Psychosocial and Mental Health Care Assistance
in (Post) Disaster
and Conflict Areas.
|In the left (yellow) column
of this document,
you will find the original text of the draft text
" Guidelines for Programmes Psychosocial
and Mental Health Care Assistance
in (Post) Disaster
and Conflict Areas." ,
as it can also be found on the site of
the International Centre of the Netherlands Institute for Care and Welfare.
Incidentally I have highlighted
portions of this text in red.
In this column (The blue column), you will find my remarks.
is a publication of the Netherlands Institute for Care and Welfare, and
all rights are reserved by the Institute. The document may, however, be
freely reviewed, abstracted, reproduced and translated, in part or in whole,
but not for sale nor for use in conjunction with commercial purposes.
This publication was made possible by subsidies from
|My critique is based on
my work in Croatia/Bosnia, Ethiopia, and Cambodia in the period 1992-1999.
In this period I worked partly as a volunteer, partly as an employee of
one of the organisations (TPO) that endorse the guidelines that I review
here, and partly as an independent project initiator for WHO and for the
Dutch Ministry of Foreign Affairs.
During this period I have met many of the 'players' in the field of Mental Health Care, as well as in general Humanitarian Aid.
My field is the Transfer of Ideology between Generations, and, more specific for this document, the transfer of Collective Trauma as a stage in the Cycle of Armed Conflict and the development of Intervention-projects to break this cycle. It is from this point of view that I give my reaction to <=this document of the NIZW
Netherlands Institute for Care and Welfare
3501 DD Utrecht
tel (0031) 30 2306552
fax (0031) 30 2306540
email to: IntCentre@nizw.nl
draft guidelines are endorsed by
Transcultural Psychosocial Organization, the Netherlands
This publication was produced
under the auspices of the International Centre of the Netherlands Institute
for Care and Welfare.
The contribution of the following persons to the development of these guidelines is gratefully acknowledged:
Mrs. Loes van Willigen, MD, PhD
Mrs. Geertrui Kortmann, PhD
Prof. Mrs. Annemiek Richters, PhD
Mr. Frans van den Boom, PhD
These draft guidelines are
circulated worldwide. It is expected that, through a process of organised
consultation throughout 2001, an improved version will be published in
Modern day conflicts and
wars are numerous and often extremely cruel. As such they are a serious
threat to the health and well being of millions of people. According to
the United Nations, there are currently more than forty million refugees,
internally displaced persons and other victims of
violence . Modern warfare, armed conflicts, repression, but also
natural or industrial disasters are not just a threat in the physical sense,
but may also lead to despair and moral disintegration.
The problems faced by large
groups of people are characterised by loss: loss of kin and home, of the
opportunity to generate an income, of social cohesion, of human dignity,
of trust and safety, of a positive self image and of a perspective of the
future. People often have to live under conditions of near total dependence.
The pre-existing social fabric is often torn. Therefore, the interhuman
relationships, which could otherwise serve to provide mutual support, are
disrupted. The losses further impede the possibilities for restoring mental
equilibrium following traumatic experiences. Moreover, in many cases there
is an on-going threat to life and limb.
|In General it is unclear
on what base <=this document gathers the consequences of natural disasters
and those of Armed Conflict in one single frame of analysis. Especially
seen from the viewpoint of mental health I feel that a clear difference
should be made, certainly in the analysis, but most probably also in the
practical approach. My remarks here focus on the field of communities after
The fact that survivors of both kinds of disasters are seen as one is probably a direct consequence of the western 'help-approach' that is basically geared to 'victims' in stead of to 'being an agent in recovery'. As an illustration I have highlighted the use of the word 'victims' in the text at the left. In our Western Ideology, our help-reflex is mainly geared towards 'victims'. Victims are, in this ideology, inherently 'innocent', and they 'suffer'. As you can clearly read from the introduction 'innocent suffering' is what seems to unite victims of 'natural and man-made disaster', and 'innocent suffering' is what entitles them to our support.
