Extra: Ian Van Engelgem - The EU's Role in Humanitarian Aid and Health Assistance

Data: Fri, 04 Oct 2024 06:00:00 +0000 · Duração: 00:51:04

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José Maria Pimentel 00:00:00.00This episode is a partnership with the European Union Civil Protection and Humanitarian Aid. 00:00:11.88Olá, só para avisar que este é um episódio em inglês, uma conversa bem interessante sobre o estado da ajuda humanitária no mundo hoje em dia e sobre o papel da União Europeia. 00:00:21.72Até já! 00:00:23.08Hello, my name is José Maria Pimentel. 00:00:25.80Welcome to 45 Graus. 00:00:27.84Did you know that the European Union is playing an increasingly pivotal role in the global response to humanitarian crises? 00:00:34.96That is precisely the topic of today's episode, with a focus on what the EU is doing on health assistance throughout the world. 00:00:43.00Our guest today is Ian von Engelgam, who is a health advisor with DGECO, the EU's department for civil protection and humanitarian aid operations. 00:00:52.20Ian is currently working based in the regional centre in Dakar, Senegal, where he draws from a wealth of experience in humanitarian health aid. 00:01:01.88He began his career as an emergency ward doctor in Belgium, before moving to Guinea with the Doctors Without Borders, where he provided vital medical assistance to refugees from the Sierra Leone conflict. 00:01:12.86Since then, he has worked across countries like Afghanistan, Cambodia and Kenya, with a focus on providing health care to displaced population and controlling disease outbreaks. 00:01:21.92He currently advises on health and nutrition policies, guiding the EU's humanitarian aid during crisis. 00:01:28.54In our conversation, Ian highlights the growing need for humanitarian aid in today's world. 00:01:34.24He explains the EU's role, through institutions like DGECO, in both helping through funding and directly intervening in crisis, describing the scope of the EU's operations from its budget size to the main countries currently receiving aid. 00:01:48.02We explored the different mechanisms that the EU currently has to assist countries facing situations ranging from conflicts to disease outbreaks, such as the COVID pandemic or the 2014 Ebola epidemic. 00:02:01.16We also discussed some of the main regions and countries the EU is helping today, such as the Democratic Republic of Congo, DRC, a country grappling with both conflict and ongoing disease outbreaks, such as the current MPOX epidemic, which the World Health Organization, as recently as August, classified as a public health emergency of international concern. 00:02:24.84A key focus of our conversation is in the EU's health assistance, and we discussed, for instance, how previously overlooked aspects like mental health are now finally receiving a greater attention. 00:02:36.18And towards the end of the conversation, Ian also shares his insights into how humanitarian aid will evolve and what we can expect from the EU operations in the future. 00:02:46.80For our Portuguese-speaking listeners, you might recall my recent episode with João Silva, also from DGECO, where we discussed the EU's civil protection efforts in fighting natural disasters ranging from wildfires to floods. 00:03:00.84In today's episode, I found it, therefore, particularly interesting to explore how the EU's humanitarian aid complements and expands on its civil protection work, and I hope you'll find it just as enlightening. 00:03:12.86And now I give you Ian von Engelgan. 00:03:23.44Ian, welcome to Conitecin' Garage. 00:03:23.44Very nice to have you here.

Ian Van Engelgem 00:03:26.86- Thank you very much for having me. - How are things in Dakar? 00:03:29.40- It's quite hot as usual. 00:03:29.40A little bit rainy these days. 00:03:29.40The winter is approaching.

José Maria Pimentel 00:03:35.58- A lot of activity. - Yeah, indeed.

Ian Van Engelgem 00:03:38.40Not so much in Senegal, but in the countries we are covering from this office here.

José Maria Pimentel 00:03:43.74- Yeah, because you cover a wide area, right? 00:03:43.74How far does it go? 00:03:43.74Like, what's the radios, as it were?

Ian Van Engelgem 00:03:48.86- How many offices are there in total? - In total here, I think we are about 10 or 12 or something in the region. 00:03:53.58In total there are, in the world, about 40, I think, 40G ECHO. 00:03:59.12- Ah, 40. 00:03:59.12Okay, interesting. 00:03:59.12That's a lot. 00:03:59.12Okay, let's talk about EU humanitarian aid. 00:04:05.66So that's the main topic of this episode and that's the health assistant side. 00:04:05.66But to start with the overall picture of what the EU does in terms of the country. 00:04:14.20- And actually, maybe it's, this is kind of a basic question, but it's better to take a step back and start with the original question, which is... 00:04:22.74- In total here, I think we're about 10 or 12 or something in the region. 00:04:22.74In total there are, in the world, about 40, I think, 40G ECHO.

José Maria Pimentel 00:04:26.74- Ah, 40. 00:04:26.74Okay, interesting. 00:04:26.74And that's a lot. 00:04:26.74Okay, let's talk about EU humanitarian aid. 00:04:26.74So that's the main topic of this episode and that within it, the health assistant side. 00:04:30.74But to start with the overall picture of what the EU does in terms of humanitarian aid, and actually, maybe it's, this is kind of a basic question, but it's better to take a step back and start with the original question, which is... 00:04:44.20- The why? 00:04:44.20Like, why does the EU need to act on this front? 00:04:44.20How big are the humanitarian needs in the world nowadays?

