Category Archives: Unit 2 – Trying to Help

Clinical Trials and Regimes of Research: Ethics, Progress, and Innovation

As we have seen continuously through our study of global health, healthcare provided by a foreign organization in a developing country affects and is affected by the local culture to a great extent. We have studied the necessity of expecting the unexpected when it comes to the possible consequences of our actions. We have learned about the ways in which cultural sensitivity and understanding have not been adopted in past interventions, thereby permanently changing perceptions of the West and sometimes negatively affecting communities an that intervention had intended to help. The readings about clinical trials in the global sphere, and the ways in which pharmaceutical companies have both benefited as well as manipulated populations in “drug-naïve” regions, are prime examples of these concepts.

Another theme we have considered in our readings and discussions has been losing sight of the people we are trying to help. Modern day methods of creating interventions rely mostly on numerical or statistical credibility, and it has caused many to ignore the humanity of the lives in question. Chapter two of When People Come First, entitled ‘Evidence-Based Global Public Health,’ illustrates the shortcomings of evidence-based medicine (EBM) and evidence based public health (EBPH) interventions. In the modern landscape of health interventions, lack of statistical evidence is equal to a lack of reliability in terms of the potential success or failure of a given intervention (Biehl and Petryna, 2013). Even so, without EBM, the safety of many treatments could not be determined with certainty. Though it could change the outlook and the questions asked, it is ultimately necessary for EBM work to be done to insure efficacy and safety. It is, however, also necessary to do qualitative studies that examine the greater social contexts and effects of interventions, and without those studies, we are missing vital pieces of information that could be used to better actuate change.

The readings all present a few reasons why global clinical trials and EBM are positive; however, they mostly discuss failures and problems with these recent developments in global health. Looking only at the three assigned readings, it is easy to become cynical about the involvement of pharmaceutical companies in global health, taking ethical advantage of needy populations for their own economic gain. In her article ‘Ethical Variability: Drug Development and the Globalization of Clinical Trials,’ Adriana Petryna talks about Chernobyl and the manner in which the crisis was taken advantage of politically, and subsequently scientifically. Those who wanted to experiment with therapies for the horrific damage that was caused by the nuclear accident were welcomed in by the Soviet Union’s leaders, casting all questions of the ethics of these studies aside in the name of aid. Petryna questions the ethics of these decisions made in times of crisis, and laments the variability in the reasoning behind them. While there are different reactions necessary to different crises, she argues that the underlying moral code of the regulation surrounding clinical trials should not allow for such variability (Petryna, 2005).

Today, though the FDA and other U.S. agencies cannot regulate trials in other countries, pressure from humanitarian organizations as well as the general public causes pharmaceutical companies to act in a less variable manner when performing research abroad. Clinical trials performed abroad also will not get the approval of the U.S. or other Western countries if done in a manner that is explicitly harmful. Of course, as the Leach and Fairhead article demonstrates, interventions or clinical trials can change the “therapeutic landscape” of a place forever. The ways in which people had previously experienced health and health care in Sukuta in the Gambia was permanently altered, shifting cultural paradigms and values. Though this particular intervention was mainly beneficial to the community, the consequences of it, and other similar projects, appear to be almost in the vein of colonialism—both invasive and patriarchal, insensitive to whatever structures or beliefs are already in place in a community.

Though there have been some sickening and disastrous outcomes from corporate involvement in global health—often from what is nominally humanitarian or philanthropic work—there have been many positive outcomes in recent years. During the Ebola epidemic this past year, many Western pharmaceutical companies jumped into action, quickly creating possible vaccines and launching animal and then human trials as fast as possible. What selfish motive could these companies have had in working to create vaccines for people at extremely high risk for a devastating disease? Yes, it would help their image, create positive PR, give people cause to stop hating “big pharma” as an impenetrable anathema, etc. However, these companies were at the forefronts of the effort because they had the money to back the research and the resources  ready to be mobilized for serious innovation. In their press release about the Ebola vaccine being tested, Johnson and Johnson lists organizations like Direct Relief International, Partners in Health, and other NGOs as organizations they are working with. Collaboration between the public and private sector is increasingly prevalent and is more successful than either one working without the other. While NGOs may have more expertise in countries of interest, pharmaceutical companies have the innovation and technology that is the basis of many interventions. The three vaccines shown in this image have all gone through Phase I clinical trials in Sierra Leone, Liberia, and Guinea, with mostly positive results. Can we really say that they took advantage of people in the developing world for completely selfish reasons when the outcome was not merely for their gain?

