Red Cross Red Crescent Magazine: The face of humanity

8/9/2019 Red Cross Red Crescent Magazine: The face of humanity

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The International Red Cross andRed Crescent Movement

is made up of theInternational Committee of the Red CrosInternational Federation of Red Cross and

Societies (IFRC) and the National So

The International Committee of the RedCross is an impartial, neutral and independentorganization whose exclusively humanitarianmission is to protect the lives and dignity of

victims of armed con ict and other situations of violence and to provide them with assistance.The ICRC also endeavours to prevent suffering bypromoting and strengthening humanitarian lawand universal humanitarian principles. Establishedin 1863, the ICRC is at the origin of the GenevaConventions and the International Red Cross andRed Crescent Movement. It directs and coordinatesthe international activities conducted by theMovement in armed con icts and other situations

of violence.

The International Federation of Red Crossand Red Crescent Societies (IFRC) is theworlds largest volunteer-based humanitariannetwork, reaching 150 million people each year

through its 189 member National Societies.Together, the IFRC acts before, during andafter disasters and health emergencies to meetthe needs and improve the lives of vulnerablepeople. It does so with impartiality as tonationality, race, gender, religious beliefs, classand political opinions. Guided by Strategy 2020 a collective plan of action to tackle the majorhumanitarian and development challenges ofthis decade the IFRC is committed to saving

lives and changing minds.

TheInternational Red Cross and Red Crescent Movement is guided by seven Fundamental Principles:

humanity, impartiality, neutrality, independence, voluntary service, unityand universality.

All Red Cross and Red Crescent activities have one central purpose:to help without discrimination those who suffer and thus contribute to peace in the world

International Federation ofRed Cross and Red Crescent Societies

National Red Cross and Red Crescent Societiembody the work and principles of theInternational Red Cross and Red CrescentMovement in more than 189 countries. National

Societies act as auxiliaries to the public authoritiesof their own countries in the humanitarian eldand provide a range of services including disasterrelief, health and social programmes. Duringwartime, National Societies assist the affectedcivilian population and support the army medicalservices where appropriate.


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Editorial

ISSUE 3 . 2014 | RED CROSS RED CRESCENT| 1

IN THE CITY OF KENEMA, the third-larg-est urban area in Sierra Leone and oneof the hardest hit by the ongoing Ebolaoutbreak in West Africa, teams of local andinternational Red Cross and Red Crescentcaregivers risk their lives daily so that every-one who enters the IFRC emergency treat-ment centre is given their best chance ofsurvival. The centre opened in September atthe request of the Sierra Leone governmentand is expected to operate for 12 months.

Meanwhile, since March, thousands oftrained Red Cross workers and volunteersin Guinea, Liberia and Sierra Leone havebeen working tirelessly to inform and mo-bilize communities, care for the sick and

conduct safe and digni ed burials, all ofwhich are essential in bringing this epi-demic under control. These workers are theheroes on the front line of a global effortto fend off an even wider Ebola outbreak.Another critical part of the Red Cross RedCrescent response has been the emer-gency preparations and training coursesheld in 15 African nations that are eitheralready affected or at immediate risk ofbeing affected.

Thanks to their efforts, we will ultimatelydefeat this disease. But even before thatday comes, we have to ask ourselves a cru-cial question: what will we do next? Will webreathe a great sigh of relief and move on toother issues? Or will we truly learn the lessonpresented by this unprecedented outbreak?

If this Ebola outbreak reveals one thing, it ishow quickly a disease can ravage societieswhere there are no adequate, functioning

health systems to detect disease, informthe public and respond quickly at theappropriate scale. Even in the most de-veloped nations, the Ebola outbreak has

revealed gaps in preparedness, trainingand equipment. But in these fragile states,still emerging from the shadows of warand years of political instability, the lack ofsuffi cient hospital beds, personnel, ambu-lances and other essential tools has meantthat many people never made it to hospi-tal. Many were sent home to be cared forby relatives who themselves often becameinfected.

The crisis also revealed serious gaps inthe response capacity of internationalhumanitarian organizations, health agen-cies and donors. In recent years, there hasbeen too great an emphasis on deliveringprojects aimed at one problem or disease,

or towards attaining speci c health goals,rather than developing functioning healthsystems able to respond to a wide rangeof unexpected health or natural disasters.

The Red Cross Red Crescent Movement willcontinue to support affected communitiesbefore, during and after the outbreak andhelp to develop the capacity of NationalSocieties as important partners in localpreparedness and prevention networks.

But this will not be enough if not matchedby investment, both public and private, inlong-term solutions that include education,good governance, improved infrastructureand functioning health systems. This willbe expensive and it will take time. But itwill not be as costly as the alternative: moredeadly outbreaks.

The recent initiative by the World Bank tocreate a US$ 20 billion emergency fund is

a positive step. But this investment shouldalso contribute to developing systems thatprevent future outbreaks, detect themquickly when they do arise and help local

communities respond themselves. Manyfragile states will always need external hu-manitarian support during emergencies.But developing stronger local capacity,built on and sustained by local knowledge,could reduce that need substantially.

We in the Red Cross and Red CrescentMovement have been working for manyyears on building community resilience inthe face of disasters and health emergen-cies. With deadly diseases such as dengue,cholera, malaria, HIV/AIDS and Ebola, theanswer almost always lies in holistic solu-tions that involve communities, local andnational governments, schools, local medi-cal institutions and civil society combiningtheir efforts.

As we work towards eradicating Ebola inWest Africa and beyond, I urge the inter-national community to deploy resourcesat a scale that re ects the magnitude ofthe challenges and matches the sacri cesbeing made by those on the front lines.And we must also keep an eye on the fu-ture so that once Ebola is defeated, we canchannel our energies towards the nextstep: making all fragile nations healthier,safer and better prepared.

ByElhadj As SySecretary General, International Federation of Red Crossand Red Crescent Societies

P h o t o : I F R C

Learning thelesson of Ebola


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A call for humanityIn Iraq and Syria, the proliferationof armed groups and the recentinternational air strikes havecompounded the suffering causedby the con icts in both countries andmade the delivery of humanitarianaid increasingly diffi cult. Thecon icts in Iraq and Syria areendangering more people withevery passing day, says DominikStillhart, ICRC director of operations. The ICRC has appealed to all partiesin these con icts to uphold theprinciple of human dignity, sparethe civilian population the effectsof the hostilities and facilitateneutral, independent and impartial

humanitarian activities.

Small weapons, big impactAn Arms Trade Treaty thatregulates international transfersof conventional weapons recentlycame into force after being rati edby 50 countries. Advocates forthis international treaty, includingthe ICRC, say it is an essential steptowards reducing the humansuffering caused by the proliferationof conventional weapons, from small

arms and ammunitions to battletanks, combat aircraft and warships.When making decisions aboutarms transfers, countries must nowtake into account the humanitarianconsequences.

Relief at the border Thousands of Libyans and foreignworkers hoping to escape theongoing armed clashes in Libyahave ed to Tunisia, where the Tunisian Red Crescent has mobilizedvolunteers to respond to the urgenthumanitarian needs of refugees. The Tunisian Red Crescent hasestablished an operations base in

the border-crossing area in order toprovide food, psychosocial care andother services with support from theIFRC and the government of Japan. The Libyan Red Crescent, one of thefew humanitarian organizationsstill working in Libya, has providedessential medical and relief assistancesince the eruption of violence in May.

Due to deteriorating securityconditions in Libya, the ICRCtemporarily moved its internationalstaff to Tunis, Tunisia in July. With thesupport of 130 Libyan staff members,the ICRC has been working withthe Libyan Red Crescent to provideessential support for Libyan hospitals,respond to emergencies and assist

internally displaced persons.

Militaries meetto discuss IHLSenior military offi cers from 57countries gathered in Xian, China,in late September to take part in theSenior Workshop on InternationalRules Governing Military Operations(SWIRMO) 2014. As part of theirmission, the offi cers simulatedan operation to liberate a smallisland under enemy control while

complying with internationalhumanitarian law (IHL). Jointlyhosted by the ICRC and the PeoplesLiberation Army of China, SWIRMO2014 offered military leaders a chanceto share experiences concerningthe challenge of applying the lawgoverning military operations.The law of armed con ict is facingmultiple new challenges, making itnecessary for countries to enhancecommunication about the law ofarmed con ict, says Yan Jun, deputysecretary-general of the Chinesearmys general political department.

Monsoon bringsoods to Pakistan

Late monsoon rains in Septemberunleashed a devastating ood,inundating large areas of Pakistanand affecting around 2 millionpeople. The Pakistani governmentsNational Disaster ManagementAuthority says close to 44,000homes were destroyed and morethan 1.5 million acres of st andingcrops lost. More than 300 peoplehave died. As part of its initialresponse to the oods, the PakistanRed Crescent Society distributed

food and relief items such as tentsand tarpaulins, hygiene kits anditems of daily use to 13,000 families.Our entire village came under twometres of water, says 40-year-oldKausar Bibi. We escaped with ourlives but have lost everything.

