This is a paper I wrote with my colleague Paul Mc Phun.
It outlines the challenges, for humanitarian organizations like MSF, to understand and respond to crisis in urban settings.
It's probably very specific to a few organizations, but that's our little contribution to the debate.
http://sites.google.com/site/urbanworldssite/Home/resourcesNow.. I hope the link works. I anyway copy the introduction here. If you'd like the whole paper please send me a message though the blog.
Here you go:
Challenges in understanding and responding to crisis in urban contexts
March 2008
Paul McPhun and Elena Lucchi
Introduction
It has been widely accepted that the world theatre of conflict is changing, with not only a general decline in the number of cross border conflicts, but an increase in the number of countries emerging from full blown internal conflict to phases of transition or post conflict. In turn there appears to be an increase in the number of hybrid forms of conflict within and across state boundaries, conflict and violence perpetrated by individual or collective groups that is often not political in nature, but instead driven by economic and/or criminal gain. These are not necessarily conflicts restricted by classical territorial boundaries, or carried out by clearly defined (and identifiable) actors. As such the civilian population may no longer be stuck on the wrong side of a border, but instead exposed in ways that allow everyone to become a victim. Urban settings in particular are fast becoming less a safe haven to escape to and more a new territory of opportunity for those with power to extort. At the same time (but only in part due to conflict dynamics) there has never in the history of the known world been such large concentrations of population living in cities and towns – estimates by urban demographers observed that in 2006 roughly half of the world’s population is residing in urban areas. This rapid urbanization is in turn also shaping trends in global peace and security. There are now more ‘child soldiers’ under the employ of urban criminal gangs worldwide than in the organized ranks of insurgent or military groups. Conflict-induced family separation produced a high number of single headed households now living in urban slums; women and children are striving to cope with this change.
The reality is we also find urban living conditions to be far more squalid, unhealthy and despairing than living conditions in conflict affected rural regions or among IDP camp settings, and access to health care where it is present is not necessarily a given. We also find (e.g. in the case of Colombia/Haiti) that conflict can continue in the urban setting in ways that parallels the rural conflict region and/or in different and less obvious or visible forms. Whether by definition we refer to a setting as post conflict (Haiti) or ongoing political/criminal conflict (Colombia) we find in fact very similar violent trends that have a significant impact on the health and wellbeing
of poor urban communities. As MSF however, we find we struggle to defend and justify the need for medical humanitarian action the farther we move away from what is generally accepted as the ‘battle field’ as defined in our strategic plan.1 We would argue however that there are un-met medical humanitarian needs in urban contexts that fit easily within the limits of our Health and Operations Policy ambitions.
Many organizations are coming to the realization that as the scale of ‘classic’ internal and cross border conflict declines; the suffering of populations as direct or indirect victims of violence does not. There is now a growing international awareness that urbanization is becoming untenable representing in some contexts a crisis that far outweighs the impact of ongoing conflict in remaining regions of a given country. That ICRC devoted a good part of its 30th annual conference (Nov 2007) to questioning the movement’s framework for action in violent urban settings is indicative of new debate among humanitarian actors coming to grips with these changing dynamics. Urban settings no longer seem to be the province of development organizations and planners alone, and perhaps even represent the failures of development in what are often increasingly unstable environments.
Evidence from Latin America further challenges the stereotype that poverty is the main cause of violence and shows that inequality and exclusion (neglect, unequal access to employment, education, health and physical infrastructure) intersect with poverty to precipitate violence. At the same time, in context of severe inequality, living conditions of the urban poor heighten the potential for conflict, crime and violence, and also the competition between those who occupy the little urban dwelling space available. As we see in Latin America it is not only countries in active conflict or recent post conflict that could fit criteria for MSF intervention according to its
Strategic Plan.2 Some of the most violent countries are in fact those with arguably no recent history of conflict (Brazil, Guatemala) or others (Mexico, Colombia) where the known armed conflict is not the only trend of violence apparent.
We are aware that people living in some urban settings are traumatized, often homeless,
unprotected, lack basic services, fall under the extortion and control of gangs or more recognized armed groups, crime blossoms as does abuse, alcohol/drug dependency, violence among youth etc. etc. The functioning of health services, security forces, judicial systems, housing, and social services is oftentimes undermined, or even completely corrupted. But despite this, among MSF we still tend to shy away from evaluating the medical (humanitarian?) needs of urban populations outside the conflict zone - largely assuming that populations should be able to benefit from the protection and social (health) services of the local authorities. MSF frequently assumes that there are fewer boundaries that prevent access to care in urban centers, and in our
desire to be impartial we identify more immediately with those people still caught up in conflict being waged elsewhere. These are assumptions that now need to be critically questioned, as does the idea that MSF will do more long term harm than short term good in an urban setting that demands order, social and structural change. How then does violence in urban settings manifest itself and result in unmet medical needs? What are the obstacles to care facing people living in these environments? What are the challenges to accessing these communities and providing medical assistance? And what do current experiences where MSF works in urban settings tell us about these realities, the needs of these communities, our choices and our ability to have an effective role?
One thing should also be clear. One urban setting does not necessarily mirror another, be it between countries, cities or even slums within the same city. There will be no quick fix for transitioning our experience into one ‘global approach’ to urban contexts, anymore than we could do the same between wars in different cultures and continents. MSF OCA does however already work in several urban contexts, (and has a history similar to most of the movement in engaging at times with various priorities such as Watsan in urban settings). This paper reviews (through questionnaire with field, workshops, debate topics, discussion etc.) five countries where MSF OCA now works in urban settings – Nigeria, Colombia, Haiti, Somalia, Papua New Guinea. This is not intended to be an exhaustive review by any means, but a start, in a limited fashion, to explore some current experience relevant to this debate.