Yet, I would like to propose here that in 'man-made disaster' the concept of 'innocence' is useless and even dangerous. As we can clearly see in most conflicts that exist world-wide, they are not incidents, but they are episodes in a cycle that sees periods of violence and periods of relative 'peace'. Parties in these conflicts have the tendency to switch roles of 'victim' and 'perpetrator' in the eye of the western comments.
In this aspect, Armed Conflict and Natural Disaster differ. In most natural disaster we may be able to speak about 'innocent victims', although here too, we may sometimes doubt the natural origins of 'natural disasters'. 1)
The concept of 'innocence'
is dangerous, because it deprives people of their responsibility, of their
active role in the onset of conflicts, and hence it usually denies an essential
aspect of the identity of the 'victims'. Our Western help-system, by projecting
'innocence' in the subjects of their efforts, imposes the role of innocent
victims on these subjects who have to comply in order to qualify for help.
In doing so, the effect is that the subjects effectively re-arrange their
identity as to be innocent. In this process usually a process of falsifying
history (and in this, falsifying personal as well as collective memories)
is started, and the result is exacerbating the loss of identity that is
so damaging to the very same people that we try to 'help'.
of the current interest in these forms of aid is that there appears to
be an explosive growth in projects without the necessary co-ordination
or quality assurance.
The required knowledge and skills to provide this care under usually complex conditions are as yet not sufficiently developed or founded. It is therefore very important that internationally approved criteria will be developed to improve the quality of these forms of aid and to promote their effectiveness. It is of fundamental importance that guidelines and good practices for psychosocial and mental health care to those who are affected by war and natural disasters, are developed and that they are sufficiently sensitive to cultural differences.
These guidelines have been formulated by and for organisations involved in providing these kinds of care for refugees, displaced persons, and victims of violence or natural disasters. They are also of importance to donors. The guidelines can be applied as test criteria for donors and institutions, or for anyone responsible for assessing psychosocial and mental health care projects.
The (draft) guidelines described
below are not just aimed at promoting quality psychosocial interventions
and mental health care, but also at stimulating new initiatives in this
Petra G. H. Aarts
|Here we come to a crucial
The question is: Why these guide-lines?
At least two general approaches
for guidelines can be imagined: the first being that groups of organisers
agree on guidelines for themselves. The set a series of criteria
to judge their own work, and they try to abide by them.
The text here mentions "An explosive growth in projects without the necessary co-ordination or quality assurance". Since the organisations that endorse <=this draft document probably do not refer to themselves in this sentence, it is clear that these guidelines have the second objective.
<=This text mimics an
outsiders-approach to the field.
A) Instances of competing
main players are for instance the IRCT,
Guidelines that do not consider
this damaging competition, and try to bridge the controversies that exist
on this level of the field, can only be seen as instruments in this
controversy, as they in their turn ignore comparable documents like the
'Tokyo Guidelines for Trauma and Reconstruction' (
Draft Conclusions and Recommendations ) developed in 1999, or, an even
more significant omission, a publication like The
Impact of War and Atrocity on Civilian Populations: Basic Principles for
NGO Interventions and a Critique of Psychosocial Trauma Projects ,
by Derek Summerfield (MFCVT, 1996)
B) There is, especially in
the chaotic situations during and after armed conflict, a structural
tension between 'incidental initiatives' and institutional organisations
in the help-industry. Incidental projects tend to be set-up by (small groups
of) all-round individuals, Jack-of all trades, that are on 'the right spot
at the right moment'. These projects have a tendency to make the most out
of minimal resources, and usually describe the established organisations
as wasting money on huge overhead, corruption, and incapacity.
