a. Security and Protection
b. Partnerships/Communications and Technical Expertise
c. Training and Education
d. Liabilities, Standards, Policies and Procedures
e. Planning and Preparedness Considerations

The groups were asked to develop a general consensus on what the "ideal situation" would be for one of these topic areas during an actual CBRNE event, and to develop a list of questions, concerns, barriers and impediments related to the achievement of this ideal. Each group then selected a spokesperson to provide a 10-minute summary to the plenary session of their group's discussion, including near and long-term recommendations and solutions, which could serve as a catalyst for forward movement.

Below is a summary of these sessions, whose discussions proved largely mutually reinforcing. The unedited presentations from the break out groups are contained in Appendix 7.d.

a. Security and Protection

• Methods and strategies for withdrawing or evacuating staff
• Individual responsibility for personal protection
• Operations in conflict area where US is combatant
• Ensuring safety of NGO staff
  • Large and small NGOs
• Risk and vulnerability assessments
• What are the possible CBRNE threats to humanitarian response in Iraq (i.e. specific agents, the most possible) and what can we do about it?

Discussion and Recommendations:

Several key questions for NGOs were raised that impact operational parameters, staff security and protection: Will we operate in a CBRNE environment? Which staff will be utilized, and in what circumstances? What collaborative arrangements with other organizations will we have? What level of protection will we employ? Will we purchase personal protective equipment and if so, what type, how much, to whom will it be distributed, what costs are associated with transport, maintenance and storage? What is our training regime and requirements? Do we have CBRNE incorporated into our security planning and threat assessments? If not, how do we effectively incorporate it and who will do it? Are they qualified and if not, how do we qualify them? What are possible contingencies in situations with adverse outcomes, such as medical evacuation? How and with whom are and these and other crosscutting issues planned?

Though there are admittedly more questions that answers at this point, the group made several recommendations.

• POLICY: Establish CBRNE policy and operational parameters in line with organizational mandate with robust protective measures and how they will be applied prior to an event occurring. The policy should address issues such as:
  • Operational guidelines
  • Health and care issues: pre-deployment vaccinations; prophylaxis; CBRNE specific meds; medical insurance coverage; post-deployment medical assessment; mental health issues; follow-up for long-term health concerns, etc.
  • Personal Protective Equipment
  • Organizational and personal liability and insurance coverage
  • Training and medical / fitness evaluation of staff
• THREAT ASSESSMENT: - Appoint security focal points and integrate into total management of organization. Include CBRNE as a "specialized threat." Ensure reach back capability to technical expertise at a minimum, and consider hiring a resident CBRNE expert.
• TRAINING: Identify the focal point(s) for training; develop competencies and a training regime and implement staff training. The training should focus on building capacity. Have system in place to monitor and evaluate effectiveness of training.
• EQUIPMENT: Considerations include type, quantity, distribution and transport and import costs. Will you distribute to national staff and beneficiaries? How do you maintain spare equipment? Transport and import costs?

b. Partnerships/Communications and Technical Expertise

• Methods and strategies for coordination
  • USG-NGO; Civil-Military; International Orgs-NGO
  • Clarify roles, assumptions, respective mandates, strengths and limitations
• What info can specialists give to NGOs regarding Iraq (i.e. likely scenarios)?
  • Summary of USG and int'l orgs to provide reliable info on CBRNE
    • Who can/should be contacted for what?
• Logistical management of response
• Who is there to telephone for advice (specifically) after hours
• Communication in the field
  • VHF Common channels and/or central transceiver?
• Chemical decontamination (can it be done in the field, what equipment required?)
  • Other inputs like water and sand?
• Challenges of working with US military

Discussion and Recommendations:

The context for discussion was an event that occurs in a country that already has NGOs present on the ground due to regional conflict and presence of large numbers of IDPs and refugees that can't manage a CBRNE situation independently. What other partners would likely be present and what is the expected role for NGOs in this setting? Depending on the level of functionality of the host government, they will be the primary responder. They are in charge and requests additional assistance, including the possibility of military support from other governments, as needed. The UN system would also provide support as needed, requested or required. In this scenario, there is likely to be a significant humanitarian role for NGOs.

