Deaths among humanitarian workersBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7254.166 (Published 15 July 2000) Cite this as: BMJ 2000;321:166
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EDITOR - Shiek et al1 fill an important gap in the humanitarian
assistance literature where firm statistics is often unavailable. Their
findings support the general opinion that an increased number of deaths
have been occurring among humanitarian relief workers,2 and that
intentional violence has become an important cause of death. However, as
the authors have pointed out, the absence of denominators representing the
populations at-risk make it is difficult to determine if the actual risks
of death have increased.1
In my recent review of more than 1,550 fatalities involving United Nations
(UN) peacekeepers,3 no difference was found in crude death rates between
the Cold War (1949-89) and post-Cold War (1990-98) periods, despite a
significant increase in the total number of deaths observed. This increase
was attributed primarily to a rise in the number and scale of UN
peacekeeping commitments after the Cold War. However, there was a 1.5
times greater risk of death from hostile acts after the Cold War, with
risk factors including African missions, assertive peacekeeping operations
and missions involving humanitarian assistance. While unintentional
violence remained the most common overall cause of death among
peacekeepers, its relative risk had actually declined in the past decade.
While the risks and circumstances of death may differ between humanitarian
assistance and UN peacekeeping missions, it can be speculated that the
rising numbers of deaths among relief workers may be similarly explained
by a post-Cold War surge in humanitarian activities. For example, at the
height of relief operations in Rwanda and Haiti, there were more than 200
and 800 non-governmental organizations operating in the respective
countries.4 At the same time, humanitarian missions are increasingly
taking place under poor security conditions, with a lack of protection
normally accorded under international humanitarian law.1,2 High personnel
turnover and recruitment problems have also led many non-governmental
organizations to employ relatively young and inexperienced volunteers,5
who may face greater risks of exposure to danger. There is a need for
greater accountability for the safety of humanitarian workers in the
field, and to avoid the all too common and altruistic conclusion that "the
humanitarian need must be greater than the risks involved".2
1. Sheik M, Gutierrez MI, Bolton P, Spiegel P, Thieren M, Burnham G.
Deaths among humanitarian workers. BMJ 2000;321:166-168.
2. Trintignac F, ed. A case by case analysis of recent crises:
assessing 20 years of humanitarian action. Paris: Medecins du Monde, 1999.
3. Seet B, Burnham G. Fatality trends in United Nations peacekeeping
operations: 1948-1998. JAMA, in press, August 2000.
4. Mackinlay J, ed. A guide to peace support operations. Providence:
The Thomas J Watson Jr. Institute for International Studies, 1996.
5. Waldman R, Martone G. Public health and complex emergencies: new
issues, new conditions. Am J of Public Health 1999;89:1483-1485.
Benjamin Seet, M.Med., FRCS(Edin), MPH
Military Medicine Institute, Singapore Armed Forces
3 Depot Road
#03-07, Singapore 109680
Competing interests: No competing interests