Blood, War and Disaster: The Red Cross to the Rescue

The Red Cross evokes images of everything from beginner's swimming lessons to shelter for Midwestern flood victims to embattled first-aid workers in a remote war zone. Swift, reliable, and effective in the aftermath of a disaster, the International Red Cross and Red Crescent Movement is all these things. How does the organization manage to be ready for emergencies in so many different places at once? Who started it, and how is it funded around the world? In this Collier's Year Book article, journalist Steve Turner takes a look at the workings of the world's largest humanitarian network.

Blood, War and Disaster: The Red Cross to the Rescue

Sometimes even cataclysm isn't a strong enough word. The spectacular explosion in the Philippines of the Mount Pinatubo volcano in June 1991 was bad enough by itself. But it was also the kickoff of a plague of other destructions. Even as pyroclastic flows were searing mountain-slope villages and farms, a typhoon struck, spreading and settling Pinatubo's plume of ash in deep, soaked drifts over a 20-mile radius. The farmlands that it fell on were ruined for decades to come. Meanwhile, torrential rains brought deadly slides of ash and mud down on other villages. Earthquakes added to the terror, and the tremors helped water-soaked ash to collapse the roofs of buildings. The falling volcanic material and the mudslides blocked waterways swollen by the rains, forcing further floodwaters out from streams that already were destroying highways, railroads, and bridges.

It seems miraculous that no more than several hundred people died. But a lot of the credit for the low death toll goes to the Philippine National Red Cross (PNRC) and its planning and preparation for disaster aid.

The PNRC had actually been on the Pinatubo scene since April, when the volcano gave its first warnings of impending eruption. The government had been urging evacuation, and the PNRC set up evacuation camps, readied supplies, and got set for the big blowup when it came.

Within two weeks after the June 9 eruption, the PNRC was operating some 250 camps of its own—and cooperating with the government in running about 60 more—sheltering, feeding, and providing first aid to over 133,000 evacuees. In typical fashion, the PNRC took the opportunity also to start special feeding programs for malnourished children in the camps, to teach home nursing skills, and to offer training in community health and hygiene.

The effort drew on PNRC resources, staff, and volunteers at the local, regional, and national levels. But relief work was going on far beyond the Philippines' borders: backup assistance came from the international League of Red Cross and Red Crescent Societies. The League, headquartered in Geneva, Switzerland, sent advisers, shipped tents and other supplies, and channeled donated funds from around the world.

The story of the Mount Pinatubo relief work gives a glimpse of the worldwide Red Cross/Red Crescent Movement in action. But that glimpse also opens up a mystery of sorts. Despite the fact that a vast number of people around the globe have encountered—or at least have heard of—Red Cross/Red Crescent programs, few really know what this multimotored presence is: who authorized it, how it works, what it all does.

And did it really evolve pure from that elixir so often missing in world affairs, the milk of human kindness?

For starters, why is something that does all this concrete work called a "movement"? The answer is that the component parts of the Red Cross/Red Crescent Movement around the world are independent bodies, bound together more by common principles than by legal ties.

The League, one of the two major components, is paired worldwide with the other—its smaller but potent parent, the International Committee of the Red Cross. The ICRC is the guardian of the famed Geneva Conventions, protector of the war-wounded, of prisoners of war, of battle-trapped civilians.

The League, meanwhile, concerned mainly with civilian affairs, is a global federation of some 150 autonomous national Red Cross or Red Crescent societies with a total of more than 250 million members. (National organizations in 26 wealthy countries are considered "donor" societies; the rest are "developing" societies.) The League is, by far, the largest non-governmental disaster relief organization in the world.

In wartime situations, it is the ICRC that coordinates relief efforts, in addition to its work protecting prisoners. Outside of war zones, however, it is the League, more than any other world organization, that daily acts on the knowledge that there will be more Pinatubos, more giant earthquakes, floods, evacuations. The League urges its member national societies to plan and prepare as the PNRC did, supplying them with experts and information to help the process along. And it prepares itself to help the member societies when disasters come.