C) Finally this document is not talking about the relationship between general organisations in humanitarian aid and the organisations 'specialised' in Mental Health and Psychosocial Care. This also is a serious omission, because mental health in (post) war situations is greatly influenced by the way that humanitarian aid is allocated. It is often said that the Help-industry is a second disaster overpowering people after the first disaster. All help during and after armed conflict has political implications, and political consequences immediately translate into psychosocial conditions in the life of refugees. All help has ideological components that are more or less at odds with other helping organisations and with the ideology of those that are being helped.
Psychosocial Assistance and Mental Health Care
Current psychosocial aid and mental health care concentrate largely on strengthening or restoring a new social balance and on individual rehabilitation. Both forms of care are not only important to the well-being and health of individuals or groups of individuals, but also in terms of providing opportunities for social, economic and political stabilisation.
The concepts of psychosocial care and mental health care usually overlap within international humanitarian aid services. In practice, both psychosocial support and mental health care strive to prevent psychological problems and to provide counseling to people who live in situations that threaten their mental balance. Mental health care, however, also provides treatment of possible pathological reactions. A broad-brush distinction has been made for the purposes of these guidelines, whereby the premise is that the specialised care of (posttraumatic) mental disorders is part of mental health care and falls outside the scope of psychosocial care.
In (post) disaster and conflict
areas a smaller part of the population will respond with pathological reactions,
including depression, psychotic reactions, post-traumatic stress disorder
and other anxiety disorders, depending on the duration and intensity of
the events. In most cases the regular local care systems are not equipped
to provide adequate care for these people. For this reason it is necessary
to support and (re)build the local mental health care system so that it
can provide specialist care.
Psychosocial care deals with
a broad range of psychosocial problems and so promotes the restoration
of social cohesion and infrastructure, as well as the independence and
dignity of individuals and groups. It serves to prevent pathological developments
and further social dislocation. Such an approach requires amongst others
psychological, historical, medical and anthropological insights. Psychosocial
care for the victims of war and natural disasters demands, by definition,
a multidisciplinary approach.
In (post) disaster and conflict
areas mental health care and psychosocial aid should be provided side by
side, though not necessarily by the same organisation. Co-ordination and
co-operation between both specific forms of humanitarian aid is crucial,
as is the development of insight into the cultural context within which
the aid will be given.
|In <=this paragraph the
endorsing organisations carve out a territory for themselves, a 'niche'
in the market of the 'help-industry', without giving any foundation. In
fact, they postulate their own functionality, where they should, at first,
respond to the considerable critique that has also recently been growing.
One of the early critics on the construct of posttraumatic 'disease' is Thomas Szasz, for instance in 'Insanity: The Idea and its Consequences' (1987), and recently in 'Is Mental Illness a Disease?' (2001). Many other critical publications on PTSD were published, see: The invention of PTSD by Dr. Ellie Lee (and are cynically illustrated for instance by the PTSD-Claim Handbook , by American Forces Vietnam Network "AFVN")
More specific, in the case of posttraumatic effects after armed conflict, the 'Guidelines for treatment of PTSD' by E.B.Foa et. al. (Journal of Traumatic Stress, 2000, vol. 4) states that there is so little conclusive research or evidence to show the effect of interventions in this field after armed conflict and especially in non-industrialized countries, that they did not include any guidelines in this field.
Very critical are also Bracken & Petty, in Rethinking the Trauma of War (1998). Although this title is mentioned in the (very short) paragraph 'literature' at the end of <=this document, there is no sign that the content of this book has influenced <=this document at all- at the contrary.
The most appropriate document that should have been addressed here, however, is 'A Critique of seven assumptions behind psychological trauma programmes in War-affected areas ', by Dr. D. Summerfield (1999).
(abstract and 7 assumptions here .)
<=This document is defining here two types of programmes (As also announced in the title):
A) Psychosocial Care, and
It then describes a wide range of expertise, needed for Psychosocial Care, but it does not do so for Mental health Care.Strange enough, the 'working through' of traumatic experiences seems to be included in psychosocial, rather than in Mental health care.