Ian Van Engelgem 00:04:49.96- As you probably know, conflicts, which are the main cause of humanitarian needs, humanitarian crises, haven't receded much over the past years. 00:04:49.96And they keep on increasing, especially... 00:05:04.20- I like your euphemism. 00:05:04.20They haven't receded much. 00:05:07.50- Especially here in the region, we have the whole Sahel region, which was quite calm. 00:05:07.50There was no conflicts. 00:05:07.50There were huge problems of malnutrition in the past, which we addressed considerably. 00:05:21.00- But then, yeah, the conflicts did spread from Niger, Nigeria, and the whole West Africa region is in a quite awesome turn. 00:05:21.00So yeah, in total, we have hundreds of millions of people that are in humanitarian needs in the world. 00:05:21.00It keeps on increasing every year, and so do the financial needs increasing. 00:05:21.00But the financial contributions, the financial means that are spent on it, they increase too, but not up to the level that the needs are increasing. 00:05:39.00- So yeah, we continue to have a widening gap of needs. 00:05:44.50- And do the needs increase because the world is getting worse? 00:05:44.50Or because we're also like lowering the threshold for intervention? 00:06:01.00- No, I don't think we are lowering the threshold. 00:06:01.00I think what we are witnessing is a real increase of basic needs that people have difficulties of surviving. 00:06:17.50- There is an increase in the violence, but also due to issues like climate change, the floodings that we currently have in the West African region, millions of people are affected. 00:06:32.00So then the issue of climate change and disease outbreaks.

José Maria Pimentel 00:06:36.00- So you mentioned that this increasing trend has to do with conflicts, but also diseases, also effects of climate change. 00:06:43.50- Do you have an idea of whether they're all contributing to this increasing trend or some of them are actually decreasing, so there are opposing trends? 00:06:51.00For instance, I would imagine that in terms of diseases, the trend would be more positive than conflicts in this century, at least I'd say.

Ian Van Engelgem 00:06:59.00- Yeah, what we see often is that those crises converge and they result in what we call in our sector, in the humanitarian aid, for complex crises where you have an increased risk for disease outbreaks because of conflict and displacement of populations, more vulnerable populations because of lack of basic services, worse health status and health services access. 00:07:23.00And so whenever there are natural disasters or epidemics, the impact of those events becomes much bigger. 00:07:32.00- Yeah, that's an important point you're making, I think.

José Maria Pimentel 00:07:34.50So these situations tend to reinforce each other, kind of in a vicious circle, right? 00:07:39.50So if you have a conflict, that will tend to make it more likely that you have an epidemic, say. 00:07:45.50And the same thing goes for a natural disaster caused by climate change, right? 00:07:49.50So when things take turn for the worse, they tend to reinforce each other, right? 00:07:53.50- No, no, no, indeed. 00:07:55.00- And that's a big challenge.

Ian Van Engelgem 00:07:57.00One thing I'm curious about is how do you define whether a country is in a humanitarian situation or not? 00:08:02.00So what's the method to define that threshold that then will lead you and other, of course, international organizations to intervene? 00:08:09.00- We will provide humanitarian aid when there is the mortality or disease patterns or security is increasing up to a level that it impacts or exceeds what is normal and also where the country itself cannot or they don't want to provide the needed support to bridge these gaps to come back to a normal situation. 00:08:34.50So it's not always clear cuts, this definition, but it's a combination of factors where, especially the risk to unsafe living conditions and safety and dignity that will define whether we will intervene in a context that we then define as humanitarian.

José Maria Pimentel 00:08:52.00- Okay, so we've established that there's a growing need for humanitarian aid in the world. 00:08:57.00And this helps to some extent explain why the EU has a role here. 00:09:01.00But maybe I'll wager that for the listener, that's not completely clear cut. 00:09:05.00So we easily see why the UN, for instance, has a role here. 00:09:08.50But for an institution which is mainly a political institution, uniting European countries such as the EU, that's not so clear. 00:09:14.50So how would you explain the rationale, the reason for the EU to intervene in terms of humanitarian aid and not, for instance, for the individual countries or even their individual citizens in Europe to do it through multilateral organizations such as the UN or, I don't know, or the Red Cross or whatever?

Ian Van Engelgem 00:09:32.50- The EU started with humanitarian aid services back in the 90s. 00:09:37.50It was to show solidarity to affected population, to provide relief to victims of the disasters and so on. 00:09:46.50Separate member states, many countries deliver humanitarian aid and they will most often function as a donor. 00:09:54.00They will give money to the UN, to NGOs or to the Red Cross to provide assistance. 00:10:01.00The countries themselves most often don't provide direct assistance. 00:10:06.00It's mainly through funding towards specialized agencies. 00:10:10.50So yeah, for the EU, we have in the Lisbon Treaty, it's written that we will, we commit to providing this assistance. 00:10:18.50We have been doing that since the 90s. 00:10:20.50And yeah, we are working together also with our EU member states and we are together, we are the biggest humanitarian donor. 00:10:28.50And so it's a key pillar of the EU external assistance where we also try to respond to, of course, to the main needs, but also in a way that shows a little bit of values of what the EU and the EU member states stand for. 00:10:44.00But why don't the member states do that independently, so by themselves? 00:10:48.00So what's the benefit from an outside observer of having it done centrally, as it were, by the EU bodies? 00:10:54.50DG Eco in this case. 00:10:55.50I think DG Eco is recognized as a reference donor. 00:10:59.50We have several comparative advantages to the individual member states. 00:11:04.50We have a huge policy and capacity, but we have also the operational capacities on the ground. 00:11:09.50So we have all the offices in the countries with the main crises. 00:11:13.00We have humanitarian experts working on the ground to work with the population, with our implementing partners, to try to offer the main services and the main support to people in distress. 00:11:25.00And we are working together with EU member states, but also with the US and other main donors to coordinate. 00:11:32.00And we are quite proud of what we developed at EU level, this really specialized organization, which is DG Eco, to inform also and to help others to better target humanitarian aid.

