Harvard International Review

A War Without Limits
Somalia's Humanitarian Catastrophe by Nicolas de Torrente, Fabrice Weissman
Rethinking Finance, Vol. 30 (4) - Winter 2009 Issue

Nicolas de Torrente is Executive Director of Médecins Sans Frontières/Doctors Without Borders in the United States.
Fabrice Weissman is the Research Director of Médecins Sans Frontières' Paris-based reflection unit CRASH.

For years, Somalia has been a byword for anarchic violence, famine, and drought. It is depicted as an inhospitable, ungovernable country ripped apart by long-standing internal feuds and, more recently, as a harbor for terrorism and piracy. Yet not only is this portrayal superficial, but paradoxically it has served to obscure both the nature and severity of the current crisis. The unmitigated disaster that Somalis have experienced in the past two years is not just another episode of the country’s troubled history; it is the result of a particularly brutal and escalating war spawned by the clash of national, regional, and international political agendas.

In December 2006, the Ethiopian army, citing national security concerns, pushed deep into Somalia to oust the Islamic Courts Union (ICU)—a multi-faceted political and military movement displaying the diverse characteristics of contemporary political Islam—that had established various degrees of relative stability in south-central Somalia, including the capital Mogadishu. On the coattails of Ethiopia’s rout of ICU militias, the Somalia Transitional Federal Government (TFG), established under UN auspices in 2004 in Kenya, was installed in Mogadishu. Supported by the United States in the name of counter-terrorism, the Ethiopian-led regime change was welcomed on January 5, 2007 by the United Nations (UN), the European Union (EU), the African Union (AU), and the League of Arab States as “an historic opportunity for the Somali people to reach sustainable political solutions.”

Yet almost immediately, an armed insurrection led by former ICU supporters started to intensify, followed by counter-insurgency operations carried out by TFG and Ethiopian forces. A fierce, rapidly escalating war was launched, leading to catastrophic consequences for an already exhausted population. Mogadishu was further destroyed, with thousands killed and injured by the fighting, while hundreds of thousands were forcibly displaced only to face dire conditions in makeshift camps.

As a humanitarian organization, Doctors Without Borders/M?decins Sans Fronti?res (MSF) has no legitimacy to comment on the rationale for using military force in Somalia or elsewhere. Neither are we in a position to pass judgment on the relevance of decisions by the United Nations Security Council or other international players to support one belligerent or another. Our concern lies only with the manner in which conflicts are conducted and with their impact both on civilian populations and our ability to assist them. In that regard, not only has internationally-sponsored regime change led to the ratcheting up of unbridled warfare, including crimes that Amnesty International and Human Rights Watch have thoroughly documented, but it has also been supported by international governments and institutions in a way that has made it more difficult for humanitarian aid organizations, confronted with mounting security threats including targeted attacks, to help an increasingly beleaguered Somali population.

A Humanitarian Catastrophe

Since the overthrow of Siad Barre’s regime in January 1991, Somalis have periodically experienced severe hardship as a result of war and political instability, none more dramatic than the famine of 1991-1992 that cost hundreds of thousands of lives. While regional islands of stability have emerged since, mainly in the northern part of the country, and while intensive, unregulated trade since the mid-1990s has generated significant economic activity, the socio-economic, educational, health, and nutritional status of a majority of Somalis has remained poor. Socio-economic surveys conducted by the United Nations Development Program (UNDP) and the World Bank estimate infant and maternal mortality to be among the worst in the world.

This already precarious situation deteriorated further from December 2006 onward. It is difficult to ascertain the precise magnitude and extent of the crisis, as surveillance systems able to provide accurate population figures, mortality, morbidity, and malnutrition rates are nearly non-existent due to security constraints. However, field observations from MSF health facilities point to an ever-worsening situation, specifically in south-central Somalia, which is not only the most populated region but also the one most affected by current violence and instability.

