A summary of the workshop

Adapting modalities to work in fragile contexts – an institutional perspective

Von Elisabeth Wingerter / Medicus Mundi Schweiz

Fragile states – whether they are fully succumbed in armed conflict or show first signs of economic crisis – drastically change the working conditions of any organization committed to public health. The workshop led by Helen Prytherch and Joëlle Schwarz from the Swiss Tropical and Public Health Institute addressed this challenge by focusing on three key questions arising when dealing with institutional fragility.

Adapting modalities to work in fragile contexts – an institutional perspective

Children Play at Sosmaqala IDP Camp in Afghanistan. Photo: United Nations Photo/flickr, CC BY-NC-ND 2.0


What are the principles for engagement in fragile contexts (go/no-go decision)?

The first question dealt with the often difficult decision many aid worker face: Do we stay engaged within unstable and even dangerous contexts? What are the principles of engagement in those situations? This ‘to go or not to go’ situation was a familiar subject for many among the discussion group.  Verena Wieland, for instance, pointed out that the Swiss Red Cross aims at strengthening its risk and security management in order to prepare an adequate response to the region-specific fragility. In doing so it is essential to take every component and everybody into account: from the desk in Geneva or Bern to the partners and volunteers on the ground.

Most participants seemed to agree that it is essential to analyze the capacity and expertise of their own organizations and local partners to respond to crises. As Carlos Diaz from Save the Children said, it is  necessary to understand that if failure occurs on the ground, it is the program that has to be adapted, not the community. As a general principle, exit strategies and inactive/withdrawal phases of organizations must be formulated as early as possible: Will it be more helpful if an organization stays on a long-term basis or would it be better to withdraw it when state reconstruction occurs?

The example of harmful interventions in Haiti came up early on in the discussion and helped setting more principles of working in fragile contexts: Rolf Maibach from Swiss Partnership HAS Haiti recalled the chaos and concluded that local community knowledge should never be underestimated. This argument was taken further by Zelaikha Anwari, Reproductive Health Director at the Ministry of Public Health in Afghanistan  who suggested a method of enabling communities to make the best decision on their own: The organization should provide ‘proper and need-based information’ to the community it is working with. It should merely assist with advice and solution-options, but let the decision-making happen within the group of affected locals. Such a sensitive decision-making process however, is not possible in cases of governments that are hostile against particular population groups. What if the government is not complicit and increases the risk of staying in the country? Thus, the dynamics of friend and foe within the country of interest are to be taken into account as much as possible.

The moderators concluded the first part of the discussion by summarizing the fruitful discussion and presented Swiss TPH’s stance to those issues.
The institute’s basic working principles represent one way of regulating the work in fragile contexts, namely:

1. The basic working conditions are upheld
2. It is possible to work independently
3. No one is put at risk.

One of the working groups at the MMS Symposium 2016 (Photo: Christoph Engeli / MMS)


How to leverage the necessary capacity to respond effectively if the security situation deteriorates?

The second question led the workshop towards understanding in how far organizations can be adaptable, since it referred to leveraging the necessary capacity to respond effectively if the security situation deteriorates. The previously mentioned security management offers limited help, especially in unpredictable situations and in countries with ‘functioning democracies’ opposing humanitarian organizations from abroad. Research seemed one of the ways to predict those problems. However, many agreed that assessment of the context is made only in the beginning, while it would be more adequate to continuously analyze the situation on the ground with partnering research agencies/companies that are no outsiders to the region (Odile Pham-Tan, Swiss TPH).

Information gathering on a daily basis and from different sources is good, said Carlos Diaz from Save the Children, but is sometimes still not enough to prepare for crises that happen swiftly and drastically. In addition to adapted research, there is also the financial component to be properly understood. What if a government spends all funds on security while organizations take on a lot of financial responsibilities in the health sector? Different political consequences might arise and even do harm to a society. Similar to a drug, aid can have direct and indirect effects that are often unexpected and manifold, ranging from sexual violence in refugee camps to benefits for local communities by the presence of refugees and thus increased access to aid.

Thus, the discussion about the second question created four fields of adaptability potential:

  1. Usage of funds
  2. Research intensity, continuity and partners
  3. Practical capacity and knowledge of the organization and its local partners
  4. Proper choice of partnerships with institutions, governments, locals etc.


How to adapt ways of working to accommodate fast-changing realities (project-cycle-management)?

After discussing the adaptation of methods in emergencies, the third question dealt with the ways in which methods can accommodate fast-changing realities. How to adapt ways of working to make justice to those developments with project-cycle-management? Again, the problem of intrusion came up as a harmful choice to make. Even fragile communities or states don’t need an organization to substitute them. Instead they need assistance for the most fragile of the fragile to empower them gradually. Doris Mugrditchian from Terres des Hommes pointed out that a gender sensitive approach would make a lot of sense. Her point was that focusing on the women, the ones who are more likely to stay in their original community, is a sustainable good practice – and should not necessarily be seen as Human Rights activism. While governments seem to come and go, women seem to be the most stable collaborators in most unsteady context. Thus came to be their paradoxical position of being the most fragile and the most stable social actors at once. According to Mugrditchian, this strategy could help to respond to societies with no other ‘cushion’ than those women in the households. Verena Wieland (SRC) agreed and added that this is just one of the layers of the necessary work of community support. Again, participant comments’ centered on the fact that solutions are to be found within the communities. Conservative communities for instance, must be communicated with in a way to make them understand that outside help and people from abroad are only a temporary solution. They must grasp that in their midst, there is always potential, e.g. women that have limited access to education could be doctors or medical staff so desperately needed. It became clear that, even in fast-changing environments, it is important to choose community collaborations least intrusive and most helpful according to constant, multi-sourced analysis.


the workshop proved fruitful in naming the particular challenges of fragile environments, suggested potential ways of adapting and confirming the center of attention: ‘The most fragile of the fragile’. Building up stability from within the seemingly most vulnerable stood out during the discussion.

Elisabeth Wingerter

Elisabeth Wingerter, Project Assistant, Swiss Malaria Group.


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