More migrants lost at sea The past few months have been oneof the deadliest periods for migrantsat sea in recent years. More than 750people, a majority from the MiddleEast and Africa, have drowned in theMediterranean Sea while en route toEurope. Often the migrants cross the

sea in old, overcrowded shing boats,which at times do not have enoughfuel to reach Europe. As NationalSocieties such as the Italian Red Crossprovide rst aid, medical assistanceand psychosocial support, the IFRC

In brief...

2 | RED CROSS RED CRESCENT| ISSUE 3 . 2014

VoicesNo one wants to be near me.They are afraid. They refuseeven to take our money if wewant to buy something in the store or eat in a restaurant. 29-year-oldNelson Sayon, a member ofthe Liberian Red Cross Societys safe anddifgni ed burials team in the countrys capitalMonrovia, as quoted byTime magazine.

1: the length of a scarf, inkilometres, hand-knitted tocommemorate missing people inPeru. In August, a portion of the

scarf was draped across an ICRCheadquarters building in Geneva tocommemorate the International Dayof the Disappeared.*44 : percentage of disaster-relateddeaths caused by oods in 2013.Floods are the type of disaster thatclaim the most lives each year.Storms claimed 41 per cent ofdisaster-related deaths in 2013.**81: percentage of people affectedby disasters in 2013 who live inAsia.**97 : percentage of burials of Ebolavictims in Guinea that have beenperformed by the Red Cross Societyof Guinea.***

529 : number of disasters that werereported worldwide in 2013, ofwhich 337 were natural disastersand 192 were technological or man-

made disasters.**810 : number of disasters reportedin 2005, the year with the highestnumber of reported disasters sincereliable records have been kept.**9,533 : number of volunteers trainedto respond to the Ebola outbreakbetween March and November.***102,000 : number of surgical caseshandled between July and Septemberin Gaza by medical authoritiessupported in part by the ICRC.*100 million : number of peopleestimated to have been affectedby disasters in 2013, well below thehigh levels of the period from 2007to 2011.**

Sources: *ICRC, **Centre for Research on the Epidemiology of Disasters, ***IFRC

Just over a year after one of the most powerful typhoons ever recordedslammed the Philippines, there are signs that recovery efforts are payingoff. One case in point is Maria Redubla Liporada, one of the thousands ofbene ciaries to receive a livelihood cash grant from the Red Cross and RedCrescent Movement. She used the grant to start a bakery. Here she crosses ariver on the way to selling rice cakes in her upland village in Burauen, Leyte,central Philippines.

is calling for better cooperationbetween countries of origin, transitand destination in order to ensurethe dignity and safety of all migrants,irrespective of their legal status.

Somalia food crisis looms Three years after a severe food crisisaffected Somalia in 2011, growingnumbers of people are once againsuffering acute problems and evenmore are at risk. A number ofdifferent factors are contributingto a series of localized problems inboth the centre and the south ofthe country, but also in the far north

of Somalia, says Mohamed SheikhAli, who coordinates ICRC efforts todevelop food production and relief.But the populations worst affectedare those suffering an overlap ofclimatic and con ict shocks.

P h o t o : C h e r y l G a g a l a c / I F R C

Humanitarian index


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26. My story

18. Out of the cross re


ContentsIssue 3. 2014. www.redcross.int

Articles, letters to the editors and other correspondence

should be addressed to:Red Cross Red CrescentP.O. Box 303, CH-1211 Geneva 19, SwitzerlandE-mail: [email protected] ISSN No. 1019-9349

EditorMalcolm Lucard

Production Offi cerPaul Lemerise

DesignBaseline Arts Ltd, Oxford, UK

LayoutNew Internationalist, Oxford, UK

Printedon chlorine-free paper by IRL Plus SA, Lausanne, Switzerland

Editorial boardICRC IFRCMohini Ghai Kramer Benoit CarpentierDorothea Krimitsas Pierre KremerSophie Orr Nina de Rochefort

We gratefully acknowledge the assistance of researchers and

support staff of the ICRC, the IFRC and National Societies.The magazine is published three times a year in Arabic, Chinese,English, French, Russian and Spanish and is available in 189countries, with a circulation of more than 70,000.

The opinions expressed are those of the authors and not necessarilyof the International Red Cross and Red Crescent Movement.Unsolicited articles are welcomed, but cannot be returned.Red Cross Red Crescent reserves the right to edit all articles. Articlesand photos not covered by copyright may be reprinted without priorpermission. Please creditRed Cross Red Crescent .

The maps in this publication are for information purposes only andhave no political signi cance.

On the cover:A member of a Liberian Red Cross safe and digni edburials team prepares to disinfect the home of a suspected Ebolafatality in Monrovia, Liberia.Photo: Victor Lacken/IFRCPhotos this page from top: Katherine Mueller/IFRC; Victor Lacken/IFRC; AnnibaleGreco/ICRC; Vladimir Rojas/IFRC; Japan Red Cross

Cover story 4The face of humanityCovered head-to-toe in protective clothing, volunteerson the front lines of the ght against the Ebola virusdisease represent the best hope for those suffering fromthis lethal disease and for preventing a global epidemic.

Burying Ebolas dead 10Teams of young volunteers often work frommorning until midnight to carry out one of the mostcritical and dangerous tasks in the effort to containEbola: burying the bodies of the deceased.

International humanitarian law 12Cities under reArtillery, mortars, rockets, missiles and bombsdropped from airplanes. These are just some of thehighly lethal and destructive weapons being usedtoday in densely populated urban settings.

Focus 14War in the streetsJust as the worlds population has grown more andmore urban, modern warfare has also increasinglyfound a home among the apartment buildings,streets, neighbourhoods, business centres andmarkets of major cities. These photos re ect on the

long-term rami cations and costs of war in the city.

Urban violence 18Away from violenceIn the wake of war and natural disaster, violence has takenroot in many impoverished inner-city areas of CentralAmerica. For young people hoping to nd a different way,four National Societies in the region offer helping hands.But is it enough to keep the violence at bay?

4. The face of humanity

10. Burying Ebolas dead

14. War in the streets

Disaster risk reduction 23A way to safetyEarthquakes are frightening enough. Imaginemaking your way to safety if you are blind orcon ned to a wheelchair. A Nicaraguan Red Crossdisaster preparedness programme aimed at peoplewith disabilities is just one example of ways thatNational Societies are reducing the risks associatedwith natural and man-made disasters.

150 years of humanitarian action 24History in the makingIn January, the ICRC archives will release operationrecords from the period from 1965 to 1975.

For historians studying con ict in the late 20th

century, it is a unique and exciting chance to betterunderstand a critical era for humanitarian action.

Proles 26My Red Cross Red Crescent storyA moving story from a long-time Red Cross RedCrescent health worker; a tale of life, death andblood; recollections on the founding of the Timor-Leste Red Cross Society; and more.

Resources 29The IFRCsWorld Disasters Report 2014 looks atthe impact of culture on disaster preparednessand a guide from the ICRC for understanding thephenomenon of children in detention, among otherMovement publications.


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Thousands of volunteers have the courage and compassion to stare done of the worlds greatest killers. But will it be enough to stop Ebo

OSMAN SESAY doesnt know how he be-came infected. Nor does the 37-year-oldremember arriving at the IFRC emergencytreatment centre in Kenema, Sierra Leone, after a

ve-hour drive from his home in Freetown.What he does remember is being approached by

Red Cross staff, all wearing their rather imposing-looking protective gear. I was scared, recalls Sesay,the second con rmed Ebola patient to arrive at the

centre. But they treated me well.When he arrived, Sesay was lethargic and had the

glazed look typical of someone infected with thedeadly disease, which by then had already claimed

almost 2,800 lives in the three countries rst affectedby the outbreak, Guinea, Liberia and Sierra Leone(the total death toll when this article went to presswas more than 5,100, including 8 deaths in Nigeria).

Over the course of two weeks, Sesay watched 11fellow patients being taken for burial in the newlydug cemetery. In the meantime, he continued togrow stronger. They talked to me and gave memedicine and food, says Sesay, a junk trader by

profession. They looked after me and helped meget better.

In late September, after two negative blood tests,Sesay became the rst person at the IFRC centre to

The face of humanity


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The early symptoms resemble cholera head-ache, fever, diarrhoea, vomiting and might alsobe normal for malaria or food poisoning. But thevast majority of those who contract Ebola do notlive more than a few weeks. Many never make it to atreatment centre. And for almost all of those that do,the last images of humanity they will see are stran-

gers dressed head-to-toe in white protective gear.Even Sesays story of survival cannot be said tohave an entirely happy ending. I am happy to beleaving, but my wife and 3-month-old twin sons diedfrom Ebola, he says. I have one 13-year-old son left.I dont know if he is healthy or not.

Faces of humanity Though shrouded by their personal protectiveequipment (PPE) the technical term for the com-bination of jumpsuits, boots, goggles and rubbersurgical gloves that make up these strange moon-suits the health workers here are perhaps the onetrue representation of humanity in the face of thisvery inhumane outbreak.