José Maria Pimentel 00:11:46.50Yeah, and there are probably benefits to scale, right? 00:11:49.50So that you're doing this at the level of the EU means that you're able to pull resources from different countries, and structure that wouldn't structure in terms of personnel, right? 00:11:58.00In terms of the number of people working that you wouldn't have in individual countries alone. 00:12:02.00You have a single point of entry probably in terms of contact with other organizations. 00:12:06.00So there's a lot of benefit there of making the EU countries act through the EU institutions, right?

Ian Van Engelgem 00:12:12.00Yeah, and I think these days it's also at the more broader level. 00:12:17.50The EU with EU member states try to do, also in development and other sectors, we try to do things more and better together in what we call a Team Europe approach. 00:12:30.50That's a little bit of the vision, I think, for that one day we'll all merge together in a perfect way.

José Maria Pimentel 00:12:37.50Yeah. 00:12:37.50How does it work in practice? 00:12:37.50So where is EU humanitarian aid present nowadays? 00:12:43.00How much funding is there? 00:12:43.00How does it work in practice in terms of you doing it directly or through funding other organizations? 00:12:48.00So how does the whole thing work?

Ian Van Engelgem 00:12:52.00Okay, so we receive like 1% over the EU budget. 00:12:57.00We're not a very big director general. 00:13:00.00Okay, there is also some funding for the civil protection side, but that's also not that important yet. 00:13:06.00So if you compare it with the total EU budget. 00:13:09.50So 1% is just the humanitarian aid side. 00:13:12.50Yeah, yeah. 00:13:12.50So it's like 3 euros per person per year for the EU as a whole. 00:13:18.50That's a good figure. 00:13:20.50That's nice to know, yeah. 00:13:22.50It's not a lot. 00:13:23.50It's not a lot? 00:13:23.50No, no. 00:13:24.50And so, yeah, most of our money goes to our implementing partners. 00:13:29.00As I said, it's the UN system, the Red Cross system or international NGOs with the basis in Europe. 00:13:37.00So aside that, we have the field network of 140 international experts like myself trying to guide better this money given to partners to make sure it's according to the needs and it's responding to those most in need. 00:13:53.00So you act as a sort of consultant locally? 00:13:56.50Yeah, we try to make sure that the European taxpayer money is used as good as possible. 00:14:05.00Yeah, that it doesn't work only on paper, but actually in reality, right? 00:14:08.50We make sure that every action we see also in real what is going on. 00:14:12.50We go to visit these places and whenever possible because we increased in security and then it's become also more and more difficult. 00:14:21.50Okay, we still reach out to the populations and then we go to see ourselves. 00:14:27.00And then, yeah, we have also other capacities at the EU level, which is more recent to some extent, I would say, to assist our partners in doing their jobs. 00:14:39.00So we have, since very long, what we used to call the eco flight, it's an air service that we fund for our partners so they can fly to the most remote places. 00:14:50.50We do also deliveries by what is called the humanitarian air bridge, where we bring in medicines or other goods from Europe or other places to humanitarian crisis, I think. 00:15:01.00Also, with our colleagues of civil protection, some 10, 12, 14 years ago, we merged the civil protection with the humanitarian aid. 00:15:12.50And so, more and more, we are lending, we're trying to use a little bit of the philosophy of civil protection, I would say, more as a doer. 00:15:23.50What is now like a slogan, echo as a doer, but that where we can also send emergency medical teams that are specialized teams from Europe that then can be sent to disasters or to crisis settings and mobile laboratories to be sent to outbreaks and so on. 00:15:42.36And so, there are some interesting shifts, I think, that make us even better adapted for what we have to do in crisis settings.

José Maria Pimentel 00:15:51.10Yeah, interesting. 00:15:51.10So, although most of what you do nowadays is still through funding and not acting directly, increasingly, you also do kind of supporting roles and also direct interventions through more of the civil protection side, right?

Ian Van Engelgem 00:16:06.62I don't think there is what we call the EU humanitarian response capacity. 00:16:06.62Is it civil protection, is it humanitarian aid? 00:16:06.62It's somewhere in between and it's not important, but it's, yeah, I think, and the spirit of developing this, it came from the outbreaks, some of it from disease outbreaks also, to bring in other EU expert capacities. 00:16:32.62So, yeah, it's in between, I think, and it's a good thing that we are trying to look for new approaches and be more effective.

José Maria Pimentel 00:16:39.62Yeah, absolutely. 00:16:39.62And actually, for those who listened to the episode with João Silva, which was precisely on the civil protection side, it's one of the things that he mentioned, that there's an increasing overlap between the two. 00:16:49.56So, in practice, in many situations, it doesn't really matter whether it's the civil protection or humanitarian aid side working out because many situations tend to be like a mix of these and the challenge tends to be on both camps.

Ian Van Engelgem 00:17:02.56Still, the difference is that as humanitarian crises are often in conflict settings, then civil protection needs to work through the humanitarian principles also. 00:17:02.56We have to be careful that we go in the right direction. 00:17:16.56Yeah, it's not always as simple as a natural disaster, simple between the humanitarian aid. 00:17:16.56It's complex and it's becoming more complex also because of more insecurity and these non-state armed groups. 00:17:31.56And when I started in the late 90s, a humanitarian career, we had some internal conflicts, but these international non-state armed groups like ISIS and others are unheard of, and there is really an increasing disrespect also for the rules of foreign and international humanitarian law, which makes attacks on health services, on healthcare workers, on schools and all that. 00:17:57.56There is no more rule or order in humanitarian aid and no respect of the humanitarian principles. 00:17:57.56I think many of these groups, they don't care. 00:17:57.56And there's still a big work to do, which also echoes through advocacy and through field work, through organizations like ICRC and others to work on this IHL. 00:17:57.56That's a main challenge still.

