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American contractor Greg Ock recounts how he was kidnapped, while driving to the clinic where he works, and held hostage in Nigeria.
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Helpers in a hostile world: the risk of aid work grows

Some 242 aid workers were killed in 2010, up from 91 a decade before. Is 'humanitarian space' shrinking, or are aid groups spreading out to more conflict zones than before?

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.

Such attacks, Ms. Hughes says, force aid groups to question not just their security protocols but also their reason to be in a risky zone. "Globally, we do accept a higher level of risk for certain kinds of work, where there is a humanitarian imperative, such as camps where if we pull out then people will die," she says.

Working in the line of fire

If aid workers are getting targeted, it's because they work on the front lines of what is effectively a broader war for political control. In Afghanistan, where US troops and contractors have taken on traditional development work – building schools, digging wells, training hospital personnel – aid workers complain that villagers have difficulty distinguishing between aid workers and combatants.

"The diplomacy, defense, and development approach has had a very significant impact on the humanitarian sector because it's essentially poked the nose of political processes and military processes into traditionally humanitarian spaces and has attempted to co-opt that for political and foreign-policy purposes," says Nic Lee, director of the Afghanistan NGO Safety Office in Kabul. "It undermines the ability of legitimate humanitarian agencies to ... make it clear that they're acting in an impartial, independent way, and they're not part of a broader foreign-policy process."

Deep hostility in Pakistan

Nowhere is the hostility toward foreign aid workers more evident than in Pakistan. Following the devastating flooding of the Indus River in 2010, and again in the spring of 2011, aid workers moved in to help the displaced. Some quickly became targets.

Perhaps the most high-profile of several recent cases is that of Warren Weinstein, a veteran aid worker kidnapped from Lahore, from where he had worked helping small and medium businesses to develop for more than a decade. Al Qaeda in the last week of January released a video saying they would release him if the United States stopped its attacks in Afghanistan, Pakistan, Somalia, and Yemen, but did not provide evidence he was in their custody.

"Now the sense is that no area is safe in Pakistan anymore except for Islamabad," says a translator for a multinational nongovernmental organization who has lived in Pakistan for years (he was unable to give his name because he isn't authorized to talk to the media). "Even those areas traditionally considered safe, like Punjab and Sindh, are no longer so."

Blurry motives for attackers

In Somalia, where two MSF workers were killed in Mogadishu last December, and two more kidnapped from a Kenyan-based refugee camp this year, workers can no longer assume that their lifesaving work will be their best protection. Somalia is a clan-based society, where the death of a local fighter in a US drone strike may prompt the dead fighter's clan to kidnap or kill a Western aid worker in revenge.

"The US government recently conducted a successful operation to get two aid workers, and judging from the mood of the Somali community and the way this is discussed on Somali language radio, the majority of Somalis are in favor of that outcome," says Rashid Abdi, a consultant for International Crisis Group in Nairobi, Kenya. "But … it is not going to be an easy terrain for aid workers to work in the future."

• Correspondents Tom A. Peter and Is­sam Ahmed contributed from Kabul, Af­ghan­istan, and Islamabad, Pakistan, respectively.

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