On Monday, a series of aerial bombs struck Sudan's South Kordofan province, home to communities who are sympathetic to the newly formed country of South Sudan. Two bombs in particular struck a hospital run by the humanitarian medical organization Médecins Sans Frontières/Doctors Without Borders (MSF). According to MSF, the bombs destroyed the emergency room, a dressing room, the pharmacy, and the hospital kitchen. In total, six people were injured, including one MSF worker.
As has become the norm, a military spokesman from the Sudanese Air Force denied its involvement. But the Sudanese government in Khartoum has been waging a campaign against the ethnic Nubans of Kordofan for the past several years, and it's unlikely the Nubans bombed themselves with their non-existent Air Force. According to MSF Head of Mission Brian Moller, the hospital was marked with “a medical red cross.” Moller emphasized, “We also had previously communicated the hospital’s position to the authorities in Khartoum.”
So while it's unclear whether MSF was targeted directly, it is clear that it's becoming more and more dangerous to be an aid worker. According to USAID statistics on international aid worker security in the last decade, the number of violent incidents against humanitarians has quadrupled, going from 63 in 2003 to 238 in 2013. Last year represented the high-water mark, with 153 aid workers killed, almost double the number killed during the height of the Iraq war in 2007.
The humanitarian space is shrinking, meaning it’s become increasingly difficult to help victims of conflict without becoming a victim of the conflict as well.
In 2010, I observed this phenomenon myself. I was deployed to Pakistan with Team Rubicon, a group of veterans who provide humanitarian aid in disaster zones. A dozen of us had volunteered to help with a medical mission to deliver support in the aftermath of record floods. More than one-fifth of the country was underwater, and a large swath of Pakistan's population was facing hunger and disease. Yet despite the scale of the disaster, there were very few other international aid organizations on the ground.
This lack of international response was due in large part to security concerns. The Pakistani Taliban had issued a public statement that they would be targeting Western aid workers who were responding to the floods. Most aid organizations had made the understandable calculation that the risk was too high. Sitting in a makeshift clinic that we had set up in northern Pakistan, I remember speaking with one of the few other Westerners who had risked the journey with us, a 30-year veteran of disaster response. "It used to be that you could practically drive an IRC [International Red Cross] truck through a firefight and nobody would shoot at you," he told me. "It was almost like the cross was a bulletproof vest. Now it’s a bullseye.”
Certainly the vast majority of humanitarian workers are able to conduct business without molestation. Nor is the accidental killing of humanitarians anything new — aid workers in conflict zones have always faced risks. What is new, however, is the targeting of aid workers and the increase in the number of attacks, kidnappings, and killings directed at them. In the Central African Republic (CAR) over the past 16 months, MSF teams have experienced 115 security incidents, 31 of which were armed attacks. In 2013, two MSF staff members and a patient were killed. In Somalia, which has become one of the most dangerous places in the world for humanitarian operations, MSF was forced to pull out in 2013 after several workers were targeted and killed. It ended almost 22 years of continuous MSF presence that began during the brutal civil war of the 1990s. "[Somalia] has always been a dangerous place," the organization stated when it left. "There's a limit to what we can accept, and the conditions that allow and permit humanitarian assistance in Somalia are no longer there."
People in the aid community suggest a contributing factor to the shrinking humanitarian space is the military’s involvement in humanitarian assistance and how it blurs the line between aid and military operations.
There are several explanations for the rising risk of being a humanitarian worker. The nature of asymmetric warfare and counterinsurgency, along with the rise of non-state actors, appear to be changing the landscape. In traditional uniformed warfare with defined fronts, the distinction between combatants and non-combatants is more explicit. In the current conflicts in Iraq, Afghanistan, Sudan, Somalia, and the CAR — the most dangerous places in the world to deliver aid — the vicious nature of the combat zones have created more civilian populations in need of care, and put more aid workers in the line of fire.
People in the aid community suggest a contributing factor to the shrinking humanitarian space is the military’s involvement in humanitarian assistance and how it blurs the line between aid and military operations, politicizes aid, and erodes the perception of aid as neutral and needs-based. When the military is conducting humanitarian assistance, it becomes much more difficult or much less necessary for an enemy to distinguish between combatants and non-combatants. In her book Helping Hands & Loaded Arms: Navigating the Military and Humanitarian Space, author Sarah Jane Meharg argues that “a military involved in combat, while also conducting humanitarian operations in the same context, puts at risk both the civilians caught in the conflict and civilian agencies providing assistance.”
Most humanitarian organizations recognize that there is a time and place for the military to be involved with humanitarian assistance operations. This past November, I was in the Philippines, responding to Typhoon Haiyan victims. Military aid and airlift was essential and non-controversial. But in some of the toughest conflicts in the world, the militarization of aid and the exploitation of that access by the military to conduct intelligence-gathering operations has been criticized for blurring the line between helping and hurting. The most high-profile example of this — although outside the context of the military — was the use of a CIA polio vaccination ruse to attempt to establish the identity of Osama Bin Laden in Abbotabad, Pakistan. The doctor involved with the operation has been arrested, and it's been reported that polio vaccinations have suffered a severe setback regionally. The CIA announced in May it will no longer use vaccinations as cover for operations or as a tool for intelligence gathering.
Still, the military is continuing to invest in humanitarian assistance and operations, a practice that continues to concern aid organizations. A 2013 report from the US Navy listed $7.1 million dollars in humanitarian aid destined for Africa.
Humanitarian corridors, safe spaces, demilitarized zones, and a commitment to work in conjunction with military forces to establish new protocols may provide some relief for aid workers in harm's way. But regardless, despite the dangers, many of the most dedicated humanitarians are simply willing to accept greater risk. In Sudan, MSF workers returned to the hospital to treat wounded villagers. “Damage to the Farandalla hospital is significant, but MSF will continue to work there,” a spokesperson for MSF said.
Sometimes in times of need, the good outweighs the grave.
VICE News Los Angeles Bureau Chief Kaj Larsen is a former Navy SEAL who has been involved in humanitarian operations in dozens of countries including Afghanistan, Pakistan, the Philippines, Somalia, and Kenya. He currently serves on the Board of Advisors and as a volunteer with Team Rubicon.