This other-worldly get-up allows people such as28-year-old community health nurse Brima MomoduJr to give patients their best chance at survival. Anddespite the barriers this protective clothing putsbetween him and his patients, he does whatever hecan to ease their suffering.

We have some patients here who are verystable, he says. They manage to get water for

themselves and they can move from one place toanother. They talk a little bit. We also have somewho are very weak. They cannot do anything ontheir own. To eat is ver y diffi cult; even to drinkwater is very diffi cult.

I feed my patients because I want them to getenergy, he continues. Because some patients passfaeces, urine, vomit all over their body, I have to givethem at least bed baths so they can feel refreshedand be more healthy. After that, I bring my patientssome clothing to change what has been messed up.

Pausing between stints in the high-risk area, heis able to take off his mask, take unhindered deepbreaths of fresh air and show his face, glistening withsweat after 45 minutes inside the sweltering PPE.Im sitting out to at least get some fresh air, to havesome time to rest, so that I can be healthy enough togo back to serve my patients well, he says.

The health of caregivers such as Momodu is criti-cal to stopping this fast-spreading disease. But its anextremely risky, diffi cult, stressful and emotionally

have survived Ebola. I dont know why I survivedwhen others didnt, he says. But I am very happyto be going home.

That same day, an 11-year-old girl named Kadiatu,also one of the rst patients to arrive at the Kenematreatment centre, was declared Ebola free. Becauseshe had been inside the high-risk area, Kadiatu wentthrough the required happy shower a chlo-rine bath followed by a normal soapy shower toremove all potential remains of the virus. Her con-taminated clothes were destroyed and she was givena clean new dress and new sandals.

Sesay and Kadiatus stories offer a sense of hopethat, with treatment, people can survive Ebola. But

such stories have been few and far between in theface of this pitiless virus, for which no cure exists andwhich attacks the organs so virulently that the in-fected person essentially bleeds to death from within.

Web extraChlorine is your friendA look into the training required to do a month-long shift in the ght against Ebola.Seewww.redcross.int.

J New recruits to the Liberian Red

Cross Societys safe and dign edburial teams undergo training inthe Liberian capital, Monrovia.As the death toll from the deadlyoutbreak grew, the NationalSociety increased the number ofsafe and digni ed burial teamsactive in Liberia.Photo: Victor Lacken/IFRC

My rst week has been a surreal rollercoasterbetween life anddeath, hope, grief,

pain and joy. As Iarrived in Kenemaat the [emergencytreatment] centre, my rst task wasto oversee fourburials.Anine Kongelf , a communityhealth delegate for theNorwegian Red Cross, workingin Kenema, Sierra Leone, inSeptember and October


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draining assignment. Most of the health-care work-ers interviewed here say that they feel safe insidetheir PPEs, which covers them from head to toe, andbecause they follow the proper protocols.

The high-risk zoneBut the dangers are very real. Ebola is not trans-

mitted through the air, but it does spread throughdirect contact with the bodily uids of an infectedperson. The health workers skin, therefore, mustnever be exposed to a patients touch, a cough, asneeze, a drop of sweat or vomit or even to thetouch of the workers own gloves.

If even a small breach in the PPEs is noticed whilethe worker is in the high-risk zone, he or she mustleave the treatment area immediately and take offthe protective clothing while being sprayed numer-ous times with a chlorine solution.

One of the greatest dangers is posed by some-thing they employ daily: the needles used to takeblood samples. Playing on their minds as they takethe patients blood samples, a routine task in mostsettings, is a fact impressed upon them during theirtraining: the survival rate among health workers jabbed by an infected needle inside an Ebola treat-ment area is zero.

The slightest wrong move, therefore, could bedeadly in an environment where visibility is limited,time is of the essence and patients are not alwaysin control of their movements. All procedures must

take place slowly and with extreme care.Numerous health workers, both local and interna-

tional, have contracted Ebola while working under

such conditions and many have succumbed. Withthe threat of the virus ever present, health workersmonitor their own health constantly with even theslightest fever or headache creating considerableanxiety in their minds.

Facing the fear

For those working with dead bodies, a task abso-lutely critical to halting the spread of Ebola, thedanger is equally real. As a member of a safe anddigni ed burials team, Edward Sannoh, a 24-year-old from Kenema, collects the bodies of those whohave died in the high-risk area, then prepares themto be taken to the morgue. The hardest part of this job is when you are in the high-risk area, he says.What makes it hard is that you dont have permis-sion to sit, lie down or touch your fellow worker. Youcan only touch a sick person if you have to. If not,there is nothing you can do.

With so much death all around, there is a palpa-ble sense of fear among both the patients and thecommunities who have already lost so many to thedisease. Of course, people are really afraid, says San-noh. And even now, people are afraid of some of uswho are working at this case management centre.

But Sannoh says he is undaunted. I dont mindwhat people might say because I have been a RedCross volunteer, so my rst fundamental principleis humanity. So Im doing this because of humanity.I want to save the lives of our brothers and sisters.

That is the number one principle of the Red Cross.Still, fear of Ebola has fostered strong emotions in

some areas affected by the disease and the threat


K Liberian National Red CrossSociety volunteers disinfect theirprotective clothing after removingthe body of an Ebola victim fromher home in Banjor, Liberia.Photo: Victor Lacken/IFRC

I dont mind what people might saybecause I havebeen a Red Crossvolunteer, so my

rst fundamental principle is humanity. So Im doing thisbecause of humanity.I want to save the lives of our brothersand sisters. Edward Sannoh, 24, avolunteer for the Sierra LeoneRed Cross Society from Kenema,one of the areas hardest hit byEbola virus disease


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to health workers is very real. On 16 September, agroup of armed men attacked a delegation of Ebola-control personnel, including government, medical,media and Red Cross staff, as they worked in thecommunity of Wom, in south-eastern Guinea.Seven members of the delegation were killed,including health workers, local offi cials and journal-ists. Two remain missing. An offi cial from the localbranch of the Red Cross Society of Guinea was seri-ously injured in the attack.

That same week, in the city of Forcariah, south ofGuinean capital of Conakry, six volunteers with thesafe and digni ed burials team were attacked by thelocal population. One of them was injured while theothers ed to seek refuge in the nearest forest.

In response, the IFRC and the Guinea Red Crosscalled on governments and communities to respectand protect humanitarian and health personnel,

adding that all actions that hamper the work of thoseresponding to this epidemic including attacks onstaff and volunteers, and violent protests and inse-curity in Liberia and Sierra Leone prevent entirecommunities from getting the help they need.

A global crisisFrom the beginning of the crisis, people such as Mo-modu and Sannoh have been on the front lines in the

ght against this outbreak, which began in remoterural districts of Guinea and later spread to Liberiaand Sierra Leone. Since then, the rapid progress of thedisease and the emergence of cases in Nigeria, Spainand the United States quickly made it clear to worldleaders that the outbreak was a threat not just to WestAfrica but also to global health.

By 17 November 2014, an unprecedented 14,386people were reported to have contracted the dis-ease, and more than 5,400 people had died from it,according to the World Health Organization (WHO).Meanwhile, the United States Centers for DiseaseControl estimated that if the outbreak continues atits current pace, the number of cases could swell to

as many as 1.4 million by January 2015.Despite this, mobilizing a response to keep pace

with Ebolas spread has been a challenge. Publichealth systems in Guinea, Liberia and Sierra Leone,

weakened by years of protracted con icts, lackedthe facilities, staff and materials needed to containthe disease.

Ebola has also exposed serious weaknesses in theglobal system set up to deal with health emergen-cies. A series of budget and staff cuts within theWHO unit that deals with health emergencies didnt

help and many humanitarian organizations, includ-ing the Red Cross Red Crescent Movement, lackedthe experience and systems to respond immediatelyto the particular requirements of this very virulentdisease (although volunteers from local National So-cieties were among the rst to respond).

The notable exception was Mdcins sans Fron-tires (MSF), which has considerable experiencewith Ebola. Because it too lacked the human and

nancial resources to take on Ebola on its own, MSFhas provided crucial training to workers from otherorganizations, including volunteers and staff fromthe IFRC and National Societies, as the Movementrapidly scaled up its own response.

Today, with support from the IFRC, the ICRC andRed Cross societies in Guinea, Liberia, Nigeria andSierra Leone, more than 7,700 volunteers have beentrained to engage at community level through socialmobilization activities, psychosocial support, safeand digni ed burials, contact tracing, transport ofthe sick and clinical case management. The IFRC hasalso expanded Ebola preparedness and responseactivities to 14 other countries in West Africa where

the disease it most likely to spread next. Since theoutbreak began, more than 169 international staffhave been deployed and six emergency appealshave been launched by the IFRC.

