Professional standards and legal standard setting: INSARAG, FMTs, and international disaster relief volunteers.

• Author: Bookmiller, Kirsten Nakjavani
• Position: International Search and Rescue Advisory Group, foreign medical teams

ABSTRACT

This Article draws attention to the nascent efforts of emergency medical personnel, convened under World Health Organization auspices, to improve humanitarian health responses following catastrophic natural disasters. The Foreign Medical Team Working Group (FMT-WG) is pursuing new professional standards related to sectoral coordination, classification and registration. As its approach has been significantly influenced by the International Search and Rescue Advisory Group's (INSARAG) prior advances in these areas, INSARAG's contributions will first be highlighted. While more atypical contributors to international lawmaking than traditionally studied, the efforts by both groups shed significant light into the burgeoning International Disaster Response Law field. Two principle assertions here: that soft law-oriented technical guidelines can address highly time-sensitive, operational challenges related to transnational relief; and that ongoing professional self-regulation within specific response sectors may bolster state willingness to open its borders to outside international relief, even in the absence of a formal convention to do so.

TABLE OF CONTENTS I. INTRODUCTION II. PART OF THE CURE BUT ALSO PART OF THE PROBLEM? "THE EPIC MEGA-DISASTER," CONVERGENCE, AND INTERNATIONAL DISASTER RESPONSE LAW III. PROFESSIONALIZING INTERNATIONAL VOLUNTEER RESPONSE: THE "INSARAG MODEL" IV. REPLICATING THE "INSARAG MODEL" IN THE HUMANITARIAN HEALTH SECTOR: WHO AND FOREIGN MEDICAL TEAMS V. A FIRST STEP TOWARD PROFESSIONAL ORDER? WHO'S FOREIGN MEDICAL TEAM CLASSIFICATION PROCESS VI. CONCLUSION "They didn't bring much with them. They didn't bring any supplies, they didn't bring water. They didn't bring food . . . They thought that shelter would be provided--that all they had to do was show up and say, 'I'm a doctor, where can I do surgery?' And it doesn't work like that." (1)

1. INTRODUCTION

   Over the past fifteen years, a new field known as International Disaster Response Law (IDRL) has emerged, seeking to address some of the most pressing challenges related to cross-border relief following natural disasters. Field literature highlights IDRL's marked paucity of hard-law frameworks compared to other more established areas of public international law, and its alternatively pronounced soft character. (2) In addition to public, state-generated declarations, resolutions, and other non-binding instruments, IDRL's soft-law nucleus also embodies sector-based, highly technical professional codes of conduct, handbooks, and guidelines. Yet scholars pay little notice to the various agents of these professional guidelines and standards and the respective strategies they have employed to ameliorate the sundry issues pertaining to international disaster response while enhancing international law in the process.

   This study draws attention to the nascent efforts of emergency medical personnel, convened under the auspices of the World Health Organization's Global Health Cluster, to improve humanitarian health responses following sudden onset natural disasters. The Foreign Medical Team (FMT) Working Group is targeting several problem areas by formulating operational guidelines related to FMT coordination, classification, and registration. However, these strategies are not exclusive to the emergency medical sector. Urban search and rescue (USAR) practitioners, under the aegis of the International Search and Rescue Advisory Group (INSARAG), were the first in the entirety of the international humanitarian system to devise protocols of this nature, dating back to (1991). (3) The FMT Working Group participants openly acknowledge the strong influence of INSARAG's approach and experience in shaping their own policy proposals. Accordingly, a preliminary examination of INSARAG's efforts will also be provided for contextual purposes.

   While a twenty-year span separates the launches of the INSARAG and FMT initiatives, it will be shown that both address essentially the same operational challenge--bringing a semblance of order and professionalism to the chaos-prone universe of large-scale, cross-border humanitarian aid following catastrophic natural disasters. The quest for professionalism within the larger system is a central concern across the discipline, even for mainstay humanitarian relief actors. (4) The added convergence of spontaneous, unaffiliated volunteers from across the globe at the disaster site--a common phenomenon to be introduced at the beginning of this study--further complicates matters greatly.

