title: Humanitarian assistance and accountability: what are we really talking about?
abstract: BACKGROUND
  In the past two decades, there has been a worldwide increase in the number of disasters, as well as the number of people affected, along with the number of foreign medical teams (FMTs) deployed to provide assistance. However, in the wake of the 2010 Haiti earthquake, multiple reports and anecdotes questioned the actual, positive contribution of such FMTs and even the intentions behind these aid efforts. This brought on a renewed interest in the humanitarian community towards accountability. Between 2000 and 2012, the number of "Quality and Accountability" initiatives and instruments more than tripled from 42 to 147. Yet, to date, there is no single accepted definition of accountability in the humanitarian context.
  
  
  OBJECTIVE
  The aim of this report was to explore and assess how accountability in the humanitarian context is used and/or defined in the literature.
  
  
  METHODS
  The electronic database PubMed and a predefined list of grey literature comprising 46 organizations were searched for articles that discussed or provided a definition of accountability in the humanitarian context. The definitions found in these articles were analyzed qualitatively using a framework analysis method based on principles of grounded theory as well as using a summative content analysis method.
  
  
  RESULTS
  A total of 85 articles were reviewed in-depth. Fifteen organizations had formal definitions of accountability or explained what it meant to them. Accountability was generally seen in two paradigms: as a "process" or as a "goal." A total of 16 different concepts were identified amongst the definitions. Accountability to aid recipients had four main themes: empowering aid recipients, being in an optimal position to do the greatest good, meeting expectations, and being liable. The concepts of "enforcement/enforceability" under the last theme of "being liable" received the least mention.
  
  
  CONCLUSIONS
  The concept of accountability is defined poorly in many humanitarian organizations. Humanitarian providers often refer to different concepts when talking about accountability in general. The lack of a common understanding is contributed by the semantic and practical complexities of the term. The lack of emphasis on "enforcement/enforceability" is noteworthy. Other aspects of accountability, such as its "measurability" and by whom, similarly lack a common understanding and community-wide consensus. To what extent these vague definitions of accountability affect agencies' work in the field remains to be documented.
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,Singapore.
authors.forename: Y S Andrew
authors.initials: YS
authors.lastname: Tan
authors.affiliation: 2Centre for Research on Health Care in Disasters,Health Systems and Policy,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: von Schreeb
mesh_terms: D000533:Altruism; D004190:Disasters; D006801:Humans; D007391:International Cooperation; D012066:Relief Work; D012941:Social Responsibility
keywords: FMT foreign medical team; MSF Médecins Sans Frontières; NGO nongovernmental organization; accountability; disasters; foreign medical teams; humanitarianism