Meanwhile, the ICRC, which has had a presence inWest Africa for many years due to con icts there, hasbeen providing various forms of technical and mate-


L Here in the low-risk area of theIFRCs Ebola treatment centre inKenema, Sierra Leone, workersdiscuss the days work. In thehigh-risk area, there are separateareas for suspected, probable andcon rmed cases and workers mustperform their tasks fully coveredfrom head to toe in personalprotective equipment.Photo: Katherine Mueller/IFRC

Liberia

Guinea

Sierra Leone

Web extraSeewww.redcross.int forblogs written by doctors andother staff in emergencycentres in Sierra Leone.

Number of reported Ebola cases in West Africa since March 2014

S o u r c e : W o r l d H e a l t h O r g a n i z a t i o n


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rial and staff support via its delegations in Liberia andGuinea (its Sierra Leone offi ce was closed in 2013).

The ICRC also deployed 20 additional interna-tional staff to the region and has beefed up itssupport to National Societies and other partners ina range of areas, from health care to forensics, en-gineering, economic security, water and habitat,

among others.But many on the ground say so far the in-ternational response is still not adequate. Wedesperately need more resources, says FridayKiyee, a member of one of the Liberian Red CrossSociety safe and digni ed burials teams in Monro-via. Without people on the ground to organize,coordinate and educate, we will be wasting ourtime Many of the hospitals here have very fewhealth workers, and patients most in need of othermedical services are not getting care.

The local health service, he says, is overwhelmed.More treatment centres are needed, as are morebeds, more equipment, more medical staff and moretraining. Often, when an ambulance is called to pickup a sick patient, the Ebola treatment unit is alreadyfull and the patient must return to their home.

They will die at home, says Kiyee. And when thepatients die at home, people keep interacting withthem prior to their death. And they too become sick.So the death rate keeps increasing.

A culture of touchOne of the sad ironies is that with Ebola, the veryhumanity that people have shown in caring for theirsick relatives and in tending to their bodies duringburial has been a leading cause of transmission. InSierra Leone, its common practice to hug the deadin order to keep a connection with ancestors.

And throughout all the affected countries, physi-cal contact (hugs, handshakes, kisses) are part ofeveryday interaction. One of the life-saving mes-sages health workers give is to avoid touching eachother. Guineas National Commission against Ebola,of which the IFRC and the National Society are bothpart, reinforced this information in text messagessent to many Guineans during celebrations for EidAl-Adha in Guinea, the Muslim holy period (alsoknown as Tabaski in many West African countries).

The messages wished us a happy Tabaski, buttold us to avoid touching each other during the tra-

ditional greetings to stop the spread of Ebola, saysAmadou, a medical student from Conakry. I knowits necessary, although it does feel a bit strange notto embrace my family during this time of Eid.

From the beginning of the crisis, local culture hasplayed an important role. Many people in West Af-rica suspected Ebola was the result of witchcraft,others feared voodoo was at work. And becausemany people turn to traditional healers, part of thehealth response included engaging with traditionalhealers such as Fallah James, from Sierra Leoneshard-hit eastern Kailahun district.

When I got the information that you can get itthrough contact, I, as the head of the traditional heal-ers in this district, have stopped treating patients,says James. And I have been advising my colleagues

that they should stop for now, until we get trainingand proper information about Ebola, so that it cannotinfect so many people in our community.

The no-touch zoneFear and stigma are not limited to West Africa, how-ever. Many humanitarian organizations have had aparticularly hard time mobilizing and deploying in-ternational staff and volunteers to take on this riskyand diffi cult assignment in part because of fearsat home among colleagues, friends and family. Ontop of that, those who deploy with the IFRC mustbe willing to spend at least one month in the eld followed by a three-week, stay-at-home periodafterwards to monitor for symptoms.

After several international health care workers wereplaced in forced quarantine after their return frommission in West Africa, the Movement offi cially urgedgovernments to ensure and facilitate movement ofhealth workers to and from West Africa. Stigma ordiscrimination against health workers includingisolating them with no scienti c basis will lead in-evitably to a human resources crisis at a time when

we need quali ed people, the statement read.One of those who took on the challenge recently

was the Norwegian Red Crosss Anine Kongelf, whosigned up for a tour in Sierra Leone because she felt

L To help stop the spread ofEbola, volunteers with the RedCross Society of Guinea visitedcommunities and met withresidents face-to-face in order tochange attitudes and practices thatcould help spread the virus.Photo:Moustapha Diallo/IFRC

Web extra45 minutes in the high-risk zoneBy Kevin Garcia, Spanish Red Cross

I start getting dressed, putting on what we have come to think of as almost a second skin, thePPE suit As soon as I have put on the mask, we begin to breathe as if in another atmosphere.The smell of the masks newness isolates me from the usual smell of chlorine in each of the separate zones of the site

I cant imaginewhat it must be like for them, to bebrought here and becorralled into fencedareas surrounded

by alien-like peoplewalking around. Garth Tohms, a volunteerwater and sanitation specialistwith the Canadian Red Cross,working in Sierra Leone


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her experience tracing people exposed to cholera inHaiti and working with communities would be use-ful in tracking Ebola.

I was working with the cholera epidemic, butthats very small compared to this, says Kongelf,whose job in Sierra Leone involved coordinatingwith other agencies to help track those exposed,

cared for, cured and buried in order to monitor allsteps taken with those who have been infected.This is unlike anything else.

Soon after her arrival, she wrote in a blog post:My rst week has been a surreal rollercoaster be-tween life and death, hope, grief, pain and joy. AsI arrived in Kenema and at the centre, my rst taskwas to oversee four burials.

The sad fact is that there will be many graves asthe centre will admit more patients, and some ofthem will lose the battle against the virus. One ofthe bodies that day was an 8-year-old boy.

And its not just people who work directly withpatients who are exposed to the dangers. Anotherrecent international recruit was Garth Tohms, avolunteer with the Canadian Red Cross Society. Aplumber by trade, Tohms felt his experience andtraining working with hazardous materials for theCanadian military would be useful in his work as awater and sanitation expert supporting the emer-gency treatment centre in Kenema. He says eventhe most basic tasks, such as replacing a valve, canbecome a painstaking task inside the high-risk zone.

The goggles are the worst, they fog up quickly,reducing our time inside, he says. I put extra anti-fog liquid on my lens from the inside of the goggles.I dont wipe away the excess, I prefer there to be somuch anti-fog that it is actually in drops on the lens. Itis a bit blurry, but I can see for a longer period of time.

How de body?To bring an element of humanity to his work, Tohmstells the patients from the outside that hes comingin and, when possible, makes a joke or two. Thatway, they will know who is walking past them andtalking to them from behind the mask, he writes.

I cant imagine what it must be like for them, to bebrought here and be corralled into fenced areas sur-rounded by alien-like people walking around.

Tohms and others here say they are also struckby the level of humanity they see every day amongpeople who are ill or highly stressed and afraid. De-spite the reports of violence against health workers,

he says many here do appreciate their work and theyare often met by locals with friendly smiles and thetraditional greeting: How de body?

Sue Ellen Kovack, a Canadian who recently re-turned to Cairns, Australia after a month in theKenema treatment centre says she was struck bythe resilience of people living through this unprec-edented outbreak.

We had a lovely lady Lucy in the hospital, wholost her husband and all her children to this disease,yet she greets me with a massive smile each morningto ask me how I am, if I slept well. How de body? sheasks. Wow! The ravaging illness on the bodies I wasexpecting, but not this resilience. It breaks my heartto see what people like Lucy are going through.

The survivorsThat same resilience can be seen in the survivors.One of the rst to survive the disease in Guinea, SaaSabas caught Ebola while taking care of his sick fa-ther. After being transferred to the Ebola treatmentcentre set up by MSF in Guckdou, Guinea, he re-covered and returned home, only to be stigmatized

by his neighbours. People avoided me even whenI showed them my certi cate of discharge, he says.Now a volunteer with the Red Cross Society of

Guinea, Saa Sabas visits communities, raising aware-ness among his fellow Guineans of how to preventthe spread of the disease and to allay some commonfear and rumours. I am one of them and I can talkto them in a language they understand, he says.Who else is better placed than me to tell themabout Ebola?

These survivors are living proof that Ebola can bedefeated. As one of the health workers who caredfor 11-year-old Kadiatu recalls: When she cameout she was clean, uncontaminated and safe. Sheturned around to wave to Haja another Ebola pa-tient who had been taking care of her inside andwalked out past the double orange fencing.

She gave one last wave to the other patients be-fore walking away from the centre for the nal timeand someone asked her: How de body?

Fine, she replied, and for the rst time in weeks,she meant it.

ByCristina Estrada,Katherine Mueller andMalcolm LucardKatherine Mueller is communications manager for the IFRCs AfricaZone. Cristina Estrada is IFRC senior offi cer, operations qualityassurance. Malcolm Lucard is editor ofRed Cross Red Crescent magazine.

K 11-year-old Kadiatu was thethird con rmed Ebola patientto arrive at the newly openedtreatment centre operated by theIFRC in Kenema, Sierra Leone. Inlate September, she was one ofthe rst patients at the Kenemacentre to be declared Ebola free.Photo: Katherine Mueller/IFRC


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10 | RED CROSS RED CRESCENT| ISSUE 3 . 201410 | RED CROSS RED CRESCENT| ISSUE 3 . 2014

PRIOR TO THE CURRENT Ebola outbreak that isravaging Liberia, Friday Kiyee worked as a mor-tician at the Redemption Hospital in the capitalMonrovia, so he is used to dealing with the dead.

