the Iraqi population, which can be furthered through the establishment of a secure environment and the provision of basic services such as health, water, and sanitation, is first and foremost a matter of governance that is the legal and political responsibility of the power in charge. As the current governing authority, it is incumbent upon the United States to fulfill its obligations under the Geneva Conventions as an Occupying Power, and to deploy adequate means to meet this responsibility. In conflict and crisis, belligerents have the obligation to allow for unmediated, direct humanitarian assistance to victims, allocated based on need alone.140 In Iraq, the Saddam Hussein regime violated this obligation in many ways, as have the violent opponents of the U.S. occupation, most devastatingly by launching deliberate and targeted attacks on aid organizations and civilians. The United States and its allies, however, have also compromised humanitarian action.

When governments drape their military and political actions in the cloak of humanitarian concerns, they undermine humanitarian action's essential purpose: the unconditional provision of assistance to those in need. When all aid efforts are presented and perceived as being at the service of political and military objectives, it is more difficult and dangerous for independent humanitarian organizations to carry out their work.

While many aid organizations recognized the danger of being too closely associated with contested military and political action, they also refused to make the choice of either fully and openly working with the U.S. government or of decisively pushing back. This indecision fuelled the perception that all aid activities were simply extensions of the U.S. agenda.141

The reason all this matters is that, at particular junctures, humanitarian action could have made more of a difference in Iraq. Humanitarian organizations could have provided more support for Iraqi health professionals and others to assist the population affected by the ongoing conflict. The politicization of humanitarian aid has put the ability of humanitarian organizations to reach out to all victims, whoever and wherever they are, in jeopardy. As fighting continues in Iraq, and as conflicts continue to rage around the world, victims will need more, not less, principled humanitarian action that responds on the basis of needs alone.<

© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)