The vaccines currently being tested in communities with especially high risk for the rapid spread of Ebola. Image: 2015 Washington Post Article entitled 'How trials will work for Ebola vaccines'
The vaccines currently being tested in communities with especially high risk for the rapid spread of Ebola. Image:  2015 article by Berkowitz and Clark in the Washington Post, entitled ‘How trials will work for Ebola vaccines.’

A 2015 article in the Journal of Medical Ethics ‘Can Informed Consent to Research be Adapted to Risk?’ discusses the question of consent in different contexts, and how it can be improved to fit different research situations better.First and foremost, the article sets down the importance of consent: “Autonomy rights protect competent adults from unwanted interference and they also give them the opportunity to live their lives in accordance with their own interests, preferences and values” (Bromwich and Rid, 2014). The article states that as risk to participants in a study increases, the l consent of a patient becomes less meaningful. When performing studies, at home or abroad, language and literacy are a huge barrier between scientists and patients. As much as interventions and medications can be simplified, what details are being lost in this simplification? How can communication of risks and benefits be enhanced, and how can we ensure that these conversations are always clear on the part of the investigator as well as understood by the patient? Articles like this one are not uncommon in today’s medical and public health journals, and the way in which hulking industries and corporations, especially those coming from the West, are now treating issues like consent has become extremely visible. It seems to me that one of the more difficult issues in global clinical trials is no longer a question of blatant human rights violations, but rather more subtle consequences to the communities that participate in these trials. Though these consequences may often be unintended, at what point, in a world where cultural and anthropological knowledge is very available to those who trouble themselves to look, do these things become the result of calculated carelessness?

A qualitative study performed in Kenya in 2005, surrounding clinical trials for HIV/AIDS treatments, used focus groups to gain an in-depth understanding of the needs of participants. The study joins a large body of work on how to make clinical trials more beneficial to those who participate as well as reducing any potential long-term damage to communities. This, along with anthropological work like that of Biehl and Petryna, gives me hope for the future of clinical trials, so that, under the public eye, innovation will no longer come at the expense of vulnerable populations. However, many questions are still unanswered about the current state of medical research and the ethics and methods surrounding it. Scientists and companies that do not move forward in a humanistic way, considering the impacts of their actions down the road, may still do harm until more clearly agreed upon standards arrive.


  1. Agnandji, S. T., et al. “Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe — Preliminary Report.” The New England Journal of Medicine (2015): n. pag. The New England Journal of Medicine. Web. 9 Nov. 2015.<>.
  2. Berkowitz, Bonnie, and Patterson Clark. “How Trials Will Work for Ebola Vaccines.” The Washington Post. N.p., 8 Feb. 2015. Web. 9 Nov. 2015.<>.
  3. Bromwich, Danielle, and Annette Rid. “Can Informed Consent to Research Be Adapted to Risk?” Journal of Medical Ethics 41 (2015): 521-28. Print.
  4. “Ebola vaccines, therapies, and diagnostics.” WHO. World Health Organization, 6 Oct. 2015. Web. 9 Nov. 2015.<>.
  5. “Johnson & Johnson Announces Start of Clinical Trial of Ebola Vaccine Regimen in Sierra Leone.” Johnson and Johnson. Johnson & Johnson Services, 9 Oct. 2015. Web. 9 Nov. 2015. <>.
  6. Leach, Melissa and James Fairhead. 2011. “Being ‘with the Medical Research Council’: Infant Care and the Social Meanings of Cohort Membership in Gambia’s Plural Therapeutic Landscapes.” In Evidence, Ethos and Experiment: The Anthropology and History of Medical Research in Africa. P. Wenzel Geissler and Catherine Molyneux, eds. New York: Berghahn Books.
  7. Petryna, Adriana. 2005. “Ethical Variability: Drug Development and the Globalization of Clinical Trials.” American Ethnologist 32(2): 183-197.
  8. Petryna, Adriana, and João Biehl, eds. When People Come First. Princeton: Princeton UP, 2013. Print.
  9. Shaffer, D. N., et al. “Equitable Treatment for HIV/AIDS Clinical Trial Participants: A Focus Group Study of Patients, Clinician Researchers, and Administrators in Western Kenya.” Journal of Medical Ethics 32 (2006): 55-60.