COORDINATION: Existing coordination mechanisms should be maximized (NGO to NGO; NGO to UN; NGO to donor; NGO to host government) but may include new actors, or actors unfamiliar with 'traditional' NGO coordination processes. The structural integrity of the coordination process is extremely important. If there is a need to evacuate or withdraw, there should be a plan in place for continuing remote coordination.

Barriers to movement and operations need to be addressed through this process; there is a need to maintain communication systems at all levels. The level of disruption of humanitarian operations depends on the nature of agent and the duration of the event. There may be new roles and new partners, including a closer relationship to the military, which may be uncomfortable for some NGOs.

NEW PARTNERS: Questions should be asked to the following:

• The Joint United Nations Environment Programme (UNEP)/Office for the Coordination of Humanitarian Affairs (OCHA) Environment Unit: Can they help NGOs and also assist with access to the private sector?
• The UNEP Post Conflict Unit: Are they a potential new partner? What is its role? (See 21 March 2003 press release: "UNEP's Post-Conflict Assessment Units Initiates Study of Environment in Iraq")
• The Office for the Prohibition of Chemical Weapons. What is their role in response and how can NGOs best partner with them?
• The Food and Agricultural Organization (FAO) Project Prevention and Disposal of Obsolete Pesticides, What potential partnerships can be leveraged?
• The International Atomic Energy Agency: what is their role in a response, if any?
• Though controversial, what military resources exist? Not just US, but foreign including host country?
• What about other NGOs in the environment and sustainable development sector? Do they have expertise response agencies can tap into?
• What about the private sector?
  • What information services, products or security information can CHEMTREC and other commercial companies provide to the INTERACTION CBRNE working group?
  • Another resource is the International Council of Chemical Associations and there are similar organizations and associations.
  • There are companies that do clean up, such as Bechtel and other companies and commercial suppliers of equipment, which can help with knowing where to buy things in advance.

LOGISTICS: The focus should be to start with what is already there, the current systems and materials. Local resources and means should be used as much as possible, but with attention paid to quality. While it's necessary to bring specific types of assistance, you need to know what to bring, which supports the importance of rapid assessment and decision-making.

A chemical or biological response is not so unusual, in terms of what to bring in, versus normal disasters. Radiation response material needs will be different. There is a need to know what commercial suppliers there are, what they provide and how fast things can be delivered. This leads to a need for contingency planning. It is possible there will be a dependency on military assets to deliver large quantities of supplies if large numbers of people are affected. The pressure is to maintain standards as much as possible, even if circumstances are uncertain, for example, the need to move camps because of changes in the security situation. Consider possible options to move materials if the population needs to move, for example, use tents that are easy to take down and don't have many parts. Food aid may need to be changed due exposure to certain toxins, i.e. difficulty swallowing.

DECONTAMINATION: Who will run decontamination sites? Will NGOs be involved, and if so, how will they build their capacity? Responder awareness of what the threat is will define the appropriate level of personal protective equipment required and will determine exposure and rotation criteria in decontamination lines. The decontamination chain will include initial triage that is specific to the agent and syndrome, followed by first aid - wash, dry, and redress - followed by further triage. Patients along with their clothes and belongings (if they are allowed) will need to be fully decontaminated prior to entering a clean facility. There may be a need for population management or crowd control.

A lot more is needed in terms of care after this step, and much of it is within traditional NGO roles. A major issue is one of finding people to do the washing and keeping people in decontamination suits and clean areas. The Iranian experience (see Lessons from Iran on facing chemical war in the Christian Science Monitor, 19 November 2002) may provide a model for procedures. Self-decontamination will still be needed if large numbers of people are involved. Education on how to self-decontaminate, and communication of the message are critical issues. Dealing with contaminated materials, such as clothes, will present additional challenges.

c. Training and Education

• What training should be given to staff/local community (pre, during, post event)
• What training is available for smaller NGOs
• Chemical decontamination (can it be done in the field, what equipment required?)
• How can an NGO develop its capacity in large-scale decontamination and where do we get the materials?
• What training materials and courses are available to NGOs? Should other training materials and courses be developed?
• How do NGOs access training and PPE? For themselves and assisted populations?