"We have warehouses in Marseille, in Costa Rica, in various parts of Africa and Asia," says Ralph Wright, a League spokesperson, "where we keep things that are hard to come by quickly: tents, plastic sheeting, certain medical equipment." Food? Not usually, says Wright, because that's always available if you have money to transport it. As to rolling stock, "We expect our national societies to have enough vehicles to lend in emergencies, and we ship them in as needed."

The national societies are the other parts of the movement, and their number changes as new countries form or old ones combine. But their basic role is constant: to support the activities of the ICRC and to operate and cooperate in providing relief and humanitarian services with and through the League. The national societies are self-directed, tied together only by their common allegiance to the movement's guiding principles. Their local programs range from first aid courses to reforestation, blood collection to AIDS prevention, medivac airplanes, post-disaster feeding and shelter, and many more.

In essence, the Red Cross/Red Crescent Movement—stretched thin, with many holes and patches—is a kind of worldwide safety net.

The history of Red Cross/Red Crescent actions is like an unending script for Indiana Jones: dealing with fires, tidal waves, collapsing buildings; digging out victims; feeding the hungry; tending the sick; braving hostile fire to bring the vaccine through. Volunteers and staff members for the League, the ICRC, and the national societies have been the unsung heroes—and sometimes martyrs—of countless perilous situations.

But in most countries around the world, the name Red Cross or Red Crescent (Rotes Kreuz, Al-Helal Al-Ahmar, Cruz Roja, Nihon Sekiji, Croix Rouge) most commonly signifies blood—as in "Lie down please. The needle will sting a little...." The League's national societies collect one-third of the world's transfusion blood supply and help to bring in much more.

It's done differently in different countries—as is true of almost all the League's major efforts. In the Soviet Union, for instance, blood work means only recruiting volunteer donors. In Canada, Japan, and elsewhere, the Red Cross runs the whole show, doing the collecting and processing too. (The Belgian Red Cross goes further, handling blood services within hospitals, while the German Rotes Kreuz actually operates hospitals.)

In the United States the American Red Cross (ARC) collects, processes, and distributes about half the nation's blood supply. But the ARC's program at times has set standards for the world.

The Beginnings. Modern blood transfusion technology is really fairly new. Blood banking didn't even exist at the outbreak of World War II in 1939. But Dr. Charles Drew, the famous American physician, had recently developed the option of transfusing blood plasma, the liquid part of blood, which, unlike whole blood, did not have to be matched to a patient's blood type. Plasma also could be stored far longer than whole blood: it was obviously made to order for battlefield use.

So when World War II began, the sympathetic but still neutral U.S. government began collecting plasma for Britain. "And since the ARC has a charter obligation to support the Armed Forces, and had a national network," says Kathy Houlihan, the ARC's general manager for blood services operations, "we were asked to conduct the program."

When the United States entered the war, the program expanded vastly, with the ARC acting as the national blood collection agency for the military. "After the war," says Houlihan, "the Red Cross said basically, 'We're not a health agency, we're a social service agency,' and each local chapter could decide whether it wanted to become a blood provider for the community. And about half the country's chapters decided that they didn't want to do that."

It wasn't just that the chapters, like national societies, were autonomous in choosing what they would do. It was also that the ARC's charter from the U.S. Congress (the Geneva Conventions require that all signatory governments officially establish national Red Cross or Red Crescent societies) tasked the ARC only to aid the sick and wounded of the Armed Forces in time of war; to serve as a channel for communications and voluntary relief between military personnel and their families; to continue and carry on a system of national and international relief in time of peace; and to mitigate and prevent the sufferings caused by pestilence, famine, fire, floods, and other great national calamities.

No mention of blood work. (No mention, either, of other well-known current ARC programs—among them water safety training for swimmers and boaters, courses in cardiopulmonary resuscitation, support for latchkey children, and AIDS education.)