   Health professionals and urban search and rescue personnel represent epistemic communities of highly specialized expertise. These groups are more atypical contributors to international lawmaking than traditionally studied. Yet their efforts shed light into the IDRL field in myriad ways. Two principle assertions will be highlighted here: that soft-law-oriented technical guidelines can address highly time-sensitive, operational challenges faced by responding and disaster-affected states related to transnational relief; and that ongoing professional self-regulation within specific disaster response sectors may bolster state confidence--and therefore its willingness--to open its borders to outside international relief in the future, even in the absence of a formal convention to do so.

2. PART OF THE CURE BUT ALSO PART OF THE PROBLEM? "THE EPIC MEGA-DISASTER," CONVERGENCE, AND INTERNATIONAL DISASTER RESPONSE LAW

   While disasters assume many forms--ranging from armed conflict to the technological--sudden onset events caused by natural hazards--including earthquakes, tsunamis, and typhoons--tend to trigger a distinctive brand of international aid response not experienced elsewhere in the humanitarian relief system. Their unexpected nature and rapidly unfolding timescale generate a global burst of public attention, far greater than slow onset natural crises such as droughts or conflict-based humanitarian emergencies, both of which may play out over years, if not decades. Rapid onset tragedies stemming from the physical environment also tend to be more "media-friendly" in that their causes are more easily grasped by news consumers and the events typically produce attendant powerful visual images. (5) Further, there may even be an innate bias, resulting in the public perception that the victims of natural disasters are less at fault for their plight compared to those caught up in violence. (6)

   Commentators have lamented the pattern of an imbalanced media coverage in favor of more dramatic natural disasters rather than crises with more complex origins. The International Federation of the Red Cross's 2005 World Disasters Report expressed its frustration regarding the greater media appeal of the 2004 Indian Ocean Tsunami compared to other concurrent but underreported humanitarian crises:

   Disasters that are unusual yet explicable, and that cause considerable death or destruction in accessible places which the audience is believed to care about, get covered. Baffling stories get less attention.... Today, TV news is part news and part entertainment. So it's understandable that sudden, dramatic disasters like volcanoes or tsunamis are intensely newsworthy, whereas long-drawn-out crises (difficult to describe, let alone film) are not. (7) Sudden onset events with significantly high death tolls and destruction, or what the International Red Cross Federation's Malcom Lucard termed the "epic mega-disasters," especially draw media notice. (8) While small and medium size disasters are far more common and cumulatively cost far more loss of life, it is the single, highly deadly, catastrophic case--such as the 2004 Indian Ocean Tsunami, the 2010 Haiti Earthquake, or Typhoon Haiyan that struck the Philippines in 2013--that garner the lion's share of global media interest. (9) Moreover, in the past decade, grassroots social media have served to further draw the world's attention to specific episodes. Photos, amateur videos, and emails circulated worldwide by Europeans vacationing in tsunami-devastated areas in December 2004 signified a major turning point in citizen coverage of disasters in the digital age; by the time of the 2010 Haitian quake, social media technology such as Twitter, Facebook, and the crowdsourcing platform Ushahidi were widespread and fundamentally shaping the global public's understanding of unfolding events. (10)

   Regular, full-time international humanitarian practitioners, including those associated with UN agencies and the major nongovernmental relief organizations such as Doctors Without Borders, CARE, and OXFAM, are guided by a professional, needs-based ethic, responding regardless of whether the popular news outlets are paying attention or not. However, after extraordinary, nature-based tragedies such as a devastating earthquake or hurricane, these professional humanitarians suddenly find themselves joined by a momentous flood of thousands of volunteers similarly desiring to help. Recognized for decades in disaster management circles as the process of "external convergence," the impacted area is barraged by outside goods and materials (material convergence), informational inquiries and offers of assistance (informational convergence), and a significant influx of people (physical convergence). The latter are motivated by a range of impulses, from a genuine wish to assist to disaster voyeurism. (11)

   One category of volunteer who participates is part of an outer ring of the more institutionalized humanitarian system, affiliated with mainstay volunteer organizations such as the International Federation of the Red Cross/Red Crescent (12) or part of an on-call roster by national governments. (13) Most in this volunteer subset will have, at a minimum, training in the international disaster response field and may further possess prior experience serving in such contexts. Far more problematic, however, are arrivals who are unattached to any...