Discussion and Recommendations:

There are various training vehicles that are currently available to NGOs. Some of them are the American Red Cross training at the Clara Barton Center in Arkansas, The International Medical Corps (IMC) planned interactive CD-ROM, the Office for Foreign Disaster Assistance (OFDA) Tier I & II training, and the WHO disaster response to terrorism course, whose modules will be field tested in 3 countries in 2003. There also may be possible training opportunities with the UN in the field, or in Europe through civil defense agencies and the International Federation of Red Cross/Red Crescent Societies. The Aid Workers Network has a good summary of private sector training and other resources posted.

Each organization should ensure that the training is repetitive to qualify current and new personnel. The organization's website can provide their personnel with CBRNE training. Another option would be to invite an integrated, interdisciplinary, inter-agency mobile training team targeted to NGO needs to conduct basic pre-departure training or "train the trainer" workshops in CBRNE equipment, self-protection and basic operations. Training should provide awareness of what is expected when a CBRNE event happens, including how to shelter, evacuate, avoid and detect, and the range of possible risks.

At the inter-agency level, the following issues should be addressed: Determination of targeted training audience, striking a balance between awareness and professional training, especially for medical personnel. What are the core areas or topics needing coverage for education? How do organizations find, collect and disseminate this information? How do you best train to coordinate, and work with response groups arriving on the scene? How do you respond to the training needs of small NGOs?

At the organizational level, the following issues should be addressed: How do you integrate CBRNE into all sectors and geographic areas where the organization works? What is the programming impact of CBRNE hazards? What kinds of other information resources should be provided? What is the policy for Avoidance-Prevention-Evacuation? What are explicit policies for expatriates, national staff and consultants? What are the recommended procedures for self-decontamination?

Senior management must be on board in order to mainstream CBRNE threats into organization training, policy and practice. It was recommended that:

• Every NGO should raise the level of awareness of CBRNE issues and consider staff training and that CBRNE training be integrated into organizational security training plans and policies.
• Donors require NGOs to conduct CBRNE training in their Safety-Security Plan, as a means of reinforcement.
• Donors should consider funding CBRNE training and equipment, to alleviate some of the costs for NGOs to meet CBRNE standards/requirements.
• Information on current training opportunities be widely disseminated
• Organizations tap into research for information sharing (list serves, newsgroups, etc) and participate in interagency working groups.
• Organizations should hold exchanges in the field with organizations to gain more expertise

d. Liabilities, Standards, Policies and Procedures

• Should NGOs develop guidelines for operating in chemical environments? What topics should be addressed in those standards? Who should lead that effort?
• Should we develop a CBRN health kit?
• As humanitarian agencies working in disaster situations or long term projects, how to develop procedures/methods for a "stay and work policy"
• Liability issues
  • Individual responsibility for personal protection
• Staff insurance coverage and effect of no CBRN staff insurance

Discussion and Recommendations:

Liability - which for purposes of this discussion includes organizational, personal, actual and vicarious - can be minimized by mitigation, or taking steps to prevent exposure. Organizations will be better prepared by establishing CBRNE policies, standards, and procedures that address, at a minimum, the following issues: position descriptions; equipment; training and certification; insurance coverage; country agreements; local labor laws; documentation; legal consultation, and informed consent. Policies must be written, disseminated, understood and signed off by staff, volunteers and employees. Consent forums that already exist in many organizations should be changed to include CBRNE risks and hazards.

Everyone in the organization must essentially be "touched personally," meaning they are aware of, understand and are fully trained in the policies, standards, and procedures. It is critical to maintain documentation of this process, in order to minimize liability. Human resource departments therefore play a key role in minimizing liability.

CBRNE policies should serve organization's operational focus and should be framed towards what organizations can, will and want to do. There is the danger that if policies and standards are not developed by NGOs themselves, a vacuum may result by others setting policies and standards that are inadequate or appropriate for NGOs.

There is also concern that liability will dictate mandates in these environments, rather than following the mandate. Sending lawyers to the field to observe operations first hand may ease tension between clear policies and liabilities.

