Agencies providing outside humanitarian assistance in emergencies fall into several categories - foreign governments, international organizations, and nongovernmental organizations (NGOs) (see Annex IV).
Latin American and Caribbean countries more frequently find themselves functioning as providers of humanitarian assistance than as aid recipients. In case of disasters, there often is a spontaneous show of solidarity among countries that share similar cultures and vulnerability to hazards.
Being an effective donor rather than contributing to the confusion through technically or operationally unsound initiatives should be a political priority in every country. In the Americas, the ministers of health adopted a regional policy for this purpose (see Annex III). The minimal criteria are to avoid common unsolicited donations (food, clothing, etc.) and to consult both with the affected country’s ministry of health and with PAHO/WHO.
Many developed countries also offer generous bilateral assistance to disaster affected countries. Special departments or humanitarian assistance offices have been established in most donor countries. Among the most important bilateral or multilateral agencies active in the Americas are the Office of U.S. Foreign Disaster Assistance of the U.S. Agency for International Development (OFDA/USAID), which directs a comprehensive disaster mitigation, preparedness, and response program; the Office for International Humanitarian Affairs of the Canadian International Development Agency (IHA/CIDA); the United Kingdom’s Department for International Development (DFID); and the European Commission Humanitarian Office (ECHO), whose budget and programs are the most significant worldwide. Other European countries and Japan have traditionally provided generous bilateral humanitarian assistance to Latin America and the Caribbean.
United Nations Agencies
The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is responsible for alerting the international community and coordinating international humanitarian response following all types of disasters. In addition to its co-ordination function, OCHA can also field a United Nations Disaster Assessment and Coordination (UNDAC) team to assist in the general assessment of needs and on-site coordination during the initial relief phase. In the Americas, a regional UNDAC team consists of qualified and specially trained nationals from PAHO Member States. This team coordinates its operations closely with the PAHO/WHO disaster team, which is activated immediately following disasters. OCHA also co-ordinates the dispatch of search and rescue (SAR) teams from different countries in the case of major earthquakes that affect urban areas, in order to avoid common duplications and gaps in rescue activities. Finally, OCHA coordinates the occasional multilateral deployment of military assets from a number of cooperating countries. A Military and Civil Defense Unit (MCDU) in OCHA is the focal point for civil-military cooperation, with special emphasis on the use of military assets for U.N.-led operations.
OCHA’s mandate is limited to humanitarian response. Overall responsibility for preparedness and mitigation in the U.N. system has been assigned to the United Nations Development Program (UNDP), as part of the approach of integrating disaster management into the development process.
At the country level, the U.N. Disaster Management Team (DMT) is made up of representatives of all agencies of the U.N. system, including PAHO/WHO in the Americas. This team is chaired by the U.N. coordinator in the country, who is usually the UNDP Resident Representative. In some countries, the DMT also includes representatives from donor governments and NGOs. The DMT aims to offer a coordinated, multisectoral approach and collaboration to the authorities of the affected country.
In health aspects of emergencies and humanitarian assistance in the Americas, the Pan American Health Organization is the focal point and coordinator for the U.N. and inter-American systems. Its priority, however, is not to substitute local resources or to provide external material assistance but to strengthen the capacity of the countries - through preparedness and training - to respond themselves to health emergencies or disasters. In case of disaster, PAHO/WHO will provide technical cooperation in assessing health needs, formulating priorities for external health assistance, and coordinating external medical and public health external response. Although PAHO/WHO is a technical cooperation agency, it may directly provide humanitarian supplies, administer public health projects or initiatives, and offer other operational services when no other agency is in a position to do so. Among the technical services routinely offered is the mobilization of the expertise and capacity for management of humanitarian supplies (see Chapter 12 and Annex II for a description of SUMA, the supply management project).
Regional and Subregional Organizations in the Americas
Several subregional disaster organizations have been established during the 1990s. Decentralization from a global to a regional level is placing disaster management closer to the countries. Cooperation between neighboring countries is far preferable to the traditional international approach.
