Overseas assistance is torn between relief and development: do we feed the hungry or teach them how to feed themselves?

The road from mogadishu to Halba Camp begins as a strip of macadam laid incongruously across the vacant Somalian desert. A flat, sere landscape is interrupted by occasional stands of acacia trees and giant red anthills that jut abruptly upward like impressionistic sand castles. Few animals cross the road. Giraffes and elephants were killed off long ago. Now only the ugly and the fleet remain: cartoonish warthogs with sinister tusks and a peculiar habit of running with tails held vertically erect, and the diminutive dik-diks, antelope measuring only 14 inches high.

Along this road ten Marabou storks, four to five feet tall, were standing in a characteristic cross-legged posture. Unlike the beautiful, elegant creatures of legends, the Marabou is more of a vulture poorly disguised as a stork. Its plumage is indeed a lush turquoise, displayed in the stork’s odd practice of facing the sun with both wings spread, like a fully-robed pope blessing the masses. But the head attached to that hunchbacked trunk of feathers is all vulture: red, wrinkled, bug-eyed, and bald, with a protruding bill designed to rip apart carrion.

These Marabou had gathered around a pool of water maybe 20 feet in diameter. We stopped the Land Cruiser and walked toward the water, where the fetid stench of death hung heavy. The evaporating pool contained two kinds of fish: a nondescript silvery variety and shiny black catfish—thousands of fish in all, piled together so densely that the top layer was completely out of the water. Thousands more, dead and dying, lined the muddy sides of the pool. As the land-locked fish near the edges scrabbled desperately back toward the water, the incesssant flapping of thousands of fins made an eerie background accompaniment to the smell and sight of death. The storks stood by, quietly waiting. They had eaten their fill, and would do so for many days until the pool had dried up and no fish were left to die.

That was the only water hole we passed on an eight-hour trip, and I thought of it often as I observed what is happening in the African nation of Somalia. An ancient and handsome people are nearly marooned in a land of vanishing resources. For three straight years in the late seventies it did not rain in Somalia, and potholes, lakes, and even the two significant rivers dried up. (Somali children count their birthdays only in years when it rains, and today if you ask an 8-year-old girl her age she will likely reply “three.”) Water is only one of the endangered resources. Trees are disappearing too, at an alarming rate. The ones that remain are being cut for firewood and few new trees are growing. They stopped propagating after all the elephants were killed off by the ivory hunters. Before then, the elephants would munch vegetation, digest it, and deposit the seeds in moist clumps of fertilizer all over Somalia. No longer.

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Somalia can barely feed its people in the best of years. Only 15 percent of the land is arable, and that consists of a terribly thin layer of topsoil that must be carefully cultivated. But now the scourges of drought, famine, and a war with Soviet-backed Ethiopia have driven the nation to the edge of disaster. In the past three years, one-and-a-half million penniless refugees have streamed into the country, many of them a few days away from starvation. No one knows the nonrefugee population, but estimates range between four and five million. Any nation would find it difficult to absorb 30 percent more people bursting upon its population, but for Somalia it is impossible. Somalia ranks as the fourth poorest country in the world, with an average annual income of $115.

Somalia now contains the greatest concentration of refugees in the world. As a result, it has become the center of a great flurry of relief activity. The familiar ones are prominent: the Red Cross, the Church World Service, the Swiss government—logos that follow disasters across the globe. The United Nations High Commission on Refugees, recipient of the 1981 Nobel Peace Prize, coordinates the 40 refugee camps. But the most visible relief activity involves a new breed of Christian organization, mostly evangelical: World Vision, the Mennonite Central Committee, World Concern, American Friends’ Service Committee, International Christian Aid, MAP International, Seventh-day Adventist, World Service, Food for the Hungry, Tear Fund, the Assembles of God, and the Southern Baptist Convention.

