Humanitarian Assistance in War, Conflict and Disaster

My name is Michael VanRooyen. I grew up in Michigan, and then I worked as a physician in Chicago and Baltimore before coming to Harvard. I am the Director of the Harvard Humanitarian Initiative (HHI), which is an inter-faculty initiative at Harvard University. I also direct the Humanitarian Academy, which is a new educational program designed to address the specific education needs around humanitarian training and humanitarianism. My other job is as the Vice Chairman of the Department of Emergency Medicine at Brigham and Women’s Hospital.

I have worked for over twenty years in the field of humanitarian assistance in war, conflict, and disaster. I have focused on building the discipline of humanitarian studies as a unique subset of global health and development. So, for example, if we were to compare Tanzania to Southern Sudan, the problems that people face at baseline may be similar: poverty, access to health, health services, health education; but the environment is quite different. Because of insecurity, population migration, extreme population stress, and political issues, serving populations in Southern Sudan is a very different proposition.

So, my real interest is in defining the humanitarian field as a unique skill set and body evidence that needs to be translated to the field of humanitarian assistance in war, conflict, and disaster. As a physician, my access to the humanitarian field has largely been in health, but the problems in the humanitarian field are not only about health. They deal with security of access, human rights, law, economics, history, anthropology, and sociology. In order to build a program that prepares individuals to work in conflict settings, you need a multidisciplinary approach. I worked to build a very health-centric program at Hopkins, but I moved here because I wanted to make it pan-university, and Harvard is a pretty nice place for that.

The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response.

In medical school, I became interested in disaster relief and humanitarian assistance, really because I read about the plight of populations caught in war and conflict and wanted to learn about how relief happened. I didn’t have any mentors at the time, so decided to work. I took a voluntary post in Geneva, doing a research study on humanitarian coordination. Shortly thereafter, I went to work in a flood-zone in India, and then ultimately to El Salvador, which was at war at the time.

From these travel experiences, I realized I was interested in the field of humanitarian relief and assistance, but that I wasn’t sure how to get involved. I simultaneously became interested in emergency medicine because it suited my personality, and so I subsequently did a residency in Chicago in emergency medicine. Because there was no time to travel during residency, I took a year off afterwards and traveled around the world working for a variety of organizations in several different capacities to explore the area of humanitarian assistance. I ended up in Somalia, right in the black hawk down era in 1992-3, where I discovered a few things: the needs were tremendous, the vulnerabilities of migratory populations caught in conflict were severe, and the numbers of people to serve were huge; but, the capacity of the international humanitarian community to serve them was limited and the variability of care that was provided was great. I really stepped back and thought that as an industry we needed to be more professional, accountable, and tailored to the populations were were trying to serve.

I decided to come back and get my Masters in Public Health to better understand the field. Throughout the nineties, I worked with a variety of relief organizations in different settlings like Somalia, Sudan, Rwanda, Kosovo, or North Korea.

In all of that, I decided that I wanted my real contribution to the field of humanitarian assistance to be helping translate evidence into practice. In order words, I wanted to build humanitarian assistance as a unique field that needs science to inform its practice. The humanitarian field doesn’t have a professional pathway like medicine. My interest has become looking at how to apprentice someone who cares about and might have some experience in humanitarian assistance and train him or her to be a professional.

I split my time between my work at the Brigham and here at Harvard. It is nice to have both patient and population contacts because they are very different fields. As a clinical emergency physician, you are on the front lines of medical care in the United States. You are in the ER and you see things as they come through the door. In a way, you serve as a safety net for the population. Humanitarian assistance is kind of like a safety net, too, as it relates to all of global health and development. So the two fields do have somewhat of a parallel. That being sad, the work is entirely different.

My day-to-day life is about being a clinical practitioner of emergency medicine, teaching residents and students, working with faculty, and overseeing a large, complicated, academic place. On the HHI side, my work is about defining the next major issues in the humanitarian environment and getting partners to work on them. Sometimes I travel to conflict areas, but more often, I stay here and help connect NGOs or UN agencies to academic thinkers in the field to develop programs, projects, and initiatives.

I would say my day is really about making connections. I work with a variety of faculty members around the university, and my job is to create an environment of innovation that helps them link with organizations and explore new fields in humanitarian assistance. For example, we have a series of programs here that focus on specific attributes on the humanitarian front like technologies. So how do we take current technologies and apply them to the field? How do we take our satellite-mapping program and apply that to the field of humanitarian policy? How do we look at the plight of women and children in conflict-affected communities? How do we advocate for their improved services and link to organizations that do that? That is the kind of stuff that we work on.