José Maria Pimentel 00:18:20.56Sorry, Ian, please explain those acronyms you just used. 00:18:22.56So, the international humanitarian law, IHL, sorry. 00:18:26.56It's not only that the situations are graver, but also the work of a humanitarian aid front person is more complicated and more challenging than in the past. 00:18:36.56Yeah, I think it's more risky. 00:18:37.56More risky, yes, more risky. 00:18:37.56Challenging. 00:18:37.56I was using an euphemism, but yeah.

Ian Van Engelgem 00:18:41.56But yeah, we have to, as a humanitarian, you have an obligation towards people in need and you have to find ways of dealing with it or trying to reach people differently. 00:18:53.56I think with our cash, which is now a main trend in humanitarian aid, since a few years, we can do things differently, but not everything can be done through cash on that. 00:19:04.56You need to be delivering services where you cannot pay for people to go to services like healthcare when there are no services or when they are overwhelmed, you need to intervene differently. 00:19:17.56Yeah, if there's no basic infrastructure funding alone will not solve it, especially will not solve it in the short term.

José Maria Pimentel 00:19:24.56Just so that people get a concrete picture of what the EU is doing in different fronts. 00:19:29.56Nowadays, what are the main destinations for funding? 00:19:29.56Like what countries nowadays are, if we were looking at the map, like, you know, those bubble graphs in which the larger the bubble, the larger the funding, like which spots would there be where the biggest amount of funding would be going to?

Ian Van Engelgem 00:19:43.56I think it hasn't changed a lot. 00:19:43.56Although yeah, with Ukraine, that's now a main country where we put our money. 00:19:43.56But yeah, for the others, most of it is in Africa still. 00:19:43.56And there we have the big crises like DRC, which has been escalating.

José Maria Pimentel 00:19:58.56Democratic Republic of Congo. 00:19:58.56I have to keep translating your acronyms. 00:19:58.56Come on.

Ian Van Engelgem 00:20:03.56That's kind of typical for humanitarian aid and we are often reminded of it. 00:20:10.56No, no, come on. 00:20:10.56It's typical for any job. 00:20:10.56It's just that the outsiders don't know. 00:20:13.56Democratic Republic of Congo, Ethiopia, Somalia, Syria, Afghanistan, those are still some of the main recipients of humanitarian aid.

José Maria Pimentel 00:20:26.56And these are situations, if I understand correctly, some of them are disease outbreaks, such as DRC, right, the Democratic Republic of Congo, whereas others are more situations of conflicts and in some cases, probably both.

Ian Van Engelgem 00:20:41.56DRC, it's a long-standing conflict. 00:20:41.56It's a long-standing humanitarian crisis since the Rwanda genocide. 00:20:41.56It continued to suffer and to degrade up to the moment now where we have millions of people around Goma in embarrassing and incredibly poor living conditions. 00:21:01.56It's horrible and it's getting worse. 00:21:01.56So, yes, there is the disease outbreak now in DRC, the EMPOX outbreak, and we have high-impact disease outbreaks in previous years, Ebola and so on. 00:21:13.56But the main needs in Congo remain the displacement, where people living under plastic sheeting, living in shags, barefoot children, and then getting sick from malaria and so on. 00:21:26.56But often, these are breathing grounds also, yeah, for disease outbreaks that will spread. 00:21:26.56For instance, the cholera, it's been known we are still in the seventh pandemic of cholera. 00:21:26.56We never stopped since it was declared. 00:21:40.56It's incredible. 00:21:42.56It's the longest-standing pandemic. 00:21:42.56So, in Congo, we have thousands of cases and hundreds of deaths every year. 00:21:42.56And then places like Syria, Afghanistan, also, it's a lot of displacement. 00:21:42.56And that's the main displacement continues to grow. 00:21:58.56The number of people that are displaced, it's millions of displaced. 00:21:58.56And that's the main humanitarian crisis. 00:21:58.56But then, as I said, yes, you have high risks of disease outbreaks in these living conditions, in these overcrowded places, lack of services, and so on. 00:22:17.56And so, you have to invest in prevention of disease outbreaks getting out of control, which can sometimes go very fast. 00:22:17.56In refugee camps in the past, people would die like flies because of shigella outbreaks, meningitis outbreaks. 00:22:17.56And so, we have to continue to invest in preventive measures, make sure that the water is also safe, and so on. 00:22:17.56It's not only the health sector.

José Maria Pimentel 00:22:41.56Yeah, of course. 00:22:41.56Yeah. 00:22:41.56It's a multi-factorial intervention. 00:22:43.56Yeah, it's multi-humanitarian aid. 00:22:43.56It's multi-sectoral. 00:22:43.56And so, we have to take care of all. 00:22:43.56And so, yeah, the disease outbreaks, that's also part of it. 00:22:53.56Yeah, because as we discussed before, these things reinforce each other, right? 00:22:53.56So, you have a conflict, then you have displacement, then you have poor sanitary conditions, then you have diseases, but then you don't have the health system to fight the diseases. 00:22:53.56So, it's a challenge that keeps on growing, in a sense. 00:23:07.56Yeah, WHO's estimated that 70% of disease outbreaks worldwide are in a fragile and conflict-affected setting, so… 00:23:16.56Yeah, that's a big number. 00:23:16.56And you work specifically in the health assistance, right? 00:23:16.56Within the overall EU humanitarian aid, you work on the health assistance side. 00:23:16.56What does that mean in practice? 00:23:16.56Like, what other types of assistance are there? 00:23:16.56And is there, and I guess not, direct correspondence between health assistance and cases of disease outbreak? 00:23:16.56Or not all health assistance goes to specifically fighting disease? 00:23:16.56And I imagine not, because part of it will have to do with, again, creating the necessary infrastructure, which can be in a conflict situation and not necessarily in a disease.

