Medical Humanitarianism: Ethnographies of Practice

Médecins Sans Frontières and Humanitarian Situations An Anthropological Exploration, Routledge, London, 2020, 2020

This book is about how MSF anthropologists apply the analytical tools and methodologies of their discipline to contribute to the development of humanitarian medical programmes. While we fully acknowledge the legitimacy and relevance of the critical tradition of anthropology, consisting of questioning the premises, modes of deliberation and political stakes of humanitarian aid as a global system, in this book we propose a change of scale and scope. We choose to work at a face-to-face level where humanitarian action actually happens. This book is about the practice of anthropology in humanitarian situations. Our conviction, forged by experience, is that anthropology can actually « work » and in a collaborative and multi-sectoral way, contribute to humanitarian operations aiming at saving lives and reducing suffering. The main objective of the book is to share experience: located at the centre of complex conflict zones, epidemics and natural disasters, the eight ethnographic chapters presented here are framed within a broader analytical discussion on the complexifying contexts in humanitarianism, the challenges of medical operations, the ethical conditions of applying anthropology in such contexts and finally, on humanitarian action in critical situations. We are glad to share our experience with MSF colleagues, scholars from social sciences, development studies and global health, as well as NGO staff and health professionals. We look forward to discussion and debate! The Editors,

2014

The present paradigm on transitional justice dictates that diverse interventions are needed in the aftermath of conflict. The West African country Liberia suffered from 14 years of civil war that ended in 2003 and is now the location for several interventions run by local NGO’s funded from abroad. In the rural post-conflict communities of Liberia’s Northern region, Lofa County, The Community Healing Project seeks to reach reconciliation, peaceful co-existence and healing. The project is run by the local NGO, Liberia Association of Psychosocial Services (LAPS), and financed by DIGNITY – Danish Institute Against Torture. One element in the project has been to produce a book documenting the massacres from the war committed in four communities in Lofa County. It is the book as a discursive tool that this thesis seeks to explore through critical discourse analysis. Based on Norman Fairclough’s (1992, 2003) theory and method the thesis unfolds how LAPS position itself as organization by c...

Contemporary protracted conflicts across the Middle East have presented health professionals and systems, as well as the humanitarian response, with unprecedented challenges. The changing nature of warfare has meant that today conflicts are increasingly taking place in urban settings with high civilian casualties and massive population displacements. The medical and humanitarian response to these needs is often partial and inadequate and takes place in settings marked by the degradation and even targeting of humanitarian health actors and establishments. The attacks on MSF health facilities in Afghanistan, Syria and Yemen have underscored the changing roles and responsibilities of humanitarian medical aid in responding to endemic conflicts in the region, and have opened up many broader questions related to rethinking the medical, public health, and humanitarian responses in contemporary warfare. On the 4th and 5th May 2016, Médecins Sans Frontières (MSF) staff members, civil society, academics, students and members of the public gathered at the American University of Beirut (AUB) to participate in a conference titled “Changing Ecologies of War and Humanitarianism.” The conference was organized by MSF, AUB’s Faculty of Health Sciences, and the Issam Fares Institute for Public Policy and International Affairs. The aim of the conference was to critically examine contemporary theoretical and operational challenges to humanitarian action within and beyond the conflict zones of the Middle East. The conference sought to historicize, analyze, and reflect on the changing dynamics of contemporary warfare and the resulting challenges in the provision of healthcare. The two-day conference was held at the Issam Fares Institute in AUB, and consisted of a keynote lecture, four panels, and multiple opportunities for open discussion. Participants were invited to engage in an active and lively discussion on the key themes and draw on lessons learnt that shape the future of research on healthcare under conflict and the practice of humanitarian aid. The conference marked two critical events: MSF’s first project in conflict was in Beirut in 1976; and AUB’s 150th anniversary, which marked the University’s long tradition of medical, educational, and humanitarian presence in the region. The conference was therefore both timely and pertinent. The concept note and program for the conference was prepared by Jonathan Whittall, MSF Head of Humanitarian Analysis, and Omar Dewachi, Assistant Professor of Anthropology and Global Health and co- director of the newly instated Conflict Medicine Program at AUB. The significance of the conference is that it was held at a critical point in time for medicine and humanitarianism. It was not a coincidence that the conference took place one day after the passing of a UN resolution on the protection of hospitals in conflict zones. While humanitarian aid in war zones has always been contested, a survey of recent events across the region suggests an unprecedented number of targeted attacks on medical facilities and humanitarian services. In light of its critical relevance to current events in the region, the conference also formally established the necessity for humanitarian and local academic institutions to collaborate to think beyond the present limits of crisis and put forth options for moving forward. The panels were organized around the following conference themes: ▸ The changing histories and landscapes of humanitarian aid ▸ War on medicine: The targeting and implication of medicine in warfare ▸ Responding to populations on the move ▸ Emerging global health trends in contemporary conflict in the Middle East Building on the themes of the conference, this document reports on the proceedings of the conference and some of the critical points that emerged during the two-day event.

