From remote control to remote management, and onwards to remote encouragement? The evolution of MSF's operational models in Somalia and Afghanistan

Hofman, Michiel; Pérache, André Heller

doi:10.1017/s1816383115000065

Cited by 8 publications

(6 citation statements)

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“…The need to link emergency funding and programming to longer term development is the dominant position in the contemporary discourse on humanitarian action, linked to the 'localisation agenda' promoting the building of local capacity to ensure that humanitarian responses are locally led [13]. The transference of risk from international to local actors is a sometimes invoked as corollary however, [14] particularly in the context of conflict and insecurity, and our study participants highlighted various existing examples risk transference in the Somali context.…”

Section: Discussionmentioning

confidence: 90%

Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study

et al. 2020

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Background: Somalia has been ravaged by more than two decades of armed conflict causing immense damage to the country's infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000. Methods: The study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility staff. Qualitative data were analyzed using latent content analysis. Results: The available quantitative data on intervention coverage in Somalia are extremely limited, making it difficult to discern patterns or trends over time or by region. Underlying sociocultural and other contextual factors most strongly affecting the humanitarian health response for women and children included clan dynamics and female disempowerment. The most salient operational influences included the assessment of population needs, donors' priorities, and insufficient and inflexible funding. Key barriers to service delivery included chronic commodity and human resource shortages, poor infrastructure, and limited access to highly vulnerable populations, all against the backdrop of ongoing insecurity. Various strategies to mitigate these barriers were discussed. Incountry coordination of humanitarian health actors and their activities has improved over time, with federal and state-level ministries of health playing increasingly active roles. Conclusions: Emerging recommendations include further exploration of government partnerships with privatesector service providers to make services available throughout Somalia free of charge, with further research on innovative uses of technology to help reaches remote and inaccessible areas. To mitigate chronic skilled health worker shortages, more operational research is needed on the expanded use of community health workers. Persistent gaps in service provision across the continuum must be addressed, including for adolescents, for example. The is also a clear need for longer term development focus to enable the provision of health and nutrition services for women and children beyond those included in recurrent emergency response.

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Section: Discussionmentioning

confidence: 90%

Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study

et al. 2020

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“…Once considered a temporary measure and only used as a “last resort,” remote management has recently become a standard or semi-permanent modality adopted in many locations including Afghanistan, Iraq, Somalia, Sudan, South Sudan, Syria, Angola, Sri Lanka, Uganda, Chechnya, and Pakistan (Howe et al, 2015, p. 31). RML allows international humanitarian NGOs to access hard-to-reach areas during conflict, react rapidly to sudden crises, gain greater acceptance by local communities, identify security threats, and quickly determine needs (;Hofman & Pérache, 2014). International NGOs rarely discuss the fact that localisation protects their expatriate staff from the same dangers that local teams face.…”

Section: Localisation Theory and Practicementioning

confidence: 99%

From Theory to Practice: A Study of Remotely Managed Localised Humanitarian Action in Syria

Elkahlout¹,

Elgibali

2020

Journal of Peacebuilding & Development

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With unique strengths, problems, and challenges, localisation is an increasingly important modality for humanitarian relief. Based on the primary research including interviews with practitioners who are expert and experienced in localisation and remote management in Syria, the article offers an important case study of remote management during conflict, with analysis of local staff adherence to humanitarian principles and standards, local access and acceptance in conflict zones, the dynamics between international and local organisations and staff, the transfer of decision making from international nongovernmental organisations (NGOs) to local NGOs, and the potential risks involved. It argues that localisation has inherent strengths due to the social advantages of local staff but lacks sufficient institutional support from the international humanitarian system and that there are ethical and legal problems with transferring risk and security considerations for local NGOs.

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“…Intense circular flows of persons, information and norms across health networks to deliver medical aid inside Syria suggest that it is “time to let go” of strict categorisation and hierarchy of actors [27]. Our findings do not support the validity of a model in which local partners can be “remotely managed” or “encouraged” from outside Syria [1]. Dewachi and colleagues used the concept of therapeutic geographies “defined as the geographic reorganisation of health care within and across borders under conditions of war” [13].…”

Section: Discussionmentioning

confidence: 58%

“…Increasingly, working through various local aid actors with better access to affected populations is preferred to direct operations. In a growing number of humanitarian crises, “remote management” has been negotiated across borders and implemented by humanitarian agencies to deliver humanitarian assistance, often with a local actor implementing services on the ground [1]. Narratives of this modality of delivering aid arguably remain reductionist, particularly with regards to the involvement of local actors and the underlying political nature of the localisation of aid.…”

Section: Introductionmentioning

confidence: 99%

Localisation and cross-border assistance to deliver humanitarian health services in North-West Syria: a qualitative inquiry for The Lancet-AUB Commission on Syria

et al. 2019

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Background In a growing number of humanitarian crises, “remote management” is negotiated across borders and implemented by humanitarian agencies through “local actors” to deliver assistance. However, the narrative describing the involvement of local actors in the delivery of humanitarian aid in armed conflict settings remains reductionist and unreflective of the complex and circular course of the “localisation of aid”. This paper explores cross-border humanitarian assistance within the Syrian conflict. We document how humanitarian actors operate to deliver humanitarian health care in North-West Syria (Turkish border), explore their challenges and critique the language used within current debates on the localisation of aid. Methods We undertook key informant interviews with Turkey-based humanitarian aid professionals involved in the humanitarian health response inside Syria. We integrated data previously collected for The Lancet -American University of Beirut Commission on Syria during field work in Gaziantep, Turkey, through meetings, conversations, discussions and expert consultations with Syrian health professionals, WHO-Turkey staff members and members of Syrian health directorates. We also drew from background desk reviews conducted by the Commission on health systems responses and timeline of events in Turkey during the Syrian conflict. Results This paper uncovers creative and effective bottom-up strategies that enhanced cross-border coordination of aid delivery into Syria. Our findings unravel the key role played by Syrian providers in accessing vulnerable populations and in reshaping coordination and funding mechanisms inside Syria, as well as the disproportionate risks local actors bear within the response. Our findings also reveal an iterative negotiation of decision-making dynamics, a “low-profile approach” promoted to gain access to populations of concerns, and an environment that is heavily shaped by close interpersonal relationships and social trust. Conclusions Our multifaceted narrative unpacks circular flows of interactions among actors and uncovers strategies developed by practitioners on the field, which are often left undocumented. We argue that there is an opportunity for the humanitarian sector to learn from these synergies to rethink how medical humanitarianism is framed (hopefully leading to a more collaborative framing that resists mainstreaming “local” actors within a “traditional” system). There is also an opportunity for the humanitarian and global health communities to reflect on how value attributed to human lives needs to be questioned in contexts where national staff face a disproportionate risk to deliver aid.

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From remote control to remote management, and onwards to remote encouragement? The evolution of MSF's operational models in Somalia and Afghanistan

Cited by 8 publications

References 1 publication

Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study

Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study

From Theory to Practice: A Study of Remotely Managed Localised Humanitarian Action in Syria

Localisation and cross-border assistance to deliver humanitarian health services in North-West Syria: a qualitative inquiry for The Lancet-AUB Commission on Syria

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