Ian Van Engelgem 00:23:46.56So, yeah, I'm working, I'm working, I'm working, I'm working, I'm working, I'm working, I'm a doctor by training, and so I cover the health and nutritional aspects of humanitarian aid in DG ECHO for countries of the region here. 00:23:46.56So, I'm giving a technical recommendation, I will go and visit now next week, projects in the northeastern of Nigeria to see that those are implemented, quite specialized humanitarian aid, delivering health services, making sure that, that pregnant women get prenatal care that is of acceptable quality to prevent congenital syphilis and whatever, which is, it still gives me the creeps whenever I see those things happening. 00:24:15.56So, we have to make sure that the quality of our assistance is good to the norms and standards that we want to achieve according to our policies. 00:24:39.56And also, nutrition, the nutrition is good to see that nutrition is a huge problem in humanitarian crisis settings, and a lot of malnourished children still are dying also because of malnutrition, and that's not because of the malnutrition, but malnutrition contributes. 00:24:55.46So, we have to make sure that those children get out of the risk for morbidity and mortality. 00:24:55.46But so, outside of the health and nutrition, so yeah, the main funding is still going, rightly so, to the food assistance, food security, and livelihoods assistance. 00:25:11.18So, according to the latest data, it's like 37% of our funding will go to that. 00:25:15.78What does that mean, livelihood? 00:25:15.78It's like houses? 00:25:17.90No, the houses, that's another issue. 00:25:17.90It's what people do to have an income to keep cattle or to feed themselves. 00:25:17.90What are they doing to feed themselves? 00:25:17.90So, we give food, but yeah, we also help people to make sure they can have food and can have also means to live a dignified life. 00:25:36.58So, health is usually the second sector, and again, in certain crises, it will shift. 00:25:36.58These proportions will shift a little bit, like in outbreaks, when there is a huge outbreak, the majority of funding will, of course, go to health and then the others. 00:25:50.94And then I think protection is a little bit the same amount of funding as health, and then there is the water, the sanitation, the shelter, the education, etc. 00:26:02.22So, in healthcare, more specifically, it's about, as I said, delivering services, but also making sure that disease outbreaks are not occurring, that other public health risks are not popping up.

José Maria Pimentel 00:26:15.62If I understand correctly, there are different types of situations, so you might be intervening in a situation of conflict or in a situation of a disease outbreak, and in each of these situations, you will typically act through all these different functions or all these different goals that you just enumerated. 00:26:35.26So, it can be food, it can be livelihood, housing, health, sanitation, but the proportions of those will vary between different challenges. 00:26:43.16And so, as you said, if there's a disease outbreak, it will be more the weight of the health aspect, which is the one you're working, would be heavier. 00:26:52.16Whereas if it's a conflict, it would tend to be lower, but it will be still there, right, in each of those situations.

Ian Van Engelgem 00:26:57.00Yeah, I think what we, for instance, learned in disease outbreaks, the Ebola West Africa 2014-2016 outbreak, which affected several countries in West Africa, and then also spread to a few cases in Europe and the U.S. 00:27:15.34But also, the other Ebola outbreaks in Congo, the COVID, and so on, is that the multisectoral nature of disease outbreaks, it's like other crisis, other humanitarian crisis, you have to respond through different approaches. 00:27:30.26For instance, what we learned, and the hard way at some times with disease outbreaks is that we need to focus a lot on communities. 00:27:40.66They say now that outbreaks, they start in communities and ending communities, and I think where we had previously a more health and biomedical approach to disease outbreaks, We learned a lot over the past years to see from a more empathic way, from a protection angle, and so on, and to make sure that people, that the care that we propose, that it's also, that it's acceptable for them, that it's according to their traditions, to their beliefs, and so on, without, of course, losing track of the main goal of providing care and preventing the disease to spread. 00:28:17.12We have to, like in humanitarian aid, I think we learned a lot from how we did humanitarian aid in the northern Kivu province in eastern Congo during the Ebola outbreak in 2018. 00:28:30.96We learned a lot from the humanitarian actions that were conducted since years there, how to put better people at the center of actions or the center of the problem.

José Maria Pimentel 00:28:43.36That's interesting what you're saying, because it means that there's still a learning process going on in terms of humanitarian aid, and things that might be correctly thought in terms of policy will not necessarily work out if you don't think of the practical aspects, such as the people, such as how the communities work in which those policies will be implemented, right? 00:29:03.56And if those conditions are not there, in the end it will not work out, even if it's very correctly devised, right?

Ian Van Engelgem 00:29:08.54And as is the case in other businesses or sectors, we are learning every day, we are adapting our approaches, and there too, I think, from the work we have been doing in disease outbreaks, it has been an interesting journey to see how we can do more and better in disease outbreaks outside of Europe. 00:29:33.20Bringing in specialized capacities from EU member states, then I think ECHO has an essential role to play there, to also make sure that whenever these outbreaks are in humanitarian settings or they have humanitarian consequences, that we try to coordinate as best as possible with whatever we can bring in, what is useful, that is available in the EU. 00:29:58.44I like we are seeing now also with the ECHO, so EU health preparedness and response authority, HERA, they managed to bring in vaccines, ECHO vaccines, so I think, again, this is a capacity that the EU developed, a capacity meaning a director general, HERA, that is intended, first of all, to respond to disease outbreaks inside the EU, but also outside the EU. 00:30:27.32And so they will procure vaccines for Europe, but in case there is need to suppress quickly an outbreak elsewhere, we have an obligation, I think, to react and to respond, and that's what we are doing, and that's what we also did in the past with the European Centers for Disease Control. 00:30:44.48So there are high-level experts, epidemiologists and other technicians that can and have contributed to controlling disease outbreaks in the different Ebola outbreaks, and now also the EMPOCs, and I think this is really what makes us stronger and a more credible actor as the EU when it considers the global health security. 00:31:05.98I think we come from a long way, it used to be mainly in the West Africa, Ebola outbreak, I think, what the US managed to do there flabbergasted us all, but we reacted, EU reacted also because of COVID and other threats inside Europe, but we managed also to bring those capacities outside Europe and to show that it's of interest for the EU, but we also show solidarity. 00:31:31.88And we know that it's necessary to prevent global spread of these outbreaks, and I think that's a very nice journey that we went through since the 2014 outbreak.

