LONDON (AlertNet) - The possible use of weapons of mass destruction (WMD) has become a central concern for relief workers, acutely aware that they are dependent on the military as they prepare for a potential conflict in Iraq.

British NGO Merlin and the London School of Hygiene and Tropical Medicine (LSHTM) have completed a study of what agencies need to consider and how they could build up their capacity to work independently.

The report, "Hope for the Best, Prepare for the Worst: How humanitarian organisations can organise to respond to weapons of mass destruction", considers the options for organisations that may find themselves close to the scene. It invites relief agencies to pool resources to equip themselves to respond to conflicts or accidents involving chemical, biological or nuclear agents.

"With the possibility of an impending war in the Gulf (plus ongoing tension in Kashmir), NGOs may suddenly find themselves needing to support people affected by a WMD scenario," Chris Piper, director of Australian agency Torquaid, said in a discussion forum on the aidworkers.net website (www.aidworkers.net)

Jane's Terrorism & Security Monitor, an authoritative publication that monitors and analyses military developments, suggests that if U.S.-led forces invade Iraq, it might launch biochemical weapons against Israel.

Dr Muzaffer Baca, of Turkish NGO International Blue Crescent, said Saddam Hussein's government might attack Iraq's Kurdish and Shia populations.

Merlin chief executive Geoff Prescott told AlertNet. "We're anxious about anywhere in the world where there are chemical or biological weapons. Maybe the Middle East is catching everyone's imagination, but we've got to think beyond that. This is going to be an issue for a while to come."

"We're anxious about anywhere in the world where there are chemical or biological weapons"

The Merlin/LSHTM report says: "This is not the time for deal-making or muddling through. Openly debating the role of humanitarian actors and the dilemmas that will surround them in a WMD crisis should also garner public support to help NGOs rise to what will be, even in the best case scenario, a terrible challenge."

Charles Kelly, a specialist in emergency relief and disaster mitigation, wrote in The Humanitarian Times: "Should (humanitarian relief organisations) curtail operations and withdraw personnel... or reinforce their local capacities to provide humanitarian assistance in the event of an attack by a weapon of mass destruction?"

NO CAPACITY

Paul Sherlock, senior humanitarian representative for Oxfam GB, told AlertNet that NGOs had no experience of dealing with these questions.

"If weapons of mass destruction were used (in Iraq), we would withdraw our staff immediately, until the U.N. and the military gave some sort of clearance," he said.

"There is no way at all that Oxfam or any other NGO or the U.N. can operate in an environment of that nature."

Prescott said: "To go into the epicentre is really difficult at the moment, because we're not equipped. In terms of normal public health -- dealing with displaced people, building camps -- that capacity exists, but it needs enhancement. People fleeing from a contaminated area may need decontamination before they enter a displaced camp. And that (capacity) we don't have."

"It's something we'd like to change," he said.

"There is no way any NGO can operate in that environment"

According to the Merlin/LSHTM report, the most likely scenario is that NGOs would want to assist people fleeing exposure to biochemical agents.

Organisations might feel compelled by their humanitarian imperative to help people at the site of an attack.

Another possibility was that NGOs could be called on to travel through potentially contaminated areas to reach people not directly affected.

Merlin and the LSHTM looked at whether NGOs were equipped to assess the risk of entering an area or receiving people who might be contaminated.

They also analysed realistic methods of protection, before and during exposure.

"Specialist clothing and equipment such as respirators and filters are prohibitively expensive, largely single use and require repeated specialist training for safe use -- putting them beyond the reach for most humanitarian organisations as individual organisations," the report said.

It says that protective suits restrict movement and communication and would increase patients' fear.

Decontamination of people exposed to chemical agents could be effective without extensive resources, the report says, but would need to take into account personal and cultural dignity and fresh clothing.

There are vaccinations for several biological agents, such as bubonic plague, but many require doses over months. Immunity is not guaranteed and there are health risks.

CONSIDER VACCINATIONS

The report suggested that aid organisations should consider vaccinating staff against smallpox and anthrax and that they may need to review their systems of pre-departure advice and informed consent.

