Book review - Hope for the best - Prepare for the worst

Peter Border reviews Hope for the best - Prepare for the worst, by Hilary Bower, Egbert Sondorp, Geoff Prescott, Linda Doull and Aroop Mozumder, published by the London School of Hygiene and Tropical Medicine and Merlin

War against Iraq is looming large. If and when it happens, it will be largely up to humanitarian organisations to "pick up the pieces". Non-governmental organisations (NGOs) such as Oxfam, MSF and the International Red Cross will supply shelter, food, water, basic sanitation and medical care to those displaced by war. Providing such services in war zones is difficult enough at the best of times. But a war in Iraq poses a new threat - the potential use of weapons of mass destruction (WMD) such as biological or chemical agents. Those who advocate war in Iraq do so (at least in part) on the basis that Saddam possesses such weapons. In addition to the risk that Iraq may be prepared to use these weapons in the event of war, there is also the possibility of inadvertent release of biological/chemical agents during the course of a military action. Whether deliberate or accidental, any release would pose new challenges for front-line workers with humanitarian organisations. The extent of these challenges, and options for dealing with them are the subject of a recent report, Hope for the best - Prepare for the worst, prepared jointly by the London School of Hygiene and Tropical Medicine and the UK-based medical charity Merlin.

A central focus of this report is the relationship between NGOs and the military. This arises because it is the military that has the know how and equipment to deal with WMD. Soldiers have protective suits, access to protective vaccines and drugs, high-tech "real time" detection systems and have been trained in decontamination and other operational methods. Front-line workers in humanitarian agencies have no such equipment and have received little or no such training. So humanitarian organisations have much to gain from working closely with the military; this could help them know when a release of WMD has taken place and assist them in protecting and training their front-line workers. But working closely with the military presents humanitarian organisations with a dilemma. Humanitarian action relies on the principle of impartiality, with assistance being given on the basis of need without discrimination. The closer the links between humanitarian groups and the military, the more such groups risk jeopardising their neutrality. For instance, as the report points out, there are already those who feel that the UN has compromised its credibility as a co-ordinator of impartial humanitarian activity by sanctioning military action in the first place.

So where does this leave the humanitarian organisations? They can attempt to go it alone, ignore the military completely and develop their own specialised capacity to respond to WMD, although this would be expensive and time-consuming. They can opt out, and decide that humanitarian aid cannot be given in an effective and principled manner where WMD are involved - although this risks damaging the reputation of the humanitarian movement. Or, and this is the option favoured by the report, they can attempt to establish some middle ground, by openly debating under what circumstances it might be acceptable to co-operate with the military. This could involve restricting co-operation to training exercises prior to any conflict. Or it could mean tapping into military expertise to establish an independent humanitarian team capable of responding to WMD but that was free from political or military control. The report emphasises that the window of opportunity for conducting such a debate and for acting on agreed principles is closing rapidly.

In addition to developing channels of communication with the military the report identifies a number of technical steps that NGOs could put in place now. These include offering humanitarian workers vaccines to protect against smallpox and anthrax, and being given training to help them recognise and treat exposure to WMD. It outlines the need for key emergency drugs and equipment to be sourced and made ready for rapid deployment, and for establishing teams of technical experts to advise humanitarian groups in the event of a release. While the report is focused on the role of humanitarian groups, in the post-September 11 world, technical measures for improving surveillance and preparedness for dealing with exposure to WMD are issues that have much wider relevance.