We are not happy to see our own Liberian broth-ers dying, says Kiyee, a leader of one of the LiberianRed Cross Societys safe and digni ed burial teams inMonrovia. We go out in the street picking up theirbodies. We are not happy about that, but the fact of

BuryingEbolas deadWorking long hours, every day, teams of RedCross volunteers risk their own lives to burythe Ebolas victims so that others will not

meet a similar fate.


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ISSUE 3 . 2014 | RED CROSS RED CRESCENT| 11ISSUE 3 . 2014 | RED CROSS RED CRESCENT| 11

the matter is that we just have to do it. If we dont,the virus will keep spreading.

His working day begins with a list of communitieswhere he must go to collect the bodies of suspectedEbola victims. His team, one of six operating inMontserrado county, can expect to collect up to 15bodies on any given day. The numbers are steadily

rising and the nature of the disease means that thebodies are highly contagious with a virus that killsmore than half of the people it infects.

There has not been one day since we started inlate July that we did not pick up a body, says Kiyee.It is playing on everybodys mind.

His team received training from the Red Cross,Mdecins sans Frontires and the World Health Or-ganization. My life is at risk because if I make theslightest mistake I will get infected, he says. Thebest thing we can do is to dress properly and fol-low all the safety procedures before going to pickup a body.

This attention to detail, ensuring that all teammembers are properly attired in protective cloth-ing and that disinfectant is used appropriately andunsparingly, has meant that none of his team hasbecome sick, despite the contagion all around them.

We have two sprayers, says Kiyee. The dirtysprayer is the man who goes in rst to disinfect thearea before the others come to pick up the body. Andthen we have a clean sprayer who disinfects thosecoming out from the house or the retrieval scene.

Not all families are happy to see the bodies oftheir loved ones taken away for disposal by menin protective suits. It can lead to confusion, resent-ment, sometimes even hostility.

Before we take the body, we do a bit of socialwork activity, he says. We call the bereaved familyand community together and introduce ourselvesand the emblem of the Red Cross. We talk to themand make sure they are satis ed before we take thebody from the community.

No one wants to be near meBut things do not always go smoothly. A reporter forTime magazine was with one Liberian Red Cross So-ciety team when they were confronted by a crowd ofvillagers, angrily asking why no one came when theycalled for an ambulance, but now they come for thebody. One of the team members, 29-year-old NelsonSayon, toldTime that many team members have alsobeen ostracized by their communities.

No one wants to be near me, Sayon was quotedas saying. They are afraid. They refuse even to takeour money if we want to buy something in the store

or eat in a restaurant.Teams in Sierra Leone face similar challenges.

Sometimes when we get to a village, they say weare bringing the disease to them so they, too, will be

affected, says Julius Tamba Kamanda, a 21-year-oldmember of the Sierra Leone Red Cross Society safeand digni ed burial team. Sometimes they stoneus, they ask us to get out of their town.

Without the help of the chiefs and other humani-tarian groups who come to their aid and tell themthat the community will not be affected, they would

not accept us, he says.The crews work long hours, sometimes from 08:00until midnight, or later, depending on the need. An-other challenge for some of the teams is a lack ofvital equipment.

The way we carry the bodies to the cemetery isby hand, Kamanda says. We strain a lot, when weare carrying it to the site. So we, as a burial team, arerequesting that they provide us with a stretcher sothat it will be easy for our movement.

Recently, his team had to carry a body more than3 kilometres to reach the cemetery. Maybe westopped about ve times before we could get to theplace, he recalls. So that can lead to delay, to dan-gers: maybe when we put the body on the ground,on the stones, the bag could get torn and the dis-ease could be exposed.

The teams also have to confront people who aregrieving and who are being asked to forgo theiraccustomed burial practices. In Sierra Leone, com-munity members traditionally bury their own. Partof the practice includes hugging the body to ensureancestral lines are continued. But it is at death that

the Ebola virus is at its strongest.This is why now, when we enter a community toprepare a body for burial and after talking with theelders, we invite the family to come and watch ourproceedings, says Daniel James, coordinator of thesafe and dign ed burials team for the Sierra LeoneRed Cross Society.

It is safe for them to watch from the window.They see we are treating their loved one with re-spect and care; that we will stop for a prayer if theyso wish. The family can still be involved and we ndit helps dispel some of the rumours of what we aredoing with the bodies.

The good news, says James, is that more peopleare getting the word about how Ebola spreads andwhat they should and shouldnt do. More com-munities are beginning to notify authorities whensomeone passes away at home, which is great, hesays.

It is dangerous work, James says, but absolutelyvital and he plans to keep going. I keep going andworking despite all the red ags, he adds, becauseit is the right thing to do.

ByVictor Lacken andKatherine MuellerVictor Lacken is a photographer and writer; Katherine Mueller iscommunications manager for the IFRCs Africa Zone.

J Liberian Red Cross Societyvolunteers remove the body ofan Ebola victim from her homein Banjor, Liberia. Members ofthe team work long hours, oftenfrom early morning to midnightin tough conditions, sometimesfacing stigma and hostility as theyplay one of the most importantroles in stopping the spread of thevirus.Photo: Victor Lacken/IFRC

Sometimes whenwe get to a village,they will say we arecoming with thedisease to them so

they, too, will beaffected. Sometimesthey stone us, theyask us to get out oftheir town. Julius Tamba Kamanda, a21-year-old member of the safeand dign ed burials team inSierra Leone


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Artillery, mortars, bombsdropped from airplanes,rockets and missiles: thesehighly lethal and destructiveweapons are increasingly beingused during con icts in denselypopulated urban settings.

JUST AS THE WORLDs population has concen-trated in towns and cities in recent decades,warfare has also become increasingly urban.In many of todays ongoing con icts Gaza, Iraq,Israel, Libya, Syria, Ukraine and elsewhere thefront lines are city streets where crowds of peopleonce shopped at open-air markets, drove to work orwalked to school.

Today, many of these cityscapes are de ned bythe blasted-out, distorted skeletons of former apart-ment buildings and shopping areas that now loomabove piles of rubble and twisted metal, throughwhich those who remain must navigate to nd theirdaily bread.

While the destruction evidenced in recent con-icts is shocking, the effect on people living among

such devastation is even more severe. These explo-sive weapons are designed for open battle elds, notbuilt-up urban areas, ICRC President Peter Maurersaid before addressing the United Nations GeneralAssembly on the matter in October.

From the evidence of recent con icts, we seri-ously question whether they can be used to targetmilitary objectives in populated areas with enoughaccuracy, or indeed whether their effects can be

limited as required by international humanitarianlaw [IHL], he added. This is not about the weap-ons themselves its about where and how theyare used.

A common featureMassive destruction in major cities is nothing newto warfare. The 1937 bombing of Guernica, Spain,and later the bombardment of vast areas, includingurban centres, during the Second World War, led toprovisions in the 1949 Geneva Conventions (laterstrengthened by the Additional Protocols of 1977)that sought to limit civilian casualties and prohibitpractices such as indiscriminate area bombing.

Meanwhile, Additional Protocol I, Article 51,prohibits attacks that may be expected to causeincidental loss of civilian life, injury to civilians, dam-age to civilian objects, or a combination thereof,which would be excessive in relation to the concreteand direct military advantage anticipated.

The legal prohibition against disproportionate

attacks and the related prohibition against wantondestruction of cities, towns or villages, or devasta-tion not justi ed by military necessity are centralto the law on the conduct of hostilities, noted John

Citiesunderre

The civilian casualtytoll and the extentof destruction areworse than any thearea has witnessed in recent years.Robert Mardini, ICRC head of

operations for the Middle East


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Borrie and Maya Brehm, two experts in the eld,writing for the International Review of the Red Cross in September 2011.

Meanwhile, recent conventions that ban otherexplosive weapons such as landmines and clustermunitions including a protocol to the Conven-tional Weapons Convention that requires states

to clean up the explosive remnants of war haveadded moral weight to arguments against the use ofindiscriminate explosive weapons in densely popu-lated areas.

Even though area bombing is illegal today, andmany states no longer consider the use of clustermunitions acceptable practice, the use of otherexplosive weapons even in densely populatedareas remains a common feature of contempo-rary armed con ict, the authors observed, citingnumerous case studies from ongoing con icts in2011: Afghanistan, Iraq, Lebanon and Somalia.

For its part, the ICRC acknowledges that war ght-ers often take up positions in residential areas andother places where civilians might be exposed. Butit argues that, nonetheless, attacking forces musttake constant care to minimize the impact of theiroperations on civilians, including through theirchoice of means and methods of warfare. Alterna-tive weapons and tactics should be considered.