Knowledge and compliance with the local laws is critical. If operating appropriately and responsibly according to those laws, organizations should not be held liable, but again documentation is critical. In the absence of accepted standards and laws, organizations must establish what is ideal and then what is reasonable.

Insurance coverage becomes a challenge in war zones; bi-lateral agreements such as "harmless clauses" between the NGO and the country involved may offset some problems. Development of minimum standards in equipment, operational procedures and documentation of training/certification will demonstrate due diligence and thus minimize organizational and personal liability.

In order to establish a common standard among NGOs, a focal point or lead organization must be identified to assume this responsibility and provide direction. InterAction was suggested as a likely organization to spearhead this endeavor since they already work with numerous US-based NGOs and have established the CBRNE working group. In this capacity, they would be able to form a committee to: help develop policy/procedure guidelines, set minimum standards, review recommended equipment standards, provide certification, and facilitate research and information sharing. They could also explore several insurance issues, such as enhanced coverage similar to OFDA underwriting (i.e. Somalia 1992), special coverage for a war zone or CBRNE environment, and the possibility of lowering organizational or personal insurance costs through a group plan or insurance pool into which contributions are made by members.

e. Planning and Preparedness Considerations

• Communications and credible sources of information
• PPE and training
• Risk/vulnerability assessments and planning considerations (similarities and differences)
  • staff and population/victims
• What types of PPE are required? What standards exist?
• Can chemical decontamination be done in the field and what equipment is required?
• How can NGO develop its capacity in large-scale decontamination? Where do we get the materials?

Discussion and Recommendations:

Inter-agency planning is a challenge, and CBRNE threats may complicate things further, particularly in a terror-charged environment. More varied actors are involved, and there is far less experience among traditional players in these environments. Many of the issues discussed in previous presentations have application here. The main issues are organizational preparedness; coordination and communication; clarity of roles; short and long term focus.

PREPAREDNESS. Preparedness can be discussed at the individual, team and organizational levels. All are important and need to be addressed but by addressing overall organizational preparedness, NGOs can best address individual and team preparedness issues through adapting their policies and training culture to these new threats. Training assures better preparedness, but training must be updated and oriented to the needs of NGOs. Training of trainers, refreshing training of those already trained, and training new employees are all important factors to enhance preparedness. People respond in crises according to how they are trained programs need to be designed with these audiences in mind to account for turn over.

COORDINATION AND COMMUNICATION. Mechanisms usually exist and should be used but may need to be attuned to CBRNE issues. There should be credible and designated sources identified and a media plan developed and put into place. Raising the awareness level of CBRNE in local population is necessary but has implications for other activities. When the humanitarian response equations becomes "medical + water + food aid/food security + shelter + psycho +social +.... + a CBRNE event, the latter addition may create a different programming environment, particularly if it is an intentional release. This may create a different programming environment. Be aware that emerging environments like CBRNE are awash with misinformation. In CBRNE, the media coverage will be especially frenzied, adding to an already chaotic situation, so have a plan ready.

CLARITY OF ROLES. In the ideal situation, roles should be clearly demarcated and understood. Who is doing what? What is expected of my agency in, for example, decontamination? Policies of all agencies need to be spelled out prior to an event. Roles between organizations need to be identified before an event occurs. The systems in place can break down without agreements made ahead of time.

SHORT AND LONG TERM FOCUS. There should be both short and long term focus. Immediate effects have to be mitigated, but attention must be paid to the long term as well. Given the nature of some of the pathogens and contaminants, oxygen, intubation and prolonged respiratory support may be required. There are also planning considerations for transitions from relief to development and possible mitigation or response to future events. The important factors are the impact on environment over time, mental and physical health issues which may only emerge over an extended time period, and expectations that change over time. Sustained programs targeting local populations to raise awareness of measures to help mitigate effects of future events is critical to avoidance and prevention.

All of these issues need to be taken into consideration as organizations develop CBRNE policies to address procedures and standards for training, equipment, administration, coordination, and communication. These should be part of the organization's security planning document. The lead agency, whether it is UNOHCA or an NGO or another partner, should be encouraged to clearly articulate roles and expectations of NGOs in a CBRNE event. Inter-organizational planning and training should become standard for these types of events.