Though much focus is currently on humanitarianism in response to recent events such as the conflict in Syria or the migrant crisis in Europe, humanitarian responses in times of conflict and war have been evolving since the 18^thcentury. This evolution was explored in the recent Medicine, History and the Humanitarian Response panel discussion that was part of LSHTM week 2016. The panel was chaired by Karl Blanchet (Associate Professor in Health Systems Research, Director of the Health in Humanitarian Crises Centre) with panellists Anne Hardy(Honorary Professor of the History of Public Health) and John Manton (Assistant Professor in the Department of Social and Environmental Health Research) bringing their insights to the topic. Some of what was discussed is captured in this blog.

The history of humanitarianism in conflict begins with the French Revolutionary and Napoleonic Wars between 1793 and 1814. It was in the latter war that the Duke of Wellington, fighting in the Iberian Peninsula with a smaller army than his opponent, came to value his surgeons for their ability to preserve military manpower – allowing soldiers to recover and return to the field of battle more quickly. This experience in turn brought a new professionalism to military medicals, which led Sir James McGrigor, the military Surgeon-General, to commission The Army Medical Officer’s Manual upon Active Service, published in 1819. Covering every aspect of military medical management from setting up camp to the provision of ambulances, the Manual was intended to act as a guide for surgeons engaged in future conflicts, when those who had experienced the war in the Peninsula were no longer there to advise. Forty years of peace, and of military economies meant however that, even with the Manual, by the time of the Crimean war these lessons learnt had been forgotten.

A second, lay, strand of humanitarianism emerged when Henri Dunant, a Swiss businessman, was so appalled by the utter neglect of wounded soldiers by both the Italian and Austrian commands at the battle of Solferino (1859), part of the Second Italian War of Independence. From this, he conceived the idea of the Red Cross, which rapidly became an international organisation of national units dedicated to the care of sick and wounded soldiers. Dunant was also instrumental in achieving the first Geneva Convention (1864), which established protection for prisoners of war, the sick and wounded, and civilians in conflict zones.

Humanitarianism again evolved in World War I when the importance of non-combatant, neutral countries in administering humanitarian aid became apparent. The Danish State Serum Institute furnished vast quantities of much needed vaccines and sera (protective against, for example, tetanus) to armies on both sides of the conflict. Its Director, Thorvald Madsen, in partnership with the Russian Red Cross, also became involved in sorting out the terrible conditions existing in prisoner of war camps in Russia.

The Nigerian Civil War (also referred to as the Biafran War) was fought from 1967 to 1970 and led to a famine crisis and humanitarian emergency in the secessionist State of Biafra and was the first televised famine. A combination of Irish Catholic missionaries with a long-standing and unashamedly partisan local presence, radicalized medical workers, and the propaganda-savvy Biafran regime elicited unprecedented personal donations from publics across Europe and North America. These groups put together an aid airlift and a mass food distribution programme inside the besieged and rapidly shrinking Biafran territory. The prominence of the relief programme, and its galvanising effect on public and humanitarian opinion owed much to its reliance on already-existing missionary administrative networks, and to a willingness to deploy partisan arguments and new media technologies that made capturing and broadcasting film easier.

These networks and methods were transformed into a new humanitarian grammar, politicised and trenchant, and decidedly non-governmental. The Biafran relief programme also transformed the organisational principles of humanitarian work. Humanitarians were charged with having prolonged the conflict, by abetting the survival of the Biafran regime; indeed, many of the charges levied against non-governmental humanitarian work derive their logic and their energy from critique of the Biafra programme. As the foundational moment for the forms of activist humanitarianism and crisis response embodied by MSF and Concern Worldwide, it has had a profound impact on our contemporary humanitarian landscape.

Every large crisis has been crucial at boosting components of the humanitarian system. At the Khmer-Thai border in the 1980s, humanitarian organisations started to elaborate guidelines and medium term strategies to support lives of Khmer refugees fleeing the Pol Pot regime. The response to the Rwanda genocide (April-July 1994) demonstrated the link between politics and humanitarian response and the importance of accountability and evaluation. The Yugoslavia war in the 1990s highlighted the lack of power of humanitarian organisations in the absence of strong political decisions. Finally, recent natural disasters in the absence of conflict (e.g. 2010 earthquake in Haiti and 2011 tsunami in Japan) were determinant at showing that the scale of these disasters cannot be tackled with the current level of humanitarian resources.

Humanitarian efforts have evolved throughout history from being run by governments and focused almost solely on the health and wellbeing of armies to extending protection and care for all citizens affected by conflict and having a stronger charitable and political motivation. Each new conflict or crisis drives changes to the way academics, governments, charities and the general public view humanitarian efforts. It is important to reflect on and learn from successes and challenges of humanitarianism in past conflict in order to best help those living in conflict now and in the future.