What I love most about being in the field of humanitarian assistance is that it is so dynamic. The priorities change. Populations all have basic needs, but the contexts change so dramatically. The way of measuring and serving populations is a moving field all the time, as are the players who are affecting the field. It is incredibly interesting, diverse, and brings me into a global community that looks at everything from mathematics and systems modeling, to aerial bombardment policy and how to better provide clinical services to refugees.

The mixture with clinical emergency medicine is also great. I get to do large thinking on major policy and public health issues, but then I also get to take care of patients and work at the bedside. I love the immediacy of the emergency department and the strategic global scale of humanitarian assistance.

But therein lies the problem. I basically have two jobs. So the challenge is trying to keep it all together. Trying to be in two places at once. Trying to advocate for my programs in Washington, or to fly to the Congo and still maintain my work at the School of Medicine or Public Health or the Brigham. There are just not enough hours in the day for that. But those are pretty good problems to have if you really love what you do and are stimulated endlessly by the work ahead.

I worked for an NGO in Somalia in the 1992-3 era, measuring child malnutrition and treating for scabies outside of a refugee camp. I was in the middle of this long line of people that needed to be served, many of whom were displaced or orphans, when I had an epiphany. I realized that as an aid worker, I came with the best of intentions. I was a fairly well trained physician and I was a pretty experienced traveler. I was working in very difficult conditions, but I realized I didn’t know enough. I didn’t know enough about the population, the community, and I hadn’t been trained for this. I realized that I was not alone. When I looked around, a lot of people in the humanitarian environment were placed in circumstances that were completely alien to them and they didn’t know what they were doing. It was not for the lack of good intentions, it was really because they had not been trained properly.

For me, that moment, looking around a refugee camp and seeing so many organizations at work, made me realize that there had to be a better way to prepare people. There were great population needs and we were not really doing what we should have been doing. There had to be a better way to teach, mentor, and bring people into the field that were prepared to work in very difficult circumstances. So that, validated by many other experiences, led me to this mixture of academia and relief work. It was such a high stakes, high pressure, and dangerous moment, and I realized I was unprepared.

I have a family, so my main interest is to chase after my children. One of my favorite things to do is travel with my wife and kids. I like to have a pretty active outside life that includes a lot of activity-oriented outdoor sports, and I love to do these with family, if I can.

I get a lot of students who are looking for advice about how to choose their career, and one of things that helps me advise someone is if they are educated about the major issues in the field that they are pursuing. Now that might sound stupid, because they should be, right? But it is amazing how many people are interested in medicine, for example, or humanitarian assistance, and they have never read anything about it. They are interested in the notion of disaster relief or population vulnerability, but they don’t know a lot about the field.

So, as a person who advises students, it is easier for me to engage with, talk to, and refer, if necessary, a student who has a specific interest. So, for example, somebody might say to me, I’m really interested in global health in Africa. But that is a bit like saying, I’m interested in air. It’s just so vast – it could be anything. Should they do a masters? Become a consultant? Work for the government? I can’t know that.

So my advice to any student that has any interest in global health, and in particular, in the field of humanitarian assistance, is to read about it. Some degree of specificity that is generated by the student and that fits their interest is really what is needed. So read. Be educated before you show up and ask somebody about something. Know what the major questions are in your field. It’s easy to do. There are websites all over the place to explore and give yourself an introduction.

My ultimate mission is to help transform the humanitarian environment into an evidence-based practice. The field is a business of about $10-20 billion a year that involves the military, aid organizations, counties – it’s huge. So the goal is to improve the work of organizations that do humanitarian assistance.

As to what I want to accomplish to do that: I really want Harvard to be the place where that happens. Through HHI and the Humanitarian Academy, I am trying to create an analytic and educational framework to train the next generation of humanitarian leaders, to explore new humanitarian topics, and to rethink the way we provide aid. I want to do it better, more effectively, faster, and in a way that is more accountable. There are a lot of jokers in this business – people who are doing it just to show up and say they were there. I’d like to reduce the space for those people.

I think it is worth a career. There’s all kind of things that people chose to be and to do with their lives. I like the idea of choosing something really huge and complicated and important. And this fits the bill.