World Humanitarian Day: Civilians Are Not A Target



August 18, 2017, New York – On World Humanitarian Day, the Center for International Humanitarian Cooperation stands with the United Nations Office for the Coordination of Humanitarian Affairs and the broader humanitarian community to denounce attacks against civilians and health and humanitarians workers in conflict - a rising and disastrous trend around the world.

According to the UN, "Over the past 20 years, 4,132 aid workers have been attacked. In 2016, 91 aid workers were killed, 88 were injured and 73 were kidnapped in the line of duty. The majority of these attacks took place in five countries: South Sudan, Afghanistan, Syria, the Democratic Republic of the Congo, and Somalia.

Attacks against aid workers are deplorable and represent clear violations of international humanitarian law. In addition to endangering aid workers, these attacks threaten humanitarian operations and the lives of millions of people who rely on humanitarian assistance for their survival."

Join us in calling on world leaders to protect civilians and those offering lifesaving assistance by joining the #NotATarget campaign. You can show your support by engaging in the conversation on social media, signing the World Humanitarian Day Petition, and reading the toolkit to learn more.

 Photo credit: United Nations Office for the Coordination of Humanitarian Affairs

Photo credit: United Nations Office for the Coordination of Humanitarian Affairs

Practitioner Profile: Naomi Gikonyo – Recent Graduate of the IIHA Master’s in International Humanitarian Action

 Naomi Gikonyo ensured refugees accessed food rations in Maban, South Sudan.

Naomi Gikonyo ensured refugees accessed food rations in Maban, South Sudan.

Naomi Gikonyo has designed emergency response interventions amidst humanitarian crises around the world – from Kenya to South Sudan, Haiti to Libya – for nearly a decade. Currently she works as an Emergency Preparedness and Response Officer for the United Nations World Food Programme (WFP). This month she also graduates with a Master’s Degree in International Humanitarian Action (MIHA) through the Institute of International Humanitarian Affairs (IIHA) at Fordham University.

Here she reflects on her vast experiences in the humanitarian sector.

How did you get started in the humanitarian field?

Like many people in the humanitarian field, it was purely coincidental. I first began to intern with International Medical Corps (IMC) and as a result, I ended up working with them for almost eight years in a variety of areas including finance, logistics, and then finally programs.

What is your greatest professional accomplishment?

I enjoy working in the humanitarian field to contribute to something larger than myself. Each emergency is different so it is difficult to specifically say which is my greatest accomplishment, but I have participated or led several emergency responses in relatively difficult contexts.

I have been deployed at the height of emergencies to set up operations from scratch, and I have bonded and worked with individuals from all different walks of life, which I am proud of. It is humbling to be able to offer assistance to people who are vulnerable and looking to you to provide support in their time of need. This is what drives me.

The most fulfilling mission I have ever had is working in South Sudan. It is a difficult country to work in, but overall each of the missions is different and I do not categorize them as one being better than the other. Each experience is important to me in a variety of ways. It is more the people you work with – this is what is crucial in this line of work.

What is the most difficult experience you have had?

At the height of an emergency there is a great deal of pressure, usually in life or death situations. The most difficult task for me was setting up operations in South Sudan right after the conflict began at the end of 2013. It is a particularly difficult country to work in, not only in terms of access, but security as well. This includes harsh working conditions in the middle of nowhere without any of the resources you usually take for granted. It is basically you, your team, limited supplies, and one vehicle. Essentially you have to hit the ground running. Setting up operations, with heightened tensions, along with limited resources is always a challenge.

In addition to being a student, you served as a tutor during last year’s International Diploma in Humanitarian Assistance (IDHA) course in New York. What were some of your main take-aways from this experience?  

It is fascinating coming back as a tutor after being a student. The IDHA is a very enriching course for most people, because students and lecturers come together to cross-pollinate ideas. It is a mid-career course where all of the participants have significant (humanitarian) field experience or some experience in other sectors. It is therefore a very interactive environment. The students learn as much from the faculty and lecturers as they do from themselves. They build networks for life with people from different perspectives and different backgrounds. There are 40 people from 29 different countries who participated in IDHA 48 and as a result there is a lot of diversity and perspective in the group. I experienced this as a student as well and I am still in touch with most of my classmates from IDHA 29, seven years later. It is definitely one of the more interesting courses offered at Fordham and in the humanitarian sector.

What was your favorite part of IDHA 48?

I find the case studies very interesting. I also enjoyed the guest lecturers. It was interesting to get perspectives from different areas of work that I did not have previous exposure to, such as the Ebola response or the Palestinian-Israeli crisis, which I found fascinating. I also enjoyed reflecting and gaining new perspectives about contexts I have worked in. It is hard to pick one highlight, but what I find most useful in the course is being able to listen to and reflect upon so many different perspectives. I also met some colleagues from WFP in the course and it was interesting to interact with them and hear their various experiences from the field.

What is one of the strengths of the IDHA course?

A strength of the course is that it is very adaptive. It is not rigid, but rather quite fluid. A lot of content shared on IDHA 48 is very different from when I was a student. When the faculty and students bring their current experience to the course, the content changes accordingly because of the knowledge in the room. It is nice to see the evolution of this sharing and learning.

What are largest challenges in humanitarian work today?

A lot of people say it is issues of access or funds, but I would say the level of complexity of the problems that we are dealing with is so great that the system has not necessarily been able to evolve as quickly in order to properly address these needs. We are struggling to adapt as fast. The game has changed but the players have remained the same, whether this be the scope of migration issues or politicization of aid. In general, these issues have intensified, but the humanitarian architecture has stayed the same. There have been attempts to evolve or adapt but they have not been sufficient enough to match the level of complexity we are dealing with. It remains a fundamental challenge to the system overall if we are to deal with future issues.