The civilian tollToday, the con icts in Syria and the ghting in Israel

and Gaza, and the ghting in Ukraine are strongcontemporary examples of what happens when ex-plosive devices are used in civilian areas.

In Gaza, public infrastructure, medical and healthfacilities, and schools have sustained severe dam-age or been destroyed. More than 2,100 people werekilled, nearly 11,000 injured and an estimated 108,000people will not be able to return to their homes.

The water network and electrical installationshave been severely damaged while the medicalsector has been stretched to its limits and hospitalshave been hit by shelling or other munitions.

The destruction in the Gaza Strip is not limitedto civilian objects and infrastructure, says Younis AlKhatib, president of Palestine Red Crescent Society.It has also had a signi cant impact on the healthand livelihoods of Gazas citizens.

Meanwhile, missiles red from Gaza into residen-tial and urban areas in Israel claimed at least velives, including that of a volunteer for Magen DavidAdom (MDA), injured more than 800 civilians andforced between 5,000 and 10,000 from their homes.

In this context, the ICRC has repeated its calls (ech-

oed by the IFRC and National Societies) to both sidesin the con ict for civilian areas to be spared and forIHL to be respected. The civilian casualty toll and theextent of destruction are worse than any the area has

witnessed in recent years, said Robert Mardini, theICRCs head of operations for the Middle East.

Humanitarians at riskTodays urban warfare also poses great risks for hu-manitarian workers, who remain active, mobile andvisible as they evacuate wounded or bring essential

services and supplies to civilian populations. Amongthe 38 Syrian Arab Red Crescent humanitarians andseven Palestinian Red Crescent workers killed dur-ing the Syrian con ict are several who were struckby indiscriminate explosive weaponry, while othercritical infrastructure has also been hit.

In July 2014, two Palestine Red Crescent emer-gency medical workers were killed and threewounded, in the course of their duties. The ambu-lances that were hit were clearly marked with theRed Crescent emblem. And in August, a volunteerwith the MDA in Israel was killed by a missile strikein the kibbutz where he lived.

Due to the deterioration of the security situation,the safety of our staff has remained a great concernfor us, says Noam Yifrach, chairman of the MDAsExecutive Committee. Particularly because, giventhe extended duration of this emergency phase, wehave had to deploy additional volunteers and staffto operational areas.

Meanwhile, as fighting continued in easternUkraine, civilians paid a heavy price as intermittentshelling of residential areas in eastern cities such as

Lugansk endangered civilians and humanitarian ac-tors alike.In September, a shell that landed outside ICRC of-

ces there took the life of ICRC delegate Laurent duPasquier, a 38-year-old Swiss national who workedas an administrator and had completed missionsin Egypt, Haiti, Pakistan, Papua New Guinea andYemen.

We are deeply shocked by this tragic loss, saidDominik Stillhart, ICRC director of operations in astatement the following day. Indiscriminate shell-ing of residential areas is unacceptable and violatesinternational humanitarian law.

L The use of high-poweredexplosive weapons in urban areasoften leaves surviving civiliansdigging through rubble to nd thethings they need to survive. Often,once thriving neighbourhoods areleft without power, functioningwater and sanitation systems,while the economy is effectivelydismantled. The severe damagein icted by these weapons means

that those who have ed havenothing to return to and mustremain displaced for years.Photo: Teun Anthony Voeten/ICRC

I As con icts unfold, theMovement works in various waysto keep basic services functioning.Here, ICRC and Syrian Arab RedCrescent water and habitatteams meet with local powerauthority offi cials in Damascus,Syria concerning repairs to criticalpower systems.Photo: Syrian Arab Red Crescent


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L In addition to killing people,the use of powerful explosivesin urban areas can cause a levelof destruction that can literallychange the urban landscape. InGaza, a boy stands in front of

a building destroyed by aerialbombing.Photo: Annibale Greco/ICRC

J The type of explosive weaponsoften used in populated areas arefrequently highly indiscriminateand are incapable of targeting withsuffi cient precision to avoid civiliancasualties. Here, a woman passesa building destroyed by shellingin the eastern Ukrainian town ofPopasna, in October 2014.Photo: REUTERS/David Mdzinarishvili

Just as the worlds population has grown more and more urban, modern warfare has also increasingly

found a home among the apartment buildings, streets, neighbourhoods, business centres and markets

of major cities. The con icts in Gaza, Iraq, Libya, Syria and Ukraine offer some recent case studies on the

impact that lethal weaponry can have on densely populated urban environments. They also emphasize

the diffi culty of protecting and preserving human life in battle zones where the systems needed to sustain

life water, sewage, electrical, transport, food and fuel supply are complex and massive in scale.

These photos, all taken during ongoing con icts, provide a grim re ection on the long-term rami cationsand enormous costs associated with once again making these decimated neighbourhoods places in which

people can safely live, shop, work and play.

War inthe streets


Focus


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J In many of todays urbancon icts, numerous actors arevying for control of variousneighbourhoods or strategic

areas. In many cases, they reexplosive weapons from areaswhere civilians are still living orworking.Photo: REUTERS/Shamil Zhumatov



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I An Israeli woman receivesmedical assistance as she isevacuated after a rocket, redfrom the Gaza Strip, fell insouthern Israeli city of Sderot, 31July 2014.AFP Photo/Gil Cohen-Magen

Focus

L In many urban con ict zones,this is an all-too-common sight.The tail of an unexploded bombprotrudes from among rubble ofdamaged buildings in an area notfar from the Syrian city of Aleppo.Aside from putting peoples livesin peril, the presence of suchunexploded remnants severelyhampers reconstruction efforts.Photo: REUTERS/Hamid Khatib


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K There is a psychologicaldimension unique to urbanwarfare, due to the ubiquitouspresence and dangers posed bycrumbling buildings and the threatof unexploded weapons, hiddenin the rubble. The destruction ofurban areas by explosive weaponryalso raises questions about thefuture, particularly among youngpeople, who must try to makea life for themselves, even findsome semblance of normality, ina very abnormal environment.Here, a Palestinian girl plays witha balloon near what is left of herfamilys house in the east of GazaCity in October, 2014.Photo: REUTERS/Suhaib Salem

J The 2014 con ict betweenIsrael and Gaza cost the livesof more than 2,000 people,including two Palestine RedCrescent Society emergencymedical workers. In north-easternGaza, the Palestine Red CrescentSociety, with the support of theICRC, helped evacuate the woundedand provided emergency medical

services to the affected population.Photo: Rama Humeid/ICRC


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In the wake of war and natural disaster,violence has taken root in manyimpoverished inner city areas of CentralAmerica. For young people hoping to nda different way, the Red Cross offers ahelping hand.

AMONG THE STEEP, uneven streets of mudand dirt, the modest houses of HbitatConfen sprout above the thick tropical veg-

etation. Its a weekday morning and the streets arequiet in the neighbourhood, one of the many com-munities that make up Ciudad Delgado, a city of120,000 people just a few kilometres from San Sal-vador, the capital of El Salvador.

Hbitat Confen is a community that sprang upas a result of the severe earthquake that occurredin October 1986, a time when El Salvador was inthe grip of civil war, recalls Mario Gutirrez, a com-munity leader and member of the community

development associations governing board.The government built 1,040 homes at what

is now Hbitat Confen, and people affected bythe war or the earthquake came to live here, ex-

Away from violenc


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sion advanced at breakneck speed, one of manyfactors that has contributed to urban violence.

A different form of violence, a new challengeCiudad Delgado is not the only city facing theseissues. Nationwide, El Salvador is one of the mostviolent countries in the region with more than 2,300

murders in 2013, though that is less than half of the4,000-plus killings reported in 2011, according to ElSalvadors Ministry of Justice and Public Security.

This new breed of urban violence is recognized asone of the regions most pressing challenges. In April2011, the Salvadorean Red Cross Society launched aproject called Opportunities for Social Inclusion, aninitiative funded by the Italian Red Cross, the ICRC,the Swiss Red Cross and the Norwegian Red Cross.

The ministries of health and education andCiudad Delgado municipal authorities are also col-laborating in the project, which aims to improve thesocial inclusion of young people and their familiesin Hbitat Confen.

While the project bene ts the entire communityindirectly, it has given concrete opportunities tomore than 400 young persons and adolescents be-tween 10 and 25 years old.

Set to run until December 2014, the initiativesfacilitate opportunities that allow young people todisplay their artistic, athletic, social or leadershipskills. The programme also offers an alternative foryoung people in order to avoid involvement in vio-

lence or the abuse of alcohol or drugs.The actions taken, says Arqumedes Flores,the project coordinator, strengthen youth andcommunity structures, improve preventive and en-vironmental health, and promote art, culture andrecreation.

Reactivating the communityThe project involved the construction of a skate park,a school programme that bene ts 1,500 students, a

plains Gutirrez, who himself was living with hisfamily in San Salvador and lost everything due tothe earthquake. That is why families from all 14of the countrys departments now live in this set-tlement.

