By Stephanie Holmes
BBC News Online
Darfur: Aid workers are in place long before the media spotlight arrives
Aid workers operating in conflict zones have traditionally shunned physical protection such as bullet-proof jackets, defending themselves instead with their reputations and political neutrality.
But that is no longer enough.
The risks now are so high that there are fears of a flight of aid organisations from the countries where they are most needed.
The decision by the medical aid group Medecins San Frontieres (MSF) to end its work in Afghanistan after 24 years there shocked the international aid community.
Fight or flight?
On Wednesday MSF said they were leaving because the risk to their staff was too great.
Five staff were killed during an attack on 2 June and militants have been blamed for the death of 32 aid workers in Afghanistan alone since March last year.
Last November, the International Committee of the Red Cross (ICRC) was forced to massively scale back its activities in Iraq after a series of car bombs targeted the organisation's Baghdad headquarters.
Why are groups that have survived decades of political transformations, continuing to offer humanitarian assistance through war and civil unrest, now being forced to pack their bags and leave?
Crossing the line
MSF says a blurring of lines between military and humanitarian activities in conflict zones is tainting the image of aid organisations in the eyes of those they are trying to help.
"In Afghanistan there is a very confused situation," Vicky Hawkins, former programme director for Afghanistan told BBC News Online.
MEDECINS SANS FRONTIERES
Founded in 1971 by French doctors
HQ in Brussels, offices in 18 countries
Operations in more than 80 countries
More than 2,000 expatriate volunteers, with average age of 30-35
Work includes restoring hospitals, providing vaccinations and improving sanitation and water supply
In Afghanistan, continued to work through Soviet invasion, mujahideen wars and Taleban rule
"There is a confusion of identity - they are making it extremely difficult for us to reach those in need."
The US military denies this, saying those involved in reconstruction and humanitarian projects - like building schools, sewage systems and basic infrastructure - should focus on working together.
Mitch Frazier, a spokesperson for the US Army Corps of Engineers based in Baghdad, says in conflict zones military personnel are often better positioned to provide the immediate logistics involved in humanitarian work.
"This is still an austere environment, this is still a combat zone but whether we are in a uniform or civilian clothes we are all here for the same reason - to assist the Iraqi people," he says.
The US Army Corps in Iraq is involved in some 2,000 reconstruction projects, he said.
But the ICRC, with 1,200 specialised staff in almost 80 countries, disagrees.
In its 2003 annual report it says that the growing trend for military operations to be presented as humanitarian is making aid work more dangerous than ever.
"It can result in people on the ground starting to confuse the two - it can be dangerous. The distinction must be made clear," ICRC spokesperson Florian Westphal says.
Waving the flag
Identity - not just through insignia and uniforms but also through understanding - is key for aid organisations.
They secure themselves by building a network of contacts on both sides of a conflict and making sure their role - of offering help and nothing more - is clear to all.
Military and humanitarian efforts are being blurred, aid groups say
"We try to gauge to what extent we, as an organisation, are understood, known and accepted. The acceptance of our neutrality as an organisation is an essential part of our security," Mr Westphal says.
Practical "passive security" measures - radio equipment, training and awareness of the situation on the ground - can also protect workers in conflict zones.
But it can do little if they themselves become direct targets.
The motives for attacking aid organisations are complex, Mr Westphal says. They may simply be criminal or there may be a desire for publicity.
But increasingly, the work of aid groups like the 140-year-old ICRC is lumped together with that of military forces.
"There may well also be groups who consider us as part of the Western bloc - in places like Afghanistan humanitarian organisations and the military forces as all part of the same thing," he says.
And aid workers are now in the spotlight as never before.
"Now there is an interconnectedness - there is a global dimension - you can get into trouble in Africa because of a certain perception of the way you behaved elsewhere," he says.
The shift demands a sea-change in attitude, he says.
"You have to change your perception of security issues - make a new global assessment," he says.
Protecting the protectors
But that does not necessarily mean routinely being accompanied by armed guards, a measure used only in the most extreme situations such as Chechnya and Somalia.
"If you are protected by soldiers then that automatically identifies you with one side of the conflict. We are medical, neutral, independent - having armed guards is not a neutral change," MSF's Vicky Hawkins says.
Even United Nations humanitarian agencies, whose workers are often accompanied by special UN armed guards, admit to feeling increasingly exposed after the series of bombs that ripped through the organisation's headquarters in Baghdad in August and October last year.
"We have lost that 'blue shield' we once had, it no longer exists," the UN World Food Programme's Caroline Hurford says.
"It is an unfortunate reality. There is a dilemma - do we reach hungry people wherever they are or do we protect our staff? It's a no-win situation."