1. The Humanitarian System is Not Just Broke, but Broken: recommendations for future humanitarian action
Paul B. Spiegel MD, MPH
Professor, International Health, Johns Hopkins Bloomberg School of Public Health
Director, Center for Humanitarian Health, Johns Hopkins University

2. of Forced Displacement
Magnitude and Cost
of Forced Displacement

3. Figures for Forced Displacement (end of 2016)

4. Refugees (end of 2016)

5. Internally Displaced Persons (IDPs – end of 2016)

6. Funding for Humanitarian Assistance (end of 2016)

7. Funding for Humanitarian Assistance (end of 2016)

8. Humanitarian Norms
and Current Trends

9. The Humanitarian ‘Norm’ was… (and still is)
Low income countries in Sub- Saharan Africa
Corinne Baker/MSF, 2013
South Sudanese refugees in Kenya
Mandel Ngan, 2013
Za’atri refugee camp, Jordan

10. The Humanitarian ‘Norm’ was… (and still is)
Low income countries in Sub- Saharan Africa
Persons in refugee camps
Corinne Baker/MSF, 2013
South Sudanese refugees in Kenya
Mandel Ngan, 2013
Za’atri refugee camp, Jordan

11. The Humanitarian ‘Norm’ was… (and still is)
Low income countries in Sub- Saharan Africa
Persons in refugee camps
Weak governments and few functioning national NGOs
Corinne Baker/MSF, 2013
South Sudanese refugees in Kenya
Mandel Ngan, 2013
Za’atri refugee camp, Jordan

12. The Humanitarian ‘Norm’ was… (and still is)
Low income countries in Sub- Saharan Africa
Persons in refugee camps
Weak governments and few functioning national NGOs
Communicable diseases
Corinne Baker/MSF, 2013
South Sudanese refugees in Kenya
Mandel Ngan, 2013
Za’atri refugee camp, Jordan

13. Current Trends Prolonged crises
>90% of countries with humanitarian crises had humanit. appeals for >3 years

14. Current Trends UN and Int’l NGOs receive funds
Prolonged crises
>90% of countries with humanitarian crises had humanit. appeals for >3 years
UN and Int’l NGOs receive funds
UN agencies and largest INGOs received 81% of humanit. assistance ( )
Local and national NGOs directly received just 0.2% of total humanit. assistance (2014)

15. Current Trends Increasing, new and complex mix of actors
Prolonged crises
>90% of countries with humanitarian crises had humanit. appeals for >3 years
UN and Int’l NGOs receive funds
UN agencies and largest INGOs received 81% of humanit. assistance ( )
Local and national NGOs directly received just 0.2% of total humanit. assistance (2014)
Increasing, new and complex mix of actors
Increasing number with varying competence
National gov’ts and local NGOs taking lead
Middle East gov’ts, Islamic agencies, and priv. sector

16. Syria

21. Future Humanitarian Action
Recommendations for
Future Humanitarian Action

22. Recommendations for Future Humanitarian Action
Operationalise concept of ‘centrality of protection’
Integrate affected persons into national health systems by addressing humanitarian-development nexus
Remake not simply revise leadership and coordination
Make interventions more efficient, effective and sustainable
Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017; (Series: Health in Humanitarian Crises):

23. Operationalise concept of ‘centrality of protection’
Recommendations:
Interpret centrality of protection in inclusive manner
Interpret centrality of protection in inclusive manner where health interventions are considered basic lifesaving protection interventions, while ensuring such health services are protection-sensitive
Always translate resolutions and laws into practical responses with concrete actions that can be monitored to sanction state and non-state actors who violate them
Do not restrict population movements nor undertake mandatory testing in humanitarian emergencies except under exceptional circumstances

24. Operationalise concept of ‘centrality of protection’ Recommendations:
Interpret centrality of protection in inclusive manner
Translate resolutions and laws into concrete actions including sanctions
Interpret centrality of protection in inclusive manner where health interventions are considered basic lifesaving protection interventions, while ensuring such health services are protection-sensitive
Always translate resolutions and laws into practical responses with concrete actions that can be monitored to sanction state and non-state actors who violate them
Do not restrict population movements nor undertake mandatory testing in humanitarian emergencies except under exceptional circumstances