Blood Banks—Raising Standards. Despite the defections, the ARC's blood program grew quickly and massively to take up nearly 56 percent, for instance, of the organization's $1.3 billion budget for 1989-1990. (Unlike disaster relief services, which are given free, production and distribution of blood products is a "cost recovery" program, which means users are charged the amount spent by the ARC to make the blood available.) Providing blood became a huge enterprise, handling over 6 million units of donated blood per year. But the ARC's blood program began to be hit in the 1980s with charges of variable purity and improper handling procedures at some of its 53 independent regional Blood Centers.

During those years also, the ARC took flak—along with most of the rest of the blood-banking industry—for its opposition to use of the hepatitis-B core antibody blood screening test, which could have prevented, as early as 1983, most transmission through transfusions of the human immunodeficiency virus (HIV), which causes AIDS. The federal Centers for Disease Control had urged that the test be used. Author Randy Shilts, in his prizewinning 1987 book And The Band Played On, demonstrates that opposition by local Blood Centers focused mainly on the expense of the "anti-core" test—and undoubtedly cost many lives.

"Everything's changed since 1985," says Kathy Houlihan. In that year the ARC did begin using a new test for HIV itself. And "we now have five more tests required for donated blood, averaging a new test every 14 months. We can make more components now. The Food and Drug Administration has become much more involved. The complexity has brought computers into the picture. We recognized the need to have one place for policies and procedures to be set, so that when someone got a unit of blood from the Red Cross, it would be the same as every other unit that has a Red Cross label on it."

That's a standard the League can only whistle at internationally, as yet. "The League strongly suggests to national societies that they meet certain qualifications on the medical-technical level," says Ralph Wright. "But as far as what are the actual standards that national society programs have to reach, that's determined by their own national governments."

Translation: blood programs in many developing nations are as low-tech as were the ARC's efforts 20 years ago. And the ARC is plunging further ahead into a much-ballyhooed upgrade, announced in May 1991 after lapses found at ARC centers by the Food and Drug Administration had caused concern that contaminated blood might inadvertently be sent out for transfusion. Starting in January 1992, every Blood Center will be completely refitted, computerized, high-technologized. And the differences within the League in blood work—as in other endeavors—between the donor societies and the developing societies will become even more stark.

As it happens, blood and body parts were what actually gave birth to the Red Cross/Red Crescent Movement. It all began in 1859 when a traveling Swiss businessman, Henry Dunant, came upon the gory aftermath of the battle of Solferino—one of several clashes between Austrian and French armies that formed the modern Italian nation. It was typical of 19th-century warfare: after the battle hordes of wounded lay amid the dead on the field (there were nearly 40,000 casualties in all), largely untended, tormented by sun and flies, lacking water, food, and bandages.

Horrified, Dunant organized volunteers from nearby villages to come to their aid. Haunted by the experience, after returning to Geneva he wrote Memory of Solferino. Published in 1862, the book found wide support with its call for advance preparation for battle casualties and for a neutral organization of civilian volunteers to treat and care for them.

Dunant's idea—that the butchery of the battlefield could be limited by humanitarian rules—was truly a radical concept in an age when militarism had become the principal basis of relations between European governments. The suggestion that combatants should respect the neutrality of medical teams giving aid and comfort to their opponents' troops on the battlefield was no less than revolutionary.

However, as weapons became more sophisticated and more destructive, the increasing savagery of European warfare was literally draining the lifeblood of warring nations, and that set the stage for change. So it was that in 1864, Dunant's vision became real when representatives of 12 European nations signed the first Geneva Convention—a treaty that established the symbol of the red cross on a white background (a reverse of the Swiss flag, in tribute to Dunant's nationality) as an international symbol of neutrality. The Convention set the first rules requiring humanitarian treatment of wounded soldiers. It also called for official national societies which would be solely authorized to use the Red Cross symbol. The Convention established as its central monitoring body the International Committee for the Relief of Military Wounded, which in 1876 became the ICRC. (That was the year also when Turkey, rejecting the Christian implications of the cross, substituted the red crescent as the symbol of its national society. The ICRC was not religiously grounded, but the Swiss flag's Christian reference was inescapable. Other Islamic nations have followed Turkey's lead, and the crescent holds the same status as the cross under the amended Geneva Conventions.)