Muslim Somalia might seem an unlikely place to find such a hum of Christian activity, since estimates of the Somali Christian population range from 14 to 50 people (precise numbers are difficult to determine since “closet Christians” exist and some avowed Christians are probably secret police). The presence of so many organizations reflects a remarkable development in the giving habits of American Christians.

While the news media have eagerly chronicled the rise of Moral Majority and TV evangelists in the U.S., few observers have noticed a simultaneous explosion in growth among organizations committed to Christian relief and development work overseas. Two examples: World Vision, based in Monrovia, California, has seen its income zoom from $30 million in 1975 to $150 million in 1982. World Concern, with headquarters in Seattle, started with a $67,000 budget in 1975; its income now exceeds $15 million. It is boom time for relief work, and nonprofit agencies descend on ailing countries such as Somalia with the same enthusiasm multinational companies show toward economically healthy Third World countries.

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The sudden plunge into relief work in countries like Somalia has altered the nature of Christian mission overseas. World Vision, the largest evangelical relief agency, had intended to include proclamation of the Christian message as a major thrust in all its programs. But recent political events have forced directors to amend that policy. Each of the Christian agencies in Somalia must similarly restrict its activites—the Somalian constitution forbids Christian evangelism. Somehow the Somalian government obtained an internal memo of one U.S.-based relief agency. It reported that staff “have had extra time recently to witness of Christ.” The organization was very nearly thrown out of the country. Christians sharing food and medicines are one thing; ideas are an entirely different matter.

The leaders of evangelical agencies who agree to such conditions justify it in two ways. Some talk in hushed tones about a grand strategy to “soften up” the Muslim (or Communist) world for future Christian penetration. “After all,” the president of one group commented, “nothing has worked for those people in the entire history of missions. At least we are allowed into those countries which are sealed off from traditional missionaries.”

Others, however, profess no ulterior motives, viewing their activities as a natural expression of Christian love and mercy. The president of World Concern, Arthur Beals, credits the boom in relief work to a raised consciousness among evangelical Christians:

“In the early part of this century, when the fundamentalists split with liberals, they rejected not only liberal theology but also the liberal commitment to social action for the poor and oppressed. Somehow those actions seemed less Christian than direct evangelism. Fortunately, that has changed in recent years. People have come to realize that when Jesus fed the 5,000 or healed ten lepers he did not first distribute questionnaires to determine the beliefs of his audience. In fact, 75 percent of Jesus’ recorded ministry was to meet physical and material needs. Relief work is not a question of being a liberal or conservative, but rather of being faithful to Christ’s example.”

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Halba 1

World Concern, a midsized but rapidly expanding Christian relief agency, was one of those called upon to respond to the refugees’ plight in Somalia. In April 1981, World Concern workers agreed to administer medical aid at one particular camp, Halba 1, just 40 miles inside the Ethiopian border. In many ways their experience serves as a microcosm of relief work in Somalia, the type of work that lurches into action whenever a major disaster strikes. I traveled to Halba Camp to view firsthand the relief work supported by millions of Americans who respond to fund-raising appeals.

Today, the refugee camp appears as a series of igloo shapes that hug the horizon and stretch out in hummocky rows for miles in every direction. In Somalia, fortunately, the refugees provide their own housing: a dome fashioned by bending long sticks toward the center of a circle and wattling other vines through the supporting sticks. Grass, burlap, plastic, or paper is woven through the sticks, or thrown over the top, as protection from the elements. From the distance, all the clustered huts appear the same, like some Boy Scout Jamboree with standard-issue shelters, but up close they’re seen to be custom-made.

A plume of dust announces a visitor’s presence miles in advance. Upon the arrival of any vehicle, scores of children, dressed in rags, fill the dirt paths that wind among the huts. Drivers thread their way carefully through the camp, alert for children who dart out without warning; striking one of them could start a riot. The children clamber around the vehicles, chasing them and giggling loudly. This, says a World Concern worker, is the most noticeable change—six months earlier those malnourished children lived a torpid, almost motionless existence. Now the visible signs of malnutrition have disappeared and Halba children are as active and exuberant as any on a U.S. playground.