In Mogadishu, the epicenter of the armed conflict, military operations carried out in densely populated areas without any regard for civilians are causing a high number of casualties and war-wounded. Between January and July 2008, the three surgical wards supported by the International Committee of the Red Cross (ICRC) and MSF in Mogadishu admitted 2,210 war wounded, an average of 300 a month. Women and children under fourteen accounted for 50 percent of the 500 war-related trauma cases operated on in MSF’s facility. These figures, though, only represent a small percentage of the injured as access of patients to hospitals is limited by extreme insecurity.

While health care has been insufficient in quality, quantity, and accessibility for years, in Mogadishu the situation further worsened with the intensification of the war. Out of the twenty functional inpatient facilities identified by MSF in January 2007, many of them privately-run hospitals that had been established in previous years, only six remained open nine months later. The number of health care professionals remaining in the city is dramatically low and far from sufficient for meeting even basic medical needs.

The intense fighting in Mogadishu has also generated the forced displacement of around 400,000 people (one third of the capital’s population) for the relative safety of its outskirts, particularly the Afgooye corridor and Daynile. Tens of thousands have fled further afield to towns in the interior of the country such as Beledweyne or Galcayo, often running a gauntlet of militia checkpoints along the way. The UN estimates that 870,000 Somalis have been displaced since January 2007.

The conditions in the makeshift displaced persons’ camps that have sprung up along Mogadishu’s periphery are nothing short of appalling. Emergency assistance has been far below public health minimum requirements to prevent a rise in mortality, with no measles vaccination, erratic general food distribution, insufficient provision of safe drinking water, poor sanitation, inadequate nutritional and health care coverage, and limited availability of shelter materials. An MSF retrospective survey conducted in November 2007 in Hawa Abdi, a camp housing some 32,000 internally displaced persons (IDPs) at the time, indicated an alarming mortality rate among children under five of 4.2 deaths per 10,000 people per day and a global mortality rate of 2.3 deaths per 10,000 people per day. Both are more than twice the emergency threshold. Diarrhea was the main cause of death in the camp (over 50 percent) due to disastrous sanitary conditions.

The nutritional situation is also particularly alarming. In ambulatory and intensive feeding centers in Hawa Abdi and Afgooye, MSF admitted over 1,000 severely malnourished children per month, with a rapid increase between March and July 2008. In August 2008, the UN estimated that 3.25 million Somalis (out of a total of 7 million) required “emergency livelihood and humanitarian support,” a sharp increase linked to the war and population displacement, but also to the “disruption of economic activities, trade and transportation networks” and “hyperinflation.”

Seeking to escape from violence and economic hardship, Somalis have also increasingly attempted to find refuge in neighboring countries, particularly Kenya and Yemen. While Kenya has been officially hosting more than 160,000 Somali refugees since the 1990s, it closed its borders in January 2007 and turned back thousands of new Somali asylum seekers to the war zone they were fleeing. In 2008, however, more than 60,000 Somalis managed to enter Kenya, according to the Office of the United Nations High Commissioner for Refugees (UNHCR), which is considering opening an additional camp at Dadaab on the Somali-Kenyan border.

In addition, UNHCR estimates that some 45,000 people, the highest number yet recorded and the vast majority of them Somalis, have embarked on the treacherous journey from Bossaso to Yemen across the Gulf of Aden in 2008. In a report entitled “No choice” released by MSF in June 2008, Somali refugees interviewed in Yemen describe their extreme exposure to violence by human smugglers. Recorded deaths and disappearances account for approximately 5 percent of those who attempt the crossing. Beatings and suffocation are commonplace on overcrowded boats, while scores of bodies wash up periodically on Yemen’s beaches as smugglers force refugees, most of whom are unable to swim, overboard as they seek to avoid detection by coast guard ships.

