As the global North moves more and more into a position of benevolent humanitarian for the global South, the reasons behind their actions, as well as the creation of the whole humanitarian ideology begins to come into question. In Miriam Ticktin’s book, the problematic idea behind humanitarianism is revealed . In the humanitarian laws of France, there is a focus on bare life, instead of a well-lived life, free of poverty and inequality (1). This type of action is representative of not only French humanitarianism, but humanitarianism worldwide. Which thus, leads me to ask if it is even plausible for a shift away from the habit of focusing solely on saving lives and ignoring the fact that medical intervention cannot cure impoverished miserable situations. Would a project that embarks on such a big mission (changing the structural violence in a community) ever be possible? In Peter Redfield’s piece the Doctors Without Boarders are introduced and depicted as volunteer doctors (usually from developed nations) who come into a country of disaster, heal the injured or diseased individuals and then leave (2). Although this may seem like the problematic tactic of sweeping in and quickly sweeping out, it in fact brings a set of quick, specialized results that people in disasterous situations need. If Doctors Without Boarders implemented a long-term structural goal that changes the socio-political inequalities of the community, the work would require a lot more time; something that countries in conflict do not have the luxery of spending. By focusing only on saving lives, the MSF organization is able to target a specific issue and work towards reaching a very tangible goal (2); which comes back to the successes of vertical programs over more long-term horizontal programs. Although the focus on bare life does bring with it unintended consequences ( keeps people in the same position of inequality as they were in before), it addresses the crucial question of health and survival in a way that a more horizontal approach would not be able to. In order to improve your socio-economic position in society, you must first stay alive.
Much Like the immigration issue presented by Ticktin, humanitarianism overlaps with refugee laws. Although at first glance it may seem like these laws are put into place to help individuals abroad, we begin to see that even when things are under the label “humanitarian” they still are based on very political, hierarchical goals (3). The very concept of humanitarianism has increasingly shifted towards an “ideology of hegemonic states in the era of globalization . . . with a growing North-South divide” (3). Are humanitarian causes (especially those that involve the government) every really free of selfish, benefiting reasons for taking action? What is so sexy about a developed country implementing programs of aid to people in far-off underdeveloped countries? Although it is easy to brush off this fact and say that regardless of intention, much needed humanitarian work and policies are being implemented which greatly help those people who are suffering the most. However, this becomes problematic, because without looking at intention, we do not realize that this is why the very idea of bare life appeals to countries of power. In order to seem like benevolent, compassionate governments hard facts and statistics are needed to show that something was actually accomplished. Social change cannot be as quantified as lives saved. For instance, the U.S. embarks on many projects to save the lives of people abroad but never focuses on the structural inequality present in many impoverished towns of their own. However, addressing these domestic needs does not make the U.S. seem as much of a hero as if they saved lives abroad. Intentionality can be a great indicator of program/law directionality.
Discussion Questions
- Taking into consideration Ticktin’s reading, is it possible for developed countries to implement humanitarian policies where the sole intention lies in morals and ethics? How does politics fit into this?
- Although the focus on zoe, or bare life brings with it many unintended consequences, as pointed out in the readings, what are the unintended consequences of focusing on the social well-being of a person? Is it plausible for humanitarian interventions to focus not only on bare vertical programs but also horizontal programs in a time efficient way
(1) Redfield, Peter. 2008. “Doctors, Borders, and Life in Crisis.” Cultural Anthropology 20(3): 328-361.
(2) Ticktin, Miriam. 2006. “Where Ethics and Politics Meet: The Violence of Humanitarianism in France.” American Ethnologist 33(1): 33-49.
(3) Chimni, B.S. 2000. “Globalization, Humanitarianism and the Erosion of Refugee Protection” Journal of Refugee Studies pg. 243-263
Hi Silvia,
Thank you for your synthesis and discussion of such concepts. I agree with the point you made in the first paragraph about the difficulty of trying to create structural-reformation programs; like you mentioned, such programs a level of time commitment/resources that (developing) countries in turmoil, themselves, may not be able to provide. But as a group that claims it does not prioritize cost-effectiveness (i.e. MSF treats money as an afterthought), I wonder whether Doctors Without Borders can use a country’s lack of resources as a justification for not implementing more long-term structural goals. I admire their goal of saving lives in the context of urgency – and as we discussed in class, this objective is hard to criticize – but I do see great potential in more sustainable approaches led by Doctors Without Borders. If they work on extending their apolitical views towards horizontal initiatives, they could possibly have a large impact on reducing underlying inequalities – at least in the health sector – within communities.
I also was wondering if you could please briefly clarify what you mean when you suggest that horizontal approaches are not able to address “the crucial question of health and survival.” Are you referring to the provision emergency care?