Discussion Questions:

  • What is the best way to create ethical standards that apply worldwide for clinical trials? Or at least reduce the variability in ethical decisions? Is this even practical?
  • How can clinical trials be designed in a way that is beneficial to the health of populations in need, but not a cultural burden that follows in the footsteps of colonialism?


Whose Consent? Vulnerable Populations and Ethical Standards

In the expansive organism of research regimes, a.k.a contract research organizations (CROs), there seems to be a baseline standard for which all research is considered “ethical”. As Petryna notes in Ethical Variability: Drug Development and the Globalization of Clinical Trials, “the ethical universe in which researchers operate [is] an essentially procedural one” with the basic but critical concerns of obtaining informed consent from subjects and assuring investigator responsibility in case of adverse reaction or death.  Especially in the context of globalized drug development, I believe it’s incredibly important to explore the ways in which these procedural ethical standards are warped according to and “across distinct political and economic contexts”.

Still, I get a nagging feeling that at the core of the research regime’s baseline ethical standard lies a more subtle danger: it seems to me  that the definition of “informed consent” is built in to whatever subjective understanding the Independent Review Boards (IRBs) and CROs may have of it. Seeing as “informed consent” acts as foundational language for an entire ethical standard, a subjective or shaky definition of the phrase is problematic in a way Petryna does not explore at length. When taken across differential political and economic contexts, the ambiguous language of “informed consent” is further destabilized.

In the U.S., informing subjects can be relatively simple if the population is english-speaking and if they have already been exposed to the culture of research, whether through ads  for subjects or through lived experience. When in a place in which research is not the norm or is in the process of becoming a norm, language barriers, stigmatization, and local knowledges seem to lead subjects to create their own understanding of the research purpose.  In Fairhead’s article, which focuses on the MRC project in The Gambia, many parents seemed to believe that the taking of blood samples was for insidious purposes.  Although MRC fieldworkers attempted to inform subjects by “explaining the immune system as the body’s soldiers” and framing their research in an attempt to understand such a system, local knowledges still prevented people from fully accepting the idea. In the end, participants were primarily concerned about the health care that they and their infants were receiving that was unavailable through the government.

If informing subjects according to time and place can be tricky, then obtaining  valid consent might prove to be exceptionally difficult.  Although most CROs would agree that the patients in the MRC study have consented despite being limitedly informed, they fail to take into consideration the structural elements involved in these people’s lives that lead them to agree to a study despite limited understanding or informed hesitancy. It begs the question: can true consent exist in structurally violent circumstances? Even if the subject is informed, outside forces such as political instability, governmental inadequacy, and economic constraints may push people in impoverished conditions towards “consenting” to a study. In this way, consent becomes antithetical to a person’s true desires.  In that case, can it even be called consent?  CROs have no  interest or responsibility in addressing  “how true” consent may be, therein perpetuating inequality while creating ethical variability across specific populations that exploits in a way that is distinct from the crises that Petryna explores. In the article by Fairhead, some people that were not able to get the care they needed from the government consented to the  MRC study because of the benefits to them and their family.

A recent October article presents a case which is not entirely analogous but still relevant to the exploitation of vulnerable populations through research.  In their WashingtonPost article, Gowen and Lakshmi discuss the “Rent-a-Womb” industry  in India that allows foreign couples to find surrogate mothers.  If the nick-name of service and commodification of the womb is not concerning, these surrogate mothers are “often poor and illiterate women from rural areas who are paid little.” It is a largely unregulated business supported by fertility clinics and produces a whopping $400 million dollar a year. Although the “Rent-a-Womb” industry is not necessarily a research study, it is again a moment in which biological bodies are used in a manner that is exploitative, in which monetary gains drive poor women to “consent” to the use of their wombs.

In this way, the shaky foundational language of ethical standards is a powerful means to exploit vulnerable populations in quite subtle ways. Informed or not, consent hinges on the socioeconomic status of subjects in a way that perpetuates inequalities between privileged and impoverished bodies. Consent is not given by subjects, but rather created by CROs to benefit their own goal of cost-effective and rapid research.