José Maria Pimentel 00:31:43.78Yeah, it's very interesting what you're saying, because it's not only the funding that matters, but also the way the organization, and in this case, it's interesting because I don't think many people know, at least I didn't know, that the EU had gained this role in recent years, which again goes beyond funding of having the organization and the capacity to intervene. 00:32:13.68In these situations in these situations in and to like, plan ahead, as you were saying, so these situations are relevant for Europe and for European citizens, because these outbreaks can then become pandemics, ultimately, so it's a smart policy, but that requires organization in a certain capacity.

Ian Van Engelgem 00:32:28.56So I don't think many people know, yeah, if I see that the MPOX today, so we have been funding MPOX interventions with research institutions and with an implementing agency in Eastern Congo since 2022. 00:32:45.24And because the mortality, it's way higher than what it has been with the 2022 outbreak in the pandemic, the MPOX pandemic in Europe, people are dying at a tenfold rate or higher compared to Europe, because capacities are weak. 00:33:04.88And standard treatment for such cases in Europe, you can't compare it with what they get in Africa. 00:33:12.68And although we are doing already a lot, I think, with our partners, trying to provide the best, but we can do more and we should do more, I think we can, we have capacities in Europe and like the emergency medical teams, which could be deployed for certain cases and have been deployed for cholera and for those things. 00:33:33.50But yeah, there again, it's a little bit, as it is a conflict setting and that's the risks are high and to bring in specialized people, it's a challenge, but maybe it's also a good call for young doctors to think also about doing some intervention whenever possible to, to, to see what you can do. 00:33:53.42You don't need to do half of your life, like I've been doing it myself, but we can bring capacities and build up capacities, which is even more important, probably in, in, in those countries, which, which have very little means, very little qualified stuff and so on.

José Maria Pimentel 00:34:16.26What's your view on the, um, impacts epidemic specifically, because I don't know if people who are listening to these know that, but in WHO, so the, the, the World Health Organization declared the epidemic just in August. 00:34:27.88So very recently as a public health emergency of international concern, which is a term I never seen before, but it does sound grave. 00:34:35.24So, and of course there are some news of, of these in Europe all the way back since it began in Africa in the DRC, I think. 00:34:43.48But the situation seems, seems tougher now, right? 00:34:46.52So, so it's like a big concern. 00:34:48.64It's probably the biggest challenge in terms of humanitarian intervention nowadays, right?

Ian Van Engelgem 00:34:52.66I wouldn't say in terms of humanitarian intervention. 00:34:55.04We can't compare what the suffering that people have in, in, in the rest of DRC, especially in the Afghanistan. 00:35:03.32In terms of disease control, at least. 00:35:04.28In terms of diseases, yeah, it's the number one today. 00:35:07.48But it's a very quick spread these days in, in the Eastern part, in the Southern part of Congo, which is fueled by the total breakdown of, of services, of society, of the decades of, of conflict and, and misery. 00:35:23.90And, and, and so, yeah, this disease has been spreading through and around mining places, the carriere, what they call it in Congo. 00:35:34.06So where they, they go and dig the stuff for our cell phones and that, but also other materials. 00:35:40.78But so, yeah, there's a lot of promiscuity in these, these places. 00:35:44.76These people live from day to day there and when they, when they find some gold or some whatever, they, they will use it, maybe not in the best way. 00:35:53.12And there is a lot of commercial sex work and, and so, and then it has been really booming there. 00:36:00.94Nobody has the full picture of why and what there is a, it seems to be that this virus, which is split off from the virus that has been in Congo for decades and called the plate 1A, which is, is nothing, which is different from the, the, the one we had in Europe. 00:36:17.68But yeah, that it seems to be more transmittable through sexual contact, but also, yeah, the living conditions. 00:36:23.56So, I, a lot of children in Africa and then children, they, they play together. 00:36:28.96It's not like in Europe where they sit behind their computer or they still have a lot of physical contact. 00:36:34.84So, you have different circumstances that makes that this, this spread has been exponential there. 00:36:41.58It has spread also to Burundi, quite importantly, more around the capital, which is not far away from the epicenter. 00:36:50.56Uganda seems also, there is, and there is more and more cases, but we are talking about handful of cases still detected. 00:36:58.40What is the real spread that's still difficult to know, but that's also seems to be true long distance truck drivers, sex workers, a little bit like we have seen spread of HIV, that's sexual transmitted diseases. 00:37:12.30But yeah, how big is the threat for Europe and for the rest of Africa? 00:37:18.00Difficult to say, but I think what we have seen with this outbreak is that, yeah, it's a fragile conflict affected country. 00:37:25.56And then also in Uganda, you have a lot of refugees from Congo. 00:37:30.68So, it's really what we sometimes call a perfect storm where you have different conditions together that makes that it explode. 00:37:39.30We have this case in Thailand, the case in Sweden. 00:37:43.12I don't think that we can have such a perfect storm in our countries. 00:37:48.94It's a completely different setting and also education and all that. 00:37:56.16Communication means it's all very different. 00:37:59.08But yeah, let's see. 00:38:00.48I remember during the 2014 Ebola outbreak when I was in Guinea and I saw the last patient coming out of the treatment center in the epicenter. 00:38:10.76And I said, oh, it seems to be done now. 00:38:13.58It seems to be finished. 00:38:14.60And then three months later, it exploded completely. 00:38:18.18So, who knows?