The refugee women stand by their huts to watch the commotion. They have a striking beauty—visitors to Ethiopia and Somalia often remark that women there are the most beautiful in the world. Not much happens in the daily routine of a refugee woman. Gathering firewood and collecting water consume almost all her daylight hours. Women and children comprise 85 percent of Halba. The scarcity of healthy men is a poignant reminder that Somalia is at war. Some relief workers suspect a high percentage of the men are carrying on a nomadic existence nearby, hiding from the guerrilla recruiters who make unannounced visits and forcibly conscript all males.

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In spite of occasional reminders of a lingering war and its recent history of death and despair, Halba Camp today seems peaceful and calm. There are no more children with orange hair and bloated bellies, no more old men with wasted flesh clinging to their bones, no more despairing mothers with empty breasts. The women devotedly care for their children, who play games and chase each other through the camp’s winding paths. Older children receive instructions in the Koran at makeshift schools in the camp. One relief worker confided to me his belief that now one-third of the refugees are not primary victims of war or famine but rather are local nomads who have settled down to enjoy the free services of the stable camp.

Halba was not always so tranquil. At night, around the campfire outside the kitchen, veteran relief workers tell the history of Halba Camp to visitors and new recruits. Just one year before, Halba looked like a chthonic scene from Dante. When World Concern moved in, medical supplies ordered months before had not yet arrived, and no food had reached Halba in five days. Sixty thousand refugees were ready to mutiny. As staff members surveyed a site to erect a makeshift clinic, an old man rushed up to the group, shaking a stick, and screamed, “We don’t need a clinic! We need food. Can’t you see our babies are starving?” As if to support his words, several Somali women silently pulled out their breasts to show how flat and milkless they were. Other women begged the Americans to take their children away to another country where they would have a chance to survive.


Seven people from World Concern could not possibly provide medical care for 60,000, 70 percent of them suffering from severe malnutrition. At least 30 babies were dying each day in Halba Camp.

The rainy season had brought a plague of flies and mosquitoes. Scores of flies crawled across every refugee child’s face, clogging up nasal passages and crawling across the surfaces of unblinking eyes. Dazed and lethargic, the children did not react. The camp doctor, an American, had to take care when sewing up cuts to make sure no flies were caught under his patients’ skin flaps before pulling them together for stitches.

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Medically, Halba Camp was hell on earth. Dysentery, whooping cough, measles, diphtheria, and tuberculosis were breaking out everywhere, their symptoms complicated by the malnutrition. Supplies were hopelessly inadequate.

World Concern headquarters put together an emergency team of ten medical workers by seconding some from a Dutch organization and recruiting two American nurses. All workers entering Somalia carried in 1,000 pounds of supplies as overweight baggage, at exorbitant prices but assured delivery. Within four weeks a vital supply link from the West to Halba Camp was in place. People in Seattle packed a 40-foot steel trailer with medicines, food, furniture, a refrigerator and stove, and an automobile. Two Toyota Land Cruisers were shipped through the free port of Djibouti. Finally, supplies arrived and in six months the situation at Halba improved dramatically.


In America and Europe, TV reports and relief agencies still depict Somalia as a basket-case country, with diseases decimating the masses of starving refugees. But those photos and images are mostly dated. They are used because of the sad truth that hope does not raise money. The fact that people are now receiving food and medicine is not a sufficient stimulus for a giving country; crisis appeals to fear and guilt work far better. Therefore, the remarkable improvements made by the relief agencies in Somalia must go largely unreported to donors. Their own success would kill them.

A city of 60,000 people, with all its basic survival needs and the logistics required to meet them, is now run by a couple dozen foreigners wearing jeans and T-shirts. The expatriate staff responsible for Halba consists of seven nurses from Holland, a Dutch mechanic nicknamed “Golden Hands,” a Finnish midwife and medical director, and 12 Americans (a doctor, four nurses, two community development workers, two cooks, and three support persons).