The WHO declaration states
on this topic:
These guidelines for psychosocial and mental health care pertain to practical aspects of national and international support for survivors of violence or disasters. They support the design, implementation and evaluation of psychosocial projects and of scientific research. They are the result of a basic consensus about standards for good practices and ethical values, regardless of the country or region receiving the aid.
By definition, guidelines are broad and general in nature, whereas the target group(s) and the circumstances under which the care must be provided are always unique as well as complex. Therefore, the guidelines do not provide an unambiguous answer to every specific situation. Nor do they define what type of intervention is needed to achieve a particular goal against a specific cultural background. The underlying assumption is that every organisation active in this field has the necessary knowledge and insights to develop high quality and responsible interventions.
The guidelines provide the standards and frameworks that can be used to develop psychosocial and mental health care projects and programmes. They are a set of standards pertaining to the practical aspects of providing multilateral or bilateral aid to refugees, internally displaced persons, and other victims of violence or natural disasters. They are not a starting point or framework for the more general social, political or strategic policy for governments or (inter) national non-governmental organisations (NGOs) with respect to the overall position of the target group(s).
Naturally psychosocial and mental health care in (post) disaster and conflict areas are subject to the same implementation criteria as all other forms of humanitarian aid. These criteria are:
|This chapter concludes in a set of criteria that seem rather obvious,
however they are much less so after some consideration. Let us start by
considering some questions that may be asked for each of these criteria:
They are also not the needs that are usually defined by the international emergency organisations that provide water, food, shelter and emergency health care in such a way that mental health is seriously affected.
The organizers of <== this document clearly refer to 'needs' as perceived by themselves, 'for the good of the target groups'. This is not in itself wrong, but it is clear that such a definition must be elaborated upon, certainly in the light of the critiques as mentioned above.
The fact is that 'local capacity'
is usually only 'used', which means that the 'aid' experts are in control,
and do not leave this position. Strengthening local capacity usually means
'training in the ideologically colored instruments that are deemed functional
by the aid-giver'.
So we see how these seemingly
logic criteria are in fact hollow sentences, created by western cliché's,
in a quasi-intellectual atmosphere devoid of real practice. This is strange,
since I know for a fact that some of the organisations that endorse these
guidelines are indeed well aware of the practical problems with this kind
Preparation, Co-ordination and Co-operation
1 The preparation phase should make as much use as possible of (assessment) data that have already been, or will be collected by other aid organisations.
2 Co-ordination and consultation with other aid organisations and local governments is vital for achieving the maximum in terms of the quality and scope of psychosocial and mental health care.
3 The definition of the target group(s), the goal(s) and the intervention methods must be done in consultation with other (aid) organisations and representatives of the target group.
4 Aid organisations should work under the umbrella of the local co-ordinating activities of other organisations or governments, unless it is clear that it is in the interest of the target group to deviate from this principle.
5 A project
that is primarily concerned with psychopathology and the improvement of
mental health care should, as far as possible, co-operate and co-ordinate
with the regular mental health care system and the authorities involved.
|The 'guidelines' in this
chapter begin to ignore the fact that intervention in a community after
armed conflict (and after natural disaster as well?) is inherently chaotic
in nature. Not only are the feelings of the population in turmoil, but
also many different international agents, with different ideologies jump
in and compete with each other. The non-sensical character of the 'thorough
preparation' - approach in this chapter is well illustrated by the first
The preparation phase should make as much use as possible of (assessment) data that (...) will be collected by other aid organisations.In situations after armed conflict all data are fluid and unreliable. Data that existed before the conflict, even if the conflict was relatively 'short' in time, are distorted by all kinds of processes, and the current reality is usually like quicksand. In any case, intervention in these situations is an action in a highly volatile situation. The fact that there is no mention of this, and that the 'guidelines' seem to ignore this completely makes this chapter again hollow.
