Helpers in a hostile world: the risk of aid work grows

Aid workers may be an idealistic sort, but they're not naive. They know the risks of crossing oceans or pressing through to remote areas to build tent cities, run feeding stations, or treat the sick in what are by definition the most dangerous and least hospitable corners of the planet.

In the decade since Sept. 11, those risks have only increased as members of the US military and other government agencies have joined the ranks of those doing humanitarian aid work.

In 2010, some 242 aid workers were killed, up from 91 a decade before, according to a survey by Humanitarian Outcomes, underscoring how many attacks on aid workers have become intentional, rather than a side effect of war. It's an environment in which the Navy SEALs may be called upon for help, as they were in the recent rescue of two aid workers from the grip of Somali kidnapping gangs.

Yet while individual cases – in a Yemeni town, a region of Sudan, a district of Somalia – may give the impression that aid groups are on the retreat, the reverse is true. Humanitarian aid budgets by donor nations have grown 10-fold between 1998 and 2008. And while the work has become much more dangerous, aid workers are honing their ability to negotiate with unsavory regimes and find new paths to achieve traditional humanitarian goals.

Among the first aid groups to go into conflict zones or disaster areas, and the last to leave, is Doctors Without Borders, known primarily by its French name, Médecins Sans Frontières. But even MSF has had its staffers expelled from Sudan and Sri Lanka and pulled its staff from aid camps in some of the neediest sections of Somalia and the northern Kenyan border because of attacks in recent years.

Michael Neuman, who has headed MSF missions in North Sudan and Niger and has run logistics in battle zones like Chechnya and Kosovo, recently co-wrote a book, "Humanitarian Negotiations Revealed," about the strategies MSF uses in an increasingly hostile world. He says the key in a war zone is to make the best of a bad situation, mediate with local authorities to create working space, and judge success by how many lives one saves.

"People have to realize there was no golden period of humanitarian aid," says Mr. Neuman. "In 1990, after the fall of the Berlin Wall, we hoped the world would be easier to work in.... But then we faced Somalia in the early '90s and the Bosnian war and the genocide in Rwanda, and we had enough examples to let you know that times had not changed."

Neuman's book looks at a number of case studies in which local MSF staff made judgment calls, at times deciding to overlook a government's inhumane actions – such as the aerial bombing of civilian areas in Yemen in 2009 or the shelling of Tamil civilians by the Sri Lankan Army in 2009 – in order to maintain health facilities for larger dependent communities.

What aid groups need to do, Neuman says, is use their ethical and practical judgment to design projects that help as many people as possible and to "make sure they are not causing more harm than good."

Heather Hughes, the global security adviser for Oxfam Great Britain in London, agrees that aid groups have to make decisions based largely on whether the reward of making a difference – in saving lives at Somali refugee camps, for instance – is worth the risk of losing staff members in what appear to be targeted attacks.

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