Even in remote Somalia, a refugee camp is energy-dependent: kerosene for the lamps, propane for the stoves, diesel for the water pump. All food is donated by the West, as are medical supplies. The usual nomad/visitor relationship has been reversed. Under normal conditions, nomads would have the advantgage over Westerners of being able to live off the land. Now the war and drought and resultant overcrowding have made refugees totally dependent on the relief workers and their steady stream of supplies—an umbilical cord to the West that sustains them. If supplies were interrupted for a week or ten days, people would begin to die.

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Although living conditions have drastically improved with restored supplies, some difficulties remain for the relief workers, obstacles to comfort not normally encountered in Finland, Holland, and the U.S. First, there is the heat. Somalia has two seasons, rainy and dry, better known as the mud season and the dust season. Since Halba is barely 100 miles from the Equator, both are mercilessly hot: a steamy heat and a searing heat.

The rainy season brings the flies and mosquitoes. Later, as the rains drift out to sea, strong winds, stirring up choking clouds of dust, dry up most breeding grounds and offer respite from those insects. But in the dry season scorpions emerge from hiding. After a scorpion stung her arm, one Halba nurse was incapacitated for three days and required a Novocain shot every four hours. She described the pain as “childbirth multiplied by 12.” Halba’s only doctor, John Wilson, was stung in the face while sleeping days before I visited him. A baby scorpion had crawled up the slope of his tent and then dropped onto his face. He awoke in searing pain, fumbled around for his shoes and flashlight, and went to find the nurse for an injection. Just outside the tent he stepped on a squirming 5-foot-long poisonous snake. On the path to the nurse’s tent he spotted four more scorpions glowing phosphorescently in the darkness. Halba is a far cry from North Carolina.

Relief workers must also avoid the dangerous crocodiles lurking in the Juba River. One refugee, a pregnant woman, met her death while bathing there. Onlookers saw the flash of a horny snout, heard a cry of terror, and watched helplessly as a trail of bubbles disappeared downstream.


What attracts people to a daily regimen of low-paid work under the equatorial sun with few of the amenities of modern life? Wilson, a soft-spoken, silver-haired pediatrician from Black Mountain, North Carolina, mentions a sense of duty. “Sometimes I feel like Jonah out here—I came because 1 thought I should, whether or not I felt like it. My father was a missionary doctor in Korea, beginning in 1907, the only doctor serving 5 million people. I have worked in Korea also, among 10,000 leprosy patients after the war. Over the years I’ve come to believe I ought to tithe not just my money but also my time to God.”

In addition, Wilson refers to the attraction of medical pioneering. “After seeing hundreds of children all year who may have nothing more serious than a runny nose or a sore throat, it does something to me to come over here and have a part in saving lives.” The doctor who preceded him performed one memorable appendectomy by flashlight inside a tent during a driving rainstorm. He used two tablespoons as retractors and dish towels as sponges. In Somalia, a dental hygienist pulls teeth and performs basic oral surgery. There are no insurance bills to pay, no malpractice suits to worry about. Most relief workers, in fact, are surprised by the resigned fatalism of the Muslim patients, who do not cast blame or complain if a treatment fails. If a baby dies, Allah has willed it.

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The government of Somolia observed health care in the refugee camps of Thailand, Bangladesh, Malaysia, and the Philippines, and concluded they were too dependent on a Western mode of treatment. Therefore it decreed that most of the health work in the camps be carried out by volunteer Somalis trained to treat the most common ailments. Twenty diseases are officially recognized and posted in bold print in all the clinics (a category numbered 21 is labeled “other”).

