The impact of humanitarian aid on conflict development

30-06-1998 Article, International Review of the Red Cross, No. 323, by Pierre Perrin

 Pierre Perrin   is a medical doctor who undertook many missions for the ICRC before becoming the organization’s Chief Medical Officer. He gives courses at the universities of Aix-en-Provence, in France, and Louvain, in Belgium, and at John Hopkins University in the United States.  

The proliferation of crises around the world has led to a sharp increase in the scale of humanitarian aid required to meet the vital needs of the people affected by them for food, water, medical care and shelter. Humanitarian organizations can either meet those needs directly or support local services engaged in the same work. In most cases, both approaches are used.

Preconceived ideas — for example that humanitarian aid always prolongs conflict — must be shunned if the way humanitarian aid influences the development of conflicts is to be judged fairly. If we are to evaluate that aid accurately, its effect on victims (its primary purpose) and on the conflict itself both need to be analysed. By combining these two factors, it is possible to make an objective assessment and draw conclusions for future work.

 The consequences of conflict from a humanitarian point of view  

Malnutrition, illness, wounds, torture, harassment of specific groups within the population, disappearances, extra-judicial executions and the forcible displacement of people are all found in many armed conflicts. Aside from their direct effec ts on the individuals concerned, the consequences of these tragedies for local systems must also be considered: the destruction of crops and places of cultural importance, the breakdown of economic infrastructure and of health-care facilities such as hospitals, etc., etc.


The direct impact of armed conflict on people and on the systems essential to their survival is highly visible but it should not be forgotten that the priority for the warring parties is their military operations, not the smooth operation of economic and social structures. The result is a gradual deterioration of these structures, even in situations where they are not directly targeted by the combatants.

The impact of armed conflict on people and systems vital to their survival can take different forms, as the following examples illustrate:

— When Rwandan refugees fled into former Zaire, the mortality rate rose sharply, to as much as 10 times what is regarded as the threshold of extreme emergency. [1 ]

— Large-scale displacement invariably causes a dramatic increase in malnutrition rates. In children under the age of five, this can reach 20% (Rwandan refugees in Zaire, 1994) or even 50% (Somalia, 1992).

— During the five years of conflict in Sierra Leone, almost 40% of the country’s population were forced to flee their homes. Hundreds of thousands of people left for Guinea and Liberia, but most sought refuge in camps within Sierra Leone itself, and by the end of 1995 over one million people were living in camps in Freetown, Bo, Kenema, Segbwema and Daru. [2 ]

— Somalia 1991: “The economic and social structure has ceased to exist. There is no electricity, communications have broken down and schools are closed. Everything that was vital to the country has been destroyed. Insecurity, conflicts between clans and even within factions — there are a variety of causes for this disastrous situation.” [3 ]

— The destruction of the water supply system in the city of Sarajevo had disastrous consequences for the population. Part of the city had no running water for a year and a half. There were a few places where the inhabitants had to go and get the water they needed, at the risk of being ambushed by snipers. [4 ]

— The number of Mozambicans killed during the conflict in that country is estimated at 100,000. Over five million people were displaced and 1.7 million people had to seek refuge in neighbouring countries. Two million people no longer had any access to health care. In some areas, half the health-care facilities were destroyed. Three million farmers, finally, were prevented by the conflict from farming. [5 ]


 The aim of humanitarian aid is to assist the victims of armed conflict, without discrimination, in coping with these problems.  

 The role of humanitarian aid  

Aid for victims of conflict remains the primary responsibility of the warring parties. The need for outside help arises when the parties to a conflict are unable or unwilling to shoulder that responsibility.

Any successful aid strategy will have different goals. For example, aid is primarily intended to prevent the disastrous consequences mentioned above by stepping in before the health of the victims of conflict deteriorates. This requires prompt action either to assist the affected population groups directly or to prevent the deterioration of health care, agricultural or other local systems. This enables those systems to cope with the situation and thereby to prevent people’s health from deteriorating. But aid should also be designed to prevent the growth of dependence on outside assistance. For example, food distribution remains a valid option when the situation calls for it, but it often goes hand in hand with action to help the beneficiaries regain their self-sufficiency quickly. This strategy can have various forms. Steps may be taken to increase food production and develop distribution channels, while protection work can help restore access to food. In some cases specific action is needed to assist individuals suffering from acute malnutrition. The overall strategy is usually a combination of various measures taken at different stages in the food-production and distribution process.

