The humanitarians' tragedy: escapable and inescapable cruelties.

Paradoxically, elements of cruelty are intrinsic to the humanitarian enterprise.(1) This paper focuses on some of these. Escapable cruelties arise from technical failings, but the gradual professionalisation of the field and improvements in relief technologies mean that they have been significantly reduced in comparison to earlier eras. Other cruelties arise from clashes among rights, and the tensions inherent in trying to promote humanity amid the horrors of war. These are inescapable and constitute the 'humanitarians' tragedy'. Among them is the individual cruelty of failing to do good at the margin: a clash between the individual's impulses and ideals and the constraints of operating in constrained circumstances. This is a version of triage. In addition, there is the cruelty of compromising dearly-held principles when faced with other competing or overriding demands. There is also the cruelty whereby humanitarians feed victims' dreams that there is an alternative reality, which in fact cannot be attained.

New variant famine: AIDS and food crisis in southern Africa.

Southern Africa is undergoing a food crisis of surprising scale and novelty. The familiar culprits of drought and mismanagement of national strategies are implicated. However, this crisis is distinct from conventional drought-induced food shortages with respect to those vulnerable to starvation, and the course of impoverishment and recovery. We propose that these new aspects to the food crisis can be attributed largely to the HIV/AIDS epidemic in the region. We present evidence that we are facing a new variant famine. We have used frameworks drawn from famine theory to examine the implications. HIV/AIDS has created a new category of highly vulnerable households--namely, those with ill adults or those whose adults have died. The general burden of care in both AIDS-affected and non-AIDS-affected households has reduced the viability of farming livelihoods. The sensitivity of rural communities to external shocks such as drought has increased, and their resilience has declined. The prospects for a sharp decline into severe famine are increased, and possibilities for recovery reduced.

Human resources for health: overcoming the crisis.

In this analysis of the global workforce, the Joint Learning Initiative-a consortium of more than 100 health leaders-proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

The epidemiology of lethal violence in Darfur: using micro-data to explore complex patterns of ongoing armed conflict.

This article describes and analyzes patterns of lethal violence in Darfur, Sudan, during 2008-09, drawing upon a uniquely detailed dataset generated by the United Nations-African Union hybrid operation in Darfur (UNAMID), combined with data generated through aggregation of reports from open-source venues. These data enable detailed analysis of patterns of perpetrator/victim and belligerent groups over time, and show how violence changed over the four years following the height of armed conflict in 2003-05. During the reference period, violent incidents were sporadic and diverse and included: battles between the major combatants; battles among subgroups of combatant coalitions that were ostensibly allied; inter-tribal conflict; incidents of one-sided violence against civilians by different parties; and incidents of banditry. The conflict as a whole defies easy categorization. The exercise illustrates the limits of existing frameworks for categorizing armed violence and underlines the importance of rigorous microlevel data collection and improved models for understanding the dynamics of collective violence. By analogy with the use of the epidemiological data for infectious diseases to help design emergency health interventions, we argue for improved use of data on lethal violence in the design and implementation of peacekeeping, humanitarian and conflict resolution interventions.

Reframing governance, security and conflict in the light of HIV/AIDS: a synthesis of findings from the AIDS, Security and Conflict Initiative.

This paper draws upon the findings of the AIDS, Security and Conflict Initiative (ASCI) to reach conclusions about the relationship between HIV/AIDS, security, conflict and governance, in the areas of HIV/AIDS and state fragility, the reciprocal interactions between armed conflicts (including post-conflict transitions) and HIV/AIDS, and the impact of HIV/AIDS on uniformed services and their operational effectiveness. Gender issues cut across all elements of the research agenda. ASCI commissioned 29 research projects across regions, disciplines and communities of practice. Over the last decade, approaches to HIV/AIDS as a security threat have altered dramatically, from the early anticipation that the epidemic posed a threat to the basic functioning of states and security institutions, to a more sanguine assessment that the impacts will be less severe than feared. ASCI finds that governance outcomes have been shaped as much by the perception of HIV/AIDS as a security threat, as the actual impacts of the epidemic. ASCI research found that the current indices of fragility at country level did not demonstrate any significant association with HIV, calling into question the models used for asserting such linkages. However at local government level, appreciable impacts can be seen. Evidence from ASCI and elsewhere indicates that conventional indicators of conflict, including the definition of when it ends, fail to capture the social traumas associated with violent disruption and their implications for HIV. Policy frameworks adopted for political and security reasons translate poorly into social and public health policies. Fears of much-elevated HIV rates among soldiers with disastrous impacts on armies as institutions, have been overstated. In mature epidemics, rates of infection among the military resemble those of the peer groups within the general population. Military HIV/AIDS control policies follow a different and parallel paradigm to national (civilian) policies, in which armies prioritize command responsibility and operational effectiveness over individual rights. Law enforcement practices regarding criminalized and stigmatized activities, such as injecting drug use and commercial sex work, are an important factor in shaping the trajectory of HIV epidemics.