How do we aid?

In light of the question of how Western countries should aid failing states—militarily, monetarily, or primarily humanitarianly—an article from last August 2013 discusses the decision by Doctors Without Borders (DWB) to withdraw from Somalia. The decision to leave Somalia after working there since 1991 came as the result of a series of extreme attacks against DWB that severely jeopardized the safety of the humanitarian aid workers. Since 1991, 16 aid workers have died in Somalia, and the organization has tried to adapt by hiring guards and militant groups. Yet in 2013, the organization reached a point where they could no longer justify the endangerment to aid workers; in 2012 two workers were killed by a former colleague, and in 2013 two more workers were released that had been kidnapped by Somalis. Just after DWB’s announced they were leaving Somalia, a DWB was attacked by al-Shabab militants.

The impact of DWB is larger than the 16 aid workers killed, however; in 2012 the organization “provided more than 624,000 medical consultations, admitted 41,000 patients to hospitals, cared for 30,000 malnourished children, vaccinated 58,600 people and delivered 7,300 babies” and provided about 1,500 local jobs. With the departure of DWB, there is now no one to provide those services as the Somali government is struggling to control violence in the country and cannot administer health services. While the DWB decision to leave Somalia will protect humanitarian aid workers, it also leaves Somalia with a severe gap in basic services that could be harmful to the population.

The question becomes whether it was correct for DWB to leave Somalia for the safety of its workers in exchange for the safety of the Somali population, and whether humanitarian aid was even the right option in Somalia. In many ways, it is not. Humanitarian aid addresses a surface problem in Somalia: a lack of access to health care. Yet healthcare is not the only problem Somalia faces; underlying health care is the inability of the government to control violence in the state, which undoubtedly drains resources and prevents medical care from being a primary focus of the state. How can medical care be of primary focus when the state cannot protect its citizens from daily, life-threatening violence?

Thus organizations like DWB step in and provide humanitarian aid while the state attempts to gain a monopoly over violence. This pattern has been in place for over two decades now, but the state still does not have control over violence. While the process the state is going through is complex and difficult, the pattern of providing humanitarian aid while leaving the conflict to the state has not been working; aid must be directed elsewhere. Specifically, aid needs to have a security focus that addresses the causes of instability in Somalia and not simply the resulting problems caused by instability. It needs to be directed towards stemming violence in Somalia and returning the monopoly over violence to the state. Otherwise, a pattern of reliance on outside aid, such as DWB, could develop that doesn’t really solve anything or make life better for Somalis in the long term.

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