The Organization of American States (OAS) is a regional organization that lends support to its Member States in assessing their Vulnerability to natural hazards and mitigating effects of disasters. FONDEM (Emergency Fund) is a mechanism established within the inter-American system for the coordination of humanitarian response among the permanent missions to the OAS, the OAS Secretariat, PAHO/WHO, the Inter-American Development Bank (IDB), and other organizations headquartered in Washington, D.C. The OAS Secretariat also offers technical assistance in risk assessment for development planning and project formulation and for reduction of vulnerability to hazards.
Following Caribbean hurricane experiences during the past few decades, and the conclusion of the Pan Caribbean Disaster Preparedness and Prevention Project in 1991, the Caribbean Governments recognized the need for a permanent regional mechanism to coordinate regional disaster management activities. The Caribbean Disaster Emergency Response Agency (CDERA) was established in 1991 by an agreement of the heads of government of the Caribbean Community (CARICOM). CDERA has 16 participating states and its headquarters are located in Barbados, West Indies. CDERA’s main function is to coordinate response to any disaster affecting participating states, and to work with countries to strengthen their disaster management capacity.
In Central America, the impetus towards integration among countries resulted in the creation of the System for Central American Integration (SICA) in 1991. In their meeting in 1994, the Presidents of Central America agreed to convert the Center for Coordination for the Prevention of Natural Disasters in Central America (CEPREDENAC) into an official organization within SICA, with its headquarters in Panama. CEPREDENAC has worked since 1988 to build the capacity of scientific institutions in reducing vulnerability to disasters. The Central American Member Governments have given it the task of promoting disaster reduction in the region through an exchange of information, the development of common approaches to problem analysis, and the establishment of regional strategies to reduce disaster vulnerability.
In the Andean countries, regional cooperation regarding health issues was formalized in the Hipólito Unanue Agreement, signed in 1971. Strategies to reduce the impact of disasters on the health sector is a focus of annual meetings of the Ministers of Health of participating countries.
Worldwide, several thousand nongovernmental organizations (NGOs) are wholly or partly concerned with international humanitarian assistance, human rights, or health, and provide material, expertise, or, in some instances, cash. There are several NGO associations at the international level (see Annex IV):
• The International Council of Voluntary Agencies (ICVA), based in Geneva;
• InterAction, a Washington-based consortium of NGOs in the United States that strives to set minimum standards and promote best practices in humanitarian assistance;
• The Steering Committee for Humanitarian Response, a long-standing and influential Geneva-based working party among the International Federation for Red Cross and Red Crescent Societies, CARE International, Caritas Internationalis. Catholic Relief Services, Lutheran World Federation, Médecins Sans Frontières International, OXFAM, and the World Council of Churches;
• Voluntary Organizations in Cooperation in Emergencies (VOICE), a consortium of European agencies working in emergencies - based in Brussels, it represents European agencies before ECHO.
Many of these agencies are supported by contributions from the general public, although they increasingly receive and depend on government financing.
Nongovernmental organizations vary considerably in their approaches to humanitarian assistance and the health contributions they can make. Larger, experienced agencies and those already engaged in development work in the affected country tend to have a better understanding of the nature of the problems encountered. They engage in disaster relief only when needs have been identified. Among the most experienced agencies, national Red Cross societies and the International Federation of Red Cross and Red Crescent Societies in Geneva have been most active in disaster relief. Médecins Sans Frontières also has established a solid reputation for competent and effective public health response.
Agencies without a prior commitment to the country concerned generally have less knowledge of local problems and sometimes harbor misconceptions about the needs created by a disaster. They can thus increase the pressure on the local government by demanding operational support (for example, transportation) that would be better allocated to another agency.
In addition, “ad hoc agencies” - those formally or informally established by well intentioned but inexperienced persons in response to a particular disaster - can be a major drain on the operational resources and patience of the government of an affected country. They are generally the main source of unsolicited and unusable donations clogging the logistical chain.
Operationally, NGOs are generally more flexible and regarded as more directly responsive to people’s needs than larger U.N. agencies. For this and other reasons, donor countries increasingly prefer to channel their material assistance and financial support through their national NGOs, rather than through multilateral agencies. The health services of the disaster-affected countries should recognize and adjust to this trend.