Regulation and ethical codes of conduct

Unlike the situation within functioning nation-states, in the field of humanitarian assistance, health professionals and their organizations often used to be able to deliver health services without having to undergo individual or organizational accreditation in the affected country for both quality and accountability. However, since the early 1990s, indicators for the assessment, monitoring, and evaluation of health services provided by humanitarian organizations to populations affected by complex emergencies have been developed to improve the effectiveness and accountability of humanitarian response, in recognition of the potential harm that such programmes could cause. A catalyst for this was the very high mortality resulting from epidemics of cholera and dysentery among Rwandan refuges in Goma, Zaire, in 1994, with wide-scale clinical mismanagement of cholera by inexperienced relief workers. Ongoing concerns are also expressed about the impact of poorly planned and co-ordinated donor-funded programmes in distorting needs, inflating prices and salaries, and taking local staff away from much-needed positions ( Cullinan 2001 ). Donor agencies and host governments are also increasingly questioning the cost-effective use of their funds.

In 1994 the Red Cross movement and NGOs developed a Code of Conduct which seeks to safeguard high standards of behaviour, and to maintain the independence and effectiveness of disaster relief. In ten principles, the Code promotes the impartial character of aid, the respect of local cultures, the idea of building on local capacities, and the involvement of beneficiaries along with respect for their dignity. Furthermore, it describes the relationship that humanitarian agencies should seek with donor governments, host governments, and the UN system.

A second code of conduct was developed in the form of the Sphere project to try and improve accountability among aid agencies. Its first objective is to assist the international humanitarian community in developing a common framework for humanitarian action. Known as the ‘Humanitarian Charter’, the framework is based on key principles in international human rights and humanitarian law, and on the Red Cross/Red Crescent Code of Conduct. The second objective of the Sphere project is to outline minimum technical standards for humanitarian interventions. This makes explicit links to the defined levels of service delivery set out in the five core sectors of water supply and sanitation, nutrition, food aid, shelter and site planning, and health services.

Despite these developments, there is still no over-arching regulatory body with the power to enforce the attainment of standards by using the indicators outlined by Sphere and in other documents. The nearest such institutions are the Ombudsman Project and the connected Humanitarian Accountability Project, which seek to create an ombudsman of humanitarian work at field, organizational, and sector-wide level. However, they still lack enforcement mechanisms. Critical work remains in ensuring that such programmes are accountable not only to the donors and governments, but to the affected population.

It is also argued that regulatory codes need to move beyond utilitarian criteria of effectiveness, efficiency, and quantitative measurements, and should also address issues of humanity, equity, and local ownership. This is reflected in the NGO collaboration, ‘The Quality Project’. It seeks a more holistic approach to quality, placing interventions in a wider political context. Others argue that the regulatory framework needs to more strongly address issues of human rights, suffering, bearing witness, and the social and political context of all humanitarian work ( Robertson et al. 2002 ; Griekspoor and Collins 2001 ). A concern would be the impact such actions may have upon the humanitarian principles of independence, impartiality, and neutrality.