Kevin M. Cahill, M.D. and Robert De Niro Address IDHA 50 Graduates

The Centre for International Humanitarian Cooperation and the Institute of International Humanitarian Affairs (IIHA) reached a meaningful milestone on Friday with the graduation of 25 humanitarian workers from the Institute’s 50th International Diploma in Humanitarian Assistance course and four from the Master of Arts in International Humanitarian Action at Fordham University.

Surprising the graduates, Hollywood actor and IDHA commencement speaker Robert De Niro joined for the occasion to honor their commitment to humanitarian action in a world increasingly challenged with a “lack of humanity.”

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Hollywood actor Robert De Niro praises humanitarian workers and IIHA graduates for serving with “compassion and dignity”

July 3, 2017, New York – The Institute of International Humanitarian Affairs (IIHA) reached a meaningful milestone on Friday with the graduation of 25 humanitarian workers from the Institute’s 50th International Diploma in Humanitarian Assistance course and four from the Master of Arts in International Humanitarian Action at Fordham University.

 Robert De Niro poses with IDHA 50 graduates and CIHC President, Kevin M. Cahill, M.D.

Robert De Niro poses with IDHA 50 graduates and CIHC President, Kevin M. Cahill, M.D.

Surprising the graduates, Hollywood actor and IDHA commencement speaker Robert De Niro joined for the occasion to honor their commitment to humanitarian action in a world increasingly challenged with a “lack of humanity.”

“You’ve found your own inner humanitarian and you have let it guide you to making our world better. You serve with compassion and dignity while you make sacrifices that take heroic risks. Now you’ve gone through this program so you can perform your work even more effectively. You have distinguished yourselves here and you will take these lessons with you for the rest of your lives,” said Mr. De Niro.

The graduates join a network of more than 3,000 alumni who hail from 140 countries, each making significant strides in responding to conflicts, natural disasters, displacement and other crises worldwide.

“My head is full of little videos, of vignettes, of cameos, of heroic deeds, that you have written to me, which have been involving you in the field. Ambushed in Syria, taken hostage in Afghanistan, crossing frontlines under fire, emergency medicine in makeshift hospitals, opening schools in remote camps. Of simply staying on when others have left, of fighting fear, of overcoming despair, feeding the hungry, holding the hands of the vulnerable. We are in that unique position that we’re not in uniform, but we fight in the frontline. Our enemy is poverty, hunger, homelessness and our allies are the beneficiary,” said IDHA 50 Course Director Larry Hollingworth, CBE in commemoration of the cumulative impact of the IIHA alumni network.

IDHA 50 and MIHA graduates work as medical professionals, logisticians, communicators, operational managers, military officers, among other roles in response to humanitarian crises and emergencies in South Sudan, Niger, Egypt, Sri Lanka, Mexico, North Korea, and beyond.

For the past month, they paused their work to take a step back from the field and study topics crucial for effective humanitarian response.

“We were all on a ship named IDHA 50, together floating on a wide ocean of experience with an incredible depth of knowledge. Luckily, we had superb and skilled captains on board with us, who navigated the ship in the right humanitarian direction and provided us with professional lectures, professional personal experiences, in quality and quantity, in form and content,” said Bart Vermeiren, IDHA 50 Student Representative who came to the course with more than 15 years of experience working for the International Committee of the Red Cross.

Throughout the IDHA course, 33 humanitarian experts, practitioners, Fordham academics, and leaders in the field gave lectures on topics such as humanitarian law, disaster management, communicable disease, logistics, civil military cooperation, and dozens of others. Lecturers also presented a series of case studies illuminating the complexity of today’s humanitarian interventions in Ukraine, Nepal, Palestine, Ethiopia, and beyond.

In his opening comments, Kevin M. Cahill, M.D. commended the students for their willingness to “not be blocked in by academic barriers or the barriers that separate us from each other.”

The Institute of International Humanitarian Affairs congratulates these graduates in their successful completion of their training and warmly welcomes them to a network of innovative and impactful humanitarians.

“You are a treasured part of our IDHA family all over the world. Make use of it. Continue to give back. Continue to come back. Continue to be in touch and be involved with our programs, no matter where you are or where we are. And please, no matter where you are, remember these days as we will remember you,” Brendan Cahill, IIHA Executive Director, reminded the graduates before they left the halls of Fordham University and returned to their posts around the world.

For more than 20 years, the IIHA has trained humanitarian aid workers in cities around the world, including Geneva, Goa, Amman, Barcelona, Kathmandu, Nairobi, New York, and more. Upcoming humanitarian trainingswill be held in Amman, Malta, Vienna and Kathmandu and are open for registration.

Press contact

Angela Wells

Communications Officer, Fordham University Institute of International Humanitarian Affairs

+1 718-817-5694

Practitioner Profile: Martine van der Does bridges humanitarian action and architectural design


New York, June 14, 2017 – An architect by trade, Martine van der Does now employs her unique expertise on functional design to improve the shelters that protect millions of people displaced from or affected by humanitarian crises around the world.

At the end of June, she will receive a Master of Arts in International Humanitarian Action from Fordham University. We spoke with her about her interesting career path and the potential of design for humanitarian action. Read more on our blog.