Social Science & Medicine, 2014

In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts. [medicine, emergency, global health, humanitarianism, anthropology]

Conflict and Health, 2015

Background: Global health policy and development aid trends also affect humanitarian health work. Reconstruction, rehabilitation and development initiatives start increasingly earlier after crisis, unleashing tensions between development and humanitarian paradigms. Recently, development aid shows specific interest in contexts affected by conflict and fragility, with increasing expectations for health interventions to demonstrate transformative potential, including towards more resilient health systems as a contribution to state-building agendas. Discussion: Current drives towards state-building opportunities in health interventions is mainly based on political aspirations, with little conclusive evidence on linking state-building efforts to conflict prevention, neither on transformative effects of health systems support. Moreover, negative consequences are possible in such volatile environments. We explore how to anticipate, discuss and monitor potential negative effects of current state-building approaches on health interventions, including on humanitarian aid. Overriding health systems approaches might increase tension in fragile and conflict affected contexts, because at odds with goals typically associated with immediate emergency response to populations' needs. Especially in protracted crisis, quality and timeliness of humanitarian response can be compromised, with strain on impartiality, targeting the most vulnerable, prioritising direct health benefits and most effective strategies. State-building focus could shift health aid priorities away from sick people and disease. Precedence of state institutions support over immediate, effective health service delivery can reduce population level results. As consequence people might question health workers' intention to privilege health above political, ethnic or other alliances, altering health and humanitarian workers' perception. Particularly in conflict, neither health system nor state are impartial bystanders. Summary: In spite of scarce evidence on benefits of health systems support for state-building, current dominant line of thought among donors might influence aid strategies and modalities in settings of crisis, conflict and longer-term health system fragility. Negative consequences may arise from dominance of political agendas over health needs, with risk for effectiveness, nature and perception of health interventions. Potential effects in at least three key health areas merit critical review: quality of humanitarian health interventions, tangible contributions to population level health benefits, perception of health and humanitarian workers. To keep health needs as yardstick to determine effective health and humanitarian priority investments, is challenging.

Medical Humanitarianism: Ethnographies of practice, which opens with a foreword by Peter Piot, the eminent microbiologist who discovered the Ebola virus and is director of the London School of Hygiene and Tropical Medicine, and concludes with a postface by Peter Redfield, whose pioneering research has provided new insights into humanitarian work thanks to its anthropological approach, was surely no disappointment to these two illustrious readers...

The neutrality of medicine and health care professionals in different conflict settings in the Middle East have come under scrutiny in recent human rights reports, and should be seen as part of the broader fallout of the US-led ‘global war on terror.’ The last two decades of US military attacks on health infrastructures in Iraq and the use of polio-vaccination campaigns to track down ‘terrorists’ are acts of war that have further blurred the lines between health care and warfare. The failure of international legal processes and institutions to prevent such assaults or to prosecute those responsible raises questions about the Eurocentric system of checks and balances that shape international humanitarian law and its invocation as a ‘legal’ and ‘moral’ framework.

Frontiers in Public Health, 2022

Drawing on ethnographic research with Somalis, within aid organizations, and within health care facilities in the Somali Region of Ethiopia, this article argues that what is called ‘‘global health diplomacy,’’ despite its origins and articulations in interstate politics, is fundamentally local and interpersonal. As evidence, I outline two very different health programs in the Somali Region of Ethiopia, and how, in each, existing animosities and political grievances were either reinforced or undermined. I argue that the provision of health care in politically insecure and post-conflict settings like the Somali Region of Ethiopia is precarious but pivotal: medical encounters have the potential to either worsen the conditions in which conflicts and crises recur, or build new interpersonal and governmental relations of trust. Effective global health diplomacy, therefore, cannot be limited to building clinics and donating medicine, but must also explicitly include building positive relationships of trust between oppositional groups within clinical spaces.