Attacks on Aid Workers

The worsening humanitarian situation has been accompanied by the shrinking ability of aid organizations to provide assistance in the hardest-hit areas. It has certainly never been easy to run aid operations in Somalia, and security concerns have always been the key limiting factor. In the early 1990s, as clan-based mechanisms replaced the state in providing a modicum of public order, foreigners, including aid staff, were left particularly exposed. In the absence of overarching authority, armed guards became a necessity, all the more so given the power wielded by aid workers in allocating resources and making staffing decisions. By the mid-2000s, MSF had developed a system to run programs with international and national teams by working through clan and community leaders for security arrangements, employment, and other matters, although threats, security incidents, and evacuations remained commonplace.

In 2006, when the ICU progressively took over many regions, MSF maintained a significant presence in the country. In Mogadishu, the unification of the city and relative security established by the ICU led to negotiations with a view of increasing MSF’s programs after years of only minimal activity. The ability of humanitarian organizations to provide aid, however, deteriorated sharply following Ethiopia’s military offensive, the arrival of the TFG in Mogadishu, and the escalation of armed opposition attacks and counter-insurgency operations.

The intensity and conduct of the war itself has caused the death of a number of aid workers caught in random crossfire or indiscriminate violence. But the most disturbing development has been the deliberate targeting of aid workers and organizations. On January 28, 2008, three MSF aid workers were killed in the port city of Kismayo by a roadside bomb that was intentionally placed and detonated as their car drove by. According to a statement issued in October 2008 by a coalition of 52 NGOs working in Somalia, “this year alone 24 aid workers, of which 20 are Somali nationals, have been killed whilst carrying out their work. The whereabouts of another ten are unknown.” Since that report three more aid workers have been killed and six more kidnapped.

It is often difficult to determine who is responsible for targeted attacks against aid workers. The ongoing conflict and the progression of the armed opposition, which in 2008 regained much of the territory controlled by the ICU before the December 2006 Ethiopian intervention, has triggered the reshuffling of authority structures at local, regional, and national levels. This generates heightened power struggles in which the safety of humanitarian workers can be at stake. As illustrated by the rise of piracy, criminal syndicates recruiting across clan and political lines have also developed, especially in the kidnapping business.

Yet beside the ongoing chaos and subsequent stresses to security arrangements on which aid agencies rely, rumors and accusations linking targeted attacks against aid workers to broader political motivations abound. Pro-TFG forces and armed opposition movements are keen to blame each other for the murder of aid workers in an effort to discredit the other side. It often happens that attacks initially believed to be the handiwork of one group are later suspected of being carried out by one at the opposite end of the political spectrum.

Since the spring of 2008, public threats from elements of the armed opposition have sharply escalated. Following a US air strike that killed one of their key leaders in Somalia on May 1st, al-Shabaab, a self-defined “jihadist” branch of the armed opposition, threatened the UN and “affiliated organizations hidden under false humanitarian names” —i.e. suspected of conducting intelligence work or of collaborating in one way or another with US and pro-TFG forces. Among others, threats and attacks against two US-based NGOs, accused of “crimes against Islam” and spying activities, as well as the selective assassination of several Somali UN aid officials seem to fit this pattern.

It may, however, be simplistic to assume, as many analysts do, that there is a fundamental incompatibility between humanitarian aid work and armed opposition forces driven by a “jihadi” ideology. Some Islamist opposition leaders have not embraced the declared policy of targeting aid workers and have worked to provide security guarantees, on a case by case basis, for humanitarian organizations they view as being independent and having substantial benefits for the population. In a recently published article, Fred Burton and Scott Steward observed that influential thought leaders within the global “jihadi” movement have taken a stand against targeting “genuine” humanitarian organizations, referring in particular to the ICRC and its valuable services to the poor and dispossessed provided “without a hidden agenda.”

