REVIEW 96 5 History and Principles of Humanitarian Action Heather RYSABACK-SMITH Brown University, Department of Emergency Medicine, USA SUMMARY Humanitarian aid has been present in some form throughout human history, yet the modern concept of humanitarian aid has only truly emerged since the later half of the 20th century. Through a complex progression of world events and largely brought about in response to armed conflict, modern humanitarian aid is provided by a multitude of organizations and actors. The purpose of this chapter is to provide a brief overview of the history of humanitarian action, a review of the principles of humanitarian aid and an overview of the major documents which delineate those principles. Keywords: Humanitarian aid; human rights. Broadly defined, the act of providing material assistance to people in need has existed throughout human history, often in the form of food or material aid provided during famine, drought or natural disaster. Yet the modern concept and system of humanitarian aid as we know it; the impartial, independent and neutral provision of aid to those in immediate danger; has only existed since the mid part of the 20th century. Although a system of international aid first originated after World War I with the Treaty of Versallies, a broadly accepted definition and key principles of humanitarian aid have only become part of conventional wisdom since the 1990s.[1] The underpinning philosophies contributing to humanitarian action are diverse. Multiple religious beliefs such as the concept of Christian charity prevalent in the West and the Islamic tradition of Zakat are reflected, as are ethical concepts of appropriate wartime conduct.[1] Issues surrounding treatment of soldiers and civilians during conflict that has had perhaps the greatest impact on the organization of humanitarian aid into the systems we see today; the horrors of war have led to many of the principles relevant to huma- nitarian aid. The empires of Greece and Rome were among the first to record principles that outlined acceptable conduct in wartim[1]; likewise in “The Art of War” Chinese general Sun Tzu alludes to appropriate conduct during wartime.[2] In more modern times the various Geneva conventions represent a modern consensus on appropriate treatment of civilians, wounded soldiers and prisoners during conflict. During the Black Death Pandemic of the Middle Ages, public health boards were created to handle isolation, quarantine and disposal of bodies and represent the very beginnings of what might be called disaster medicine.[1] Modern technologic advances in weaponry, transportation and communication in the late 1800s enabled not only destruction of human life and property on a never before seen scale; but also the communication of those events to the world at large.[1] This communication and transportation infrastructure also allowed the potential for timely organization and provision of aid for the first time in history. While today humanitarian aid is often thought of as response to natural and manmade disasters such as hurricanes, earthquakes and typhoons, it was once almost exclusively Correspondence: Heather RYSABACK-SMITH, M.D. 32 George St, Warwick, RI, 02888, USA e-mail: © 2015 Emergency Medicine Association of Turkey. Production and Hosting by Elsevier B.V. Originally published in [2015] by Kare Publishing. This is an open access article under CC BY-NC-ND license ( Turk J Emerg Med 2015;15(Suppl 1):5–7 doi: 10.5505/1304.7361.2015.52207 Turk J Emerg Med 2015;15(Suppl 1):5–7 6 related to military conflict. The concept of appropriate treatment of wounded soldiers was put forth by Swiss activist Henry Dunant in “A Memory of Solferino” proposing a permanent relief agency to provide aid to wounded soldiers and civilians during battle.[3] This book prompted the creation of the Red Cross in 1863; one of the first true international aid organizations.[4] The Red Cross received a formal mandate at the first Geneva Convention in 1864 to provide neutral and impartial assistance to civilian and military victims of conflict under the organization of national Red Cross Committees.[4] The very beginnings of international monetary aid can likewise be traced to the late 1800s with the Northern Chinese Famine of 1876-1879, which prompted one of the first formal international relief funds.[5] After World War I, the Treaty of Versailles established the League of Nations, which would become the United Nations (UN); the first permanent international organization tasked with protecting vulnerable populations and maintaining peace.[1] In 1945, the UN ratified the Universal Declaration of Human Rights, for the first time establishing an international precedent for international intervention during both civil and international conflict.[6] At the same time, multiple UN organizations such as UNICEF, the WHO and UNHCR (formerly IRO) were established. Post WWII there was a sudden and unprecedented growth of non-governmental organizations (NGOs), with over 200 organizations established in the 4 years immediately following.[1,7] Aid began to become more global with increasing advances in transportation and communication, and began to shift from Europe to the less developed parts of the world. The term “third world,” was initially used to describe countries not aligned with North Atlantic Trade Organization (first world) or the Soviet Block (second world).[9] It contained many of the poorly developed new, post-colonial governments in Africa, Latin America and Asia and thus over time became collectively used to describe those underdeveloped and impoverished countries.[9] In -cold war humanitarian aid began to be focused on those co-called third world countries as the ideas of development and underdevelopment began to take hold in modern society.[1,7] As NGOs proliferated, so did advertising campaigns with images of starving children, largely African; these images became the dominant Western idea of humanitarian aid which tend to persist to this day.[1] There are many controversies surrounding the modern provision of aid, which are beyond the scope of this chapter; however the modern era can be largely characterized by a shift in thinking from short term aid provision and mitigation of suffering to development, largely provided by so-called developed countries. The rapid growth of NGOs and aid or- ganizations has been attributed to many causes, including increased need in -colonial era, the proliferation of both natural and manmade disasters and an increasingly integrated global system. However, it is important to note that this also points to a potential shift in political and governmental interest and funding, with as-needed provision of assistance preferred over long term and complex developmental strategy.