‘Working within the context of war, from Afghanistan to Iraq, from Rwanda to Cambodia, we understood that it is not only the injured, but also all those ‘normal’ people forced by war to leave their homes, reduced to poverty and deprived of their essential rights, that are included when counting the victims. This awareness has pushed us to not only broaden the scope of our actions in terms of types of clinical activity, but also to reflect upon what type of model and what type of impact we wanted to have with our work within these situations.
We have constructed our universe of principles and values, making reference primarily to the Universal Declaration of Human Rights, the Charter of the United Nations, and to the Italian Constitution. On this basis we have structured our approach and our model, which emphasises the idea of and desire to be an ‘agent of change’, to push for change in the contexts and countries in which we operate.
To be a true agent of change, not just in theory, it is necessary to construct a model which is sustainable in the long term, with clear and solid foundations. On the one hand, we have put the patient at the centre, organising all projects and structures around their needs, and strengthening local capacities with this in mind; on the other, we must consider the involvement of local authorities at various levels, because they have the final responsibility in guaranteeing the right to treatment for their citizens.
However, this is not enough. We strongly feel the need to relate, to those who cannot see it with their own eyes, the realities, both close to home and further away, that we have experienced through our work, because we believe that it is necessary to create awareness, to encourage involvement and participation. In an interconnected world like ours, we must all feel responsible, even for situations which, on a surface level, may seem distant. Migration, one of the main challenges facing the world in recent years, is a further confirmation
of the global scale of the geopolitical, economic and social dynamics of our time. Each of us must know that, even from our own home, even from our headquarters in Milan, we can have an impact on what happens in the rest of the world, whether it’s in Kabul or Baghdad. Convinced of this, we have worked on promoting a culture of peace and respect for human rights with the aim of giving ‘ordinary people’ the tools to actively promote change.
From this viewpoint, the work carried out over the past 25 years fits perfectly into the framework of the Sustainable Development Goals (SDGs) set by the United Nations in 2015, which propose a qualitative, circular and global approach to build our future and to challenge ourselves to create a better world.
DIFFICULTIES AND PARADOXES OF SUSTAINABILITY
“I want to try to get across the difficulties and paradoxes – but also the challenges – that arise when analysing the issue of sustainability within an organisation like ours, for the specific work we do, namely treating civilian victims of war and poverty and promoting a culture of peace.
Sustainability means being able to carry something out without leaving a significant impact on your wider surroundings. It’s saying, ‘I can take this on my own back.’
The idea of sustainable development aims to reduce the negative impact of mankind on our planet, connecting the environment, economy and society. How can we meet our needs without harming the ability of future generations to meet theirs?
Businesses, as actors in global society, describe the sustainable development in their activities in sustainability reports. In its sustainability report, EMERGENCY, as an actor in global society, explains how its humanitarian work is sustainable in terms of the enviornment, economy and society, according to internationally recognised and applied standards.
What we want to try to explain, in our sustainability report, though, is the unusual nature of sustainability in a humanitarian organisation like ours.
Third-sector bodies exist and operate on the subsidiary principle. Where the state does not manage to cover the needs of the people, it is up to third-sector bodies to step in. And this is where the paradoxes come in.
The first paradox is that this makes the state’s activities unsustainable, if it cannot meet the needs of the people. If it could and did do so, there’d be no need for third-sector bodies.
The second paradox is that the very reasons we exist unsustainable. War is not sustainable. War kills people, it destroys cities, regions, work and life. It is not sustainable for humanity.
The third paradox is that poverty is not sustainable, in a world where there are enough resources to satisfy everyone’s needs but they are not distributed fairly. Unfortunately, poverty, above all in poorer countries, too often also means not being able to get treatment, because even in the poorest countries, health care is paid for.
An organisation like EMERGENCY cannot treat all the victims of war and poverty. Sustainability in our work, guided by the subidiary principle, can only mean producing a treatment model that is sustainable and will eventually be taken over by the state. This is true sustainability for us. But it’s a kind of sustainability with a single ultimate goal, namely the non-sustainability of our very existence. The point of our work is to become redundant.
Alessandro Bertani, Vice President of EMERGENCY
ECONOMIC AND SOCIAL SUSTAINABILITY
EMERGENCY’s humanitarian activities around the world are always carried out in collaboration with local authorities.  It is a distinctive characteristic of the organisation’s intervention methods, whose goal is not to replace national health services – where they are present and functioning – but to integrate with them. The ultimate objective of our work is always for local governments to take responsibility, as well as the integration of our various activities into the economic and social fabric of the countries where we operate. To this end many of the governments we work with contribute financially to our projects.
Upon the launch of a new project, EMERGENCY and the relevant national authorities – usually the ministry of Health – sign a Memorandum of Understanding (MoU), an official document defining the organisation’s mandate in the country, roles and mutual responsibilities, and terms of collaboration between the two parties. Furthermore, we sign specific MoUs with relevant ministries or directly with local schools of specialisation (where present) to formally recognise the training courses that EMERGENCY provides for its medical and nursing staff.
Other documents are agreed in accordance with the requirements of the country we are working in within specific areas, such as technical matters. Other dialogues and agreements take place with different representatives of civil society, for example with community elders in Afghanistan, the popular committees in Sudan or, in cases of collaboration, local NGOs.
EMERGENCY works hard to act in accordance within legislative frameworks in countries of operation, being careful to comply with all codes and regulations on work, taxes, and imports, where they exist. In all our projects, we involve local authorities from an early stage, both in defining activities and training programmes for local staff, in order to share goals and responsibilities. This assumption of responsibility by local authorities also translates into government funding to support hospitals, thus facilitating both present management and future hand-overs.
A positive case of cooperation with local authorities is the Surgical and Paediatric Centre in Anabah, in Afghanistan’s Panjshir valley.
Here, the government contribution, which EMERGENCY has received since 2012, covers almost all of the management costs of the
hospital and First Aid Posts, strengthening the local economy. A good part of the funding goes back into the community in the valley, through staff (329 people) wages and buying material for the hospital on site. This government funding, in addition to representing an important gesture of trust towards EMERGENCY, also attests to the economic ability of the local government to take independent charge of the management of the facilities when the hand-over will take place.
In Italy, we sign memorandums of understanding with local health authorities to govern our partnerships with them and our work in local areas. Depending on the area in question and the type of project proposed, agreements are signed with regional governments, municipal councils or local prefectures.
A positive example of cooperation with local authorities in Italy is the earthquake project we began after the disaster in 2016. There were six areas involved in the earthquake project in the province of Teramo in 2018: Penna Sant’Andrea, Civitella del Tronto, Campli, Castelli, Montorio al Vomano and Nerito di Crognaleto. In March 2018, we started to collaborate with ASUR Marche – Area Vasta 3 to send a second team, composed of nurses and psychotherapists, to work in the province of Macerata, within the districts of Caldarola, Camerino, Muccia, Pieve Torina, Tolentino and Visso.
Designed by Renzo Piano Building Workshop, with EMERGENCY’s technical office and TAMassociati, the hospital has been built using the traditional rammed earth technique, which thermally insulates buildings, keeping internal temperatures and humidity constant throughout the year. The hospital will be equipped with 2,600 photovoltaic solar panels, which will provide a portion of the electricity required by the facility.
Large floor-to-ceiling windows will bathe the interior in light. The hospital is located on the shores of Lake Victoria and is surrounded by a large garden with 350 trees. We are currently finalising the construction of the Centre of Excellence in Pediatric Surgery in Entebbe, Uganda, which will be active from Spring 2020.