“To unite Red Cross Societies throughout the world in a concerted effort to prevent, mitigate and alleviate the suffering caused by disease and major disasters”. This was the primary aim of the League of Red Cross Societies (now the International Federation of Red Cross and Red Crescent Societies) whose seventy-fifth anniversary we have just celebrated. The League, it will be recalled, was founded in response to the wishes of National Red Cross Society leaders and eminent representatives of the medical world — inspired by President Woodrow Wilson's ideals — to submit to Societies programmes of action in the general interest of humanity and coordinate their efforts in dealing with the scourges of that time.

This year, the International Federation of Red Cross and Red Crescent Societies has celebrated an important anniversary. Seventy-five years ago, five men from five different Societies — American, British, French, Italian and Japanese — sat together to forge a union of Societies around the world, a global consortium united in its quest to serve humanity. Decades later, with a membership of 162 National Red Cross and Red Crescent Societies, a total of 124 million individual members and 250,000 employees, the Federation has marked 75 years of response to the suffering of humankind. Now some changes are in order to help us meet our humanitarian goals. Yet our mission, governed by the fundamental principle of humanity, the cornerstone of the International Red Cross and Red Crescent Movement, remains constant.

What can be done to counter the innumerable attacks on human dignity? This vexing question is today a global issue. Over the past 75 years — ever since the founding of the League of Nations and the International Labour Organisation — it has given rise to increasing concern. Indeed, the history of our century, with its seemingly endless succession of wars and economic crises, has furnished constant reminders of its urgency. The problem is currently taking on a new dimension in many States and international organizations, and it is in this context that “improving the situation of the most vulnerable”, the strategic aim of the International Federation of Red Cross and Red Crescent Societies, should be situated.

The recent explicit focus on “vulnerable groups” by international assistance agencies — particularly those that respond to emergency situations around the world — reflects two important concerns. First, aid providers want to be able to identify potential victims of disasters in order to anticipate and mitigate such events, and second, they use the identification of vulnerable groups as a way of targeting assistance, which is always restricted by limited resources, towards those groups who most need it. However, vulnerability should be understood as a far more powerful concept in the design and implementation of aid operations than simply as a criterion for targeting aid. In fact, problems arise when the notion of vulnerability is used only or primarily to identify groups who should receive assistance.

The Swedish Red Cross initiative to organize a workshop to exchange experience on vulnerability and capacity assessment in Europe and discuss the feasibility of conducting the assessment in a consistent manner was sparked by the report of the Working Group on the Implementation of the Strategic Work Plan for Europe (formed at the Fourth European Regional Conference in The Hague, in May 1992), which recommends that the European National Societies proceed with identifying vulnerable groups in their respective countries and initiate a discussion on future cooperation on vulnerability and capacity assessment.

According to UNHCR figures, in 1970 there were 2.5 million refugees in the world. In 1980, the figure was 11 million. By the early 1990s, the alarming spread of civil wars was prompting an average of 10,000 people a day to flee across an international border. In 1993, the estimated number of refugees had risen to 18.2 million. In addition there were at least 24 million people who been forcibly displaced within their own countries (UNHCR, 1993:1). In 1994, the situation has deteriorated further, particularly in Africa. In the past few weeks, well over a million refugees have fled the fighting in Rwanda.

The Malaysian Red Crescent Society (MRCS) has provided all facilities for the care and maintenance of Vietnamese Boat People (VBP) since the first landing on 4 May 1975 of 47 VBP, on a small island off the northeast coast of the Malay Peninsula. Since then, over a continuous period of 19 years more than 250,000 VBP have landed in Malaysia and all of them except about 6,500 have either been resettled in third countries or have been repatriated to Viet Nam. The remaining 6,500 are housed in two camps, located at Sungai Besi and Cheras, each a few kilometres outside the city of Kuala Lumpur.

What is the present situation, what are the lessons to be learned and what strategies should be adopted in the field of communicable diseases? These are the issues now facing us, some 15 years past two milestones in the evolution of health care: the Alma Ata Declaration on primary health care and the discovery of the last case of smallpox worldwide. The present article will attempt to address these issues, on the basis of the experience of the Swiss Tropical Institute in Africa.

In the 1980s and 1990s vulnerable people worldwide have suffered assaults on their basic survival and civilized existence. Ethnic upheavals have convulsed the former Yugoslavia and new republics of the former USSR. The struggles have produced human tragedies beyond calculation in Rwanda. Political terrorists have operated freely in some Latin American, Middle Eastern, and Asian countries. Hunger, disease, ethnic strife, and praetorian governments continue to stalk much of Africa, Asia, and Latin America. Economic restructuring has marginalized citizens of some countries, placing people even further below already abysmal poverty lines. Families and civilized social values continue to disintegrate in the inner cities of the United States of America where income disparities between the poor and everyone else are increasing, threatening to create an underclass extending well beyond current geographical confines.

During the century now nearing its end, the human race has undoubtedly fostered the notions of peace, solidarity and human rights. For this purpose, it has established bodies transcending national borders and creating awareness that everyone is a citizen of the world. Paradoxically, this century has also attained extremes of violence and horror. Yet the paradox is only apparent, since the awareness came about precisely because conflicts grew to world proportions.

The very title of this work is thought-provoking for any member of the International Red Cross and Red Crescent Movement, but especially one from Latin America or the Caribbean.

As late as the 1970s, conventional wisdom in epidemiology held that communicable diseases were on their way out as the predominant contributor to the world's morbidity profile, and were being replaced by noncommunicable diseases (NCDs) comprising degenerative diseases such as diabetes, circulatory disorders and cancers, and by accidents. Except for the developing countries, most of the rest of the world was already experiencing this so-called “epidemiological transition” from the terrible epoch of famines and pestilence that lasted from the dawn of mankind to the middle of this millenium, followed by the age of epidemics that culminated with the influenza pandemics of the earlier part of this century, to the prevailing situation since the 70s where diseases largely due to changed lifestyles — lack of exercise, high-fat diet, smoking and other substance abuses — predominate.

The closing years of this century will be challenging ones indeed for all Red Cross and Red Crescent Societies. Vulnerability is increasing for much of the world's population as political and economic changes accelerate. Constraints on the resources that may be applied to meet the needs of the vulnerable are also becoming more numerous.