A new report has highlighted the difficulties faced by humanitarian agencies delivering aid to parts of Somalia controlled by militant group Al-Shabaab.
(Transcript from World News Australia Radio)
The joint study by the Overseas Development Institute and the Mogadishu-based Heritage Institute for Policy Studies say aid agencies in Somalia have been forced to choose between breaking the law or letting people die.
They've found Al-Shabaab demands money for access to areas in most need of aid.
As Kerri Worthington reports, aid agencies are reluctant to discuss the findings.
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The report "Al-Shabaab engagement with aid agencies" raises concerns that aid workers were faced with threats and extortion attempts by the Islamist militant group.
Report co-author Ashley Jackson says aid workers in Somalia also told her Al-Shabaab demanded registration fees, ordered them to sign pledges not to proselytise and forced recipients of aid to spy on the international agencies.
Ms Jackson says Al-Shabaab fighters themselves admit demanding payment for access, which they justify because they see themselves as an alternative government.
"Al Shabaab sees itself as a government in waiting and they want to be seen to be able to provide an alternative to the Somali government and so having aid agencies provide things like health care allows them to do that. It says 'look we can govern, we can administer, we can provide services.' But it was also greed, it was also an economic motivation because they did profit from this."
Al-Shabaab expelled several humanitarian organisations, including CARE and the United Nations Mine Action Service, accusing them of spying or otherwise undermining Al-Shabaab control.
The report notes the Islamist group proscribed 16 international organisations, including several UN agencies, for "illicit activities and misconduct".
Other organisations decided to put up with the conditions in order to assist about 750,000 Somalis affected by the recent famine.
Ms Jackson, a research fellow with the Overseas Development Institute, says the association with the aid agencies benefited Al-Shabaab, not only financially, but by enhancing its image among supporters and citizens.
"If you don't have these principled approaches you're more vulnerable to coercion from al-Shabaab, if you aren't able to access leverage such as withdrawing or going public with their demands. And I think a lot of aid agencies have felt themselves stuck, not able to talk about publicly to their donors or to the public in their home countries about the true compromises and constraints about working in places like Somalia."
SBS contacted several Australian offices of aid agencies who operate in conflict zones in Somalia, Afghanistan and Syria.
None was willing to speak about whether they work with insurgent groups like Al-Shabaab, saying it's a sensitive issue that could affect their image of impartiality.
Ashley Jackson says aid agencies are also reluctant to discuss the issue because they're constrained by laws in their home countries prohibiting contact with what are deemed terrorist organisations.
Medical aid organisation Medecins Sans Frontieres says it is often confronted with such demands in the world's most dangerous areas.
Amsterdam-based MSF general director Arjan Hehenkampf says his organisation is practiced in responding to extortion and threats.
"MSF specifically organises itself so that it can control its actions and it can control its resources, knowing that it doesn't want to get its resources to be abused in a conflict situation which can adversely affect its neutrality. So we make sure we have our own staff on the ground. We make sure that they have clear negotiation rules and clear limitations in terms of what they can agree. And we make sure that if we need to make compromises then we know those compromises, we discuss and debate those and are transparent about them."
Mr Hehenkampf says in most countries where there is conflict, aid agencies are expected to negotiate with militia, rebel groups and governments putting forward unreasonable demands.
He says if one organisation pays, it sets a precedent for ever increasing demands on others.
"Sometimes the demands and the constraints that we face go so far that instead of being the solution for the populations in crisis you become part of the problem, you perpetuate the problem in a way. You need to be able to recognise that point, and that's the point at which you as a humanitarian organisation should be very clear and expose the constraints and recognise the limits of what you can do as a humanitarian organisation. We've done so in a repeated manner, most recently in Somalia where we withdrew all of our staff because of the constraints that we faced and the security that affected us as an organisation."
The report follows allegations and revelations through Wikileaks that some western countries use aid delivery as a cover for intelligence gathering.
Save the Children foreign workers in Pakistan in 2012 were asked to leave the country by authorities convinced that the aid organisation was used as cover by US spies hunting Osama bin Laden.
The concerns were raised after a doctor accused of assisting the CIA in its search for the al-Qaeda leader claimed that Save the Children had introduced him to US intelligence officers.
So are groups like Al-Shabaab justified in suspecting aid agencies of spying?
ODI researcher Ashley Jackson says the revelations have undermined the image of humanitarian organisations among such groups.
"Most agencies don't willingly allow spies in their midst but what it does underscore is the need to always behave impartially, to not take sides with their own governments and therefore in policy objectives, or on groups to really keep the needs of civilians and the concerns of civilians in war at the centre of their agenda."