In this interview, humanitarian aid worker Sally Becker evaluates contemporary challenges in humanitarian response by unpacking how aid workers navigate through complex emergencies, as well as providing insights on partnerships in the aid sector. Informed and inspired by decades of Sally’s work across Bosnia-Herzegovina, Iraq, Ukraine and Kosovo, this interview further focuses on the intersectionality of gender, children, politics, technology and finance, and identifies progress and opportunities for reform.

Question:

As an independent aid worker, what are some of the principles that guide you in the field?

Sally Becker:

I am guided by the four humanitarian principles which are fundamental to humanitarian action. Humanity refers to preventing and alleviating suffering wherever it may be found. Other than protecting life and health and to ensure respect for the human being, I am concerned with giving priority to the most urgent cases of distress and making no distinctions on the basis of nationality, race, gender, religious belief, class, or political opinions. Independence refers to remaining independent from political, economic, military, or other non-humanitarian objectives. Finally, in line with the neutrality principle, I attempt to abstain from taking sides in hostilities. It is key to refrain from engagement in political, religious, racial, or ideological debates and controversies.

Question:

Being familiar with real-life scenarios in complex humanitarian emergencies, how do you navigate yourself through the unexpected?

Sally Becker:

When working in a conflict zone you must be prepared to act quickly as it can often be a matter of life or death. When I first arrived in Bosnia in 1993, I spent the first few weeks bringing aid to the local hospital in Croat controlled West Mostar and helping the Jewish community who were living close to the front line. 60,000 Bosnian Muslims were trapped on the east side of the river and the area was being shelled night and day. No one could get in or out and people were dying for lack of food and the most basic medical supplies.

One day an officer from the UN Civil Police asked me to use my ‘influence’ to help get permission to evacuate a sick child from the besieged east side of the city. I approached Dr Ivan Bagaric, head of the Croatian Health Authorities, who I knew from various trips to the local hospital, and he agreed to authorise an evacuation of all the sick and injured children. He suggested I travel with the UN convoy which was preparing to take aid to the besieged Muslim enclave. The convoy included representatives from the major organisations such as the International Red Cross and there were 50 ODA trucks filled with aid. They were flanked by an escort of armoured vehicles from the UN Protection Force and accompanied by the international press.

When I showed the UN officer the signed documents which would enable me to carry out the mission, he said it was not possible because I was not affiliated with any organisation and I had to watch as the mile long convoy passed me by. After the aid had been unloaded in east Mostar, hundreds of women and children sat down in front of the vehicles and refused to let them leave. They were scared that as soon as the UN had gone the ceasefire would end and they would once again be targeted by snipers and rocket propelled grenades. The following morning I received a call from the UN Civil Police telling me that everything had been arranged so I could carry out the evacuation after all. I set off in an ambulance filled with medical supplies and as I crossed the disused airfield a sniper began shooting at my vehicle. Having never come under fire before and having no idea which way to go, I was terrified. The only options were to turn back, stop and hide beneath the vehicle or continue towards the city and hope that I wouldn’t be killed. I chose option three and fortunately it was the right one because I made it safely to the hospital where five seriously injured children were in urgent need of medical help.

Question:

In your own experience, what have you found that works effectively to engage with crisis-affected communities?

Sally Becker:

There is no general rule for this because it depends on the situation and what is possible, but I have usually found that the best way to operate effectively is to make contact with local people who have influence within the community such as the local health authorities and/or religious leaders.

Question:

In 2015, you founded a non-profit charity called Save A Child. It has developed a mobile app to help specialists deliver assistance remotely. How does telemedicine operate in poor infrastructure? How is digital health shaping the future of humanitarian action?

Sally Becker:

The unrelenting violence in areas of conflict puts an immense strain on local resources, outstripping the ability of any local health care system to provide adequate care. Access to paediatric expertise is limited which can lead to suboptimal treatment. Children with acute or chronic illnesses are often equally at risk as those with traumatic injuries and the high mortality rate of these patients suggests that untreated medical conditions can often be more lethal than the weapons of war.

Our mobile app was developed for areas with low wifi connectivity and is an efficient and effective tool in overcoming barriers like remoteness, damaged infrastructures, or active conflict zones. In areas where the fragmentation of the healthcare system has led to a collapse in the referral network, we can provide doctors and nurses with direct access to our global paediatric network.

According to the Centers for Disease Control and Prevention, virtual care is among the best solutions for mitigating the spread of disease and provides a safer option for healthcare staff, reducing potential infectious exposures. This kind of software can also contribute to data collection by providing a comprehensive tool for documenting outbreaks and other health hazards. Working directly with expert paediatricians helps local clinicians to improve their knowledge of paediatric diagnoses and treatments to better address similar cases in the future, and they will also help the global paediatric community to build a better understanding of location-specific paediatric challenges and healthcare needs.

Question:

When it comes to accessing remote areas and negotiation with hostile actors, gender can emerge as a barrier. How can aid workers best navigate such circumstances?

Sally Becker:

There are currently at least eight violent conflicts in Africa and Asia alone which are causing child casualties. While international aid agencies and NGOs can enter some of these war zones, they are not able to enter them easily or safely. One of the main advantages of telemedicine is that it can be used by local healthcare workers and its use will not be affected by passport controls, visa restrictions or checkpoints. This is particularly relevant in Afghanistan right now where the Taliban’s Ministry of Economy has ordered all international and non-governmental organisations to stop women working in their organisations. Through telemedicine it’s possible to address some of these gender-related issues by supporting local healthcare providers and by improving healthcare for children by providing remote consultations with highly specialised paediatricians, physiotherapists, psychologists, and pediatric nurses.

Question:

Where do you see the most urgent need for change in humanitarianism?

Sally Becker:

With 80 million people displaced by conflict and violence the humanitarian system is overwhelmed and over stretched. There are not enough health workers in the world. By 2030, there will be 15 million fewer health workers than needed. The scale and complexities of the crises we face today are putting our system under enormous strain and funding has failed to keep pace with rising needs. We need to create a new humanitarian model that gives responsibility directly to those people most affected by conflict or disaster. It is not sufficient to just supply humanitarian assistance and then move on. We also need to find a way to work with the affected communities to help them recover after the crisis has passed.

Sally Becker is a renowned humanitarian most known for her active role in Bosnia and Kosovo in the late 1990s as a independent practitioner leading evacuation of civilians in besieged areas and ceasefire efforts. Sally’s humanitarian outreach spans from Lebanon to Iraq, and most recently Ukraine. She played a critical role in the development of pediatric emergency response as founders of the British charities Road to Peace and Save A Child. Dubbed as the “Angel of Mostar” for her life saving work in the Balkans and appointed as a Goodwill Ambassador for Children of Peace. Sally has also been bestowed numerous awards for her outstanding bravery and service in war-torn areas.

This interview is conducted as part of the the “Humanitarian Diplomacy” research project. The Humanitarian Diplomacy project assesses policy, practices, and impact of new forms of humanitarian action and foreign policy, and is funded by the Research Council of Norway.