25. Recommendations: Operationalise concept of ‘centrality of protection’
Interpret centrality of protection in inclusive manner
Translate resolutions and laws into concrete actions including sanctions
Do not restrict pop. movements nor undertake mandatory testing in humanit. emergencies except under exceptional circumstances
Interpret centrality of protection in inclusive manner where health interventions are considered basic lifesaving protection interventions, while ensuring such health services are protection-sensitive
Always translate resolutions and laws into practical responses with concrete actions that can be monitored to sanction state and non-state actors who violate them
Do not restrict population movements nor undertake mandatory testing in humanitarian emergencies except under exceptional circumstances

26. Integrate affected persons into national health systems by addressing the humanitarian- development nexus
Recommendations:
Take into account existing development health strategies
in situations where existing systems cannot be quickly capacitated to respond, when humanitarian principles cannot be upheld, or security reasons are paramount
important differences in terms of legal rights, international law, choices and options, and coping mechanisms according to status of affected persons

27. Integrate affected persons into national health systems by addressing the humanitarian- development nexus
Recommendations:
Take into account existing development health strategies
Integrate affected pop. into national health systems; avoid parallel health services
in situations where existing systems cannot be quickly capacitated to respond, when humanitarian principles cannot be upheld, or security reasons are paramount
important differences in terms of legal rights, international law, choices and options, and coping mechanisms according to status of affected persons

28. Integrate affected persons into national health systems by addressing the humanitarian- development nexus
Recommendations:
Take into account existing development health strategies
Integrate affected pop. into national health systems; avoid parallel health services
Compensate for temporary disruption of national cost-recovery systems
in situations where existing systems cannot be quickly capacitated to respond, when humanitarian principles cannot be upheld, or security reasons are paramount
important differences in terms of legal rights, international law, choices and options, and coping mechanisms according to status of affected persons

29. Integrate affected persons into national health systems by addressing the humanitarian- development nexus
Recommendations:
Take into account existing development health strategies
Integrate affected pop. into national health systems; avoid parallel health services
Compensate for temporary disruption of national cost-recovery systems
Equitable access to quality health services should be available to all persons in specific area regardless of status
in situations where existing systems cannot be quickly capacitated to respond, when humanitarian principles cannot be upheld, or security reasons are paramount
important differences in terms of legal rights, international law, choices and options, and coping mechanisms according to status of affected persons

30. Remake not simply revise leadership and coordination
Recommendations:
Undertake wholesale reform of humanitarian leadership and coordination
More customised approach
Fewer UN and int’l operational agencies
Prioritisation of key interventions by leader with sufficient authority
Undertake wholesale reform of humanitarian leadership and coordination
More customised approach delivered in varying combinations with ability to flexibly scale up & down is needed rather than ‘set’ package
Fewer UN and international agencies that are operational should be chosen to respond in certain large scale emergencies
Prioritisation of key interventions must occur by a leader who has sufficient authority
Monitor closely UN and INGOs who must relinquish some influence and authority
Monitor closely WHO’s humanitarian reform process to ensure fundamental changes are made
Rebecca Blum, Haiti, 2010

31. Remake not simply revise leadership and coordination
Recommendations:
Undertake wholesale reform of humanitarian leadership and coordination
More customised approach
Fewer UN and international operational agencies
Prioritisation of key interventions by a leader with sufficient authority
Monitor closely
UN and INGOs who must relinquish influence and authority
Monitor closely WHO’s humanitarian reform process to ensure fundamental changes are made
Undertake wholesale reform of humanitarian leadership and coordination
More customised approach delivered in varying combinations with ability to flexibly scale up & down is needed rather than ‘set’ package
Fewer UN and international agencies that are operational should be chosen to respond in certain large scale emergencies
Prioritisation of key interventions must occur by a leader who has sufficient authority
Monitor closely UN and INGOs who must relinquish some influence and authority
Monitor closely WHO’s humanitarian reform process to ensure fundamental changes are made
Rebecca Blum, Haiti, 2010

32. Make interventions more efficient, effective and sustainable
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure at the beginning of an emergency recognising that refugees and IDPs will likely be in protracted settings; this will save money in the long run (donors, private sector).
Initiate multi-year funding for health, nutrition and WASH-related activities to allow for sustainable interventions that will improve integration into and national health services in the coming years (donors, private sector).
Actively and systematically scale up cash-based transfers, particularly multi-purpose cash transfers, in humanitarian emergencies following context-specific assessments (donors, private sector).
Undertake research on conditional and unconditional CBTs as well as remittances for health, WASH and nutrition interventions in humanitarian emergencies to build up the evidence base and provide future guidance.
Explore different health financing models for humanitarian emergencies such as pay for success financing and other social impact bonds as well as health insurance (all partners).
Provide guidance according to context and data as to which sectors should be prioritised according to need and which interventions within sectors should prioritised according to efficacy and cost-effectiveness (all partners).