The Red Cross movement spread rapidly through Europe. Despite parallel developments in the United States, however, the full connection was not made in America until 1882. By happenstance, in the same year that Dunant published Memory of Solferino, Clara Barton, the pioneering humanitarian who founded the ARC, was organizing civilian relief—shepherded by the U.S. Sanitary Commission—for the wounded in the American Civil War. Hauling medical supplies and food to field hospitals, nursing the wounded, assisting surgeons, and nearly losing her life on two occasions, Barton was dubbed "the angel of the battlefield."

Clara Barton traveled to Switzerland in 1869. There she was approached by officials from the International Committee, who urged her to persuade the U.S. government to sign the Geneva Convention. She agreed. But volunteer service for the Red Cross in the Franco-Prussian War, dealings with her family, and her own exhaustion put off the founding of the ARC until 1881. The needed federal endorsement of the Convention—and the charter for the ARC—followed in 1882.

It was the ARC that began an expansion of the scope of the Red Cross/Red Crescent Movement to include peacetime relief efforts. Clara Barton "was a 'disaster' person through and through," wrote Patrick Gilbo in a 1981 article in Smithsonian magazine. In fact, she first used the Red Cross banner in Dansville, N.Y., in 1881 while appealing for funds and clothing for victims of forest fires in Michigan. Red Cross-chartered steamboats took relief supplies to families flooded by the Ohio and Mississippi rivers in 1884, and the organization provided emergency housing and other relief after the legendary Johnstown flood of 1889.

The new focus proved attractive to other national societies—so much so that when the League of Red Cross and Red Crescent Societies was formed in 1919, disaster abatement took center stage.

And so it is today for the League—and sometimes also for the International Committee of the Red Cross. But the ICRC alone still bears the wartime responsibilities associated with the Geneva Conventions. The original stipulations about treatment of wounded combatants and protective neutrality for Red Cross/Red Crescent operations have been expanded several times: to cover war at sea (1907), to protect prisoners of war (1929), to protect civilian populations in wartime (1949), and—in 1977 protocols not yet signed by most military powers—to prohibit warfare that would "attack, destroy, remove or render useless objects indispensable to the survival of the civilian population." (Under that restriction, the bombing of Iraq's infrastructure in the Persian Gulf War would have been a violation of international humanitarian law, right along with Iraq's stripping of Kuwaiti property.)

Unlike the League, which is a federation of its member national societies, the ICRC—as required by the first Geneva Convention—is a private Swiss organization composed of 25 Swiss citizens. Its delegations that enter combat situations to monitor observance of the Conventions are made up solely of Swiss specialists and doctors. Only in its support staff (600 at the Geneva headquarters, up to 2,500 in the field) are other nationalities represented.

ICRC delegations must have the permission of combatant nations before entering their territory to inspect prisoner-of-war camps, hospitals, and prisons. ICRC reports are always confidential, delivered only to the government involved, unless breaches of the Conventions are so flagrant or repeated that an appeal to other Convention signatories is appropriate. "We rarely condemn," says ICRC spokeswoman Jette Soerensen. "If we were to [routinely] publicly condemn, all doors would be closed to us."

But that does not mean the ICRC is passive. Using the power of initiative granted it by the Conventions, it actively seeks to intervene even in civil wars, revolutions, and rebellions. So it is that in the African nations of Rwanda and Burundi, ICRC delegates have worked to prevent tribal massacres. In Northern Ireland, they have visited prisoners taken by the British.

The moral impact of ICRC delegations on the practices of warring governments and groups is indisputable—as is the publicity value of charges that an opponent is not observing the Geneva Conventions. The Conventions and their guardian ICRC have in fact become a worldwide icon of fairness and decency.