7 Organisations must ensure that their interventions do not contribute to or worsen any friction and rivalry within the target group communities or with their immediate environment.
8 Where refugees are housed within a host community, the host community must be provided with adequate information. Key persons from the host community must be involved in the reasons and planning of the aid interventions.
9 If there is more than one organisation concentrating on a particular target group, these organisations must do so in co-operation and consultation with each other.
10 Groups or individuals must not become stigmatised or unnecessarily medicalised, nor should their trust be broken.
|As we saw before end as
we see again in the next chapter, <= these guidelines tend to prepare
the way for 'aid-projects to take over the whole mental health system in
a community after an emergency. Of course, mental health care should be
available to 'the entire community', this seems obvious, but it is highly
questionable if this is the task of any outsiders assistance after some
form of emergency, let alone that this is 'preferable' as is stated <=here
Mental health care is highly culturally sensitive, and should therefore be defined by and within the community itself. There are (there may be) instances in which after some form of disaster, outside help is required, but certainly it should not be the task of outside experts to rethink and set up the entire mental health care system.
To define 'target' groups in terms of 'vulnerability' is, again, spurious. There are many other reasons for the definition of target groups as should have been discussed in the chapter about 'exit strategy' .
Since it is obviously not the place of an outsiders initiative to target the whole community, the target group(s) should also be defined in terms of strength: those that can most easily and quickly take over the initiative and translate it 'into' the community.
6: Target groups are usually
predefined, as the writers of <= this document should well know. Organisations
as UNICEF target children by their mandate, etc.
Phasing and Exit Strategies
12 Wherever possible, and relevant, efforts must work towards achieving independence of local partners, in terms of expertise, financing and integration within the local care system. This requires the dissemination of expertise with respect to the quality of care, management, mutual consultation, co-operation, co-ordination, public relations and fund raising.
13 The striving for independence of a local aid infrastructure should be expressed in specific and appropriately phased milestones and goals. These should be regularly evaluated, and if necessary adjusted, after each completed phase of the project.
14 Every form of humanitarian aid struggles with the balance between striving for continuity of care and the available resources. Both the implementing organisations and the donor organisations should be aware of this issue during the planning and budgeting phase of the projects.
15 The local partners should be kept informed as to the possibilities and limitations of the international efforts, and should be actively involved during the planning and phasing of the project.
The international organisations are responsible for ensuring that the projects
are not terminated ahead of schedule. If it can be reasonably foreseen
that the available finances or personnel will not be sufficient to complete
the project, the goals should be adapted to reflect the available resources.
|As said above, it seems
like this document is carving out a long-term presence for Mental-Health
projects in disaster-stricken area's. As I have observed, it is not unusual
that organisations in this field use the presence of an armed conflict
as a pretext for involving themselves in the community care. Once established
it soon becomes clear that it is rather difficult, if not downright impossible
to locate the 'traumatized' patients, since in each community the results
of armed conflict show themselves in very different ways. Also, the population
is not defining the consequences in terms of pathology, or even in terms
The next step then is that these projects start to target the complete field of mental illnesses, and start to compete with the indigenous ways to handle symptoms that seem in western eyes comparable with schizophrenia, psychosis...( and the complete DSM IV), as well as epilepsy and mental retardation. It should be clear that these activities do not belong to emergency programmes, and should not be run by expatriates.
Therefore, every program
should be defined in terms of an exit strategy, or better even: the
exit strategy should be the program. Longer lasting and/or structural
aid should be received and handled by local organisations. Points 11 to
16 <=here concern, implicitly or more explicitly the problem of funding.
Implementing organisations tend to bring their own funding, and tend to
withdraw when their funding ends. This is, of course, at odds with their
objective to establish permanent care. What is expressed here is a kind
of dismissal of the responsibility for the fact that they introduce an
activity that will not be sustained after their departure.
Interventions and Methods
18 Representative delegates of the target group(s) should be involved during the formulation of the goals and intervention strategies.