33. Make interventions more efficient, effective and sustainable
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure
Initiate multi-year funding
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure at the beginning of an emergency recognising that refugees and IDPs will likely be in protracted settings; this will save money in the long run (donors, private sector).
Initiate multi-year funding for health, nutrition and WASH-related activities to allow for sustainable interventions that will improve integration into and national health services in the coming years (donors, private sector).
Actively and systematically scale up cash-based transfers, particularly multi-purpose cash transfers, in humanitarian emergencies following context-specific assessments (donors, private sector).
Undertake research on conditional and unconditional CBTs as well as remittances for health, WASH and nutrition interventions in humanitarian emergencies to build up the evidence base and provide future guidance.
Explore different health financing models for humanitarian emergencies such as pay for success financing and other social impact bonds as well as health insurance (all partners).
Provide guidance according to context and data as to which sectors should be prioritised according to need and which interventions within sectors should prioritised according to efficacy and cost-effectiveness (all partners).

34. Make interventions more efficient, effective and sustainable
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure
Initiate multi-year funding
Actively and systematically scale up cash-based transfers
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure at the beginning of an emergency recognising that refugees and IDPs will likely be in protracted settings; this will save money in the long run (donors, private sector).
Initiate multi-year funding for health, nutrition and WASH-related activities to allow for sustainable interventions that will improve integration into and national health services in the coming years (donors, private sector).
Actively and systematically scale up cash-based transfers, particularly multi-purpose cash transfers, in humanitarian emergencies following context-specific assessments (donors, private sector).
Undertake research on conditional and unconditional CBTs as well as remittances for health, WASH and nutrition interventions in humanitarian emergencies to build up the evidence base and provide future guidance.
Explore different health financing models for humanitarian emergencies such as pay for success financing and other social impact bonds as well as health insurance (all partners).
Provide guidance according to context and data as to which sectors should be prioritised according to need and which interventions within sectors should prioritised according to efficacy and cost-effectiveness (all partners).

35. Make interventions more efficient, effective and sustainable
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure
Initiate multi-year funding
Actively and systematically scale up cash-based transfers
Explore different health financing models
Provide guidance on prioritisation
Recommendations:
Provide upfront investment by donors in health and WASH infrastructure at the beginning of an emergency recognising that refugees and IDPs will likely be in protracted settings; this will save money in the long run (donors, private sector).
Initiate multi-year funding for health, nutrition and WASH-related activities to allow for sustainable interventions that will improve integration into and national health services in the coming years (donors, private sector).
Actively and systematically scale up cash-based transfers, particularly multi-purpose cash transfers, in humanitarian emergencies following context-specific assessments (donors, private sector).
Undertake research on conditional and unconditional CBTs as well as remittances for health, WASH and nutrition interventions in humanitarian emergencies to build up the evidence base and provide future guidance.
Explore different health financing models for humanitarian emergencies such as pay for success financing and other social impact bonds as well as health insurance (all partners).
Provide guidance according to context and data as to which sectors should be prioritised according to need and which interventions within sectors should prioritised according to efficacy and cost-effectiveness (all partners).

36. Summary
Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

37. Summary
Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

38. Summary
Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

39. Summary
Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017.

40. Forgotten Emergencies

41. Forgotten Emergencies
South Sudan

42. Forgotten Emergencies
South Sudan
Central African Republic

43. Forgotten Emergencies
South Sudan
Rohingyha conflict in Myanmar
Central African Republic
Khin Maung Win, AP, 2012

44. HopkinsHumanitarianHealth
Vision
To pursue new knowledge and disseminate this learning to save lives and reduce human suffering and the consequences of humanitarian emergencies and disasters
HopkinsHumanitarianHealth.org
@Humanit_Health
HopkinsHumanitarianHealth