Annual Report Launch

In a year of ongoing global social justice issues, the CIHC and IIHA continue to bridge the gap between academia and humanitarian efforts. The success of the IIHA over the past year can be seen in the work of its students and alumni who are gathering from around the world to find solutions to combat these pressing issues. Equally, the IIHA also expanded the reach of its impact through the formalization of partnerships with other humanitarian agencies, including the International Organization for Migration, the International Federation of the Red Cross and Red Crescent Societies, and the Jesuit Refugee Service. The 2015-2016 Annual Report records the meaningful work of the IIHA over the past year and gives insight into the humanitarian efforts of its alumni. Read the report to learn more.

IDHA 50 Comes to New York City

International Diploma In Humanitarian Assistance

Shaping Humanitarian Leaders


Media reports and images inundate the world with humanitarian crises: refugees drowning at sea, populations ravaged by famine, and seemingly endless conflicts. Collective and coordinated responses to humanitarian crises have never been more essential. Good intentions to respond and act must be informed by practical experience, technical knowledge, and academic critique.

Grounded in social justice and humanitarian ethics, the Institute of International Humanitarian Affairs (IIHA) at Fordham University endeavors to make the global response to humanitarian crises more sustainable, effective, and dignified. Through the intersection of critical academic analysis and concrete hands-on experience, we believe that humanitarian action can transform the world.

The International Diploma in Humanitarian Assistance (IDHA), the flagship program of the IIHA and the CIHC, equips mid-career humanitarian professionals to drive the humanitarian sector of the future in a more innovative direction. For 20 years, the IIHA has trained thousands of humanitarian workers in cities around the world – from Kathmandu to Amman, Geneva to Cairo.

This June the IIHA will commence its 50th IDHA course in New York City and we want you to join us! IDHA 50 students will join a cohort of diverse and highly qualified aid and development professionals from all over the world in a one-month intensive course to receive one-of-a-kind training from world-renowned experts in the humanitarian field.

The course provides the critical skills and knowledge to more effectively intervene in the complex emergency and protracted crises of the 21st century. The curriculum is highly interactive and participants will gain:

  • Extensive insight to the needs of people affected by conflict, disaster, and displacement;
  • Skills in facilitating cooperation and dialogue between international, governmental, and non-governmental agencies;
  • Awareness, understanding, and skills essential for effective service in emergency and protracted humanitarian crises;
  • Opportunities to collaborate and network with colleagues working for diverse international, governmental, and non-governmental humanitarian agencies;
  • Tools to evaluate interventions and identify examples of good practice; and
  • Methods for anticipating and preventing humanitarian crises.

Upon completion of the course, graduates will receive eight graduate level credits accepted towards a Master of Arts in International Humanitarian Action at Fordham University, or potentially their studies at other academic institutions.

Course Fee: $5,500 includes tuition, course materials, lodging, and all weekday meals for one month.

Applications are still open for the New York course in June and another IDHA course in Vienna, Austria from November 5 to December 1, 2017.

Visit the IIHA website to learn more and apply.

Housed at Fordham, the Jesuit University of New York, the Institute of International Humanitarian Affairs (IIHA) educates a future generation of humanitarians in the classroom, shapes humanitarian leaders in the field, and innovates solutions to challenges in humanitarian crises.


Diplomacy Then and Now: Prevention is Always Better Than Treatment

New York, March 21, 2017 – Aid workers and healthcare providers working amidst the ravages of war understand all to well the crucial importance of stopping conflict through diplomacy and negotiation before it starts or escalates.

Perhaps no one advocated for preventive diplomacy more ardently than founding member of the Center for International Humanitarian Cooperation (CIHC) and former Secretary-General Boutros Boutros-Ghali. Yesterday, representatives of the United Nations Alliance of Civilizations (UNAOC) and CIHC joined together to commemorate the life and noble efforts of Mr. Boutros-Ghali.

At the event, Kevin M. Cahill, M.D., President of the CIHC and University Professor and Director of Fordham University’s Institute of International Humanitarian Affairs (IIHA), was part of a high-level panel together with H.E. Nassir Abdulaziz Al-Nasser, High Representative for UNOAC and Diplomat-in-Residence at the IIHA, Ambassador Maged Abdelaziz, Under-Secretary-General and Special Advisor on Africa, Tomas Christensen, Chef de Cabinet of and Ambassador Amr Aboulatta, Permanent Representative of Egypt to the United Nations.

“Almost in the role of a public health professional, he opened his talk by noting that in matters of peace and security, as in medicine, prevention is self-evidently better than cure. It saves lives and money and it forestalls suffering,” said Dr. Cahill of Mr. Boutrous-Ghalis’ powerful address at the 1995 UN Conference.

Dr. Cahill served as Mr. Boutros-Ghali’s physician and personal advisor for many years, including during his time as UN Secretary-General. Mr. Boutros-Ghali was also a founding member of the CIHC in 1992, which is now celebrating its 25th year.

His approach to preventive diplomacy was guided by four elements: fact-finding, confidence building, early warning and preventive deployment.

“He described preventive diplomacy as ‘action to prevent disputes from arising between parties, to prevent existing disputes from escalating into conflicts and to limit the spread of the latter when they occur’,” said Mr. Al-Nasser.

Mr. Boutros-Ghali’s landmark 1992 report, An Agenda for Peace, has become a guiding document for diplomats and UN representatives in their pursuit of sustainable social peace throughout the world.

“In our ever more dangerous world, in the throes of both inter- and intra-state conflicts, the need for a new approach in international relations, seems obvious. Preventive Diplomacy should deal with — and even direct — where a nation can move towards peace rather than replaying where it has been in endless wars. That surely was our intention in promoting this option, and neither Boutros nor I ever abandoned that dream,” concluded Dr. Cahill in his speech.

