How can agencies gain access in difficult contexts? Valuable work has been done on negotiating access with armed non-state actors, but what if negotiation is not enough? What if the context is so challenging that a conventional approach is impossible? One solution is remote control or shared management, where national staff are dispatched to manage projects directly. For a variety of reasons, this approach is controversial. This article suggests that a different approach explo-action may be an effective answer.
What is explo-action?
Explo-action means exploratory mission together with medical action. It is commonly used by Médecins Sans Frontières (MSF) in emergency situations, whereby medical activities are launched concurrently with an assessment or exploratory mission. It is generally characterised by the rapid setting up of medical services to implement treatment and gather medical data and other information necessary to understand the nature and gravity of an emergency. This method is often used when the situation is so urgent that the usual methods of needs assessment, project design and implementation are too slow. Explo-action was formalised as a distinct methodology in Colombia, for MSF Spain. There it is used to open projects using mobile clinics in new, highly insecure areas, with the expectation that, in time, a more regular service can be implemented.
Explo-action in the Niger Delta
MSF Spain decided in early 2007 to launch a conventional needs assessment in Bayelsa, in Nigerias oil-rich Niger Delta. This area was chosen because it was expected that already difficult security conditions in the Delta would deteriorate further, affecting the health and humanitarian situation of an already marginalised and distressed population. MSF Holland has been present in Nigeria since the 1990s, and carried out a malaria project in Bayelsa from 2001 until 2005. MSF France has a trauma hospital in the commercial capital, Port Harcourt. MSF Spain had no presence in the area, and the needs assessment represented the first step in commencing activities there.
The state of Bayelsa has a population of some 1.7 million. The main ethnic group, the Ijaw, is the fourth-largest in the country. The state covers two of the regions three large oil basins, with a topography characterised by complex river networks known as creeks. Nigeria derives an estimated 80% of its foreign earnings from oil. The oil fields are nationalised; all revenues are taken at the federal level and shared with the oil companies, but no compensation is given directly to host communities. Oil-producing states are allocated 13% of the revenues, but a significant proportion of this money perhaps as much as 90% never reaches its destination through a process of misappropriation known locally as chopping. These resource-rich areas, like others around the world, suffer from the paradox of plenty: far from benefiting from the valuable resources they contain, they become impoverished and marginalised.
Bayelsa is a very complex society. Key elements within it include the legitimate authorities, traditional rulers, the Ijaw Youth Council (IYC), a powerful social and political force, and the Movement for the Emancipation of the Niger Delta (MEND), a loose coalition of militant groups that emerged in 2005. There is also the phenomenon of cult groups, made up of disaffected youth and often very violent. Religion is important: the region has a plethora of Christian churches following a variety of different creeds, alongside a deep-rooted belief in traditional forms of religion. The practice of magic is common. Although the Niger Delta region has a history of communal violence, over the past few years anger at the government has grown, and most conflicts have become very political in nature. In particular, MEND kidnaps expatriate oil workers, in part as a statement of protest against the federal government, and attacks oil installations in an attempt to cut production. Few expatriates move around without armed guards, and several Western governments warn against travel to the Delta. The families of prominent Nigerians are also at risk.
The process of entering such an unsafe area included several weeks of desk research, followed by an initial rapid field visit to determine whether security conditions allowed freedom of movement and access to populations in need. After the initial rapid visit, an in-depth explo (needs assessment) was launched. Initially this was confined to areas reachable by road, as it was said to be too dangerous to go into the creeks, which are only accessible by boat (kidnapping, apparently, was an inevitability). With careful planning, however, it was possible to make two visits to communities in the creeks. The assessment team spoke to a broad cross-section of the population, in markets, restaurants, at creek boat hubs and in medical institutions. We also interviewed political leaders. Very few people are willing to speak freely in the presence of armed guards, and none were used by the assessment team.
The assessment found extreme marginalisation and poverty among the majority of the population. According to the local media, as many as 70% live below the poverty line. Throughout the state, the infrastructure for basic utilities such as water, sanitation and electricity is poor at best and non-existent at worst, even in the state capital, Yenagoa. In rural and creek areas, frequent oil spills contaminate waterways and arable land. Continuous gas-flaring is said to cause acid rain.