Regarding your first question, I think that it is possible for many groups – including MSF – to enter different countries and contexts with the sole, ethical-driven goal of helping people. However, as we discussed in class and as discussed in the readings, the fact that humanitarian aid is taking place in a the context of political/social turmoil can lead to the politicization of healthcare and other types of aid. This politicization can take place in many forms: the prioritization of certain peoples or certain illnesses over others (gate-keeping); the exclusion of certain people from refuge/asylum; etc. Overall of the frameworks in which humanitarian aid is taking place, it isn’t exactly possible to separate politics from humanitarianism. However, I think that groups who are trying to provide aid can still focus on this main goal of saving lives; perhaps this is the best way to preserve an apolitical attitude.
I found your second question very thoughtful, and I had to spend some time thinking about it. I would say that the main consequence of focusing only on social well-being is that creating social change and creating a better environment for livelihood requires much more time than treating someone’s biological symptoms. For example, let’s say an organization wants to create jobs in an impoverished community so that people will be able to earn money and, thus, will be able to go to a doctor. In the time that it takes to produce those jobs (and implement infrastructure), several lives will most likely have been lost. In other words, like you said in your first paragraph, “in order to improve your socio-economic position in society, you must first stay alive.” So while social well-being is incredibly important, I think this particular issue is perhaps why humanitarian groups put a great emphasis on ‘zoe’ as opposed to ‘personhood.’
Next, I do think it’s possible for humanitarian interventions to focus both on vertical programs and horizontal programs. As Professor Mason indicated in class, many humanitarian organizations do not fall strictly into either category (vertical or horizontal). For example, MSF must be able to provide a wide range of interventions/resources because of the fact that they work in emergency settings; this makes them seemingly horizontal. However, they do not focus on implementing sustainable and continuous care – this makes them, in a sense, more vertical. I think that with reformation and with more resources (volunteers, funds, etc.), it is possible for humanitarian groups not only to focus on states of “emergency,” but also to implement more sustainable health interventions. And I think this reformation would have to address this idea of intervening not only when a “crisis” is happening, but also when any inequality is perceived (because of the fact that a crisis may not be a discrete event but rather a normalized state of a community/country).
Hi Silvia,
Thank you for your post! You briefly commented on how helping countries and people in crisis appeals to countries of power. This implies that they do so to present themselves as compassionate and generous nations. I find this statement intriguing since I had not thought about this idea before. To an extent, being humanistic can benefit those who are providing the aid just as much as those receiving the aid. This also makes me wonder if in some scenarios, these initiatives can as selfish and they are unselfish. That being said, I still overall believe that these programs are definitely helpful and valuable.
I am still personally trying to work out the ideas presented in your first discussion question. I think it is possible for developed countries to implement humanitarian policies that lie in moral and ethics however I also think it would be tremendously complicated. Targeting such issues would require targeting structural inequalities and other deeply rooted. On the other hand addressing dilemma of bare life is usually simpler. In addition, it allows developed countries to help without “getting their hands dirty”. Involvement in morals and ethics often requires involvement in that country’s politics and government. This can be controversial and possibly borderline “colonialist”. I also think back to Maslow’s triangle of needs. Physical health is still just as important as moral health. Therefore, wouldn’t be almost immoral to focus only on solely on morals and ethics? If they wished to target bios they would also have to target zoë as well, which overburdens the initiative even more. Of course, I would love to see programs that prioritize bios, however considering the obstacles presented above it is not surprising that most humanitarian projects only attempt to fix the more “physical” issues at hand.
Hi Nini,
Thanks for your comment!
What I meant by “the crucial question of health and survival” was that the vertical approach taken by the Doctors Without Boarders team has the ability to address the issue of death and survival; while a more horizontal approach will address structural readjustments but doesn’t necessarily deal with the issue of the lives that are being lost at the moment. I do believe that these type of structural interventions are very necessary, however, in order for socio-economic conditions to be improved, people have to actually be able to survive in the first place. The interventions of MSF, make this first crucial step (survival) possible.
Thanks for this clarification!
Thank you Silvia for your post, and Nini for your comment. I understand your response that since MSF treats money as an afterthought, they should not be using the country’s resources (or lack thereof) as a justification for limiting their intervention. However, I think we need to remember to consider the time of foreign aid workers as a resource being offered, and one could at least justify MSF’s allocation of such resources as being necessarily triaged. This does not absolve them of criticism, especially in the front of imposing Western or postcolonial values in some of their actions and focus. It just means that every organization is going to need specific and tangible goals, as Silvia said in her post. This is crucial not only for allocation of limited resources (of all kinds), but also for the difficult challenge of demonstrating outcomes quickly to donors.