Twenty-five years later as the international community struggles to remedy and end dire conflicts and complex humanitarian crises in Iraq, South Sudan, Syria, Yemen, and beyond world leaders should be reminded of this call to action.

Lecture by Kevin M. Cahill, M.D. at The Boutros Boutros-Ghali Memorial on Preventive Diplomacy

The Boutros Boutros-Ghali Memorial


Kevin M. Cahill, M.D.

A UN Alliance of Civilizations Forum

United Nations Headquarters

March 20, 2017

Boutros Boutros-Ghali played many roles in a long and full life; some can be captured in the various titles that characterized his decades of public service. There were common threads that linked these official roles into a cohesive tapestry, but only those privileged to know Boutros on a personal level could fully appreciate the exceptional qualities that made him such a unique individual. I knew him for many decades as his physician, confidant and friend. He was a fiercely independent man, one of exceptional integrity and honesty, with an endearing, self-effacing humor. He possessed a rare modesty and humility that came from a long noble struggle to help his nation, family, friends, and a world in desperate need of his generous insights.

The topic I have chosen for this Inaugural Lecture in honor of Boutros Boutros-Ghali, is one that was very close to his heart. In a final interview, shortly before his death on February 16, 2016, at age 93, reflecting on his life’s work, Boutros was asked what he considered his most important legacy: he responded, "my work with Doctor Cahill in the mid-1990s on preventive diplomacy". There is a lovely story behind that response. For many years Leia, Boutros, my wife Kate and I would gather for a week-long retreat to discuss difficult issues that were likely to arise in the United Nations or other international debates. From these retreats came many long-term projects, including his commitment to Preventive Diplomacy.

Boutros, in a remarkable gesture of confidence in the importance of creative ideas, and in the capacity of his physician to explore — and explain — the concepts of preventive diplomacy, asked, in 1995, that I convene and Chair a plenary conference on the concept at the United Nations. The invited speakers were to view the topic through the prism of public health, seeing if the latter’s strict methodology could bring clarity to the vaguer outlines and approaches that characterize diplomacy. Speakers were asked to present their arguments using the universally understood semantics of health, disease and medicine.

Ambassadors, as well as the general public, often use common medical words, and diplomats can readily adapt these terms in explaining the evils of spreading discord, and the multiple methods employed in efforts to restore peace. Conflicts — like malignant tumors — can metastasize if appropriate therapy is not provided, can become endemic in innocent populations, defying early diagnoses. There are contagious effects in conflicts that may cause political paralysis, and the hemorrhaging of societal understanding leading to mental scars, post traumatic psychological syndromes, physical deformities, amputations, the terminology of sexual assaults and the escalation to epidemic levels of uncontrolled local feverish fighting. We talk of the search, usually futile, for instant cures, for DNA-like analyses of impending strife, of seeking the proper peace-keeping prescriptions for warring patients, of using quarantine and isolation to contain diseased states with diplomatic tools, of maintaining treatment protocols until remission is realized by adjusting the dosages of, for example, sanctions.

So also, with Preventive Diplomacy, we suggested that it might be helpful to use public health cost-benefit examples to justify the large expenditures often necessary to alleviate conflict-prone situations. In conflict resolutions one tries to identify obstacles to — and blockages in — the search for peace as if one were diagnosing and treating an impaired circulatory system. We can argue for the long-term involvement of peacekeeping operations by citing preventive chemotherapy, and the public understands such analogies. These are but a few of the benefits of utilizing universally known medical terms to explain the often arcane goals and methods of diplomacy, goals that must now convince a citizenry that demands increasing transparency to sustain costly international interventions and relief operations.

The conference speakers included leading figures at the United Nations including Boutros as Secretary General, Kofi Annan, then in charge of peace-keeping operations, UNRWA’s Peter Hansen, Jan Eliasson, the first Undersecretary General of the UN Department of Humanitarian Affairs, the former Secretary of State of the United States, the former Foreign Ministers of the United Kingdom, France, Sweden, and Sudan, the President of the International Court of Justice in The Hague, the Secretary General of the Organization of African Unity, as well as distinguished Professors and a Nobel Peace Prize Laureate. I edited the manuscripts into book form, and that text, in follow up editions and translations, is widely used in academic and diplomatic training programs throughout the world.

One of the supreme creations of the human spirit is the idea of prevention. Like liberty and equality, it is a seminal concept drawn from a reservoir of optimism that centuries of epidemics, famines and wars have failed to deplete. It is an amalgam of hope and possibility, which assumes that misery is not an indefinable mandate of fate, a punishment only redeemable in a later life, but a condition that can be treated like a disease, and, sometimes, cured, or even prevented.

During a lifetime in the practice of medicine — in Africa, the Middle East, Asia, and Latin America, as well as my own country — I have seen the daily wonders of the healing arts: lives rescued from once-fatal cancers, disease outbreaks miraculously cut short by new drugs and vaccines, and countless millions of people saved from communicable diseases such as polio and smallpox. Indeed, the conquest of smallpox, one of history’s deadliest scourges, is itself a triumph of prevention attributable not only to Edward Jenner’s inoculation, but to the skills and untiring efforts of thousands of public health workers over a span of 200 years.

I also follow, on a daily basis in the practice of medicine, the wisdom of Hippocrates’ adage from 2,500 years ago: "Primum Non Nocere" — "First do no harm", and to try to help those who seek my care without indulging in public comments to anyone but the patient, family and professional colleagues collaborating in difficult clinical situations.

Caught up in hawkish rhetoric, diplomats and politicians too often embark on interventions without carefully considering the consequences. In today’s world of instant communications, and the apparent need for politicians to appear to personally solve every problem, the fundamental principles of medical practice — careful reasoning, civil dialogue, and a balanced consideration of different options in devising an optimal course of therapy — are frequently absent in political/diplomatic decision making.


