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
By Steve Turner
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?
A Worldwide Safety Net
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.
Giving the Blood of Life
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
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
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.
The Birth of an Inspiration
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
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.
The ICRC—a Double Role
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
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
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.
Who Pays for it All?
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.
Of Peace and Politics
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."
The ARC: Intervention Before the Fact
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.
The Global View
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
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
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.