Life for the 5,500 residents of Hbitat Confen hasimproved greatly in recent years with a decreasein the actions of violent groups in part due to projects launched by the Salvadoran Red Cross andother local and international partners. Yet violenceremains a concern in the community and opportuni-ties for young people are limited.

Initially, conditions in the settlement were limitedwith few social services, says Gutierrez. But withthe passage of time, we organize the community tomanage various local institutions and developmentprojects, which currently include entertainmentspaces for children and youth with support from

the Red Cross, which has joined us during the lastve years.In the aftermath of El Salvadors civil war, which

lasted from 1980 to 1992, unplanned urban expan-


K Violence among gangs of heavilyarmed young people has been afeature of life in Ciudad Delgado formany years. But there have beensome positive signs. Here, a gangmember arranges weapons to behanded over to authorities as partof a truce between gangs in CiudadDelgado in May 2013.Photo: REUTERS/Stringer

J In Hbitat Confen, in the CiudadDelgado section of El Salvadorscapital, San Salvador, young peopletake part in a hip-hop dance school,one of many activities implementedby the Salvadorean Red CrossSociety through its Opportunitiesfor social inclusion project.Photo: Vladimir Rodas/IFRC

With the passageof time, we organizethe community to manage various local institutionsand development

projects, whichcurrently includeentertainment spaces for childrenand youth. Mario Gutirrez, a communityleader and board member ofa community developmentassociation in Hbitat Confen inCiudad Delgado, El Salvador


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football pitch, a lookout point, a recreational parkfor children, and the creation of the Henry Dunantyouth centre, where some 550 students attendworkshops on sewing, making piatas ( gures con-taining toys and sweets used in celebrations) andcandles, computer courses, dance classes (includingbreakdancing) and various art forms.

The Salvadorean Red Cross also offers an alcoholand drug abuse prevention and assistance plan forteenagers.

When I was 12 years old, I started smokingmarijuana,, says one 14-year-old adolescent whoparticipates in this programme. There was noth-ing for us young people to do around here, we hadnothing to occupy our time. So we joined the gangin our part of the settlement.

My mother would say, So young and alreadysmoking marijuana! But I took no notice of heruntil one day I went to one of the programmesworkshops, he recalls. I met young people fromother areas of Hbitat Confen and started to get toknow them. It changed the way I saw things I gaveup drugs and started going to school. Now I thinkabout my future. I want to study aeronautics and bean astronaut.

But how effective will such preventive effortsbe over the long term? And what should the RedCross Red Crescent role be in violence prevention?While the Movement has traditionally focused onresponding to violence, more National Societies

see the need to do more to in uence some of theroot causes.The Norwegian Red Cross has traditionally fo-

cused efforts on rural health projects and disasterrisk reduction, explains Lars Erik Svanberg, a pro-gramme adviser for the Americas region at theNorwegian Red Cross. In view of the growing hu-manitarian consequences of urban violence, in thelast two years we have shifted our focus towards thisarea of action.

Svanberg doesnt expect National Societies, asnon-governmental organizations, to be able totackle all the problems that cause violence, but hebelieves they can mitigate the humanitarian conse-quences.

We think that the Movement, since it is foundedon the principles of neutrality and impartiality, iswell placed to become involved in this kind of workin the region, he says.

As in many areas around the world, the Salvado-rean Red Cross has often had easier access to areascontrolled by violent groups than some other publicservices because its mission is purely humanitarian

and it does not represent national government orpublic authority.

The biggest challenge confronting projects onurban violence here, according to organizers, is not

to lose momentum, to ensure they are sustainable,through both secure funding and community buy-in, so that the social impact of the project in theneighbourhood can expand and even spread to therest of Ciudad Delgado.

Another challenge has to do with the gangs them-selves. If the ultimate aim of the Salvadoran RedCross is the integration and social inclusion of young

people, including those who might be sympatheticor be involved in a gang, might the gangs see theseinitiatives as a threat to their ability to recruit newmembers and maintain power over rival gangs ?

Youth leadership in GuatemalaIn the neighbouring country of Guatemala, vio-lence also has its roots in the aftermath of civilwar and the rapid, uncontrolled urban growthduring and after the war. The community of SantaIsabel II, about ten kilometres from Guatemala City,for example, came into being as a community of re-turnees people who ed during the Guatemalascivil war and then were relocated here when thecon ict ended.

They were originally from the Ixil area in the de-partment of Quich, which has a mainly indigenouspopulation, says Miguel ngel Estrada, coordi-nator of a social inclusion programme run by theGuatemalan Red Cross. Although the indigenousworldview is based on a deep connection with theland, the con ict between 1960 and 1996 drovethem from their homes. They went rst to Mexico

and were later repatriated by the government andrelocated here.

In this community, the Guatemalan Red Crossruns one of three violence-prevention projects

L Boys and girls participate in afootball camp, an activity offeredby the Salvadorean Red CrossSocietys Opportunities for socialinclusion project in Hbitat Confen.One key challenge for the project isconsistent funding, without whichthe activities could not continue.Photo: Vladimir Rodas/IFRC

In an environment like this, where somechildren dont even go to school, people start to dabble indrugs and alcohol atan early age.Duilio Monterroso, whomanages a violence-preventionprogramme for the GuatemalanRed Cross


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aimed at young people in high-risk districts. Theproject in Santa Isabel II, called Children and YouthFor a Better Life, was launched in 2011 and is beingimplemented in collaboration with the Spanish RedCross and the ICRC, with the support of municipalauthorities of Villa Nueva.

The main pillar of this project is a community cen-

tre run by the Guatemalan Red Cross. This facilityprovides children and adolescents with a safe placeto go; we want them to feel at home here, saysDuilio Monterroso, coordinator of the project. Wehope to develop young peoples leadership skills toensure that their voices are heard in their communi-ties. Developing such skills is a key factor in ensuringa better future for them.

The first phase of this four-year project aimedsimply to bring young people on board. In anenvironment like this, Monterroso continues,where some children dont even go to school,people start to dabble in drugs and alcohol at anearly age. This is the first step towards joining agang, which they see as a means of protectingthemselves.

The centre offers alternatives: a recreation area,drama classes, dance classes (including break-dancing and hip-hop), urban art classes andlearning-support classes to help the younger oneswith their homework.

If funding can be sustained and the programmecontinues to take root in the community, organizershope to create a school at the centre to help youngpeople learn a trade and to promote microenter-prises, says Monterroso.

Integration of adolescents in high risk

In Nicaragua, the Red Cross takes a somewhat differ-ent approach, by working with teenagers who arealready involved in the justice system. Consider thecase of 19-year-old Donald Ordez: when he was just 14 years old, he was sentenced to ve years inprison. I had nothing, he says, and one day I de-cided to take something that wasnt mine.

Today, Ordez is one of 60 young people at-tending workshops held at the central judicialcomplex in Managua, the countrys capital, as partof a programme called Transforming Leadershipfor adolescents and young people in high-risk situ-ations.

This programme is part of a larger projectHuman Rights of Childhood, Adolescence andYouth, which aligns with the Nicaraguan RedCrosss strategic aim of protecting young peoplethrough defense of their human rights and by

ghting against discrimination.During the workshops, psychologists and social

workers guide groups of 15 teenagers through activ-

Now I am justthinking about myfuture; I dont wantto get involved inanything bad.

Donald Ordez, 19, wassentenced to ve years inprison when he was 14 but nowparticipates in a programme foryouth run by the NicaraguanRed Cross

K This workshop, part ofa programme run by theNicaraguan Red Cross along withlocal authorities, seeks to helpadolescents serving sentences fora variety of crimes but who havenot been incarcerated.Photo: Vladimir Rodas/IFRC


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ities and exercises that help them to develop toolsfor coexistence and, above all, to stop resolving con-

icts using violence, explains Moiss Cordero, oneof the programmes psychologist.

Our activities also aim to help them understandthe power relations that exist in society in order toavoid them, he adds. For example, the power that

many times they have had on women, or the powerand violence of gangs to which some of them be-longed in their neighbourhoods.

The workshops are part of a programme run bythe Nicaraguan Red Cross with funding from theSpanish Red Cross and the European Union andimplemented in collaboration with the Nicaraguan judiciary.

Judges decide when adolescents should par-ticipate in the programme to assist with their socialrehabilitation and reintegration, says Ericka Blan-dino, director of the section of the Nicaraguan judiciary that deals with enforcement and moni-toring of penal sanctions imposed on adolescentsaccused of breaking the law.

The young people who have participated so farare offenders convicted of theft or drug traffi cking.Most of these children come from very troubledfamily situations, says Mara Jos Blanco, the project coordinator.

With problems so deeply rooted, and the solu-tions required so comprehensive, most National

Societies in the region say partnership with otherorganizations is critical. National Societies cannottake on the role of schools, justice systems, tacklethe drug problem or reform national economies. Butthey can contribute towards helping positive com-munity practices take root, especially among youthsuch as Donald Ordez whose lives are literally atstake.

Now I am just thinking about my future. I dontwant to get involved in anything bad, says Ordez.I just want to go back to my village, Len, become abricklayer and get married.