The American Red Cross is almost alone among national societies in its high level of peacetime support for military personnel, drawing criticism that in effect it acts partly as a branch of the armed forces. On the other hand, the United States is a principal funding source for peaceable ICRC projects such as the Central Tracing Agency, which keeps tabs on prisoners of war, war victims, and refugees, interlocking its efforts with those of every national society.

The ICRC also temporarily takes over the League's civilian aid functions in wartime situations—whether the need results from war or from nature—because it is the only element of the Red Cross/Red Crescent Movement protected by the Geneva Conventions in zones of conflict. So in strife-ridden and famine-stricken Sudan and Ethiopia the ICRC has been both moral monitor and relief agency.

The financing for all of the Red Cross/Red Crescent Movement's activities is as polyglot as the work that results. Governments that have signed the Geneva Conventions voluntarily assess themselves to support the ICRC's operating budget (about $230 million in 1991). Budgetary goals set by the ICRC offer guidelines, but the political and economic circumstances of the contributing nations—and the health of the treasuries of the national societies, which also contribute—determine whether those goals will be met. About 13 percent of the ICRC's budget is supplied by the United States and the ARC, more than from any other single nation. The League, by contrast, with an administrative budget in 1991 of some $14 million, operates on the basis of required "tax" payments from its member national societies, with the rate set by the League's General Assembly. On a sliding scale, the ARC pays about 25 percent of the total, with the poorest society paying a token 0.001 percent. The League's relief budget, twice as large, is donated separately by national societies and other sources.

National societies are funded in a variety of ways, ranging from full dependence on the national government in some socialist countries, to partial government funding (as in much of Europe), to complete dependence on voluntary contributions—as in the United States, where the ARC is closely tied in with the United Way. Again, appeals for major relief efforts are separate from basic budgets.

Basically, the fiscal future for the Red Cross/Red Crescent Movement seems secure, but that security really depends on the movement's willingness to work within what amounts to a fundamental compromise. The most obvious way to prevent the horrors of war is not to have war in the first place. The second most obvious way is to remove the weapons that cause the worst destruction. So it is that every International Conference of the Red Cross and Red Crescent, the movement's top decision-making congress (usually held every four years), adopts a resolution advocating peace.

Only some of the national societies, however—in Scandinavia, for instance—have felt free to integrate advocacy of peace and disarmament into their programs. The League and the ICRC, as Jette Soerensen puts it, keep "quite a low profile" on those issues. "Once you start talking real peace efforts, or activities for peace," says Soerensen, "you become political. We have to be completely neutral."

If prevention is out for the movement when it comes to warfare, however, it's in with regard to disaster relief. Prevention, that is, of unnecessary damage and injury, through planning and preparedness.

Robert Vessey, the ARC's bluff, friendly director of disaster services, is not just coordinator of the nation's biggest rescue squad. His more important job is to think about disasters: how to help communities prepare for them, how to minimize their effects, and how best to provide relief in their aftermath. Take shelters, for instance. Vessey notes that hurricane studies have shown that in several coastal areas of the United States, shelter sites previously thought safe are actually unprotected from potential high storm waves.

"We can't put people into a shelter where they're going to get killed," says Vessey. "We damn near had a situation like that [in 1989 with Hurricane Hugo] in South Carolina, because the state officials thought the shelter site was 22 feet above sea level and it was actually 11 feet. And the people were in the shelter, and by that time they couldn't move anywhere else. And the water kept rising, rising, rising, they were holding children up in the air."

Vessey says that the ARC, carrying out its congressional mandate, is committed to working cooperatively with local governments to resolve such problems. Action is perhaps nowhere more needed than around the New Madrid fault in Missouri, where the largest known earthquake in the United States took place in 1811. It reversed the course of the Mississippi River and violently shook the entire midwestern-southeastern region of the country. That was so long ago, however, that seismic protection codes were never established for public buildings—hence most major structures in an area around the fault zone that spans several states are vulnerable. And another big quake is sure to hit, perhaps by 2020.

