10.5 Necessary Condition: Access To and Delivery Of Basic Needs Services

10.5.1 What is access to and delivery of basic needs services? Why is it a necessary condition?

The Universal Declaration of Human Rights states that everyone has the right to adequate food, housing and medical care.⁶²⁴ Access to and delivery of basic needs services is therefore a condition in which the population can obtain water, food, shelter and health services in adequate quantity and quality to ensure survival and satisfy their right to “life with dignity.”⁶²⁵ Normal systems for accessing these necessities will likely have been destroyed or incapacitated due to the conflict or may have failed to meet needs to begin with. Building or rebuilding physical infrastructure is necessary for the provision of services over the long term. Restoring access to these services is necessary to ensure the survival of conflict-affected populations, sustain livelihoods over the long-term, and to boost the legitimacy of the state.

10.5.2 Guidance for Access To and Delivery Of Basic Needs Services

10.5.3 Approach: Appropriate and Quality Assistance

Appropriate and quality assistance refers to how services are delivered. Appropriate means assistance that reflects conditions on the ground and is tailored to the cultural, social, and survival needs of the population. Quality assistance refers to providing equal access, coordinating assistance across the multiplicity of providers, and nesting the immediate methods of delivery in a locally driven plan for development and sustainability. It involves a required sensitivity to impartiality for service delivery and the recognition that inappropriate service delivery may actually do harm.

10.5.4 Provide assistance based on the needs of conflict-affected populations to ensure equal access for all. Maximizing equal access requires the ability to recognize the vulnerabilities, needs, and capacities of conflict-affected groups. Age, gender, disability, and economic and HIV/AIDS status can create severe disadvantages for certain groups of people, who can be further marginalized as a result.⁶²⁶ Provision should be enhanced for the most vulnerable to ensure that they are afforded the same access as the rest of the population. Providers should be trained to identify vulnerabilities.

10.5.5 Tailor assistance to local culture. When delivering services, take care to avoid dishonoring local beliefs or traditions related to water, food, shelter, and health. Careful consideration of the local culture can help avoid sowing distrust in the population or exacerbating social cleavages.⁶²⁷ Host nation actors know what systems the community will accept and how service programs can respect indigenous models and methods.⁶²⁸ Incorporate women into planning and implementation processes and understand how the choice of host nation partners could impact stability in communities.

10.5.6 Discourage the population from using coping strategies that arise from the inability to access basic services. Destructive coping strategies or “crisis strategies” include sale of land, distress migration of whole families, and deforestation. Some coping strategies employed by women and girls, such as prostitution or travel to unsafe areas, expose them to a higher risk of infection or sexual violence.⁶²⁹ Understand which groups are employing coping strategies, why they are doing so, and use mitigation programs based on the context.

10.5.7 Do no harm. In conflict-affected countries, assistance activities can never be completely neutral. Resources inevitably represent the distribution of power and wealth. Managing these resources can and will create tensions if careful attention is not given to how they are distributed and delivered. “Do no harm” is a principle that recognizes the potentially negative impacts of aid and seeks to prevent aid activity from harming the populations it is trying to help.⁶³⁰ For more on nondiscrimination in providing service, see Section 8.6.11.

See Trade-off: Section 8.9.3, Rapid service delivery and resource procurement vs. empowerment of spoilers or criminal elements.

10.5.8 Prioritize immediate relief, but do not neglect the impact on long-term development. One devastating impact of violent conflict may be an acute humanitarian crisis. While this may require direct aid, always seek to maximize opportunities for building host nation capacity for the long-term and to minimize dependency. Understand the distortion of the host nation economy that can result from prolonged delivery of relief goods and services.⁶³¹ Risks to the host nation economy can be severe, including the creation of a “second civil service,” the inevitable drawdown of international assistance, and the inability to sustain services.⁶³² Pay adequate attention to restoring or building basic service infrastructures that will allow host nation actors to provide necessities themselves after international actors leave.⁶³³

10.5.9 Coordinate humanitarian assistance and development strategies to maximize coherence and sustainability. Facilitating a smooth transition from relief activities to sustainable development is a major challenge in current practice. This transition refers to the shift from primarily life-saving measures to restoring livelihoods that contribute to long-term growth.⁶³⁴ Activities in both areas of relief and development are often funded and managed as distinct programs. This may create gaps—both financial and institutional—in provision of basic needs when relief activities end and the development activities largely take over.⁶³⁵ Coordinate assistance strategies closely with development strategies to ensure that relief activities are nested in and coherent with the longer-term objective of sustainability.⁶³⁶

See Gap/Challenge: Section 10.10.3, Transition from relief to development activities.