Sixty thousand people living in close quarters, with poor sanitation and a breeding ground for flies and mosquitoes nearby, combine in what one camp worker calls “a time bomb of communicable disease.” Diseases like measles and whooping cough hit the camp in waves, taking the weak. Nearly every refugee in the camp has some latent form of malaria. Expatriate relief workers drill their Somali volunteers in the symptoms and treatment of those top 20 diseases. The health workers get no pay or special treatment and they, too, must roam for water and firewood and care for their families. Yet most take their training so seriously that some nurses estimate 90 percent of the health work could continue if all expatriates left. “They’re the best thing we have going,” one said. “We’ll all be gone someday, but they will stay. If we do our training right, they can permanently change the culture for good.”

In just six months, relief workers have moved Halba Camp from a flashpoint of disaster into an organized community with basic food and medical needs supplied. Short-term emergency goals have been met. A far greater challenge looms ahead: dealing with the long-term implications of the refugee crisis. Indochinese refugee camps were holding stations where refugees waited until Western host countries could absorb them. In contrast, no one is lobbying to relocate Somali refugees in other countries. And yet, few observers there judge the nation of Somalia capable of absorbing them. As long as the war drags on, refugees cannot return to their homelands.

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While Somalia has extended an open hand to scores of relief agencies, which in turn have made giant strides toward stabilizing the refugee problem, every outside interference brings its own long-term consequence. Refugee camps, for example, ruin the grazing capacity of the land. As nomads, Somalis never stayed in one place long enough to cause irreversible damage to vegetation. But drilling a borehole or providing a water supply at a stationary camp allows the livestock and goats to trample the ground until the root systems of vegetation are permanently destroyed. A seeming improvement, a well, actually proves to be destructive.

The communal search for firewood also denudes the landscape. Halba Camp was first located in the shade of a forest, an unheard-of luxury among Somalia’s camps. Each month, however, the number of trees shrinks as refugees ignore rules and tear down some of those remaining. Refugees must now walk 8 miles for firewood. Soon they will walk 10, then 12. Goats and donkeys will eat the new green shoots of trees, and in a few years the forest will vanish, replaced by the desert. For the people at Halba to survive, massive changes must come. But no one seems very sure what those changes should be.

The camp director has one idea: he is now teaching Halba’s children to fish in the Juba, where a fast-growing species called talapia abounds. Somalis in the camp have never tasted fish—hundreds starved to death within sight of a river glutted with them. The children are trying the new idea, to the disdain of their parents. Agriculture faces even greater resistance. Before returning to the U.S., John Wilson sketched out a crude design for a passive-flow irrigation system. The Juba falls sharply near Halba, and a pipe buried in the river upstream could follow a downward slant and provide energy-free water for irrigation. If money can be found, the Halba workers may install such a system. But there is no guarantee that the Somalis will use it. Their abhorrence of the settled agricultural life runs deep. None of them has shown any interest in the camp garden.

“Water is the best feature of Halba Camp,” says Wilson, “but it is also the biggest health problem. We could probably prevent half the illnesses in this camp if we could just teach the refugees not to drink the river water. We have a German-built filtration system that pumps river water through three treatment tanks. It’s not totally pure—if we purify it completely, then the infants will grow accustomed to distilled water and will build up no resistance to the germs they’ll find in water when they leave the camp. But the refugees at the extremities face a difficult choice. Should they take our advice and walk three or five miles for filtered water, carrying a heavy load back to their huts? Or should they do as they have always done and scoop it from the river a few hundred yards from their homes? So far, only a few of our Somali health workers have been effective in warning them against drinking the river water.”

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Relief workers don’t talk much about another problem that, to their executive officers back in the U.S., looms as the largest long-term problem of all. Will fickle American givers, who underwrite their salaries and life-giving supplies, grow tired of Somalia? Before long, word will reach U.S. contributors that the crisis in Somalia has faded somewhat, and funds will surely drop off. Relief organizations are at the mercy of the cruel realities of fund raising. They need a crisis atmosphere to sustain interest in Somalia.

