Millions of Ukrainians on the move set off an aid revolution

Christian Aid’s Head of Humanitarian Policy Simone Di Vicenz argues the Ukraine war shows a change in approach is required to respond more effectively to global crises.

Simone Di Vicenz

Simone Di Vicenz is Christian Aid’s Head of Humanitarian Policy.

People help unload aid parcels from the side of a van, some wearing body armour.

In a recently liberated Ukrainian village, locals unload aid they helped choose.

Credit: Christian Aid.

In the first few months of the war, TV news showed the pictures we have come to expect of civilians caught up in conflict: rapid evacuations, temporary shelters and soup kitchens as millions left their homes for safety. Donations poured in from around the world to pay for this response.

Christian Aid was at the heart of this by channelling donations to our Ukraine partners such as Hungarian Interchurch Aid (HIA) and HEKS-EPER of the Swiss German church. Nothing was easy in those early frantic weeks but these long-established international charities already working in Ukraine had the contacts and legal permits to scale up their support for those on the move.

Months later, those donations are still helping and are paying for different kinds of help as the needs of displaced people evolve. Christian Aid has now made its own direct links to Ukrainian national charity organisations like the Alliance for Public Health (APH).

It’s an umbrella organisation supporting even smaller partners on the ground and through them Christian Aid has pioneered and applied a community-led way of working. It involves displaced people deciding for themselves their own priorities for the kind of support they need. In short, international charities must do more listening and less telling.

The advantages of this approach, known as survivor and community led response or “sclr” are remarkable. Instead of large impersonal and distant support, agencies are going down to the micro-level of organisation such as church groups, village councils and school parents.

To succeed, local people need to collaborate on what they want, how to do it and who to involve. It breeds community cohesion, empowerment, and self-help.

These small, community-level groups know much better their urban or rural needs. For example, Christian Aid small grants of a few hundred pounds, for APH and Heritage organisations in Odesa, bought playground equipment for a children’s centre and a generator to draw water from a well in a recently liberated village.

Instead of relying on big blobs of non-transparent funding sloshing around vulnerable to fraud and waste, small groups of individuals are much more accountable to each other. Although no system is perfect, locals will know if the cash has been spent because the playground equipment and generator are there or they’re not.

It’s not just about receiving aid. The process itself brings people together by repurposing existing civil society groups or supporting new ones where Ukrainians have joined up to help those who have left occupied regions.

To succeed, local people need to collaborate on what they want, how to do it and who to involve. It breeds community cohesion, empowerment, and self-help - especially among women having to operate without their partners. One microgrant provided by Christian Aid to a local kindergarten was used to pay skilled locals to build an internal staircase to a kindergarten bomb shelter.

The sclr concept has been evolving since it was first used after the Haiti earthquake but the scale of the war in Ukraine has supercharged its application because it can be replicated easily by Christian Aid’s network of faith and non-faith Ukrainian partners across the country. It’s also being enthusiastically adopted by Christian Aid’s bigger partners like HIA and HEKS. They too can see the advantages of moving beyond “traditional” humanitarian support.

Christian Aid believes this community-led approach is a message of hope for the future as Ukraine moves away from its post-Soviet past. It’s a model for a civil society after the war where local people are entrusted and empowered to decide their own futures. It’s also a model that we’d like to see more aid agencies copy in other global crises.

Who knows, that in an age of government and institutional distrust, it might even be an approach that could be adapted to revitalise grassroots democracy in the UK.

Find out more about Christian Aid's work on empowering locally-led action in Ukraine.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.