José Maria Pimentel 00:38:19.96Yeah, and because also of under measurement, right? 00:38:22.94So, the fact that under diagnosis, sometimes you don't really know.

Ian Van Engelgem 00:38:27.26Especially with sexually transmitted diseases, I think, yeah, that is still a big... 00:38:33.70It stays on the ground often more in Africa than in Europe also, in Europe and in other places. 00:38:38.64But you can't openly talk about those things as we do in Europe, I think. 00:38:44.78Especially then when it concerns men having sex with men or other groups, then it's completely out of the question. 00:38:52.88And let's hope it's not going to spread through these groups. 00:38:56.62But probably this and those people will have it very difficult of getting care because most important still is to make sure that people can be accessing health care and don't have to hide and suffer meaningless. 00:39:13.76Yeah, again, what you're saying underscores your previous point that the practical challenges and the human challenges are often bigger than the pure medical or even logistical challenge, right? 00:39:24.36So, even the way local society is configured can bring a big challenge to a situation. 00:39:29.94Let's go back to health assistants in general. 00:39:32.14I wanted to close the overview that we were doing 20 minutes ago. 00:39:35.84I don't know how long. 00:39:37.36So, if I understand correctly, you have, in terms of health interventions, you can intervene in epidemics such as MPOCs, for instance. 00:39:44.16And it can be through treatment or vaccination or whatever.

José Maria Pimentel 00:39:47.02You can intervene through helping set up primary health care systems in these countries so that they are able to have proper health and even in a better position to fight these diseases. 00:39:58.40And then you also intervene, and this one surprised me in a positive sense, you also intervene in terms of mental health and psychosocial support. 00:40:04.88And that's interesting because it's often an overlooked dimension, but I mentioned specifically in conflict situations, it shouldn't really be overlooked because it's probably a very big thing. 00:40:16.88Like, if you go through a conflict, the amount of, I don't know, PTSD and whatnot. 00:40:21.88This time it was me using an acronym. 00:40:23.80Yeah, indeed, I wanted to correct you. 00:40:27.82My bad. 00:40:29.60Post-traumatic stress disorder and, I mean, other consequences. 00:40:33.58I mean, that should be big. 00:40:34.56So, it makes a lot of sense that you intervene also through this front.

Ian Van Engelgem 00:40:37.64Yeah. 00:40:38.42So, in the conflict settings, the humanitarian crisis settings, in camps and displacement settings. 00:40:45.24So, we try to provide a basic package of health care. 00:40:49.88Mental health is part of it, although it has been gone unrecognized for very long, I think. 00:40:57.66I think also in Europe, mental health is still sometimes taboo to go to a psychiatrist, like a psychologist. 00:41:05.72But in the conflict settings, yeah, everybody's exposed to violence and to undignified living conditions. 00:41:12.22And so, it's estimated that one in five will go towards things of depression and anxiety syndromes. 00:41:20.04And so, the caseload is extremely huge. 00:41:23.16But in most of these countries, mental health was never developed also. 00:41:28.38I think in Africa, we had a transition since decolonization. 00:41:33.84But yeah, in the colonial times, infectious diseases was the important issue. 00:41:39.88We have been seeing in Africa now all those, what we call the epidemiological transition. 00:41:45.86We have more and more mental health, but also the non-communicable disease, cardiovascular is its main mortality now and then. 00:41:52.70But although we have this transition also, and the needs in conflicts and humanitarian crises are extremely huge, the health systems in many of the countries we work in, have not prioritized it, the mental health. 00:42:08.06And like, I was recently in Chad, there is one psychiatrist for the whole country. 00:42:14.12So, well, in Nigeria, it seems to be a little bit better. 00:42:17.88There are 200 million, so they have 300. 00:42:20.22It's also... 00:42:22.06But that's the main... 00:42:23.68Suddenly, it sounds a lot. 00:42:24.90That's the main difficulty in developing these aspects of mental health. 00:42:31.12So, it has... 00:42:32.68Mental health is also... 00:42:34.38You can do... 00:42:35.26There is a broad scope. 00:42:36.36You can do the more community activities and often the more traditional societies in Africa and so on. 00:42:42.86They have their resilience mechanisms and the churches and the community groups. 00:42:47.62And they play a very important role. 00:42:49.36And that's why we try to work with them also to reinforce them, even to learn. 00:42:53.54And I think we are also learning from... 00:42:55.34It's not only one way. 00:42:56.94Often, when providing aid, you also learn and try to do things better. 00:43:02.44But then, yeah, that's one side of the scope of mental health and psychosocial services, as it's called in HPSS, in our jargon. 00:43:12.92So, we can go from a more community approach to the psychiatric services for people with psychosis or other. 00:43:21.28And that's another aspect also. 00:43:23.56And those people with major psychiatric disorders, when a crisis happens, they're not looked at often. 00:43:31.88They're forgotten. 00:43:32.86And you will find them strolling around and being forgotten. 00:43:37.14So, yeah, it's a bit of a high risk of death then, because they don't know how to access services and so on. 00:43:43.56So, yeah, it's a huge... 00:43:44.76It's one of our priorities in humanitarian aid. 00:43:48.22It's mental health, aside from sexual and reproductive health, where you have also very specific issues with a lot of sexual violence in humanitarian settings. 00:43:59.54That continues to be a reality that's difficult to bear, the unwanted pregnancies, with all the consequences. 00:44:12.14But then, also, yeah, pregnancies, people not knowing where to go for deliveries, the conditions, health facilities that were destroyed, that were attacked, that were flooded, or whatever. 00:44:25.68How to do a delivery, then you have to do it in humane conditions. 00:44:30.52And so, maternal mortality remains a big issue in many of the countries and settings where we work. 00:44:38.24Also, there, the human resource factor remains important, and the lack of qualified human resources.

