Humanitarian Health Action

Proceedings from the WHO Conference on the Health Aspects of the Tsunami Disaster in Asia

Phuket, Thailand, 4-6 May 2005

Benchmarks, standards and codes of ethical practice

28. Over the last few years, a considerable effort has been made to develop standards, norms, tools, techniques and health kits for use in disaster situations. The “Sphere Project”, a multi-agency initiative, sets minimum standards to be used in disaster situations. WHO has developed standardized health kits. A Standardized Monitoring and Assessment of Relief and Transitions Initiative has also been developed. Gaps include indicators for assistance to vulnerable subgroups, and aspects of analysis methodology.

29. While progress on standard setting has been made at the global level, and while there has been a general professionalization of humanitarian assistance, the Tsunami experience highlighted the gap between what is desirable and what happens in actual practice. Different organizations used different measurements, methodologies and interpretations in their own assessments, making it difficult to compare results, identify the populations of greatest need, and achieve consensus on priorities. This lack of coordination resulted in wasted resources and was partly explained by inconsistencies in leadership, undue pressure to generate information rapidly, and lack of expertise in the application of available standards. Inadequate assessments result in inappropriate strategies that neither make the best use of resources, nor result in optimal reductions in avoidable morbidity and mortality.

30. To avoid this state of affairs, disaster preparedness plans should include standardized assessment and reporting formats, with an appropriate set of indicators, to ensure that key data are collected in a comparable manner, and yield reliable information on gaps that need to be filled. An essential requirement is widespread international acceptance of standards and indicators, together with the means to enforce them. Participants proposed the establishment of a peer group to serve as a means through which health organizations working in disasters could regulate themselves and assess (and accredit) the competences of response personnel. They asked that WHO consider options for such an initiative. They also proposed that the curricula of health training institutions incorporate standards and basic best practice for humanitarian health work.

31. When humanitarian agencies respond to a crisis and define a set of goals and objectives for their operation, they enter into a professional contract with their partners and donors. However, it is often forgotten that they are also entering into a moral contract with their beneficiaries. There is an obligation for humanitarian actors who accept donated funds or commit to assisting a community or institution to behave ethically, to function transparently and to be accountable for the impact and outcomes of their actions and not just for their use of donated resources. Complementary ethical codes of practice are expected from donors, to ensure common consistency.