A question of vulnerability

By Liesl Graz

“Improving the situation of the most vulnerable” as a challenge to the movement was enthusiastically adopted by National Societies from Canada to Zambia at the beginning of the decade. With time, it has become apparent that taking the steps that lead from initial enthusiasm to concrete action is not so simple. Liesl Graz looks at why.

It is time for another sharp look at the concept of vulnerability after ten years of reflection and implementation. For the International Federation of Red Cross and Red Crescent Societies, vulnerability is a key feature of the Strategic Work Plan for the Nineties. For the International Committee of the Red Cross, defining vulnerability has been less central to the reflective process — perhaps because in the light of the ICRC’s mandate to assist victims of war the concept seems self-evident.

What is vulnerability?

The first great difficulty in trying to grasp the concept is to distinguish between vulnerability and risk. Is there, in fact, a real difference between being vulnerable and being at risk, or is it all a question of semantics? Is “vulnerability” the state of being vulnerable, or is it something else, something more? True, “at risk” smacks of the technical vocabulary of the insurance business, but is that reason enough to abandon it?

A more serious difficulty with “risk” is that it cannot be dissociated from the idea of probability, itself applicable in two entirely different meanings. The first is the actuarial probability that a harmful event, whether flood, earthquake, tsunami, chemical contamination, drought — or war, will occur. The second is the probability that a given individual (or group of individuals) will be affected by the harmful event. One way of looking at it would be to say that vulnerability is what turns a potentially dangerous phenomenon into a catastrophe.

It seems impossible to isolate a single distinctive marker of which it could be said: with it vulnerability exists, without it we are talking about something else. There is little similarity between the vulnerability encountered in economically depressed villages of post-industrial Welsh valleys and that of children in refugee camps of central Africa, between the vulnerability of young drug addicts on the streets of Copenhagen, the mothers of ten children in Egypt, and peanut farmers in Senegal; all of them have been the subject of recent studies in vulnerability.

What is common about these cases are certain factors that affect vulnerabilities. The British Red Cross identified these factors as: place, i.e. living in a particular area; participation, i.e. exclusion from social participation; and personal resources, lack of material means and social support. The Federation uses proximity and exposure, poverty and exclusion/marginalization as global indicators to measure vulnerability.

Vulnerability and, by extension, “the vulnerable” cannot really be used as a non-specific term. There is always the necessary complement: vulnerable to what? Going one step further in that direction, vulnerability cannot be divorced from time and space. The British Red Cross, in trying to set out a definition, has said that those who are vulnerable are “people in need and crisis,” which is not bad, except that one man’s (or woman’s or child’s) need is another’s plenty. Who sets the limits?

When the National Societies adopted “improving the situation of the most vulnerable” as a framework, they began by incorporating vulnerability into mission and vision statements; putting in systems to identify the most vulnerable at the regional and local level; reviewing traditional programmes such as first aid, health and disaster preparedness; and re-focusing assistance to the most vulnerable. According to Alvaro Bermejo of the Federation, “a Federation strategy which has the ‘modest’ effect of re-directing towards the most vulnerable 5 per cent of current Red Cross, Red Crescent expenditure in programmes and services would mean that an additional 1,200 million Swiss francs would be reaching the world’s most vulnerable people annually.”

A major difficulty with trying to consider vulnerability as a universal theme is that it inevitably means different things to different people, at different times — not to speak of different organizations. The concept can be an important instrument for many local or national organizations (Red Cross and others) who do not necessarily, or not only, deal with emergencies; they may find it useful in evaluating, or perhaps redefining, their goals, their programmes, what they do. For people or organizations who deal primarily with emergencies, the concept of vulnerability, in one or another of its definitions, could also become a criterion for setting priorities. If you cannot help everyone equally — and that is usually rarely the case — whom do you help? Whom do you help first? Is vulnerability anything more than a simple criterion of triage? Which of course takes us straight to the third major question: who is vulnerable?

All that one can learn

Agustina Badia is 82 years old. For the past eight years, she has been living in an apartment building owned by the Barcelona Red Cross. The building provides housing to the aged of Barcelona. Agustina moved in because she was living alone and could no longer climb the stairs to reach her third floor apartment.

