By Julie E. Fischer – A month after Cyclone Nargis pummeled Burma/Myanmar on May 2, less than half of the estimated 2.4 million people affected have received any humanitarian assistance. The World Health Organization (WHO) and its partners are assessing the extent to which the ongoing lack of safe water, food, shelter, and medical services have spawned infectious disease outbreaks. Many of the Irrawaddy Delta’s rice paddies remain smothered with brackish mud, threatening food security for months to come.
Myanmar’s ruling generals have stalled and stymied aid for their people with a flare that would border on the farcical if so many lives were not at stake, but how far should the international community go to rescue the Burmese people – and their leaders – from spectacularly bad governance? French Foreign Minister Bernard Kouchner, a founder of the medical aid organization Doctors Without Borders, has argued that the international community can and should force the generals to allow aid workers necessary access by authority of the UN Security Council. Although Chinese and Russian objections stand in the way of such a resolution, international voices continue to clamor for the protection of the Burmese people, by force if necessary, under the relatively new doctrine known as the Responsibility to Protect (R2P).
The humanitarian dilemma in Myanmar is acute and the junta’s ongoing obstruction of large-scale aid leaves thousands of lives at risk, but is R2P the right framework? The R2P doctrine arose to establish a “just cause threshold” for international military intervention to protect civilians whose governments perpetrate or fail to shield them from atrocities such as genocide, war crimes, and ethnic cleansing. Its framers explicitly rejected the idea that R2P extends to health disasters such as HIV/AIDS. Failure to prevent unnecessary deaths in the wake of natural disaster falls into a grey area: the actions of Myanmar’s generals certainly meet the R2P threshold of “large scale loss of life…with genocidal intent or not, which is the product either of deliberate state action, or state neglect or inability to act.”
On the other hand, would forced disbursement of international assistance using military logistics – an aid invasion – actually help the storm’s victims? UN officials have rejected “confrontational” paths to force aid on an already paranoid junta as unproductive in negotiating access for aid workers. U.S. Defense Secretary Gates described the generals’ policy as “criminal neglect,” but demurred on forcing supply drops or other actions sure to be perceived as hostile. Some concerns are purely practical: unmonitored aid dropped from the skies may not reach those in the greatest need and cannot include technical assistance for sustainable recovery. Aid-by-force could elicit reprisals, violent or bureaucratic, against non-governmental humanitarian aid workers as well as military forces. The fledgling concept of R2P appears too narrow and too fragile to test when the outcome of delivering assistance by force remains unpredictable. That doesn’t mean that the international community shouldn’t evolve doctrines to deal specifically with natural disasters and health crises made worse by governance failures.
Current global health security strategies focus primarily on states’ obligations to the international community rather than to their own people, a doctrine that could be called “the responsibility to report.” Accelerated by the 2003 SARS epidemic (when China delayed reporting an emerging outbreak that eventually took a global toll), WHO implemented a new international health regulatory framework requiring member states to build capacity for detecting and reporting public health emergencies that could spill across borders. In return, the international community can offer technical assistance to mitigate a crisis. This system alerts developed nations to potentially explosive outbreaks, a shield against future SARS scenarios. However, few resources have been made systematically available to help developing nations build sustainable disaster and health emergency preparedness.
Myanmar may represent a uniquely perfect storm: a natural disaster in an ecosystem made fragile by agricultural exploitation, against a background of misgovernance by a regime more bent on protecting its increasingly fragile hold on internal security in the face of political pressure than saving its people. On the other hand, the same might be said of the more slowly unfolding hunger crisis in North Korea, or the endemic disease burden in dozens of fragile states. Climate change is expected to increase the frequency of disasters in Asia and elsewhere; without mechanisms and strategies to build community, state, and regional resilience, the poor will continue to lack resources to cope with natural disasters and other threats to human security.
At the moment, aid workers on the ground have few options beyond helping the victims of Cyclone Nargis salvage what they can of their lives while unintentionally succoring a junta that will live to misgovern another day. As genocides in Cambodia, Rwanda, and Bosnia spurred the evolution of the R2P doctrine to prevent sovereign states from permitting or committing crimes against humanity, Cyclone Nargis and the generals should serve as the springboard for an active global dialogue on the international community’s responsibility to protect human health and livelihoods in the face of disaster. If R2P is not quite the right fit, the humanitarian and global health communities must begin to explore a paradigm based on reciprocal responsibility. Health is the ultimate global public good: limiting disease outbreaks and mitigating health consequences of disasters in one nation benefits all in our increasingly interdependent, globalized economy. All-out aid after a disaster is not enough; sustained and sensitive international investment is needed to strengthen the most vulnerable states and regions before the next crisis. In a paradigm based on mutual amelioration of global risk, the international community could focus on balancing sovereignty, building trust and transparency, and – when the next dual catastrophe of nature and poor governance strikes – defining a clear mandate for humanitarian assistance offers that sovereign states cannot refuse.
photo credit: International Federation of Red Cross and Red Crescent Societies
Dr. Julie E. Fischer leads the Global Health Security program at the Henry L. Stimson Center.