Humanitarian aid frequently also takes other forms as well.


— In Afghanistan, the ICRC assists five hospitals, the aim being to improve the quality of surgical treatment for war casualties and to provide regular supplies of medicines and medical/surgical items. [6 ]

— To prevent water contamination in Albania — which is more likely in the summer months and poses a threat to public health — the ICRC gave 52 tonnes of chlorine last year to the authorities responsible for water quality. [7 ]

— “The United Nations maintained the embargo on Iraq, which had been in force since 1990. (...) Iraqi water installations continued to deteriorate for lack of spare parts, equipment and qualified personnel. Throughout Iraq, including the three northern governorates, the ICRC kept up its efforts to lessen the effects of this deterioration on public health by rehabilitating water supply and treatment facilities which had been identified, in cooperation with the Iraqi water authorities, as priority sites.” [8 ]

— In Brazzaville, ICRC delegates worked on both sides of the front lines to supply drinking water to displaced people, support medical facilities and evacuate to Kinshasa any wounded people who could not be treated on the spot.

— “Regular contact was maintained at all levels with the relevant Rwandan authorities in order to remind them that they themselves bore the main responsibility for ensuring that the conditions of detention were acceptable. At the same time, the ICRC continued the large-scale assistance programme launched in 1994 to enable the detainees in those prisons to survive. The programme undoubtedly had an effect: by late 1995, the prison mortality rate had dropped to approximately that of the rest of the population (...).” [9 ]

— In Somalia in 1992, several different kinds of assistance were provided by the ICRC, including food relief (120,000 tonnes), a veterinary programme, an agricultural programme and one in support of medical facilities.

Humanitarian action can thus take very different forms:

— a limited, one-time operation;

— complex, long-term rehabilitation programmes;

— relief operations for people whose lives are directly threatened;

— operations combining immediate relief work and medium-term rehabilitation;

— operations for the purpose of preventing violations of humanitarian and human rights law.

Over the last five years, there has been a marked trend in humanitarian aid towards preventing or, at the very least, alleviating the worst effects of armed conflict. Direct and massive relief operations naturally remain necessary in certain situations, but there has also been a stepping-up of work to support local services essential to people’s survival. The inclusion of humanitarian aid in more long-term projects thus makes it possible to restore self-sufficiency.

 This comprehensive approach — which takes into account people’s need for assistance and protection, combines short-and medium-term strategies and seeks to prevent the worst human consequences of armed conflict — has many positive effects. It helps to save lives, relieve suffering, improve health, maintain health-care systems, place the victims’ economy back on a sound footing and also restore people’s dignity.  


Nevertheless, humanitarian aid can in the following ways also have a negative effect on the victims and on local systems:

— Aid can discourage those who come to rely on it over the long term from overco ming the crisis by their own means.

— Poorly managed operations can do more harm than good. Up to the early 1980s, for example, the uncontrolled distribution of powdered milk to large population groups caused more health problems than it solved.

— Aid has the effect of attracting people to it, and they then tend to become concentrated in distribution centres. This leads to overcrowded camps, which have their own specific health and security problems.

— Aid can lead to significant alterations in the lifestyles of its beneficiaries, for example by encouraging a trend towards profit-oriented agricultural production as people’s basic food needs are being met by the relief provided. When the aid comes to an end, people find themselves facing food shortages.

— Aid can prompt national political leaders to transfer resources from the socio-economic programmes to which they had been allocated to uses that the leaders regard as more important (buying arms, for example).

— Humanitarian aid may be interpreted as support for the political systems in place when it is supplied directly to those systems’ leaders who, at best, distribute it in their own name or, at worst, misappropriate it for their own benefit.

 Humanitarian aid is thus essential to save lives, relieve suffering and restore dignity, but it also has negative effects on the victims of conflicts and their local systems.  

It is important to understand this in order to reply rationally to the question “What impact does humanitarian aid have on the development of armed conflict?”.

Very briefly, we can trace the theoretical development of an armed conflict using a curve that passes through a series of different stages: stable situation (peace), cri sis, armed conflict, conflict settlement, reconstruction and, finally, return to a stable situation. In between are many intermediary stages peculiar to the development of each individual conflict. Our aim here is not to study this development but rather to establish a framework within which we can study the extent to which humanitarian aid influences the dynamic of armed conflict.