Many of the volunteers in the Barcelona Red Cross know a great deal about being vulnerable. They were once or still are receiving assistance from the Red Cross. The Spanish Red Cross has organized a campaign to include beneficiaries as volunteers in the planning and management of programmes. This is all part of the effort by National Societies and the International Federation to enhance people’s capacities and build up local support services for the most vulnerable in the community.

Agustina is volunteering with her local chapter of the Red Cross. She has been visiting Florinda, a 77 year old who has problems walking and cannot get out of her house. “I go to see the doctor for prescriptions, then I go to the pharmacy to buy medicines and take them home to Florinda. Afterwards we spend a long time talking. In our talks, we remember old times gone by and former neighbours. My visits to Florinda are very pleasant for both of us. It is like taking a great trip back to the past.”

Agustina is grateful for the assistance she has received from the Red Cross, but she is even more pleased to be a volunteer. As she says, “I have learned a great deal from all this experience. Indeed, perhaps, the most important part of giving oneself to others is all that one can learn.”

Who is vulnerable?

As “vulnerability” emerged as an almost self-contained concept for re-thinking relief and development work there were some surprises in store. At the Office of the UN High Commissioner for Refugees (UNHCR) there has recently been an effort to step away from the traditional thinking that, “of course” women and young children are always the most vulnerable people in refugee situations — and therefore need special protection. This tallies with A.P. Davis’s iconoclastic study on vulnerability in Kenyan refugee camps showing that, in an emergency situation, the relative mortality of children under five increased less than those of other parts of the population, notably children over five. Another veteran of work with refugees has given the example of breastfed babies: probably less vulnerable to waterborne diseases than any other group in the camp.

It is probably true in most situations, including most natural phenomena, that the poor are more vulnerable than the rich, but poverty alone is not necessarily the reason for that vulnerability. As an example, an earthquake will probably not hit a poor area harder than a rich one, but in many cases well-built houses will be better able to withstand earthquakes than shoddy ones and besides, rich people are more likely to have insurance to pick up the pieces of their lives. However, as the 1988 quake in Armenia demonstrated, shoddily built earthquake-prone housing is not necessarily the lot only of the individually poor; it can be the norm in a given society. On the other hand, the light bamboo houses of much of rural and poor South-East Asia, traditionally held together by ties rather than nails, will be more resilient than most of the concrete-and-glass construction of the new megalopolis.

Vulnerability is usually considered in relation to a physical phenomenon — disease, injury, hunger, age, displacement. But there is also such a thing as organizational vulnerability, the result of societies breaking down, or becoming totally inefficacious. Remoteness has been identified in a Canadian Red Cross study, no doubt correctly, as a factor of vulnerability, especially in the aged. On the other hand, in many epidemics that no longer holds true. The AIDS epidemic in Africa has been mapped as it spread along the truck and bus routes. Inaccessibility here proved to be a protective factor.

Vulnerability can also be psychological, individual or collective. A simple example of collective psychological vulnerability is a panic reaction in the face of adversity, of the sort of mass hysteria that may be found anywhere from an angry football mob to a refugee camp.

Very few, if any, people in the world could not, at some point in their lives, become vulnerable. One of the factors that gave the war in ex-Yugoslavia such an enormous impact in western Europe was the realization that it was affecting people who looked exactly “like us”, who lived “like us”. Seeing the Croats, Serbs and Bosnians so vulnerable to the horrors of war inevitably reminded Europeans — who had almost forgotten what that meant in half a century of peace — of their ultimate vulnerability. Yes, there are natural catastrophes in Europe and in North America, but even the most recent of them, the devastating floods along the Elbe in the summer of 1997, showed that excellent preparation and good organization can mitigate damage to the population. That is one illustration of how studying vulnerability can lead, at the local and regional level, to the building of capacities that will help deal with even potentially catastrophic situations.

Vulnerability Indicators*

The most vulnerable are those who:

-lack material resources and/or social support
-are excluded from full social participation
-live in areas marked by high levels of deprivation – inner cities, former industrial areas
and isolated rural communities

*Who are the most vulnerable?
A report from the Research and Planning Department of the British Red Cross, December 1995

When is vulnerability collective?