In working with Boutros to refine an approach to preventive diplomacy it was only natural for me to think of clinical and public health models in contemplating the disorders threatening the health of the world community as it emerged from the rigid alignments of the Cold War and groped for new organizing principles in an age of high technology, global economic competition and multipolar politics. For power balances, realpolitik, and the other blunt-edged tools of East-West confrontation simply did not fit the need for far more subtle, creative and prospective approaches to the problems complicating the search for peace.

Wanton killing and brutality within supposedly sovereign borders, ethnic and religious strife,millions of starving or near-starving refugees, other millions of migrants fleeing their homes out of fear for their lives or in a desperate search for a better life, human rights trampled down, appalling poverty in the shadows of extraordinary wealth, inhumanity on an incredible scale in what was supposed to be a peaceful dawn following the end of the Cold War: these were the awesome challenges that faced us, and they were quite different from the nation-state rivalries and alliances that preoccupied statesmen during most of the 20th century.

There had to be a new mindset where diplomats would try to sense dangers before crises exploded, invest in early warning exercises, and intervene, if necessary, at latent stages of conflicts. Some problems — maybe most — may have no immediate solutions, but the good public health professional, using all the data of epidemiology and public persuasion, can be positioned to intercede effectively whenever necessary. Diplomats must learn to deal with causes before they are results, to probe societal and political problems when the stress is still manageable, to honor crisis avoidance even more than crisis management.

But if preventive diplomacy was to replace traditional reactive diplomacy, there must be fundamental changes in our international approaches. At present only problems that attain crisis proportions seem to attract the attention of politicians or diplomats. Our leaders simply are not attuned to deal with incipient disorders at a time when prevention is possible. This will not change easily, especially because journalists, even more in an age of instant information overload, will always prefer to report dramatic conflicts and so-called resolutions rather than the non-story, in their minds, of an avoided tragedy.

Preventive diplomacy emphasizes earlier diagnoses and new kinds of therapy. Underlying causes have to be attacked sooner rather than later, before they become fulminating infections that rage beyond rational control or political containment. This is the defining principle of this new preventive diplomacy, which argues that social detection and early intervention should be as honored in international relations as political negotiation and military response. In its pristine form, the idea is simplicity itself; it is reason opposed to irrationality, peace preferred to violence. In the reality of a disordered world, however, preventive diplomacy is incredibly more complex and, in some respects, controversial.

People can disagree on how to define social health and political disease. The tensions between rights and obligations may seem to be intractable. Force sometimes can be necessary to achieve social progress, so it cannot always be condemned. But while violence may be understandable, it rarely leads towards lasting peace. The very breadth of this view of preventive diplomacy suggests that the term itself is far more restrictive than its purpose and conception. For diplomacy, as it has been practiced during most of a now-dying Industrial Age, had been centered on the idea of nation states dealing with each other on a government to government basis with the help of professionals specializing in secret negotiations and political conspiracy.

Today, however, international relations have been utterly transformed by instant communication, by better informed and more active publics, by the spread of market capitalism, the fragmentation of politics and a veritable explosion of commercial transactions and nongovernmental activism. Even the supposedly bedrock principle of national sovereignty has been eroded. Furthermore, preventive diplomacy indicates the many disparate efforts aimed at the maintenance of international peace and security is not a matter for diplomats alone. For the current sources of human stress, community breakdown, and group violence are far too diverse and too deeply embedded in social change to be consigned to the windowless compartments of conventional diplomacy. Many problems do not move in a straight line but rather in endless gyres of cause and effect, so that a fall in coffee prices, for example, can trigger economic unrest, genocide, and precipitate fleeing refugees, starvation, cholera, dysentery and other diseases that overwhelm medical workers and relief organizations.

The patterns Boutros and I discussed in the 1990s concerning Rwanda and the Balkans have re-emerged decades later in Syria and Afghanistan, Iraq and the Occupied Territories of Palestine. The cycles of disaster and the search for solutions involve many different disciplines, including medicine, so that prevention calls for a symphony rather than a solo performance by a single profession like diplomacy. It also calls for a new kind of diplomat. But diplomats, unlike physicians, have not fully accepted a preventive ethos and a disciplined method of using tools to avoid conflicts. If that thesis is valid, then the orchestra clearly needed a knowledgeable and committed conductor capable of promoting preventive diplomacy around the world. Secretary General Boutros Boutros-Ghali assumed that mantle at the United Nations.

I had long suggested to Boutros that health and humanitarian issues should be the pragmatic as well as the symbolic centerpiece of the United Nations. If the Organization was founded to beat weapons into ploughshares, then the fiscal and political focus on military peacekeeping was misplaced. The basic question we discussed, over and over, was how to best present the arguments for an emphasis on preventive diplomacy. I suggested to him that the methodology of public health, and even the universally understood semantics and metaphors of medicine, provided a unique basis for a new type of diplomacy.

Five hundred years ago, Machiavelli, utilizing an apt medical analogy, noted, 

When trouble is sensed well in advance, it can easily be remedied; if you wait for it to show, any medicine will be too late because the disease will have become incurable. As the doctors say of a wasting disease, to start with it is easy to cure but difficult to diagnose; after a time, unless it has been diagnosed and treated at the outset, it becomes easy to diagnose but difficult to cure. So it is in politics.

There are several important lessons in that quote. The shrewd and cynical Machiavelli knew that health images would help make his message clear to a skeptical public, and he unapologetically linked medicine and politics as part of life.

