The Changing Realities of Humanitarian Assistance: Commentary from 22 Years in the Field


It's a long way from a middle-class upbringing in Cedar Rapids, Iowa, to the refugee camps of Darfur. But for more than two decades, Nancy Aossey's work has taken her to the most desperate corners of the globe, bringing hope and lifesaving medical care to those in need.

Speaking at the Milken Institute, Aossey recounted a career spent on the front lines of wars, famines and natural disasters. As president and CEO of the International Medical Corps (IMC), she has transformed this Santa Monica—based operation into one of the world's most respected relief agencies.

Aossey's approach is not only to provide relief but to train local people help themselves and their neighbors. She recalled a mission to Angola in 1990. "Instead of sending in a handful of nurses, who could reach a limited number of people, we decided to offer basic medical instruction," she explained. "We trained trainers, and that had a multiplying effect so that more children could be immunized." Her strategy has become increasingly important in the face of an acute worldwide shortage of doctors.

The realities confronting aid workers on the ground have changed drastically over the years. "There's been an alarming deterioration of security in the places where we work," Aossey explained. "I first experienced this in the early 1990s in Bosnia, when Serbian militias began to specifically target journalists and relief workers. One of the scariest experiences of my life was driving through Sniper's Alley, where they were picking people off with AK-47s. I knew this would fundamentally change the way we work. The bad guys were willing to target innocents and children. There were no boundaries left."

Security teams now accompany IMC workers, ensuring that they operate inconspicuously. In Iraq, for example, IMC health-care workers drive battered trucks to blend into the background. "We have to take risks to work in tough places," explained Aossey.

Aossey described the humanitarian arena as an increasingly crowded space. She noted the growing involvement of the private sector, but questioned the disease-specific initiatives launched by some well-intentioned foundations and corporations. This concentrated vertical funding can produce dysfunctional results - say, a shiny new TB hospital standing across the street from a crumbling, ill-equipped general clinic. Aossey has found that it's more effective to take a holistic approach to health services.

The technology improvements of the last decade have presented relief workers with new tools of the trade. "At age 27 I had to make a huge financial decision: whether to spend our money on a fax machine to communicate with Pakistan," said Aossey with a laugh. "Little did we dream how technology would one day change the way we operate." Today, high-tech tools — from cell phones to mapping software — are improving communication, coordination and assessments in remote areas.

Aossey now finds a greater media presence in the field than ever before. Americans are confronted with immediate images of human suffering in the developing world, beamed right into their living rooms. "People around the world see more and more that we are bound together. After the tsunami, the coverage tapped into the generosity and the big hearts of Americans," she recalled. "But there are always what I call 'silent emergencies' — like Darfur — that just don't get media coverage."

One thing hasn't changed over the years: IMC's focus on reaching out to young children and women of childbearing age. "Women often bear the brunt of suffering in these areas," Aossey explained, "but they embody the greatest hope."