10.5.10 Approach: Minimum Standards for Water, Food, and Shelter

Meeting the minimum standards for water and food broadly involves ensuring the population has equal access to water and food, in adequate quantity and quality to survive, to contain the spread of waterborne diseases and to prevent malnutrition. The minimum standard for shelter involves ensuring access to housing to protect against environmental elements and ensure life with dignity.

10.5.11 In the emergency phases of recovery, strive to meet the immediate survival needs of the population for water, food, and shelter.

• Clean water and proper sanitation. At the minimum, the population should have safe and equal access to an adequate amount of clean water to prevent death from dehydration and to enable consumption, cooking, and good hygienic practices. The population should also have access to adequate sanitation systems to reduce the transmission of faeco-oral diseases and provide a means for excreta disposal, vector control, solid waste management, and drainage.⁶³⁷

• Food security. At the minimum, the population should have access to food in adequate quantity and quality, in a way that ensures their survival and upholds their dignity.⁶³⁸ Food security includes access to food, affordability of food, adequate quantity and availability of food, along with safety and cultural acceptability.

• Shelter. At the minimum, shelter should provide for personal safety against environmental elements and disease, provide a space for living and storage of personal belongings, and protect privacy to promote human dignity and emotional security.⁶³⁹ The right to housing includes adequate space and protection from environmental elements and disease vectors. Strive for housing that is inhabitable, accessible, affordable, and culturally appropriate, and that enables access to goods and services such as safe drinking water, energy for household activities, sanitation and washing facilities, refuse disposal, drainage, and emergency health care services.⁶⁴⁰

10.5.12 Provide quantity and quality of water to ensure survival, improve hygiene, and reduce health risks. People can survive longer without food than water.⁶⁴¹ Protecting clean water supplies from contamination is therefore a major priority. Water-related transmission of diseases results from both contaminated water supplies and insufficient quantities of water for personal and domestic hygiene. If it is impossible to meet both standards, focus first on providing access to sufficient quantities of water, even if the quality may be substandard.⁶⁴² HIV/AIDS-affected individuals will have a special requirement for water and personal hygiene. Water will also be in high demand for livestock and crops. Maximize storage capacity with containers, reservoirs, and tanks; storing untreated water undisturbed can considerably improve water quality.⁶⁴³ Determining the number and location of water sources will depend on an assessment of the situation on the ground, including the climate, individual physiology, social and cultural norms, and types of food generally consumed.

10.5.13 Impart important information to the public about the benefits of water and sanitation services and facilities.⁶⁴⁴ Providing clean water and sanitation facilities is not enough. Treated water sources have limited effects if the population does not understand its health benefits and the importance of using it. They may opt for water from rivers, lakes, wells, or other sources because of convenience, proximity, and taste. Focus on promotional messages that stress the importance of using protected water sources. Good personal and environmental hygiene is derived from knowledge and education about public health. Also consider creating water or sanitation committees to manage communal facilities such as water points, public toilets, or washing areas.

10.5.14 Tailor water and food distribution and assistance according to local factors.⁶⁴⁵ The availability of supplies such as fuel, soap, clean water and cooking utensils will determine whether foods provided need to be ready to eat or if they can require some preparation. Also be sure to understand what foods may be culturally inappropriate. Assess the nutrition situation and tailor food programs based on nutritional conditions of the population.⁶⁴⁶ Deciding the location of water sources will depend on population density and security requirements for women and others traveling to communal water sources.

10.5.15 Use food assistance strategies that facilitate sustainability. Consider strategies to complement or replace direct food aid, such as bolstering the primary production capacities of the population, generating income and employment to improve purchasing power and livelihoods, and ensuring people’s access to markets to acquire necessary food and other basic needs.⁶⁴⁷ Other constructive options include subsidized food or food-for-work programs. These options are more desirable because they uphold dignity while promoting livelihood development and independence.

10.5.16 Aim for equity in food and water distribution.⁶⁴⁸ Consult with local leaders on how to equitably distribute food and water resources and inform the population about the basis for determining food rations and water source location.⁶⁴⁹ The population should perceive the provision of food and water to be fair and based on need, rather than on gender, disability, religion, or ethnic background. Local distribution agents for food and water should be selected based on their commitment to impartiality, capacity, and accountability. These agents can include local elders, elected relief committees, local institutions, host nation or international NGOs, or the government. Choose distribution points based on safe accessibility by the population rather than the convenience of the logistics agency. Registering individuals and households receiving food assistance will also boost effectiveness, especially when assistance will be needed over an extended period of time. Also be sure to evaluate the process to ensure that the food is reaching its intended recipients.