The International Community’s Blind Partiality

To maintain access and reduce security risks, humanitarian organizations must establish a degree of trust in their motives and actions. Yet not only is demonstrating their humanitarian character and lack of hidden agenda to the satisfaction of every armed group always difficult, their task is made that much harder when the main government donors of humanitarian assistance and the United Nations have chosen one side in the conflict and renounced exerting any scrutiny into its conduct of the war.

While implemented militarily by Ethiopia with the help of the United States and its regional allies, the policy that ousted the ICU and installed the TFG in Mogadishu has been supported politically by the International Contact Group on Somalia, comprising the United Nations, the African Union, the European Union (Presidency and European Commission), the League of Arab States, the Intergovernmental Authority on Development (IGAD), and several countries (Italy, Kenya, Norway, Sweden, Tanzania, United Kingdom, and the United States). It has been given a legal framework through AU and UN resolutions backing the TFG and authorizing the deployment of an 8,000-man strong African Union mission (AMISOM, currently comprising 3,400 Ugandan and Burundian troops) to protect it.

International diplomats have attempted to move towards a more balanced position in 2008—shoring up conciliatory elements within the divided TFG and supporting Special Representative of the UN Secretary General Ahmedou Ould-Abdallah’s pursuit of a negotiated solution with “moderate” factions of the opposition, which led to a peace agreement concluded in Djibouti in June 2008. However, the polarization remains, with the TFG continuing to benefit (at the time of writing) from a vital lifeline of international diplomatic, financial, and military backing, while opposition forces ranging from the Alliance for the Re-Liberation of Somalia to al-Shabaab insurgents and other armed factions receive varying degrees of support from groups and governments opposed to Ethiopia and the United States, including Eritrea.

An “Accountability-Free” Zone

While all sides have displayed wanton disregard for civilian welfare in their conduct of military operations, there have been no significant efforts by any party involved in Somalia to hold accountable those responsible. As early as March 2007, the methods of warfare deployed in Mogadishu by Ethiopian and TFG forces were so heavy-handed that the European Commission in Nairobi issued an internal memo warning about its possible complicity in war crimes.

The situation is reminiscent of 1992, when Western forces operating under UN Security Council authorization carried out brutal military operations in the name of protecting humanitarian relief. As Alex de Waal points out in a recent article of the Harvard International Review (Spring 2007), the resentment and mistrust towards the UN and Western governments among ordinary Somalis that resulted from this conduct, which included torture, rape, and summary killings, should not be underestimated.

Escalation and brutalization of the conflict has been fueled as much by egregious breaches carried out by internationally backed forces in the name of counter-terrorism and nation-building as by those committed by armed opposition groups. Yet as opposed to Darfur, where the UN Security Council has mandated inquiries into human rights violations and referred the situation to the International Criminal Court, it has consistently declined to appoint an independent commission of inquiry to investigate allegations of war crimes and crimes against humanity committed by all sides and remained silent on even the most serious violations committed by the forces it supports.

Humanitarian and Security-Political Agendas

Doubts concerning the “genuine” humanitarian motivations of NGOs and UN agencies have been further reinforced by the use of the United Nations Development Program (UNDP) to channel financial support to the TFG police force. Donors such as the European Union and the United Kingdom may have been embarrassed to directly fund a police force, which the Times of London has described as “filled with militiamen and led by one of the country’s most notorious warlords.” In an effort to neutralize criticism, UNDP has been mandated to do it on their behalf, therefore encouraging the confusion between impartial relief work and financial support to a party to the conflict.

Independent humanitarian action has also been compromised by the US approach to counter-terrorism in the Horn of Africa. Military action against al-Qaeda operatives and regimes accused of sheltering them (such as the ICU and part of the current Somali armed opposition) is clearly the centrepiece of US policy, whether it is funding Somali warlords in the (ill-fated) “Alliance for the Restoration of Peace and Counter-terrorism” in 2006 or backing Ethiopia’s military intervention with a combination of logistical support, special forces, and aerial strikes.