19 Psychosocial care must not specifically focus on ‘curing’ posttraumatic psychopathology, but on the prevention thereof by means of promoting socially and culturally suitable bonds and activities.
20 The methods, such as creative expression; grieving rituals; re-establishing daily routine; promoting self-help groups, income generating activities, (vocational) education and family reunion or stabilisation must strive to restore (social) self sufficiency and integration of the target group within the community at large.
21 In principle, psychosocial and mental health care are offered to all individuals and groups of individuals within the target group. The care should be readily accessible and should work in a socially reinforcing manner; it should not be medicalisation and stigmatisation.
22 Both the international and the local care providers involved in psychosocial projects should be able or be trained to identify those persons in need of more intensive or professional care. The co-operation with NGOs or local care institutions, which can provide the required special care, is essential.
23 (Professional) groups such as teachers and religious leaders should not be trained as diagnosticians and psychotherapists. Instead they should be trained in counseling techniques and social skills, and be furnished with the knowledge to identify people with serious mental or behavioural problems so as to refer them for special care.
24 Care should be taken to ensure optimal verbal and written communication with the target group. The quality of the translators and interpreters is key to this.
25 The dissemination and mobilisation of knowledge and skills within the target group communities, together with psycho-education, serve to promote self-sufficiency, autonomy and continuity. These are to be preferred to direct care by international aid providers. The use of foreign personnel in aid projects should be limited as much as possible.
26 Unless there are urgent reasons for deviating from this principle, psychosocial and mental health care should not be provided within the same project as material resources such as food, clothing, housing, income and the like. Care providers are strongly urged to play an active role in co-operating, co-ordinating and exchanging information with the organisations that provide these material resources.
27 Psycho-education and information are crucial activities in any psychosocial or mental health care project. They serve to prevent unnecessary fears and uncertainties, and the stigmatisation of refugees, internally displaced persons and other survivors of violence. They also promote general awareness of the possible negative consequences of violent experiences and social disruption.
28 Programmes that focus (in part) on conflict management, peace building, and on reconciliation are important in order to prevent further social and societal disintegration. This requires the development of insight into social-psychological, cultural, political and historical processes.
29 The promotion of conflict management, peace building and reconciliation must not lead to a situation in which anger, hatred or fantasies of revenge are summarily dismissed or ignored. These reactions are understandable within the context of experiences of violence and repression, and should be treated accordingly. By having an opportunity to express and discuss these emotions, victims gain insight into and control over these feelings and fantasies. Without this, any true reconciliation or peace building is not possible.
30 Psychosocial and mental health care for children and adolescents must concentrate on the reduction of stress factors and the re-establishment of a normal daily routine.
|In this chapter <= these
guidelines cross the line with some kind of manual. The guidelines have
a wide diversity from very general to very practical and seem rather randomly
gathered. Maybe this is a result from the 'draft' character of <= this
Some comments : guideline
nr. 26, printed in red. In this article, the fact that all aid-projects
that provide 'material resources such as food,
clothing housing, income and the like' carry a strong mental
health-component is completely overlooked. In the way that these resources
are made available aspects such as 'aid-dependency', self-esteem, 'resiliency',
have to be considered and are deeply influenced whether one wants or not.
To say that intervention in the field of psychosocial and mental health
care should not be provided at the same time is as saying that programmes
on housing should be separated from social reconstruction. The fact that
conventional programmes indeed are often implemented without any consideration
for Mental Health aspects is the source of great problems.
17. A guideline like this is completely tautological. It says that projects have to be effective in order to be effective.
18. This guideline however is the opposite: Projects that are implemented after armed conflict are the result of western thinking about armed conflict and its implications. Guidelines like these are in fact already steps in de development of goals and strategies, as the title indicates. What should happen is the acknowledgment that most, if not all aspects of these projects are initially developed by initiators that have access to funding. Projects are also an expression of the ideological character of this funding. The next step should be that in an explicit exit-strategy, the project develops clear ideas how the initiators concede their positions as fast as possible to partners from within the target population, and how these partners can be prepared to handle the ideological character of the funding.