The origins of violence, especially obvious in today’s world, clearly lie in incubating prejudices and injustices that inevitably breed contention. But how rarely are these evil forces exposed early enough, or fought with effective tools before predictable disaster strikes. In preventive medicine one begins by searching for fundamental causes, for the etiology of a disease, and for techniques that can interrupt transmission before serious signs and symptoms become obvious and irreversible damage occurs. If a fatal disease threatens to spread, health experts devise control programs based on careful research and laboratory experiments, sophisticated statistical studies and models, field trials and double-blind surveys that try to minimize biases and biological variants, which often contaminate the best intentioned projects. When deaths do occur, scrupulous postmortem analyses are customary, so that the errors of the past become the building blocks for a better approach to the future. One should, we both believed, be able to adapt this approach to the epidemiology of conflict.

Diplomatic exercises should be subjected to similar probes and autopsies. Nations, particularly great powers and international organizations, must become humble enough to learn from failed efforts rather than merely defending traditional practices. If there are new actors in world conflicts, and a new global environment created by, among other factors, a communication revolution, then the therapeutics of international mediation must change. Unfortunately, public figures are obsessed with dramatic solutions, with a fire brigade approach that assures a continuation of catastrophes.

The international system is always in transition and the contours of the post-Cold War age are still far from clear. But there are already a number of fascinating trends that are central to the development of the preventive diplomacy concept. One is a tentative shift in the direction of individualism that focuses international attention on personal human rights rather than only on the rights and privileges of national sovereignty. Medicine and public health also teach us that diplomatic tools are more effective than coercion. In the case of AIDS, for example, attempts to curb the disease through legal enforcement failed. Only persuasion, education, and cooperation had any success in altering lifestyles that contributed to the problem. In the same way, force has proven to be a poor treatment for violence. Indeed, military intervention and sanctions often do more harm than good. And that is the attraction of preventive diplomacy in international relations — to stop wars before they start.

Even if, as we must fully expect, that noble goal proves elusive, this approach offers the best, and maybe the only viable alternative to the failed practices of the past. Even after conflicts have begun, this new diplomacy, based on a philosophy that focuses on root causes and promotes early involvement can help de-escalate violence and hasten the restoration of peace. The development of sanitation, vaccines, and, more recently, environmental controls have produced phenomenal progress against the enemies of health. In the case of human societies, the promotion of liberal democracy and individual rights marked an historic advance beyond such ancient concepts as slavery and the divine right of kings.

It was for these many reasons we believed that 50 years after the founding of the United Nations, there was the possibility that the principle of prevention just might take its place as a significant improvement over inaction or coercion in dealing with conflict, and we were determined to try. We knew there were no final answers to offer; there cannot be in our finite and imperfect state. But in the presence of disease, there is common pain that makes no distinctions of race or religion or class or wealth. No matter where medical disaster strikes, all the strands of shared humanity converge in shared suffering. A tumor or tubercular lesion or an arrhythmia present in an identical manner, and it makes no difference whether the patient is an ambassador or a street cleaner.

I shall now provide, in some detail, ideas that Boutros delivered in a powerful keynote address to the 1995 UN Conference, where he used, as you will appreciate, many similes and analogies of medical parlance. Most of what I shall present here are direct quotes from his speech. Almost in the role of a public health professional, he opened his talk by noting that in matters of peace and security, as in medicine, prevention is self-evidently better than cure. It saves lives and money and it forestalls suffering.

He defined the main types of such action available at the United Nations: the use of diplomatic techniques to prevent disputes arising, prevent them from escalating into armed conflict if they do arise, and if that fails, to prevent the armed conflict from spreading. The Secretary General can use negotiation, inquiry, mediation, conciliation, arbitration, judicial settlement, resort to regional agencies or arrangements, or try any other peaceful means, which the protagonists may choose. To these techniques can be added confidence-building measures, a therapy that can produce good results if the patients, i.e. the hostile parties, will accept it. Central of course to the idea of preventive diplomacy is the assumption that the protagonists are not making effective use of techniques on their own initiative and that the help of a third party is needed.

The techniques employed in preventive diplomacy are the same as those employed in peacemaking (which, in United Nations parlance, is a diplomatic activity, not the restoration of peace by forceful means). The only real difference between preventive diplomacy and peacemaking is that the one is applied before armed conflict has broken out and the other thereafter. But today, as in health, there are many endemic situations where the causes of conflict are deeply rooted and chronic tension is punctuated from time to time by acute outbreaks of virulent fighting. In such cases it may be artificial to make a distinction between preventive diplomacy and peacemaking or indeed between preventive and post conflict peace building. Those who want to help control and cure such chronic maladies need to maintain their efforts over a long period of time, varying the therapies they prescribe as the patient’s condition improves or deteriorates.

One is sometimes asked to give examples of successful preventive diplomacy. It is not always easy to do so. Confidentiality is usually essential in such endeavors, as it is in the practice of medicine. Time may have to pass before one can say with assurance that success has been achieved. Many different peacemakers may have been at work, and it can sound presumptuous for just one of them to claim the credit.

Preventive humanitarian action addresses, in addition to its healing purpose of bringing relief to those who suffer, the political goal of correcting situations, which, if left unattended, could increase the risk of conflict. A wide range of measures can be required. They can include planning for the humanitarian action that will be required if a crisis occurs, e.g., the stockpiling of relief goods in certain places. But they can also include action to create conditions, which will help to persuade refugees or displaced persons to return to their homes, e.g., improvements in security and greater respect for human rights, creation of jobs, etc.