"Specialist clothing and equipment are prohibitively expensive"

It also emphasised that making information available about medical response, self-help and evacuation for communities likely to be affected was one of the most valuable activities that NGOs could offer.

Any assessment of risks to plan appropriate action would require knowledge of the agent used, how it was dispersed, how long it would remain active in the environment, and whether exposed people required decontamination or isolation, the Merlin/LSHTM report said.

It said NGOs should examine their capacity for independent risk assessment, since governments and military actors might not be forthcoming with information in a war zone.

"There may be instances when it is not in the interests of the military parties to reveal the nature of the agent/s that have been released," the report said.

"It may also be politically expedient for governments to describe events in such a way as to, for instance, emphasise the evil-doing of the adversary, or dissuade non-military witnesses from entering an area."

Prescott said: "You need this capacity somewhere even if it's small and lightweight. By keeping neutrality, it would be able to bring matters to the world's attention if there have been chemical and biological incidents to make sure that resources are marshalled in the best way to favour the innocent casualties."

The Merlin/LSHTM report argues that NGOs are more independent than any other actor, and emphasises that if, the United Nations sanctions a war on Iraq, it will become an aggressor itself.

"Neutrality does save lives," said Prescott, "because, if you're allowed access to areas and to people who are suffering where others aren't because they're not seen as neutral, then it counts."

"We will need help -- in the first stage only -- from Western governments"

The report considers the ethical restrictions on contact with the military, but says NGOs will have to access military information structures well in advance if they want to respond in the first hours or days after an attack.

Prescott told Reuters: "Our goal is to establish an independent, neutral humanitarian capacity to respond to casualties of mass destruction anywhere in the world and to gain that we will need to get help -- in the first stage only -- from Western governments."

INDEPENDENT FROM THE MILITARY

The report says: "Some NGOs may opt out of any involvement with humanitarian assistance in the crisis on the grounds that it is not possible to act independently or safely without collaborating with the military and political forces, with the consequent damage to humanitarian reputation.

"Others may decide to accept donor money and try to build their own capacity without any collaboration with the military.

"Others may accept some practical collaboration with the military and belligerent donors in the hope that they will be able to fulfil their own mandate.

"Still other organisations will enter the arena only well after the event as guided by their donor governments."

Sherlock said: "The military controlling the environment (would) have been the power which would have attacked and done the damage. That would make it very difficult ethically for organisations like Oxfam."

A decision not to respond also requires preparation, the report argues. "It will be crucial for NGOs to be able to explain clearly and with precision the reasons for their absence if they are not to lose public, and potentially donor, support."

"Some NGOs may opt out of collaborating with the military "

Few if any NGO medical staff have the knowledge to cope with a biological, chemical or nuclear attack. Kelly said: "NGO guidelines to do not address radiation illness and blindness, skin loss from vesicants (chemical agents that cause blistering) or mass burns."

"A lot of the weapons work by stopping breathing, so you need to keep people oxygenated," explained Prescott. That usually means sticking a tube down someone's throat and pumping their lungs full of oxygen. In field conditions that's quite a complex matter."

Prescott said transporting and administering vaccinations and antidotes also presented challenges.

Merlin and LSHTM suggest that NGOs willing to have limited contact with the military could request training for a core multi-agency team.

Prescott said that Merlin was not seeking to propose itself as a lead agency but wanted to start the debate.

"We're at the birth stage," he said.

The report said NGOs could find themselves playing a crucial role in mental health support for people exposed to risk. They could act as a buffer between fearful host communities and an influx of terrified and potentially contaminated victims to prevent or deal with panic, rumours, discrimination or aggression.

The report warns NGOs that, if agencies are unprepared, they could make life worse for vulnerable people.

"If the worst does not happen, we will be euphoric"

"Multiple foreign organisations, overlapping agendas and conflicting messages (could increase) confusion and anxiety, rather than (decrease) it.

The report forestalls the criticism that time and resources could be wasted in preparing for an eventuality that never occurs. It concludes: "If the worst does not happen now, we will be euphoric. We will also be prepared, for next time."

Click here to see the full Merlin/LSHTM report