US military engagement is, however, wrapped up in substantial “hearts and minds” campaigns conducted under the banner of humanitarianism. The “Combined Joint Task Force-Horn of Africa” based in Djibouti publicly portrays its work as “95 percent civil affairs” and the recently created Africa Command (Africom) is officially presented as geared “not to wage a war” but to combat terrorism through “a more effective use of humanitarian and development assistance,” including by “incorporating humanitarian organizations to work alongside the US staff.” Such policies can only reinforce suspicions about “hidden agendas” associated with humanitarian action and increase the danger faced by aid workers.

The Adaptation and Restriction of Aid Operations

These heightened risks have triggered a shift in the mode of operation of aid organizations that remain active in Somalia. In particular, the presence of international staff has been sharply reduced. Since the Kismayo attack, MSF has only allowed international staff to undertake short visits, while relying on Somali staff to continue to run programs in the field. It has been near impossible to increase activities to tackle essential unmet needs like vaccinations in the IDP camps around Mogadishu or to achieve more extensive coverage of existing activities such as water and sanitation, outpatient consultations, inpatient care or nutritional rehabilitation, let alone to respond to new emergencies.

MSF is not alone in having to adapt and restrict its activities due to worsening security conditions. Major organizations such as ICRC and the World Food Program have perforce abandoned the usual practice of targeting recipients based on status or vulnerability and decided instead to “flood the market” with food aid with the hope that this will “trickle down” to those most in need. The important limitations and significant risks in the current mode of operation of aid organizations must be weighed against the severity and magnitude of the crisis, and the scale still tips in favor of continuing programs for the moment.

Whether the alarming humanitarian situation in Somalia will deteriorate further towards a disaster similar to 1992, when record mortality and malnutrition rates were documented, is difficult to predict. It is, however, clear that Somali citizens, especially those trapped in Mogadishu, the Afgooye corridor, Lower Shabelle, or fleeing the fighting zones, need to have access to significantly more assistance than they are receiving at the moment.

Conclusions

Disillusioned with the TFG and feeling the economic burden of an unpopular war, Addis Ababa announced at the end of 2008 the withdrawal of its armed forces from Somalia. A flurry of dire statements by members of the International Contact Group predicting a “security vacuum” and the country’s further plunge into “anarchy” soon followed. The United States has led calls for a UN peacekeeping operation to fill the gap left by Ethiopia’s departure, while UN Secretary General Ban Ki-Moon has instead advocated for the reinforcement of the AU mission given the reluctance of most UN member states to commit troops.

Noting that Western governments are still ready to fund relief efforts and provide military escorts against pirates for ships along the Somalia coastline (including WFP ships carrying food), some like Philippe Lazzarini, the former head of the UN office for the coordination of UN Office for the Coordination of Humanitarian Assistance in Somalia, accuse the international community of “subsidising humanitarian operations as a way of filling the political and moral void,” while Ahmedou Ould-Abdallah has denounced “a reluctance to go back there or a deliberate decision to punish all Somalis, many of whom were not even born during the last international intervention.” Other observers, like the Somali scholar Abdi Samatar, consider instead that international military disengagement would represent an opportunity, arguing that “if left to themselves, Somali factions will eventually reach some sort of modus vivendi, if not reconciliation.”

Whether or not further international military engagement is required is not for MSF to decide. What is certain, however, is that the international community’s heightened involvement over the past two years has been accompanied by a tolerance towards war crimes committed by belligerents it has sided with, thus contributing to the worsening of the humanitarian situation and the shrinking ability of aid organizations to assist people struggling to survive the crisis. The mixing of political and security agendas with humanitarian assistance has also played a part in the increasingly insecure environment that further imperils the task of relieving the suffering of the Somali population. In that perspective, it is of paramount importance for all belligerents involved in Somalia to provide the space and respect for impartial humanitarian work, and for independent humanitarian organizations to separate themselves from international political and security agendas that bear such great responsibility for the escalation of the crisis.