Guideline 22 seems ad odds
with nr. 21 and 23. Training local care providers to 'identify those persons
in need of more intensive or professional care' is in fact turning a whole
society into a diagnostic field. By turning the eye to the possible problem,
one turns the eye into 'a pathologizing mode'. It happens often in our
western society: after some kind of new pathology has been publicized in
the popular press, suddenly half a population is diagnosed with the particular
problem. Especially in situations where a complete population is feeling
the effects of a disaster the question should be if individual pathology
is/ can be/ relevant , and if so, who should be qualified to search
for it. To think in terms of pathology like 'traumatized' about children
for instance will lead most teachers on completely false ways while working
in situations like after armed conflict. In these situations teachers are
encouraged to define 'learning problems' in terms of problems with the
children, in stead of as problems with the didactic climate, for instance.
Ethnic, Cultural and Religious Neutrality
33 It is foreseeable that, in some situations, the principle of neutrality will lead to ethical dilemmas or problems. These, then, need to be submitted to an ad hoc forum of experts.
34 Those planning and implementing aid projects should be aware of the dependence and vulnerability of the target groups. The provision of aid may not be linked to the promotion of those particular political, cultural, sexual or religious convictions tied down to the aid organisation.
35 Aid organisations must protect the target group from abuse by journalists. All media interviews with the target group must be conducted on the basis of informed consent.
Although it is preferable to work together with local governments or authorities,
it is not always possible or ethically responsible to do so. Where that
is the case, aid organisations must take care not to provide governments
or those in power with any information that could potentially be used against
the target group, such as the location of refugees, the specific vulnerabilities,
ethnic background or their political and religious persuasions.
|There is no such thing
We are used to see the philosophical, religious or political convictions of those that differ from us as 'ideology'. We rarely, however understand that likewise we too have our ideology, and that this too is not a 'neutral' agent. In fact, no human group can operate without ideology, because it is the ideology, that is permeated in all aspects of our knowing and acting, in our language and in our beliefs, that permits us to act and reflect upon our actions.
Especially in the case of intervention in another belief-structure, and this in a period of distress too, there is no situation thinkable in which we can be considered 'neutral'. We, as the acting agents that are 'helpers' and at the same time carriers of funding, always have to be questioned ethically; before, during, and after the intervention.
There can be no intervention project, therefore, that does not permanently assesses its own ideological points of departure, and brings this assessment also to the core of the relationship with the clients in the form of a permanent discussion in a form that is acceptable to the clients.
A good example is the problem of western helpers regarding 'innocence' or 'guilt', or as it is stated here, 'victims' or 'perpetrators'. As seen above, in our ideology, victims must by definition be innocent, and we see ourselves (and present ourselves) as the helpers of 'innocent victims'. In situations of armed conflict in communities, these distinctions are highly questionable, and definitions of guilt and innocence are closely connected to the terminology of specific groups in a conflict, or may even be even absent. In many cases, the west is introducing the concept of innocence and therewith creates a new element in the self-image of the people involved. Therefore the west should discuss how to eliminate these concepts where necessary.
Transcultural aid should have as a rule of thumb that all aid is given within the ideological framework of the receptant, and make explicit those field where the ideological framework of the receptant is not accepted by the donor in a separate document on forehand. This document should always be available to all people that ask for information on a project, and be translated in the language of the receptants with help of local philosophers (= which means: not translated by the 'technical translators' that are usually made available to the NGO-community). This document should also be updated constantly.
A special mention should
be for point 35.
38 The evaluation methods should bear direct relevance to the specific and operationalised goals. Where pertinent, the negative effects of a project or programme should also be investigated.
39 The evaluation methods and instruments must be able to realistically assess the processes and outcomes of the interventions.
