Humanitarian Health Action

Purpose statements for panels and sessions

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

Panel 2.14: Contribution of non-governmental actors


Non-governmental organizations play an important role in the aftermath of disasters to deliver emergency health care and provide long-term medical support. NGOs provide certain advantages, including: their presence on the ground as first-responders, their flexibility to emphasize and deliver different services in a fast-changing environment, and their long-standing presence and understanding of the local environment, culture and systems of health care. NGOs also have a greater ability: (1) to understand the effects of the disaster, and subsequent policies, upon the livelihoods of survivors, (2) to identify human rights that either result in the denial of health care or lead to poorer health outcomes for survivors and (3) to develop and promote the right to health care in the aftermath of a natural disaster. Thus, NGOs argue that Inter-governmental Organizations (IGOs), aid agencies and governments should make a greater effort to develop stronger systems of coordination and communication with NGOs to strengthen delivery of essential services. They should also make a greater effort to include NGOs in the decision-making processes that occur amongst IGOs, relief agencies and government services in the aftermath of an emergency. Finally, the capacity of NGOs to engage in disaster prevention and response should be bolstered in the interim by building the capacity of NGOs to engage in disaster response, and by opening permanent lines of communication between government, IGOs and civil society.

NGOs also acknowledge certain limitations in the aftermath of a disaster. This includes: limited technical capacity and expertise in disaster management, a lack of coordination amongst non-governmental organizations delivering relief, a lack of understanding of the “bigger picture” during relief operations (often because NGOs are not included in decision-making and planning), a limited time-frame to engage in disaster relief (often necessitated by strict time limits imposed by funding agencies on projects) and a lack of access to affected areas resulting from a government emphasis on political security over human security.

Furthermore, given the central role of the military in delivering aid, particularly in Aceh, special consideration should go towards examining the relationship that existed between NGOs and the military to deliver health care services in the tsunami’s aftermath. Finally, in those areas where non-state actors, particularly militants, control the provision of services and maintain effective self-government, the interaction of NGOs with these non-state actors to deliver emergency services after a disaster should be explored.

Key questions

Recognizing these realities, the panel will examine the role of non-governmental organizations to consider the following issues:

  • NGOs as first responders: In what ways did non-governmental organizations act as ‘first responders’ immediately following the tsunami with respect to health care delivery? How effective were NGOs as first responders? What level of coordination and communication existed between NGOs, government/military and IGOs during the initial phase? Was there a greater level of coordination between government/IGOs/military and larger international NGOs than with community, national and local NGOs?
  • Service delivery: What services did NGOs provide effectively in the aftermath of the tsunami, particularly compared to other stakeholders and actors? What were the advantages to delivering certain forms of health care through NGOs? What were the major limitations in service delivery by NGOs? What level of coordination existed between NGOs in the aftermath of the tsunami to deliver health care services, and how was coordination facilitated by the military, governments and IGOs? How can this be improved hereafter by the WHO and Ministries of Health? What was the role of NGOs to provide psychosocial care and support in the aftermath of the tsunami?
  • Decision-making: What level of influence/role did NGOs have in planning/coordinating health care service delivery, particularly at the local and community level? What is the role of NGOs in the planning and decision-making process? What exactly do NGOs add to the decision-making process? How could NGOs be more effectively incorporated into the decision-making process in the future? What are the barriers to incorporating NGOs into the decision-making process?
  • Protection of Human Rights and sensitivity to local cultures: In what ways were NGOs particularly suited to identify human rights considerations, cultural sensitivities and the immediate needs of affected populations after the tsunami? How can NGOs promote the right to health as a central framework to guide emergency activities and relief? What role do NGOs play in identifying discrimination in the allocation and distribution of health care services, and how do NGOs rectify this problem? How important should a NGO’s ability to identify human rights/cultural concerns be when determining their role in decision making for delivery of health care services? How can these concerns identified by NGOs be communicated to government officials, the military and IGOs in a manner that benefits the affected communities?
  • Improving the effectiveness of NGOs in health emergencies: Based upon the limitations of NGOs in delivering health care services, how can NGOs improve their response to emergencies hereafter? What role do IGOs and government have in strengthening the capacity of NGOs to engage in an effective response? What barriers to delivering services resulted from the activities/policies of governments, militaries and aid organizations (e.g. restricting access, lack of inclusion in decision making, confining or delaying delivery of resources, tight guidelines/restrictive aid)? How should these barriers be addressed and what steps can be taken in the future to prevent similar problems from arising? Finally, how can NGOs help the affected countries and IGOs prepare for disasters hereafter in the affected countries?
  • Defining the relationship of NGOs with the military and non-state militant/rebel groups: How did NGOs and civil society interact with the military in disaster affected areas, particularly Aceh, Sri Lanka and India? What were the successes and problems that arose in the interactions between these two actors? How can the military and NGOs improve interactions hereafter? How do NGOs interact with non-state actors, and in particular militant or rebel groups (e.g. LTTE in Sri Lanka, GAM in Aceh)? What challenges are presented to NGOs in these interactions, and how can governments and IGOs facilitate the ability of NGOs to work in these conflict areas?