Like its post-conflict cousin, preventive peace building is especially useful in internal conflicts and can involve a wide variety of activities in the institutional, economic, and social fields. These activities usually have an intrinsic value of their own because of the contribution they make to democratization, respect for human rights, and economic and social development. What defines them as peace-building activities is that, in addition, they have the political value of reducing the risk of the outbreak of a new conflict or the recrudescence of an old one.

The United Nations should, ideally, have the clinical capacity to prescribe the correct treatment for the condition diagnosed. To fulfill this condition, the Secretary-General needs to be able to assess both the factors that have created the risk of conflict and the likely impact on them of the various preventive treatments that are available. Making those judgments in an interstate situation is easier than in an internal one. In the first case, much can be learned from consultation with the states concerned, and with their neighbors, friends, and allies. In the second, the crisis is often due to ethnic or economic and social issues of an entirely internal nature and of great political sensitivity, and the potential protagonists may include non-state entities of questioned legitimacy and with shadowy chains of command. If in such circumstances the Secretary General probes for the information needed to identify the right treatment, he can find himself accused of professional misconduct by infringing the sovereignty of the country concerned.

Another potential source of difficulty for the Secretary General at this stage of the process is the need for triage. His analysis of the symptoms may lead him to conclude that there is no preventive action that the United Nations can usefully take. This could be because he judges that, contrary to the general impression, conflict is not actually imminent and that what is being observed is posturing or shadow-boxing rather than serious preparations for war. Or he may judge that there is no effective treatment that would be accepted by the parties, or even that there is no effective treatment at all.

Sometimes the situation is so threatening that the United Nations’ efforts should be concentrated on stabilizing the patient and that, for the moment, the modalities for longer-term treatment become a matter of second priority. Unless the patients take their physician’s advice seriously, most physicians would turn elsewhere. In internal conflicts, sovereignty is an added complication, and the Secretary General has to proceed with great delicacy and finesse if he is to succeed in persuading both patients to consult the doctor and take the medicine he prescribes.

The salient fact that emerges from this analysis is that the Secretary-General’s ability to take effective preventive action depends most critically on the political will of the parties to the potential conflict. In international politics, as in human medicine, the physician cannot impose treatment that the patient is not prepared to accept. Important improvements have been made in the Secretary General’s capacity to diagnose and prescribe. Failure to take effective prevention action is, in any case, only rarely due to lack of early warning; the symptoms are usually there for all to see. What is too often lacking at present is a predisposition by the parties to accept third party assistance in resolving their dispute.

Once a course of therapy has been defined and agreed upon by all concerned, decisions have to be taken on the modalities for its application. There is no fixed pattern. Specific modalities have to be worked out for each case. The Secretary General’s role can take many different forms. He can do the work himself, directly or through his Secretariat. He can refer the patients to specialists, such as the agencies of the United Nations system, regional organizations, individual Member States, or nongovernmental organizations, and work with them to apply the therapy. He can coordinate the work of others or simply provide them with political and moral support.

Such public manifestations of the Secretary General’s concern can sometimes have a useful therapeutic effect. But more often he will prefer to provide his good offices quietly, especially where the looming conflict is an internal one. Quite apart from sovereignty-related sensitivities, it is easier for parties to make concessions when it is not publically known that they are being urged to do so by the Secretary General of the United Nations who can guarantee little or nothing in return. As already mentioned, preventive diplomacy is usually best done behind closed doors, which can make difficulties for the Secretary General if the world is clamoring for the United Nations to do something but he knows that to reveal what he is actually doing would impair his chances of success, as well as being the diplomatic equivalent of violating the Hippocratic oath.

Peace building is even more complicated. It can require a wide range and variety of actions not all of which will fall under the direct executive responsibility of the Secretary General. His functions in his context are essentially those of a general medical practitioner. He can diagnose the patients’ condition and advise them that certain general measures of a political, economic, or social nature will help reduce the risk of conflict. He must persuade the specialists to apply the therapy that he has prescribed and the patients have accepted. The best way of doing this, of course, is to associate the specialists with the earlier consultations and make them a part of the diplomatic process through which the parties are brought to accept the desirability of preventive action and the nature it should take.

There are no guaranteed vaccinations to prevent conflicts from starting and no miracle cures to end them once they have started. The best prevention is for the region or country concerned to follow a strict and healthy regimen of democratization, human rights, equitable development, confidence building measures, and respect for international law, while eschewing indulgence in such unhealthy practices as nationalism, fanaticism, demagoguery, excessive armament, and aggressive behavior. Most of the elements of such a regimen are prescribed in the United Nations Charter and in the corpus of international law.

The difficulties of prevention in the field of peace and security do not arise because the warning signs of conflict are more difficult to detect than those of human disease; on the contrary, they are usually more obvious. Nor is it that the therapies are less effective; many effective therapies have been devised over the years. The United Nations dispensary is well stocked and many experienced consultants and specialists are on call.

The problem is with the patients, and with the friends and enemies of the patients. Human beings may be full of phobias and superstition about disease but they can usually be relied upon to respond fairly rationally to the diagnoses and prescriptions of their physicians. The same cannot, alas, be said of governments and other parties to political conflicts. Many general practitioners would have been tempted to retire in despair long ago if their advice had been disregarded by their patients as consistently as the advice of the United Nations is disregarded by those to whom it prescribes therapies to avert imminent conflict. But the Secretary General of the United Nations cannot abandon his principal duty any more than a conscientious physician can abandon a difficult case. The Secretary General’s duty is to use all the means available to him, be they political, military, economic, social, or humanitarian, to help the peoples and governments of the United Nations to achieve the goal, emblazoned in the first paragraph of its Charter, of "saving succeeding generations from the scourge of war."