10.5.17 Resort to providing free food aid only when the need is severe and there is no other alternative. Free distribution of food aid should be used only when absolutely necessary and should be stopped at the earliest possible moment to prevent dependency.⁶⁵⁰ Direct food aid may be necessary to sustain life in some situations or to mitigate dangerous coping strategies of the population. This is the case if normal systems for food production, processing, and distribution have been disrupted, co-opted or destroyed by warring parties to the conflict. Any mass feeding or provision of cooked food that is ready to eat should only be provided on a short-term basis to those in greatest need who are unable to prepare food for themselves or if the distribution of dry food rations could endanger recipients. Avoid free distribution when food supplies are available in an area but people lack access to it, or if the absence of food in an area could be resolved by improving market systems.

10.5.18 Develop tailored sanitation programs to best benefit the population. Sanitation programs involve many different areas: excreta disposal, control of disease vectors, solid waste management, and drainage systems.⁶⁵¹ In designing sanitation facilities, pay close attention to preferences and cultural habits. It may be difficult to accommodate the needs of every group—women, men, children, disabled—when building communal facilities intended to serve large numbers of people. In general, facilities should be located in safe places and have adequate lighting to better protect women and girls from attacks in communal sites. Vector control programs can mitigate the spread of disease, but simple steps such as hand-washing and other good hygienic practices can also go a long way. Reduce public health and environmental risks by setting up a means for managing solid waste and drainage to address standing water or water erosion from storms, floods, and medical waste.

10.5.19 Provide shelter assistance to meet survival needs. Everyone has a right to adequate housing that sustains life and dignity.⁶⁵² During and after violent conflict, many displaced people will require shelter assistance after being driven from their homes or while deciding whether or when to return to their homes.⁶⁵³ Shelter assistance should strive to protect as many people as possible from environmental elements such as the cold, wind, rain, or heat. Locations of shelters should consider the presence of unexploded ordnance, availability of food and clean drinking water, proximity to toilets and other sanitation facilities, and accessibility of the site by relief agencies. Providing temporary transit housing for displaced persons can mitigate the problem of ad hoc housing occupation.⁶⁵⁴ Primary transitional shelter options for displaced populations include residing with host families, self-settling in rural or urban areas, or residing in mass shelters or camps.⁶⁵⁵

10.5.20 When choosing a site for mass shelter, pay close attention to land rights.⁶⁵⁶ While the host nation often offers land for mass shelters, local communities frequently assert traditional or customary rights to the land.⁶⁵⁷ Tensions and resentment may surface in local communities if the land depreciates as a result of a settlement, the settlement population refuses to leave, or if the camp population enjoys greater benefits and support than the local community. When choosing a site, clarify land ownership whenever possible. Any use of land should be grounded in formal legal arrangements in accordance with domestic law.⁶⁵⁸ Occupants of the site should have full access and land use rights to graze animals and engage in agricultural activities.

10.5.21 Tailor shelter designs and planning to local requirements. In designing emergency shelters for survival, consider cultural norms for sleeping accommodations and subdivisions of living space to ensure safety and privacy for women, girls, and boys, who are most vulnerable to attack. When assisting with housing, other factors to consider include affordability; habitability; location; cultural appropriateness; access  to natural resources; and the availability of services, facilities, materials, and infrastructure.⁶⁵⁹ Build insulation or ventilation into the design as needed, depending on the climate.

10.5.22 Use shelter construction processes as an opportunity to build host nation capacity and promote livelihood development.⁶⁶⁰ Host nation actors should partake in procuring building materials or contributing manual labor to build capacity and promote livelihood development. Develop skills training programs and apprenticeship schemes to maximize capacity building for host nation actors in housing construction processes. Those who are less physically able can assist in tracking inventory and other administrative responsibilities.

10.5.23 In addition to housing, be prepared to provide nonfood items that may be necessary to maximize self-sufficiency and self-management.⁶⁶¹ Most displaced people will have few possessions and may need everyday items such as changes of durable clothing bedding materials that are culturally appropriate; bath and laundry soaps; and cooking facilities and utensils, including stoves, ovens, fuel, pots, pans, and silverware. Materials from damaged homes or buildings can also be used to enhance living spaces in improvised shelters.

10.5.24 Approach: Minimum Standards for Health Services

Minimum standards for health services involve the provision of care to prevent untimely death and illness. Careful thought should also be given to laying the foundations for a health care system built on sustainable infrastructure, services, and public health education.⁶⁶² After violent conflict, it is not uncommon to find that health care systems, if they even existed before the conflict, have collapsed, health information has disappeared, and communication systems have broken down. Other major health challenges include a lack of health-related information about the population, low absorption capacity, and persistent political and financial uncertainties.

See Gap/Challenge: Section 10.10.8, Mental health needs of conflict-affected populations.