Should that happen, says Vessey, "every hospital, every school, is going to fall down. It's going to be just like Armenia in the earthquake of 1988. I went through a place there where every single doctor except two were killed, every single nurse, every lab technician, every patient.

"So the shelters we normally use—schools, armories—they aren't going to exist after that quake. For us to predesignate a shelter that's not seismically safe would be criminal in my view. The United Nations has declared a decade for disaster [impact] reduction, and the United States has too, and we're trying to get those off the ground so that the country can say that by the year 2000 we're going to make those hospitals and schools in seismic danger zones seismically resistant."

In all this planning, as well as in action, the ARC coordinates nationally and locally with other disaster relief organizations ranging from the Salvation Army and Catholic Charities U.S.A. to the Federal Emergency Management Agency (which is activated in local situations only by presidential declarations of emergency or disaster). "The Red Cross has the most extensive disaster services from start to finish," says Vessey, "but others have specialties. The Southern Baptists have a specialty in [mass] feeding. The Church of the Brethren provides a child care service for shelters and service centers, where they play with children in a very focused way, to draw out the child's feelings after a tornado or such. Taking care of the kids but helping deal with some of their problems too."

But first response is the burden of the ARC. In most communities in the United States, agreements have existed for years empowering the local ARC chapter to take control of certain public buildings in times of emergency—for use as shelters or for feeding displaced persons, providing first aid, handing out emergency supplies and vouchers for replacement goods, and beginning the casework process that may lead all the way to a rebuilt housing unit, free of charge. (The ARC's policy is to enable disaster victims to resume their lives without crippling loss, by filling gaps that federal and state relief grants and insurance payments don't cover. This is usually done through vouchers redeemable at local businesses, designed to stimulate the local economy as well.)

Like the League, the ARC maintains strategic warehouses—11 Disaster Field Supply Centers dispersed around the country, full of cots, blankets, tents, and the like. There's also a fleet of 170 Emergency Response Vehicles garaged at various local chapters. And these supplies and even vehicles—like the German Red Cross medivac and transport aircraft—are available whenever possible to the League for use abroad.

It's all part of the worldwide effort. And on that level, too, there's important interagency coordination. The ICRC, dealing with prisoners from all kinds of conflict situations, conducts what Jette Soerensen describes as a "discreet" cooperation with the human rights organization Amnesty International. The League, providing relief in the field, integrates its activities with those of other relief agencies, ranging from the officialdom of the United Nations and World Health Organization to Oxfam, Save the Children, and the large array of church relief organizations.

Foreseeing tragic situations is as important as dealing with them, says Wright. "The issue is making sure your structure's in place beforehand so that when there is, for example, a major volcanic explosion in the Philippines, there's a national society that's strong enough to provide the initial emergency response."

Just so in the Persian Gulf, where the ICRC's Jette Soerensen notes, "With regard to Iraq, we had already prepared before the war and during the war months. We had set up infrastructure in all the countries surrounding Iraq. We had the camp modules, we had logistics, we had vehicles in Jordan, Iran, and Bahrain from various national societies in Europe—which also sent boatloads of blankets and tents and medicines, dry food, and so forth."

And water purification systems. In the immediate aftermath of the Allied bombing of Baghdad, it was ICRC personnel who got enough of the city's ruined water system back in operation to supply hospitals and orphanages. Mobile units, too, brought some relief to parched outlying areas. Civilians, particularly children, would still die in Iraq from lack of pure water. But "at least," says Soerensen, "we prevented a cholera epidemic."

And so it is generally with the international Red Cross/Red Crescent Movement. It doesn't have the resources to repair all the world's man-made and natural damages. It can't be present in force everywhere at all times. It can't make governments do what they don't want to do.

But what it does, it does very well. As Dick Wilson, city manager of earthquake-ravaged Santa Cruz, notes, "We would have made do somehow without them. But we were very glad the Red Cross was here."

About the author: Steve Turner is a freelance journalist and member of the National Writers Union. His articles have appeared in more than 50 newspapers and magazines.

Source: 1992 Collier's Year Book.