[7] The face of humanitarian aid today is complex, with hundreds if not thousands of NGOs and other organizations from many countries providing a variety of aid and development efforts. Today, both armed conflict and natural disasters affect an ever increasing number of people. Between 1980 and 2004, and estimated two million people were killed and five billion affected by approximately 7,000 natural disasters with staggering economic and social costs.[9] Around the clock media outlets provide to the general public extensive coverage of many of these natural disasters and conflicts, and internet and social media provide easy communication, organization and fundraising. This proliferation has led to both positive and negative developments in aid provision and will likely continue to greatly impact the delivery of aid far into the future. There are four basic principles that govern humanitarian aid: Humanity, neutrality, impartiality and independence. These principles were formally established by the UN General Assembly in 1991 (humanity, impartiality and neutrality) and 2004 (independence)[10,11] and reiterated by the ICRC.[12] Humanity refers to the provision of aid to all who are in need, wherever the need exists, with the purpose to protect and respect all human beings. Neutrality is the responsibility of aid organizations not to choose sides in conflict or to favor a particular political, religious or ideological bent. Impartiality demands aid be given based on need alone and based on any other distinctions including gender, race, nationality, ethnicity, class, political party or religious belief. Finally, independence refers to the requirement that aid organizations are autonomous from any political or military objectives or with those goals in mind.[13] Several well accepted international documents elucidate and expound upon these principles. The UN Code of Conduct, signed by more than 492 aid organizations, provides a set of common standards for organizations involved in the provision of aid and a commitment to the four principles.[13] The code establishes humanitarian assistance as a right to be provided to citizens of all countries, regardless of race, creed or nationality; without political agenda and with the preservation of the recipient’s dignity and respect for the recipient’s culture.[14] It also delineates the need for transparency, capacity building and long-term planning for rebuil- Rysaback-Smith H History and Principles of Humanitarian Action ding and prevention of future disasters[14]; in this way it presents a framework for aid which is both present and forward thinking. The Sphere Handbook was written to develop a set of “minimum standards” for international relief to be adopted by NGOs, government and donor agencies. It was first published as a draft in 1998, and since has gone through several iterations with a cadre of international agencies and impartial observers.[15] The Sphere handbook was devised by the Sphere project, a group of international NGOs who came together with intentions to improve the effectiveness of humanitarian aid and encourage accountability of aid orgnaizations (Gostelow). Underpining humanitarian action are several major principles of humanitarian law, specifically the rules set out by the Geneva conventions of 1949. While not directly addressing aid organizations, they provide some justification for the provision of relief to civilians and wounded military and impose upon the ratifying countries the obligation to allow assistance to be provided.[7] They also insist upon the provision of aid to be impartial, humanitarian and without favoring one particular side of the conflict, thus strengthening the principles of neutrality and impartiality.[7] Today, aid workers face an increasingly complex environment fraught with controversy, political battles and multiple international organizations. This is but a brief introduction to some of the history and principles of humanitarian aid. As conflicts and disasters become more frequent and increasingly geopolitical, adherence to the basic four principles becomes ever more important. To alleviate suffering and mitigate the effects of disasters such always remain at the forefront of provision of aid. References 1. Davey E, Borton J, M Foley. A history of the humanitarian system, Western origins and foundations. HPG Working Paper. London: Overseas Development Institute; 2013. http://www. 2. Sun T. The art of war. Orange Publishing, 2013. 3. Jean-Henry D. A memory of Solferino. Geneva, Switzerland: International Committee of the Red Cross, 1986. 4. ICRC. Discover the ICRC, 2007. Available at: http://www.icrc. org/eng/resources/documents/publication/p0790.htm. Accessed June 1, 2015. 5. China Famine Relief Fund Shanghai Committee. The great famine: report of the committee of the Chine famine relief fund. Shanghai: American Presbyterian Mission Press; 1879. Available at: The_great_famine Accessed May 22, 2015. 6. Marks S. Health and human rights: basic international documents. Cambridge, USA: Harvard University Press; 2006. 7. Mackintosh K. The principles of humanitarian action in international humanitarian law, HPG Report 5. Published March 2000. Available at:, Accessed May 20, 2015. 8. Tomlinson BR. What was the third world. Journal of Contemporary History 2003;307-321. 9. Strömberg, D. Natural disasters, economic development, and humanitarian aid. Journal of Economic Perspectives. 2007:21:199-222. 10. United Nations. Strengthening of the coordination of humanitarian emergency assistance of the United Nations. UN resolution 46/182. Available at:, Published December 1991. Accessed May 16, 2015. 11. United Nations. Strengthening of the coordination of humanitarian emergency assistance of the United Nations. UN resolution 58/114. Published February 2004. Accessed online May 16, 2015. 12. ICRC. Resolutions of the 26th International Conference of the Red Cross and Red Crescent, 01-01-1996. Available at: http:// Accessed May 15, 2015. 13. OCHA. Humanitarian principles. Available at: http://www. Accessed May 10, 2015. 14. ICRC. Code of conduct, 1994. Available at: http://www.ifrc. org/en/publications-and-reports/code-of-conduct/ Accessed May 15, 2015. 15. The Sphere Project. Humanitarian charter and minimum standards in disaster response. Oxford, UK: Oxfam Publishing; 2004. 16. Gostelow L. The Sphere Project: the implications of making humanitarian principles and codes work. Disasters 1999;23:316-325. 7


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