10.5.25 Treat those with the most immediate health risks while restoring basic health services for the broader population.⁶⁶³ Provide medical attention to those in greatest need. The immediate priorities of health care in this environment should be to prevent and reduce levels of death and illness.⁶⁶⁴ The greatest vulnerabilities often involve women, children, the elderly or disabled, and people living with HIV/AIDS. Epidemics may be rampant, while other ailments common among war-torn populations may include mosquito-borne and gastrointestinal diseases.⁶⁶⁵ In these environments, the most staggering health indicators are maternal mortality and under-five mortality from waterborne diseases, lack of immunization, malaria, and other infectious diseases. Standing up health clinics at the community level is critical to treat people with immediate health needs and provide necessary attention to HIV/AIDS and other communicable diseases with the potential to adversely affect stability. Pay special attention to the possibility of public health epidemics and focus on strategies that deliver the most health benefits to the most people.⁶⁶⁶

10.5.26 Support a sustainable health care system for the population.⁶⁶⁷ While service delivery is critical, address the development of health care infrastructure, education, and training that are the foundation for sustainable health care. This may begin with support for the ministry of health in developing a national health policy and plan. Developing an effective and efficient health care system will be an enormous undertaking, as it is a complex interaction of parts that may have been absent or severely dilapidated before and following the conflict.⁶⁶⁸ In laying the foundation for this system, strive to provide equal access to the population by overcoming geographical or financial barriers. Building a health sector from scratch is very difficult, so refrain from throwing out what is there. Assess health care structures and build on them.

10.5.27 Work closely with host nation health authorities and affected populations to ensure that critical needs are met. Consult closely with host nation health authorities to identify areas with the most need, where the population is not already being serviced by a local facility. Because women and children will be the primary users of health care, women should participate in the planning and design of health care services to maximize the effectiveness of those programs.⁶⁶⁹ Consider infrastructure obstacles that may restrict certain populations from accessing these services. Mobile clinics may be necessary to fill gaps in service, but be careful not to duplicate existing efforts. The best entry points for emergency health care provision will be at the community level in the form of clinics and health posts. Many people will seek medical attention in these environments—community-level facilities can help to accommodate this influx, separating critical cases from those involving simple ailments.

10.5.28 Mainstream multi-sectoral HIV/AIDS interventions into recovery programming. Recovery programs do not adequately account for HIV/AIDS challenges. Given its broad impacts across society, HIV/AIDS is an issue that should be “mainstreamed” or seriously accounted for in broader recovery programs.⁶⁷⁰ Ensure that peacekeepers, humanitarian staff, and other military forces present in these environments are included in prevention strategies.⁶⁷¹ HIV/AIDS should be factored into food security programs, and shelter and site planning projects. Those handling HIV/AIDS programs should understand cultural stigmas and discrimination that hamper the effective provision of treatments. Use approaches that reduce the root causes of stigmas through awareness programs, mass media campaigns, public dialogue and interaction between HIV-affected people and target audiences, and participatory education to address common fears and misconceptions.⁶⁷²

10.5.29 Respond appropriately and adequately to victims of sexual and gender-based violence. The lawlessness of war-torn countries often makes women particularly vulnerable to sexual violence and exploitation and more likely to assume high-risk sexual behavior in exchange for goods or services as a means for survival.⁶⁷³ Common forms of assault against women include rape, sexual harassment, genital mutilation, domestic violence, forced marriages, and sexual exploitation.⁶⁷⁴ Men can also suffer sexual and gender-based violence through rape or genital mutilation. Health care providers should be trained to respond appropriately and provide psychological services for these victims, taking into account cultural stigmas and discrimination that may be relevant. Be prepared to provide free voluntary and confidential counseling services, testing for HIV/AIDS and other communicable diseases, and necessary medical supplies to treat infections that occur. Health care providers should also be sensitized to medical confidentiality and should be trained on international standards for handling victims of sexual violence. Sometimes health care providers will have to fill out police forms or testify in court in cases involving sexual violence, which is difficult to balance against principles of confidentiality and respect for the victim.

10.5.30 Restore information systems to promote public health.⁶⁷⁵ Information systems will likely be broken down after violent conflict, making it difficult to communicate important public health messages to the population and collect critical data that informs the delivery of health care services. Without a means for communication, it will also be difficult to identify or access victims of sexual and gender-based violence to determine the prevalence of HIV/AIDS and to provide necessary treatments. Restore public information systems as quickly as possible and develop education and prevention strategies.⁶⁷⁶ Collecting accurate information on the prevalence and spread of diseases is also a serious gap that should be improved to enhance responses to those in most need.⁶⁷⁷