Humanitarian organizations, it is thought, should provide impartial assistance to all those in need. But for the European Union and NATO, military, political and humanitarian goals all fall under the banner of joint crisis management, according to Antoine Gérard at the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in Brussels.

"I have seen many humanitarian organizations in Brussels that refuse to work with the European Union, or with NATO, fearing it was too political," said Gérard, who before becoming head of OCHA's liaison office worked for a number of aid groups.

Instead of pulling out entirely, Gérard thinks these organizations should instead question the involvement of the European Union and NATO. "For example, humanitarian organizations are currently being asked if they can provide a map showing the positions of the Syrian army and the opposition. They should not hesitate to make their concerns known at such a request," he said.

The idea that humanitarian aid be part of military strategy should, based on the principles of international humanitarian law, actually be dismissed, Gérard argues and aid organizations must continue to refuse such demands.

Impartial, neutral, independent?

The difficulties of maintaining impartiality have been made especially clear in the Afghanistan conflict. Humanitarian aid organizations should, in effect, not be financed by warring parties. But in Afghanistan, nearly all the states of the European Union, the United States and other UN member states are involved to some extent. Therefore, any humanitarian aid from these sources would be excluded, if it were based on the strict interpretation of the independence principle.

Ultimately, each organization must decide for itself how to maintain its impartiality, and this can result in different approaches. While some groups have decided on principle not to publicly comment on the situation in conflict areas, others deliberately take a position. It is not about deciding which attitude is better or worse, says Andreas Schultz, director of the medical aid group, Ärzte der Welt; instead, the different approaches are complementary.

"For us, it's essential that we have the right to bear witness to what happens. If human rights violations occur, we document them and we publish them," said Schultz. The organization stands by this principle, even if it means being expelled from a troubled state and not having access to those in need.

Emergency aid falls short

One thing is clear: if one wants to provide humanitarian assistance, difficult decisions are inevitable. After the Haiti earthquake in January 2010, for example, doctors did not have time to care for most of the seriously injured. Often, the welfare of individual patients had to be compromised in order to save the greatest possible number of people.

Various humanitarian organizations have created ethics committees to answer such conflicting questions, but there is no one-size-fits-all solution, said Doris Schopper, director of the Geneva Center for Education and Research in Humanitarian Action (CERAH).

"In an emergency situation, an organization may decide not to treat a patient with tuberculosis, because it wouldn't have time to complete the treatment," said Schopper. "In such a case, the patient would die because they'd be unable to give him the life-saving treatment."

For its part, Schultz said Ärzte der Welt has decided only to take on projects with a long-term focus. "Whether Syria, Haiti or the Dadaab refugee camp in Kenya, we only start projects if we are able to stay," he said. "We want to create structures that we can hand over to the public over a five or 10-year period.