40 In terms of design, implementation and reporting, the evaluation study should follow the same guidelines as those for scientific research (see below).
41 Preferably, the evaluation of the results of interventions should be carried out by independent experts.
42 The evaluation must be cost effective and proportional, in terms of scope and methods, to the project or programme to be evaluated.
43 The evaluation report or any summary thereof should be thorough and reliable, and be made available to donors, to partners and to relevant third parties.
If the evaluation method requires research amongst the target group, the
group should be made aware of this well in advance and if necessary, after-care
should be provided.
|Evaluation is a step in
a cycle. Every intervention project should be permanently
evaluating the development of the project . To evaluate means, in many
cases, an explicit observations of the difference in frames that helpers
and clients have. Clients may very well differ in their evaluation of results,
especially if the helper has objectives that are wider than that of individual
clients, or special groups of clients. Evaluation is therefore a rather
complicated process in itself, a fact that is made more difficult because
the field of professional mental health workers in these situations has
offered no accepted criteria for 'results'.
In <= these guidelines evaluation is mainly seen as an overall process, to be set up before a project, and to be implemented after the project. To set up a system of evaluation, actively involving local partners (<=37), is however usually impossible in projects after armed conflict. One is very happy to slowly involve local partners in the process of the project, but to expect that partners could really be involved in such a process before the projects starts, is to say in fact that they would be perfectly able to manage the project themselves. In this case, outside organisers should not be necessary.
Even such an overall 'evaluation'
can not be set up like scientific research, for the simple fact that the
objective of intervention is subjective. This means that the project interferes
with reality on the base of permanent observation and evaluation, and as
a result, develops shifts in objectives, concepts and the interpretation
of facts. These shifts are not compatible with scientific - distanced-
observation, reason why exactly these shifts are forbidden in the scientific
Note: Scientific research
refers to research that falls outside the scope of the preparation and
evaluation of projects.
46 Research must be carried out and supervised by sufficiently qualified and experienced researchers. The study must be designed, implemented and reported in accordance with appropriate current standards for responsible and qualified research.
47 The design and protocol of the study must be submitted to an expert (medical) ethical committee for evaluation, preferably also one from the country in which the research will be carried out.
48 Participation in the research projects should be on the basis of informed consent. Potential respondents must be provided with adequate and complete information on which to base their decision. Where possible this information should be provided in written form and in a ‘language’ that is readily understood.
49 For research involving children below the age of 12 years, the information and the decision as to whether or not to participate goes to the child’s parents or caregivers.
50 The offer to provide care must not be contingent upon the decision by the target group as to whether or not to participate in the research.
51 If the research is likely to place an emotional or practical burden on the respondents, they should be provided with adequate counselling and after-care. It may be necessary to exclude the participation of particularly vulnerable individuals.
52 The research results must be made public through the appropriate scientific or policy forums. They must be made available to the donors of the research and - if so agreed - to the participants.
Any research data that are subject to potential misuse must not be made
available to those institutions that are capable of using the information
against the participants or their communities. A request for research by
such an institution must be denied on ethical grounds.
|Scientific Research and
Intervention projects can not be combined. .
The main reason for this
is that both actions have paradigmata that are too far apart, and, partially,
contradict each other.
Of course there should be
an obligation for everybody setting up intervention projects, to analyse
and integrate all results of scientific research and evaluation. Here again,
the scientific community is making this impossible. There is no place where
the full body of scientific results is available in a form that a) has
the approval of the scientific community, and b) is readable for intervention
professionals. Instead, literature is scattered in all kind of places,
and authors ignore too often the results of competing scientific models.
There is no authority that forces scientists to integrate each other's
results, or to collectively abandon results that did not prove correct.
On the other hand, intervention
projects should be open and co-operative for scientific research, as long
as this research does not corrupt the intervention. Scientific projects
should have their own funding, and use their own infra-structure.