Humanitarian aid is usually furnished at the heart of conflicts. To analyse its impact on how these develop, we can take two parameters: the level of violence and the duration of conflict.

 The effect of humanitarian aid on violence in conflicts  

Humanitarian aid can help increase violence in conflicts. If diverted, these resources can be used to buy arms and thereby aggravate the conflict. The beneficiaries of aid (be they the general civilian population or detainees) may become the target of armed groups trying to get their hands on relief supplies. Such victimization take different forms:

— pressure on or harassment of the aid’s beneficiaries to relinquish part of the aid they have received;

— the forcible enlistment of young men, or even the displacement of entire population groups, by armed groups when food distribution prompts large groups to assemble;

— large groups of civilians taken hostage so they can be used as “bait” for humanitarian aid, which is then misappropriated by armed groups;

— direct attacks on the people receiving aid (looting, murder);

— attacks on humanitarian warehouses and convoys.

Humanitarian aid often serves as a substitute for action that should be taken by the warring parties themselves, helping those parties to shirk their responsibilities. Where the State has been weakened, humanitarian aid contributes directly to exacerbating the situation, in particular by setting up a parallel economy or a non-State health-care system, run by the aid organizations. This effect is all the more serious when it occurs in a State that is already in the process of collapsing, as it hastens that collapse and increases the risk of unrestrained violence.

But humanitarian aid can also help reduce violence. We have seen how it both relieves and prevents suffering — by providing treatment for the wounded, food supplies, sanitation, etc. — a nd thus helps alleviate the silent forms of violence that are part of armed conflict: hunger, thirst and disease. Aid also helps to reduce violations of international humanitarian law, which are very direct forms of violence. In all armed conflicts, the ICRC reminds the warring parties of their obligations, in particular where non-combatants are concerned. For example, “the ICRC calls on all the parties involved to abide by the rules of international humanitarian law, and in particular to make a clear distinction between civilians and combatants and to respect persons who are not or are no longer taking part in the hostilities.” [10 ] An appeal such as this is the first stage in the ICRC’s work, aimed at actually preventing violations of international humanitarian law (so-called primary prevention). Prevention work will be all the more effective if the ICRC is present on an ongoing basis, as is the case with aid operations. This presence constitutes a mode of protection for the victims, and thus helps lessen violence in conflicts. The following excerpt from a weekly bulletin of ICRC-related news, serves as an illustration:

“After territories previously controlled by Fikret Abdic were taken over by Bosnian troops from Bihac on 7 August last, more than 20,000 Muslims fled Velika Kladusa heading for Vojnic in Croatia. They are clustered along seven kilometres of road and are surviving thanks to an ICRC emergency operation. Despite the aid provided by ICRC delegates in terms of medical care, food and hygiene, these people are living in very precarious conditions. They have for example only fifty houses in which to seek shelter. For more than a fortnight the ICRC, which fears for the safety of these people, has had two delegates constantly present among them.” [11 ]

But the mere presence of humanitarian personnel is not always enough to prevent violence. When they witness lawlessness, they must take all possible steps not just to help its victims but a lso to ensure that the violations do not recur. This may be done by reminding States of their obligations. The following excerpt from an ICRC Annual Report is an example.

“After the mass expulsions in the Bijeljina region, the ICRC President called a meeting of all Geneva-based diplomatic representatives of the international community at the ICRC headquarters on 7 September. In his formal address, he spoke out strongly against the brutal harassment, discrimination, hostage-taking, arbitrary detention, forcible displacement, forced labour and other, sometimes worse, forms of ill-treatment suffered by civilians in the conflict areas of the former Yugoslavia, and the Muslim population of Bosnia-Herzegovina in particular. The President called on the parties to the conflict to put an end to these practices and reminded all the States party to the Geneva Conventions of their collective obligation to ensure that the provisions of international humanitarian law were respected in all circumstances.” [12 ]

The ICRC also takes practical steps to assist the victims of conflict. For example:

— “In 1996, the ICRC: (...)

— continued to approach UNITA [13 ] for information about the fate and whereabouts of the 78 detainees last visited by the ICRC in 1994;

— informed the political leaders concerned of over 150 allegations of arrest or disappearance that had been brought to its attention by families.” [14 ]

Assistance and protection are closely linked. Although it is difficult to define the overall impact of the former on the latter, there is no doubt that the very act of furnishing assistance contributes directly to the beneficiaries’ protection and that it thereby helps reduce violence.