It is necessary to distinguish between risks that are freely taken and those that are imposed, particularly with respect to collective vulnerability. When they are self-imposed the situation is simple, but relatively few of them are. There are the risks of pure chance, but in many others, especially economic or ecological vulnerabilities, the question of responsibility arises. An example at the intersection of these can be found in the Bhopal chemical disaster. To be living near a dangerous chemical factory when it explodes is not just a matter of bad luck — being in the wrong place at the wrong time. Human beings were responsible for creating the risk; to be living near the factory was a factor of heightened vulnerability. Other examples can be found in the landslides that occur when building is tolerated — or encouraged — on soil-thin mountainsides; the danger and the responsibility is compounded by allowing roads, perhaps built to substandard specifications, to snake along above the settlements.

Economic vulnerability, which used to be barely whispered about, is a complex web leading from individuals to whole countries and geographic regions. Families living on the edge of survival may be particularly vulnerable to a single bad crop, or a dramatic change in the exchange rate. But the exchange rate, or a drop in commodity prices, can affect whole countries, leading, for example, to dramatic curtailment of educational and health spending — often the first to be cut in tight budget situations.

The vulnerability of a population can also be the result of decisions made by political leaders. The people of Iraq have been hungry and medical supplies in critically short supply as a result of the embargo imposed after the invasion of Kuwait, and still, at least partially, in force. It is well to remember, however, that the terms of the embargo provided for the import of essential food-stuffs and medical supplies paid for by Iraqi exports of oil to be sold under supervision of the United Nations. The UN was also supposed to control distribution to ensure the supplies would go to the people and not just to the rulers and the military. Until earlier this year, the Iraqi government refused to accept the conditions.

These cases are clear-cut examples of how the vulnerability of the population was deliberately given lower priority than economic and political considerations. Most others will be more ambiguous. The Red Cross has always shied away from “talking politics”, but if a discussion of vulnerability is to be carried through to any logical conclusion, there will be many instances where some political thinking, in the widest sense, will be difficult to avoid entirely. Even the goal, for many National Red Cross and Red Crescent Societies, of capacity-building — as a logical corollary to studies of vulnerability — will need to be thought about in these terms.

What, if anything, organizations like National Red Cross and Red Crescent Societies can — or in fact should — do to prevent ecological or economic vulnerability is far from clear. Some say that it is none of their business; others have tried. In southern Africa there was an attempt, between droughts, which come frequently but not in a precisely predictable cycle, to work on reducing the vulnerability of populations by measures such as building reservoirs or distributing drought-resistant seeds. Even when it is effective, such preventive work has not always been seen as fitting the criteria of working with the most vulnerable. Preventive work also does not have the visual impact of a conflict, famine or disaster to generate donor interest.

Both the Federation and the ICRC have, in the past few years, done some major thinking about their roles. It has been more difficult for the Federation, which is, after all, just that — a federation of over 170 independent bodies of enormously varying sizes and styles. Some are still emerging from the traditional framework where doing good was emblematically positioned within the triangle of knitting socks, sending blankets and running blood banks. Even doing good deserves occasional examination with a critical eye. What is most difficult is to turn the same, unique critical eye not only on close to two hundred National Societies that make up the Federation, but on all their regional branches and local chapters.

Boots made for walking

With winter temperatures reaching down to minus 50 degrees Celsius, being without winter boots in the Pamir mountains of Tajikistan is a virtual prison sentence. Children who do not have adequate footwear — and there are many — are condemned to stay indoors and miss school.

In the past, the Federation has supplied thousands of boots to the Pamirs, but now, thanks to a programme supported by the Swedish government via the Swedish Red Cross, school children in the Pamirs are learning to make their own boots.

The Federation and the Tajikistan Red Crescent Society (TRCS) conducted a pilot shoe-making project last winter which produced a total of 1,200 pairs of new boots and restored another 750. Next winter, the programme will provide appropriate training, tools and material for secondary school children to produce over 6,000 shoes.