Silvia, in response to your first question – I think a focus grounded purely on ethics would be very difficult. One challenge would be narrowing or specifying the ethical focus being used here – some could argue that some variation on a cost-benefit analysis could produce the most utilitarian outcome (that the ends justify the means, and that the most ethical action is the one which ultimately brings about the most happiness to the most amount of people), but other ethicists can easily criticize this type of intervention for using problematic means or favoring the many over the few. Another type of focus – like one which centers around the importance of autonomy, could be criticized for valuing a specifically Western version of ethics (due to the fact that some cultures do not put as much value in autonomy and instead focus on more collective rights and responsibilities). The point I’m making is that I think a government/organization is best served finding a specific goal/outcome it considers worthwhile, then working to develop the most ethical process to accomplish that goal (rather than the other way around).
Snaps to this: “For instance, the U.S. embarks on many projects to save the lives of people abroad but never focuses on the structural inequality present in many impoverished towns of their own. ” I am not implying that Western countries shouldn’t intervene, yet I can also see how doing so reifies the superiority-inferiority relationship between “developed” and “developing” countries. Wealthy Western countries are able to assert their power when they tackle outside problems as opposed to their own internal problems, which may put them at a more vulnerable position. When you ask how humanitarian efforts can address “impoverished miserable situations” and “structural violence in a community” worldwide, I too ask the question of how these organizations can address these issues even in their own countries/communities.
In regards to your first discussion question, it would seem difficult if not impossible to make humanitarian policies based solely on morals and ethics due to varying perspectives on what is moral or ethical. Some could say that MSF’s policy of being apolitical may be unethical because it is excluding an important factor that if addressed could lead to positive changes in the health of a population.
Silvia,
Thank you for your post! I find your stance very refreshing—it is both realistic and bold of you to assert that humanitarian organizations are most practical in that they provide the results we need. You’re right, “In order to improve your socio-economic position in society, you must first stay alive.” Each global health organization has a specific purpose for the innate reason that no one can save the whole world at once. No matter how many critiques humanitarianism receives, it is quite unreasonable to expect that they can respond with emergency medical care AND create sustainable infrastructure to create long-term improvements.
To answer your first question, I think that the vast majority of humanitarian causes involving the government are never selfless. It is a hard aspect of human nature to shake that every action is in self-interest. In one of my audio responses, I expressed that self-interest, while shameful, is a useful tool in global health. As long as a goal is reached under the guise of developed countries’ self interest, we have won. However, I do acknowledge that consequences of self-benefitting actions such as unethical limitations on immigration are harmful and that there should be a push to loosen these restrictions.
However, I believe that as one moves away from governmental organizations, there are more people willing to take action outside of self-interest. In lieu of US governmental attempts to superficially improve life in developing countries, there is still hope in private organizations strictly motivated by morals.
You raise the question of whether or not tackling structural violence at the community level is possible, and I think this is one of the questions we keep coming back to in our discussion and critique of global health initiatives. What does it mean to do community organizing, and how do we strike a balance between curative medical intervention and preventative and horizontal social approaches?
Your discussion of the possibility of vertical vs horizontal approaches to aid makes me think about the critiques we are giving to Doctors Without Borders. Though it focuses primarily on the “crisis” at hand, in order to do so, it implements feigned-horizontal changes — temporary bathrooms, shelters, water supplies, etc. In doing so, MSF attempts to make a temporary systemic change in the region (one that is inherently impermanent) for the sake of their curative interventions. What does this mean going forward? What does it mean to put up a plastic hut a opposed to a wooden one? What does it mean for some people to be able to implement systemic change — just for a moment — so that they can do their own bidding?
You raised some good points about the problems with humanitarianism. It doesn’t seem like it’s enough to just focus on the “zoe,” people need more than just clean water, shelter and medical care. Bringing a horizontal approach into humanitarian efforts would relieve suffering beyond the superficial. However implementing something that addresses the problems of an area at a structural level, requires a lot of time and resources and also would most likely need some government interaction which goes against the policies of groups like MSF. Additionally many of the places that humanitarian relief efforts are aimed at are political unstable, and that by going beyond the goal of just saving lives would put some of these organization in danger. This sort of answers your second question about unintentional consequences. By focusing on the zoe a lot more time would be spent in these areas and would require a more political stance from groups like MSF. This could potentially be very dangerous especially in unstable areas.
Hi Silvia,
I very much agree that we shouldn’t’ be too quick to criticize humanitarian interventions, like MSF, that focus on quick fixes to save lives. MSF certainly shouldn’t be held responsible for not producing lasting, systemic change to they country it is in. I think this issue arises when a state depends on NGO humanitarian intervention to solve the larger issues when really this responsibility cannot fall solely on the shoulders of humanitarian programs.