I should like to add complementary thoughts from two other contributors to the Preventive Diplomacy conference. Jan Eliasson, who later became the Deputy Secretary General of the United Nations, was, as a speaker at the 1995 conference, the Secretary of State for Foreign Affairs of Sweden. As a direct result of his involvement he instituted an official government policy in his country that all diplomatic actions and decisions should be examined through the prism of preventive diplomacy.

Lord Owen drew the inspiration for his lecture from an 18th century physician’s cautionary advice: "Beware of overly aggressive doctors". In international relations, Lord Owen noted that by understanding — and accepting — limitations, and by using persuasion rather than reflex aggression, one might be able to prevent, or at least limit, a conflict. Alternatively, trying to extricate oneself from an unwise involvement, as in recent decades for Western Powers in Iraq or Afghanistan, can prove very difficult indeed.

In our ever more dangerous world, in the throes of both inter- and intra-state conflicts, the need for a new approach in international relations, seems obvious. Preventive Diplomacy should deal with — and even direct — where a nation can move towards peace rather than replaying where it has been in endless wars. That surely was our intention in promoting this option, and neither Boutros nor I ever abandoned that dream.

It is most fitting that the venue for this first anniversary Boutros Boutros-Ghali Memorial is at the United Nations where his tenure as Secretary-General is remembered fondly by those who continue the search for peace, and that it is sponsored under the broad mandate of the office of the UN Alliance of Civilizations.

I conclude by returning to the importance of ideas. For Boutros believed, passionately, that ideas cannot be extinguished by mere political power. Boutros Boutros-Ghali — the scholar and teacher, the bibliophile and archivist, at the end of a most remarkable career as an unvanquished servant of his fellow man — donated his personal books and papers to libraries so that future generations can study his approaches to alleviate suffering and end conflicts through diplomacy. And, as a final codicil to this Memorial, it is a joy to report that the Francophonie, with the support of the Ministries of Defense of France, Belgium and Canada have established a new Boutros Boutros-Ghali Observatory for Preventive Diplomacy.

Thank you.

Kevin M. Cahill, M.D. is the University Professor and Director of the Institute of International Humanitarian Affairs, Fordham University; President of the Center for International Humanitarian Cooperation. He served as Chief Advisor for Humanitarian and Public Health Issues for three Presidents of the United Nations General Assembly.

 Kevin M. Cahill, M.D.served as Mr. Boutros-Ghali’s physician and personal advisor for many years, including during his time as UN Secretary-General.

Kevin M. Cahill, M.D.served as Mr. Boutros-Ghali’s physician and personal advisor for many years, including during his time as UN Secretary-General.

Fighting Ebola with Information

What can be learned from the use of data, information, and digital technologies, such as mobile-based systems and internet connectivity, during the Ebola outbreak response in West Africa? What worked, what didn’t, and how can we apply these lessons to improve data and information flows in the future?

When the Ebola outbreak hit West Africa in late 2013, the world was caught unprepared. The consequence: over 30,000 Ebola cases, including more than 11,000 dead, and billions of dollars lost across the global system.
In response to the outbreak, USAID joined with communities, governments, and organizations to help affected countries control and, ultimately, contain the disease. As part of celebrating this hard won achievement, the international community must reflect, learn, and act based on this experience to help ensure such a tragedy is not repeated.

This report is a contribution to that end. It focuses on one aspect of the multi-faceted response: the role of data and digital technologies. Grounded in over 130 interviews and peer review, the report surfaces a breadth of experiences and perspectives, and concludes with practical recommendations that health, humanitarian, and development actors should take to be better prepared for the next crisis.

Information was critical to the fight against Ebola. Both for responders, who needed detailed and timely data about the disease’s spread, and for communities, who needed access to trusted and truthful information with which they could protect themselves and their loved ones. Yet, as we now know all too clearly, the technical, institutional, and human systems required to rapidly gather, transmit, analyze, use, and share Ebola-related data frequently were not sophisticated or robust enough to support the response in a timely manner.

We must strengthen these systems. This is essential both to keep pace with diseases that spread with the ferocity and velocity of Ebola, and to be more resilient in the face of future threats.

Although the focus of this report is the need for strengthened capacity, systems, and use of data, we recognize that this alone is not sufficient. Our hope is that these recommendations are incorporated alongside new knowledge of effective public health interventions, preparedness, and priorities for health system strengthening. Ultimately, our willingness to engage these challenges–on a daily basis and within public health systems–will be the best predicator of our success in stopping similar events.

Let us learn from and act upon these lessons to do justice both to those directly affected by Ebola, and to the efforts that ultimately brought to heel one of the most significant health and humanitarian crises of the early 21st century.

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This is the Foreword from the new USAID report, Fighting Ebola with Information: Lessons from the Use of Data, Information, and Digital Technologies in the West African Ebola Outbreak Response. The report details key findings and recommendations about the collection, management, analysis, and use of data and information in countering the Ebola outbreak in West Africa in 2014 and 2015. It reveals common sources of the confusing data picture, particularly in the early days of the response and examines the use of digital technologies to support data and information flows, considering both common barriers and insights from what worked. 

The report was co-authored by Institute of International Humanitarian Affairs Research Fellow Larissa Fast. Dr. Fast is a Fulbright-Schuman Research Scholar at Uppsala University’s Department of Peace and Conflict Research. Her current research compares the practices of data collection and use on the part of scholars and practitioners, focusing specifically on data collected by and about peacekeepers and aid workers. She is also the author of Aid in Danger: The Promise and Perils of Humanitarian Action.