“The programme has two important effects,” said outgoing relief delegate Scott Simmons of the Australian Red Cross. “It provides a basic necessity and it also creates a change in thinking when people see that goods like shoes can be made locally and do not have to be imported.”

Schools in the Pamirs are usually closed during the bitterly cold months of January and February. But a Federation survey in 1995-1996 revealed that 30 per cent of school-age children did not go to school in December and March either because of lack of footwear. The problem was somewhat averted due to deliveries of shoes from the outside last winter. With the shoe-making project, the Federation is supporting local solutions rather than dependence on outside donors.

Thorir Gudmundsson

Where does vulnerability fit in?

The Federation identifies the most vulnerable as “those at greater risk from situations that threaten their survival or their capacity to live with a minimum of social and economic security and human dignity”. This can be interpreted into local, or at least regional and national idiom. In that sense it is indeed a tool — as is sometimes said at the Federation — to help National Societies and their local branches rethink their roles. As an example, the Danish Red Cross used it in exactly that capacity, and found reality somewhat different from popular perception. Ask the average Dane who are the most vulnerable and the answer will probably be “the elderly”. But today’s elderly are precisely the people who are reaping the benefits of Denmark’s remarkable social security system; many are now far better off (problems of loneliness and family break-up aside) than young people who are jobless, live on the streets, may be HIV positive, etc.

And what is the next step? The response lies within an often overlooked factor in measuring vulner-abilities — assessing capacities. Vulnerability and capacity are two sides of the same coin. When doing a vulnerability assessment one studies the weaknesses and strengths. The balance between the two determines who is more at risk. Programme design must focus on both elements. As the Federation Vulnerability and Capacity Assessment Guide states: “We should recognize that even the weakest in a community have some skills, resources and strengths to help themselves and perhaps others. This can be an important asset to build upon in a crisis.”

By supporting capacities, the International Red Cross and Red Crescent Movement expands its role from provider — giving blankets, feeding victims, and dressing wounds — to becoming a facilitator supporting and developing local capacities. To what extent National Societies have taken this on and re-oriented programming is not yet so clear.

If one were to accept that vulnerability is what turns a potentially damaging phenomenon into a disaster, the Movement can make an important contribution to reducing vulnerability, according to the Federation’s Guide, by “targeting the root causes through development, pre- and post-disaster mitigation programmes and by targeting the symptoms through better disaster preparedness and response.” This is certainly a significant step towards alleviating and preventing human suffering.

Being part of the process

“Here we receive very little aid, maybe during electoral periods or when floods happen,” says Carlos. “Then they bring us some clothes or food. Sometimes, if we are lucky, they’ll even give us construction material to repair a bit of the damaged houses. Lately, since the municipality decided to construct a contention barrier along the riverside, nothing is sent as there should be no more floods.”

Carlos lives in one of those marginal suburbs that abound in South America’s cities. He has 10 children to take care of, and no job. His wife died a few months ago from cholera. Since that date Maria, his 12-year-old daughter, looks after her younger brothers. Despite his daily struggle, Carlos works as volunteer with the Red Cross branch of Clorinda in the north of Argentina.

Carlos is part of the Clorinda Red Cross branch working group for the La Plata Basin project. Floods in the La Plata Basin region in South America constitute the most recurrent natural disaster in the region. The International Federation, working with 21 Red Cross branches from Argentina, Paraguay, Uruguay and Brazil, has developed community programmes in disaster awareness, promotion of community health, and education. Together with the people directly impacted, the Federation is identifying the most effective ways of mitigating and responding to the flooding.

Carlos, and the working group he is involved with, is responsible for preparing a review of the community’s resources and needs. The working group has also participated in several workshops organized by the branch, as well as discussion sessions for the planning of the La Plata Basin project. Today, Carlos comments: “Before we would ask ourselves: and now, what are they about to bring us? Since we actively participate in the activities and especially in the decision-making of what is going to be done or not in our community, we have all found something that no one can give us: self confidence.”

Macarena Aguilar

Cathryn J. Prince
Cathryn Prince is a freelance journalist based in Switzerland.