The health situation is equally worrying. Estimates of average life expectancy range from 4346 years. No global data is available, but figures can be extrapolated from a few focal sites. Available medical indicators show high levels of malaria and waterborne diseases as leading causes of morbidity and mortality. Of special note was the finding that 8% of mortality in 2005 was caused by anaemia. This is a fertile area that should have abundant fisheries; if true, this figure gives cause for acute concern. Vaccination coverage in many areas is low, and according to a government health official less than 10% of pregnant women have any sort of ante-natal check (this is very low, even by Sub-Saharan African standards). The health system barely functions, and access to health care is severely limited by a lack of staff and medical supplies, corruption, a troubled public health insurance scheme and access difficulties.
Given the medical indicators and the poor state of the health system, there is clearly good grounds for some sort of external intervention. Right from the outset of the assessment, there was a strong feeling that there was space for MSF to work. It is a general rule of thumb that, if hunting is required to identify a project, the question is it necessary here? needs to be asked. In Bayelsa, it was more a case of where to start?. While the assessment barely scratched the surface, it was felt that further assessment would yield little more of value, and it was decided to move into explo-action mode. In Bayelsa the rationale for this approach was based on the complexity of the society, insecurity, the sparse medical data available and the need to gain the trust of all key stakeholders.
In Bayelsa, most needs are in the creeks, but access is extremely problematic, for logistical reasons as well as insecurity, making this a difficult place to choose as a point of entry. Rather than being mobile, in the first instance it was decided to establish roots on the land. A township near Yenagoa and a busy creek hub were selected as the best sites to undertake a modest medical intervention. The initial proposal was to establish an independent clinic (so as not to become entangled in the failing health system) with stabilisation in-patient facilities. A clear and comprehensive project would be established after further assessment. In particular, the original assessment did not examine the public health impacts of oil pollution and gas-flaring, and it is expected that adapted epidemiological monitoring will prove or disprove the hypothesis that pollution is adding significantly to the health burden. After some delay due to administrative demands, the clinic is in service, and MSF-Spain is hoping to conduct further assessments in other areas.
Max Glaser, Humanitarian Engagement with Non-state Armed Actors: The Parameters of Negotiated Access, HPN Network Paper 51, June 2005.
Abby Stoddard, Adele Harmer and Katherine Haver, Providing Aid in Insecure Environments: Trends in Policy and Operations, HPG Report 23, September 2006.
Chop Fine, The Human Rights Impact of Government Corruption and Mismanagement in Rivers State, Nigeria, Human Rights Watch, January 2007. UNDP, Niger Delta Human Development Report, 2006.
- The Swamps of Insurgency: Nigerias Delta Unrest, Africa Report, no. 115, 3 August 2006.
Fuelling the Niger Delta Crisis, Africa Report, no. 118, 28 September 2006.
- Failed Elections, Failing State?, Africa Report, no. 126, 30 May 2007.
- Ending Unrest in the Niger Delta, Africa Report, no. 135, 5 December 2007.
Bayelsa presents a unique set of variables, making conventional approaches to establishing a new project hazardous. Explo-action assumes a risk of failure, but it is also seen as a least risk approach when there are so many unknowns. Remote control could have been proposed, but it has been controversial in MSF (and elsewhere) as it contradicts the agencys operational policy of proximity to affected populations and increases the risks national staff are exposed to. Starting work in a new country with unproven national staff, especially in light of the high levels of corruption, also makes remote control a high-risk approach. Explo-action is therefore a means of retaining proximity, ensuring that national staff do not bear the brunt of insecurity and maintaining the integrity of projects.
To date, outside of emergencies MSF has tended to use explo-action on a case-by-case basis. No clear parameters have been defined governing when to use this method to gain entry into a new context. There is scope for more formal definition of explo-action, and context indicators should be identified, so that explo-action can become a tool of choice rather than a default position. It would also be interesting to establish whether explo-action has been used by other groups, and if so whether the method can be adapted to non-medical activities.
Jacqueline Tong (email@example.com) led MSF Spains assessment in Bayelsa in JulyAugust 2007. This article is written in her capacity as an independent consultant.