 What effect does aid have on the duration of armed conflicts?  

Arms purchases made possible by diverting aid tend to make conflicts drag on even longer. Another factor to be considered is the role of aid as a ‘fig-leaf’, a substitute for political action to resolve conflict. Those seeking to help the victims are caught in a trap: aid does help lower the level of violence — its fundamental role — but in the eyes of the political world that very fact minimizes the need to settle conflict, and thus actually prolongs it.

Conversely, aid can help shorten conflict, as the presence of the humanitarian personnel providing it tends to encourage a resumption of dialogue between the belligerents and to influence negotiations aimed at bringing about a cessation of hostilities.

 Humanitarian aid thus influences the dynamics of conflict by acting on both its duration and the level of violence.  







It is therefore possible to improve humanitarian aid strategies.

 Which humanitarian aid strategy to choose?  

There are several possible strategies for humanitarian aid:

1. The extreme strategy — stopping all forms of aid so as to prevent its undesirable effects would have disastrous consequences for the victims of conflict: no more food, no more medical care, no more humanitarian presence. This is clearly not acceptable.

2. Some have proposed that humanitarian aid should be supplied on condition that the humanitarian rules are respected by the parties to the conflict. With this approach, the people in need are twice wronged as it amounts to stopping humanitarian aid to them because their rights are being violated. “The linkage between aid and human rights”, writes Katerina Tomasevski, “is dominantly punitive, in that people whose government is violating their rights are likely to get additionally victimized by the withdrawal of aid.” [15 ]

3. Sharing the aid equally between the parties to the conflict amounts to basing humanitarian aid on political considerations, and no longer on the victims’ needs, with the result that humanitarian aid’s impartiality is called into question: “The principle of impartiality lays down two clear rules of conduct: (a) there must be no discrimination in distributing the aid given by the Movement (either in peacetime or in time of conflict or disturbances); and (b) relief must be proportionate to need — the greater the need, the greater the relief.” [16 ] By the same token, giving humanitarian aid to the parties in o rder to gain access to the victims is tantamount to rewarding those who, by initially refusing access to the victims, violate international humanitarian law.

4. Military force as a means of protecting or distributing humanitarian aid has been used recently during operations in places such as northern Iraq, Somalia, the former Yugoslavia and Haiti. This tendency runs counter to two fundamental principles of humanitarian aid: impartiality and neutrality. Military personnel engaged in humanitarian operations should make no distinction between conflict victims on the basis of their religious faith, their membership of a political group or their race. That said, simply to assume that the military does would be to accuse it on the basis of assumption, not fact.

Combined military and humanitarian action is limited, however, to particular situations, of humanitarian concern certainly, but also of political interest. A humanitarian organization’s impartiality should be judged as well by its ability to cope with the problems being faced by the victims, including those of ‘forgotten conflicts’. It is undoubtedly the loss of neutrality that presents the greatest risk in the case of military-cum-humanitarian action. While impartiality is practised directly vis-à-vis the victims, neutrality is shown vis-à-vis the parties to the conflict. The principle of neutrality is founded on the obligation to take no part in the hostilities, nor in the disputes underlying them. The decision to use military methods to impose humanitarian aid is thus not one to be taken lightly as it entails sacrificing one’s neutrality; or it means at least that this principle will lose much of its meaning for the parties to the conflict. More generally, this lack of clarity regarding the principle of neutrality has repercussions for all those involved in humanitarian work, which it complicates. “Certainly, enforcing the delivery of humanitarian aid is likely to turn the parties to a conflict agai nst the aid agencies and potentially delay political settlement.” [17 ]


5. It remains to study ways of improving operational strategies for humanitarian aid. During the last ten years, a good deal of progress has been made with this. Examples of this progress may be grouped under three headings:

 A more rigorous analysis of the victims’ needs, taking into account the socio-economic and cultural context. This has made it possible to develop strategies based on strengthened compensating mechanisms and support for the economic microsystems and health-care systems already in place, an approach that has made it possible to restrict direct aid, in particular food distribution, to the absolute minimum. And these direct operations go hand in hand with work to rebuild local capacity. Humanitarian aid is thus better targeted and its volume reduced to the minimum necessary to meet urgent needs. The ICRC has implemented this type of strategy particularly in its operations in Somalia and Sudan. It is an approach that also c an be linked with development work. Clearly, this strategy depends on access to the victims and respect for their rights.