José Maria Pimentel 00:44:48.08Yeah, I imagine, yeah. 00:44:49.12There are a lot of fronts to act on and limited resources to do so. 00:44:52.80So, it's a big challenge.

Ian Van Engelgem 00:44:53.84That's where we need solidarity. 00:44:55.80Yeah.

José Maria Pimentel 00:44:56.70Ian, thank you so much. 00:44:57.68This has been, frankly, a very fascinating conversation about this topic, on which I didn't know that much, I must confess. 00:45:04.28I like to end these interviews asking the guests whether there's anything I didn't ask, and in this case, you wanted to say. 00:45:11.06There's one topic we only slightly covered, I think, which is looking at the future. 00:45:14.72I think you made a lot of remarks that I think are related to that in terms of what you used to do in the past and what it's doing now, and the overall trends in humanitarian needs with which we opened our conversation. 00:45:26.96But what's your perspective? 00:45:28.12Like, looking to the future, what's your perspective in terms of the challenge side? 00:45:32.08So, the size of humanitarian emergencies? 00:45:35.18Also, question marks, trends, what we can expect from EU humanitarian aid looking into the future? 00:45:41.44I don't know. 00:45:41.84Whatever you want to say.

Ian Van Engelgem 00:45:42.68Well, yeah, as I said in the beginning, the trends are not looking good. 00:45:46.82The widening gap between needs and available resources, that's something that the humanitarian system is looking at and trying to solve it through a more efficient response. 00:45:58.88I mentioned already, for instance, for some of the sectors or some of the needs people have, for instance, the food security, and that will go more in a cache, which can be more efficient. 00:46:11.18But as I said before, it's not for all needs and sectors and so on, education and health. 00:46:18.42And then, yeah, the challenge is this non-respect of the international humanitarian law. 00:46:37.48And it's not only Africa or not only non-state armed groups, it's also the state armed groups. 00:46:44.00So, something has gone wrong, as we are seeing daily in the news, all that. 00:46:49.68So, how to correct that? 00:46:51.38Well, that's a big issue, I think. 00:46:54.20But then, yeah, I think doing more with the same resources, there is also the ground bargain. 00:47:02.78It was a huge meeting going on for several days and prepared for months. 00:47:07.22There was the issue of more localization of aid. 00:47:10.46So, beefing up the capacities to provide services and to provide assistance by local NGOs or by local emergency medical teams or other, and that's something that the humanitarian world is really serious about. 00:47:27.84But it's difficult, it remains difficult, because you don't train a doctor in two weeks, as to say. 00:47:34.44And then, yeah, I think what we are more and more looking at is also, aside from the localization, is the preparedness and the anticipatory approaches to be specifically more for the natural disasters, the flooding, the earthquakes. 00:47:47.90But not only, it's also when there are complex crises, there are often flare-ups of violence, and how can you better anticipate, because each time having to restart from scratch a response, it's also not the best, most efficient way. 00:48:01.82So, we need to look also in how can development do more, what we call the nexus, it's also quite humanitarian in development language thing. 00:48:15.14Yeah, you can do more with the same funding, ultimately. 00:48:17.52It's to bring in also, to make sure that there is some mind shift in development, in the development world, with development actors, to be less reluctant to go into fragile and conflict-affected settings, and which has been going on for years. 00:48:34.70Many of the development actors and the global health initiatives, they're working also now in these conflict settings, and try to see how they can adapt and be more flexible. 00:48:44.00There, I think, echo us also, and all the humanitarian actors, we have to see how can we assist those development actors and budget fundings, which are much more massive than humanitarian funding, how can they better survive in some way, whenever there is a crisis, to see how we can do things together, providing assistance in these settings. 00:49:11.72Also, yeah, I think there is still need for more evidence and more data-driven approaches, I think that that's also something that, because we are sometimes, we have a little bit difficult seeing the real impact also. 00:49:27.50Okay, that's somewhere classical, I would say, for humanitarian aid, but we should not just say and accept it as such, but we have to do also efforts to use modern means, digital means, and so on, to make sure that we do the things the best possible way, in the most efficient way.

José Maria Pimentel 00:49:48.42Yeah, a lot of what you mentioned has to do with planning, ultimately, and the fact that so many times you have to fight an emergency means that you, in the end, you don't have time to plan. 00:49:59.42And that, in a sense, goes with it, but if you can, if you're able to, you, in general, so, yeah.

Ian Van Engelgem 00:50:05.78Life-saving first, right, the humanitarian imperative, as we call it, if something bad happens, well, we have to make sure that we can save as much lives as possible.

José Maria Pimentel 00:50:16.72Yeah, I like, in these situations, the distinction between the urgent and the important. 00:50:16.72Those situations are urgent, but it's also important to plan for, to do it better next time.

Ian Van Engelgem 00:50:26.42Yeah, you have the urgent and the less important, whereas the line between those different things, indeed.

José Maria Pimentel 00:50:33.58Yeah, indeed. 00:50:33.58Ian, thank you. 00:50:33.58It was a great conversation, and keep the good work in Dakar. 00:50:39.30Thank you very much, Jose. 00:50:39.30It was a pleasure, too. 00:50:41.96Este episódio foi editado por Hugo Oliveira. 00:50:45.06Contribua para a continuidade e crescimento deste projeto no site 45curauspodcast.com. 00:50:50.18Selecione a opção Apoiar para ver como contribuir, directamente ou através do Patreon, bem como os benefícios associados a cada modalidade.