ByManuel Ruiz RicoManuel Ruiz Rico is a freelance journalist based in Brussels, Belgium.

First aid, a steptowards peaceIn a school playground in the Colombian city of Medelln,

laughter and shouting can be heard where a group of youngpeople re-create the scene of an emergency, with made-upinjuries, stretchers and dressings. Suddenly, another groupswings into action to help the injured and put into practice theirknowledge of rst aid. Wearing red shirts emblazoned with RedCross emblems, these young people belong to the EducationalBrigades, a Colombian Red Cross Society programme that hasbeen running in the country for more than 65 years.

Now the brigades are also part of a project to prevent and reduce violence in schools called More humanitarian spaces, morealternatives, implemented jointly with the ICRC and the Antioquia branch of the Colombian Red Cross in Medelln.

The idea behind the brigades is to generate informal, participatory educational processes that involve the young peoples ownlife experiences and that help form them as fully-rounded people, with discipline, vocational skills and an ethic of service andconcern for others. Ideally, they will also become leaders in the schools and act as guardians and mediators who promote a cultureof coexistence and peace.

The impact we are looking for is that the children say, We do not want violence, we have other ways and alternatives to moveforwards; drug addiction, arms and violence are not for me, says Valentina, a volunteer teacher in the Educational Brigades.

The experience with the brigades gives the young people an opportunity to develop their skills and creativity and allows them togo forwards more con dently in the diffi cult environment of the citys most vulnerable districts. We have seen many cases of drugaddiction and threats in school because many students are already involved in the armed con ict, says one of the students involvedin the programme. They bring violence into school with the aim of spreading their ideas. The goal of the brigades is to prevent thisand show the way to a better world.

The Educational Brigades are also a learning process for the ICRC and the Colombian Red Cross Society, as they seek to re-create and design activities that re ect the reality that young people face in Medelln today. The greatest challenge, according to

organizers, is how to instil in the students the value of helping neighbours, love of life, respect for what is different and care forthe environment and milieu in which they live. While the impact of the programme is diffi cult to quantify, there have been someconcrete results: during the three years the brigades worked in Medellns educational institutions, they inspired 42 students tobecome active Colombian Red Cross volunteers.

L Students at a school in adiffi cult area of Medelln, whereviolence from armed gangs andcriminal groups is frequent, take

part in an Educational BrigadesProject, in which students learn tolive together without violence in avery uncertain environment.Photo: Didier Revol/ICRC


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AT THE CENTRE for blind and partially sightedpeople operated by the Marisela Toledoassociation in Managua, Nicaragua, two

people lean over a three-dimensional map, running

their hands over carved lines, ridges and bumpsthat represent the riverbeds, fault lines, ood zones,landslide areas, roadways and neighbourhoods thatmake up Managuas District II.

The map is helping these two people better un-derstand how to avoid key risks, particularly duringnatural disasters such as earthquakes or oods. Bothare participants in a unique programme run by theNicaraguan Red Cross that helps people who are vis-ually impaired nd their way to safety when naturaldisaster strikes. This mock-up is a very helpful tool;it could help save our lives if disaster strikes, saysMara Cristina Aguilar, a blind woman participatingin the project.

Living through a ood, storm or earthquake canbe a terrifying and dangerous ordeal for anyone. Forthose who cannot see, yet live in a crowded, urbanenvironment, the prospect is even scarier. The visualcues that many people take for granted are absentand, if the urban landscape is damaged or changed,there are likely to be unexpected obstacles andchaos all around.

The project aims to strengthen capacities for pre-

paredness and response to earthquakes in urbanareas of Managuas district II, this kind of prepara-tion helps people avoid potential obstacles and riskyareas and reach safer grounds.

Reducing urban riskFunded by the European Commissions Humanitar-ian Aid and Civil Protection Department (ECHO) anda consortium of the Nicaraguan, Netherlands andSpanish Red Cross societies, the project is just one ofmany activities offered by the Nicaraguan Red Crossand other partners in Managua speci cally for thosewith disabilities.

In Latin America, reducing urban risk is critical ascountries in the region have some of the highestrates of urban growth among low- and middle-income countries. From a predominantly rurallandscape with economies focused on agricultural

and agro-industrial production, the region is nowundergoing a fundamental shift in economic andsocial activities de ned by irregular settlement pat-terns, limited access to land ownership, poverty anda range of other social and economic issues.

To prepare vulnerable communities effectivelyin these diffi cult and complex environments, or-ganizers of the Nicaraguan project say the criticalchallenge is to make sure people with disabilitiesare themselves directly involved in developing pre-paredness plans, identifying potential architecturalbarriers and mapping local risks and resources.

Preparedness and response plans, meanwhile, de-tail the number of people with disabilities and thoseresponsible for helping them during an evacuation,while drills and simulations serve to both test theplans and promote involvement of people with vari-ous types of disabilities. All training sessions shouldalso be regular and adapted so as to be accessibleto everyone.

A question of cultureThe IFRCsWorld Disasters Report 2014 makes the case that it is short-sighted, dangerous and ultimatelycostly for aid and development organizations to ignore the role of local culture in disaster risk redCase studies show how understanding local culture can lead to breakthroughs and greater involveamong important local institutions. For more, seewww.ifrc.org/world-disasters-report-2014.

A waytosafetyLiving through an earthquake or ood isterrifying enough. Imagine what its likefor a city dweller who is visually impaired orcon ned to a wheelchair.

L The Nicaraguan Red Crossengages in preparedness actionsaimed at reducing inner-city risks.Here, two people from a centrefor the blind in Managua explorea 3-D model of the city that showsareas where they can nd safetyand how to avoid potential dangerzones.Photo: Vladimir Rodas/IFRC


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There is also the very matter-of-fact descriptionof a delegates interview in 1967 with a politicaldetainee in South Africa named Nelson Mandelawho, along with 30 other detainees, was workingin a limestone quarry on Robben Island, one of themore notorious prisons operated by South Africasthen apartheid government.

The ICRC began visiting security convicted pris-oners in South Africa in 1963. After that, the ICRCregularly met Mandela on Robben Island and laterin Polsmoor prison, until his liberation in February1990. Mandela mentions these visits in his biogra-phy A Long Walk to Freedom .

Notable in the report is Mandelas frank andeven-handed description of prison conditions anda detailed account of the medical conditions of hisfellow inmates. But when discussing his own case,he replies simply: I personally have no complaints.

Transparency and re ectionNot all the records, however, have been completelysealed until now. Researchers can ask for permissionto review unreleased portions of ICRC archives forparticular research projects and those involved inevents described in the records can ask to look overrelevant les.

But the records are not just interesting to histori-ans. They are also a resource for the Movement, asthey contain considerable information about Na-tional Society actions, and for anyone who might

want to appraise humanitarian action and its impact.The archives ensure the organizations ability to

take stock of the actions called for by its mandate,says Jean-Luc Blondel, head of the ICRC archives.

They play an important role in the duty of an or-ganization to be transparent. As part of this dutyand in order to bene t from outside perspectives andapproaches, the ICRC encourages research and inde-pendent critique of its history and the ful lment of itsmandate, Blondel adds.

Such an attitude doesnt come without risks,

he notes. The examination of dossiers can put intoevidence the mistakes in negotiation, the misuse oflanguage or a lack of diplomacy. In some cases, itreveals certain prevailing cultural attitudes of thetime a lack of cultural sensitivity and even rac-ist undertones in the way some people expressedthemselves, Blondel notes.

In other cases, for example in the Middle East orthe Indian subcontinent, some events that occurredmore than 40 years ago are still very present in peo-ples minds today and the analyses or the course ofevents described then could affect present actionsand negotiations.

Nonetheless, the illumination offered by the past,Blondel suggests, also allows a better understandingof the roots of con icts and a potential insight intohow to facilitate resolution to con icts or at least en-gage parties in a positive dynamic towards that end.

The Movement also recognizes the importanceof the memories contained in these archives, onereason the Council of Delegates in 2011 adopted aresolution that calls for the preservation of its his-toric and cultural heritage. This issue will be revisited

during the Council of Delegates in 2015.

ByMalcolm LucardMalcolm Lucard is the editor ofRed Cross Red Crescent magazine.

L A distribution of medicineduring the Biafran war.Photo: H.D. Finck/ICRC


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My Red CrossRed Crescent storMY FIRST CONTACTwith the Red Crosscame way back in

1966 when I was a young medi-cal graduate in Yangon. I wentout to volunteer in a suburbantownship called Mingaladon,where the Ministry of Healthand the Red Cross were workingtogether in the health clinics.When I started my volunteerwork, I never imagined thatmore than 50 years later, theRed Cross would still play sucha central part in my life.

Back then, Myanmar was inthe early phase of independ-ence from the British and

poverty rates were very high. I will always remem-ber the desperate faces of people, including nuns,monks and beggars, lining up to be treated for ill-nesses like diarrhoea, dysentery and malaria, andthe commitment of the loca

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Red Cross Red Crescent Magazine: The face of humanity