 Respect for the rules of international humanitarian law . Humanitarian aid is required when local services find it impossible to meet the victims’ needs. This inability may result from their own failure to deal with the situation, or from a decision by the authorities to block access to the victims. Implementing the rules of humanitarian law (torture forbidden, respect for the dignity of the individual, no hostage-taking, etc.) ensures that the victims will be protected. It also safeguards items essential to their survival (prohibition of famine as a means of warfare, ban on destroying drinking-water facilities and irrigation systems, ban on attacking hospitals and other medical facilities). Failure to comply with these rules brings about a growing imbalance between the ever greater needs of the victims as a direct result of the war (wounds, forced displacement) and the ever shrinking ability of local services — often destroyed by the hostilities — to meet those needs. Respect for international humanitarian law thus constitutes a form of primary health protection. [18 ]

Sadly, as many recent examples show, that law is not always respected. To improve its implementation, the ICRC endeavours to spread knowledge of its rules as widely as possible among members of parties to conflict. It also engages in intense diplomatic activity vis-à-vis all States so that, when faced with violations of humanitarian law, they will be aware of their collective responsibility to ensure implementation of the law, in particular in seeing to it that its violators are punished. An example is the following statement to the UN General Assembly:

“(...) The establishment by the Security Council of ad hoc international tribunals to prosecute violations of international humanitarian law committed in the former Yugoslavia and in Rwanda is a clear breakthrough. The creation of these tribunals gives some hope of putting an end to the reign of impunity in both internal and international conflicts; the ICRC interprets this as a sign of the international community’s refusal to tolerate barbarity.” [19 ]

The media have a role to play in reporting not only violations of human rights but also the successes of humanitarian aid.

 A comprehensive approach to humanitarian aid makes it possible to minimize its negative effects while guaranteeing an appropriate response to the victims’ needs.  


Humanitarian aid remains essential to helping the victims of armed conflict survive. It can influence the conflict itself — in particular its length and level of violence — either for better or for worse. To lessen the negative effects of humanitarian aid, each situation needs to be analysed in detail, with due account taken of the socio-economic and cultural context, in order to provide a response specifically tailored to the needs while minimizing the undesirable effects of the aid. Such analysis requires access to the victims, and the best strategy for obtaining this consistently lies in respecting the fundamental principles of the Red Cross and Red Crescent, in particular impartiality and neutrality. The relationship between humanitarian aid and respect for the rules of international humanitarian law is fundamental to ensuring that those in need have access to treatment, food, water, their customary means of production and, if necessary, humanitarian aid. In the event of humanitarian law being violated, everything possible must be done to have the violations stopped immediately and to punish the perpetra tors.


1. UNHCR, Center for Disease Control, Crude mortality rates, selected refugee and displaced populations , 1992-1994. The extreme emergency threshold is two deaths per 10,000 people per day.

2. Source: ICRC (unpublished).

3. ICRC Bulletin, October 1991.

4. Source: ICRC (unpublished).

5. Michael Cranna (Ed.), The true cost of conflict , 1994.

6. Source: ICRC (unpublished).

7. ICRC News , No. 32, 21 August 1997.

8. ICRC, 1996 Annual Report , p. 246.

9. ICRC, 1996 Annual Report , pp. 57-59.

10. Republic of Congo: the ICRC urges respect for humanitarian rules , Press release 97/18 of 12 June 1997.

11. ICRC News , No. 34, 23 August 1995.

12. ICRC, 1994 Annual Report , p. 149.

13. UNITA: National Union for the Total Independence of Angola.

14. ICRC, 1996 Annual Report , p. 76.

15. Katerina Tomasevski, Human Rights and Wars of Starvation , Joanna Macrae and Anthony Zwi (Eds), War and Hunger, Zed Books Ltd, London, 1996, p.76.

16. Marion Harroff-Tavel: “Neutrality and impartiality -On the impo rtance and difficulty, for the International Movement of the Red Cross and Red Crescent, of being guided by these principles”, IRRC , No. 273, November-December 1989, p. 538.

17. “Military support for humanitarian aid operations”, in IISS, Strategic Comments , No. 2, 22 February 1995.

18. Pierre Perrin, “ The Law is an Asset ”, The Health Exchange, December 1996.

19. Speech by the ICRC on 28 October 1996, United National General Assembly, 51st session, 1996.