The executive director of one major relief organization, who asked not to be identified, expressed his dilemma this way. “I tell you, the temptation is very strong for me to start up an ‘Adopt a Child’ program, whether it is needed or not. Those adoption programs are guaranteed fund raisers, although they are bureaucratic nightmares. Since the government started scrutinizing them several years ago, some agencies now spend $12 of each $17 they take in on the overhead, just to keep track of the children and communicate the specifics to the donors. I can’t justify that.

“We got talked into Guatemala by another relief agency, and I’ll always regret it. So much food was dumped down there after the earthquake that it put the local entrepeneurs out of business. I have vowed to stop ambulance chasing. I won’t go into a country that suddenly appears in news headlines just to clean up on the fund-raising dollars that are sure to follow. But to do any kind of meaningful development, I must feature the crisis aspects of a place like Somalia. I admit it, our film footage is a year old. But people will give money on that emotional appeal. About half the donors will specify their gift for emergency food or medicine supplies. The other half will check ‘Use as needed,’ and that’s all the money I have to work with for true development activities.”

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The field of health services provides the most striking example of the conundrum of relief work. People will eagerly donate drugs and medical supplies to combat outbreaks of diseases. Mission hospitals readily attract donors. And yet, as wise health professionals know, those responses to health problems do not attack the underlying causes of disease. Civilized countries experienced steep declines in the incidences of bronchitis, pneumonia, influenza, tuberculosis, whooping cough, measles, and scarlet fever long before any effective immunization or therapy became available. Improved nutrition and sanitation did far more to disarm those diseases than any treatment devised by medical science. Parisian sewers were more effective than a hundred hospitals. The World Health Organization estimates that 80 percent of all health problems in the Third World relate to polluted water supplies. But try to raise money to clean up a river, or install a passive irrigation system, and you won’t cover the cost of the mailing.

“A million people are plunging like lemmings off a cliff,” muses one relief worker. “We can easily raise money to pick up the survivors and nurse them back to health. But there are no funds at all to set up prevention and warning programs at the top of the cliff.”

For the present, it seems, relief agencies need situations like Somalia as badly as Somalia needs relief help. The experience of that country summarizes everything right and wrong with relief work. For the short term, relief agencies have worked miracles. Masses of people have been kept alive, fed, and medically treated in an extraordinarily brief period of time. The logistics of a poor country with no infrastructure absorbing a 30 percent increase in population have somehow been overcome. For the moment, the crisis in Somalia is no longer a life-or-death matter, as long as the tenuous thread of help from the West stays intact.


No one knows, though, what might happen in the long term as the focus changes from relief work to development. Money itself is no guarantee of success in development. Africa’s greatest previous crisis was a devastating drought in the Sahel Desert that killed up to 100,000 people and 20 million cattle. In the past ten years a consortium of European agencies has spent $8 billion to “drought-proof the Sahel.” Yet realists admit that the Sahel is no better off now. Mismanagement and ecological complexities have undermined any hope for substantial change. The Sahel continues to encroach on fertile land. Some relief workers predict that in a decade or two there may not be a single surviving tree left in the entire region.

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The Somalian government is just beginning to adjust to the fact that the camps—40 cities spread across Somalia—may turn into permanent settlements of squalor, somewhat like the Palestinian camps. Yet the land simply cannot support that kind of concentration; finite water and firewood resources will not allow it. Will the Somali nomads forfeit an entire cultural history and embrace agriculture or industry or fishing? Will the West continue the massive outpouring of aid required to support such a change?

The relief workers in Somalia are just now beginning to consider such questions. Their experience there vividly illustrates a universal principle of relief work: in relief work, as in wars, it’s easier to get in than to get out.

Philip Yancey is editorial director of Campus Life magazine. He adapted this article from his book, Open Windows, published this month by Crossway Books, and used bv oermission: copyright 1982 by Philip Yancey.

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