Armed conflict is often accompanied or followed by the outbreak of famine. The legal foundations of global humanitarian policy for dealing with famine are reviewed in this article, with special attention to conflict situations and their aftermath. The existing law is examined first, and then recent proposals in the form of drafts and expert studies which seek to develop legal instruments or policy relating to international humanitarian assistance are considered.

Armed conflicts always have dire effects on the health of the civilian population. Apart from the harm — wounds, burns, asphyxia and radiation — caused directly by weapons of war, the people fall prey to disease because of the disruption of their normal living conditions.

In most cases, it is the latter rather than the former which takes the greatest toll.

Some basic health protection principles are therefore common to all development and disaster situations.

The ICRC visits prisoners all over the world, whether they are prisoners of war in camps or political detainees held in prisons or police stations. In 1990, ICRC delegates visited more than 84,000 prisoners in about 40 countries. These visits are made by teams of delegates, the number of whom varies depending on the number of prisoners to be seen. Each team is made up of Swiss delegates specially trained to carry out such visits, including at least one doctor

The surgical activities of the International Committee of the Red Cross stem from the institution's general mandate to protect and assist the victims of armed conflict.

The war wounded are thus only one category of the victims included in the ICRC's terms of reference.

The ICRC's main role in relation to the war wounded is not to treat them, for this is primarily the responsibility of the governments involved in the conflict and hence their army medical services. The task of the ICRC is first and foremost to ensure that the belligerents are familiar with the provisions of the Geneva Conventions and apply them, that is, care for members of the enemy armed forces as well as their own and afford medical establishments and personnel the protection to which they are entitled.

From its very beginnings the ICRC has been concerned with the war disabled and has done what it can to help them. After the Second World War it was involved in orthopaedic activities in various countries, such as Finland, Viet Nam, Jordan, Hungary, Algeria, Morocco, Israel, Egypt, Nigeria, Somalia and Yemen.

Disasters create specific problems shaped by both the type of event (earthquake, volcanic eruption, war) and its consequences (sudden or gradual impact on the victims).

The process that unleashes a disaster is often more complex than appears at first glance. For example, drought is obviously caused by poor climatic conditions, but it may also be precipitated by human behaviour detrimental to the environment.

While internal conflicts do not always have a direct and major impact on civilians beyond the casualties they claim, the breakdown of local services, particularly medical care and food supply, may have dire effects on health and nutrition, so that the entire civilian population falls victim to the situation.

The early 1980s marked a turning point for humanitarian aid. During those years most of the major emergency relief agencies became aware that steps were needed to heighten the efficiency of their assistance to disaster victims.

New policies were therefore introduced to:

• promote preventive measures,

• codify assessment methods,

• standardize medicines and equipment,

• rationalize intervention criteria, and

• improve coordination among humanitarian organizations.

Disasters are not merely very large accidents. They imply complex public health problems that must be resolved under difficult circumstances: society's normal coping mechanisms are disrupted; the high visibility and critical coverage provided by the mass media make the situation politically sensitive; logistic nightmares abound; the multi-agency response from outside the affected area is often poorly coordinated. In short, decision-making in a climate of uncertainty is the norm. Information management, not the medical management of patients, is often the main challenge facing health managers and volunteers in the initial or relief stage of a disaster.

“Health for All by the Year 2000” has been a major goal, an important rallying cry for individuals and organizations around the world concerned about improving the physical, mental and social well-being of vulnerable people. Of course it has been a somewhat idealistic goal, as has the World Health Organization's definition of health. However, it has served a useful function, both in terms of what it says positively about our vision for the future and also by reminding us, implicitly if not explicitly, that for many hundreds of millions of people the reality is still very far from the dream.

Former ICRC President Alexandre Hay died on 23 August in Geneva at the age of 72. With Mr. Hay's passing the International Red Cross and Red Crescent Movement has lost a true champion of the humanitarian cause, wholly committed to upholding the law and the Movement's ideals and to promoting peace through dialogue.

Alexandre Hay bore the last few months of his illness, which he knew was extremely grave, with lucidity and fortitude. He had full confidence in his doctors but as a deeply religious man he knew that, while our duty as human beings is to strive for success in what we do, the final word lies with the Creator. He never made a show of his religious conviction, but at the hour of reckoning did not hesitate to affirm his unreserved submission to God's will.