Leach, Melissa and James Fairhead. 2011. “Being ‘with the Medical Research Council’: Infant Care and the Social Meanings of Cohort Membership in Gambia’s Plural Therapeutic Landscapes.” In Evidence, Ethos and Experiment: The Anthropology and History of Medical Research in Africa. P. Wenzel Geissler and Catherine Molyneux, eds. New York: Berghahn Books.

Gowen, Annie, and Rama Lakshmi. “India’s ‘rent-a-womb’ Industry Could Close Doors to Foreigners.” Washington Post. The Washington Post, 28 Oct. 2015. Web. 8 Nov. 2015. <>

Petryna, Adriana. 2005. “Ethical Variability: Drug Development and the Globalization of Clinical Trials.” American Ethnologist 32(2): 183-197.


Can the consent of people in such impoverished communities ever be taken as true, regardless of whether they have been informed?  How does allowing these people to have bodily autonomy complicate the issue?

How can IRBs or other bodies claiming to uphold ethical standards prevent exploitation of vulnerable communities given that structural violence often drives such individuals to use their biology in order to benefit themselves and their families?

Turning people into Numbers? Downsides and Possible Solutions to Clinical Research in a Global Context

Since the 1990s there has been rapid growth in the number of people participating in clinical research. Even though most clinical research is funded and controlled by more developed countries like the United States, the rise in human participants is primarily coming from developing low-income countries. There are a multitude of reasons why researchers are now going to low-income countries to find human subjects. Research guidelines may not be as strict, allowing researchers more freedom in conducting their studies. People may be more willing to partake in clinical trails because they are getting drugs they may not get under other circumstances. Lastly, the testing population in the United States has been gradually shrinking despite the increasing demand. Thus, compelling more researchers to adamantly search abroad from human participants (Petryna 185).

The United States drug testing pool has been shrinking since the 1970s. This was when the “use of prisoners as subjects was exposed and severely limited” (Petryna 185). Researchers had to turn directly to the American public to find human subjects since incarcerated individuals made up a large portion of their previous subject pool. The current issue at hand is slightly different. The US population has become a “treatment saturated” population (Petryna 185). Most individuals are on some sort of medication. Using medicalized individuals in clinical research could result in drug interactions and bias data. Some researchers have found a solution in using international individuals instead. Many individuals in less affluent countries have not had the same access and exposure to medications. This makes them naïve test subjects. This desire for the naïve subject is pushing American research initiatives abroad.

There are significant downsides to conducting medical researcher abroad. This current situation puts developed countries at risk for exploitation (Emanuel et al). In developed countries this risk is minimized because there is infrastructure that protects individuals. However, developing countries are less likely to have this framework in place, leaving individuals in these communities more susceptible. Ethical Variability by Adriana Petryna presents a good example. Researchers in developed countries usually target individuals in neighborhoods with easy access to hospitals and centralized healthcare. However, while searching for research participants abroad, many researchers seek out communities with broken health care systems. These areas are more likely to have more willing participants because the people there have no other access to healthcare. It is clear that the primary goal is getting as many subjects as quickly and cheaply as possible (Petryna 187). On a similar note, Petryna also discusses questionable clinical trials shortly after Chernobyl. She claims that chaos enabled researchers to perform trials they usually would not get permission to perform (Petryna 191). Even though some kind of attention was being directed toward the issue at hand, corners were likely cut and subjects were valued less as humans and more as unique testing opportunity. An element of humanity is definitely lost in this kind of approach.

Research projects themselves have become more about the numbers produced and less about the individuals themselves. This is a concern thoroughly discussed in When People Come First by Petryna and Biehl. Evidence Based Medicine, especially Randomized Controlled Trials, are now considered research standard (Petryna and Biehl 58). The issue is that these rigid research methods are not always applicable to the broad, complicated and unpredictable field of global health. Furthermore, studies resulting in defined measurements and statistical significance do not necessarily provide helpful conclusions or a useful platform for future initiatives (Petryna and Biehl 83). Recently, studies that actually aim to help individuals are often shut down because they will not produce the desired numerical results. Forcing determined NGOs to seek private funding if they want to implement effective projects.

When faced with such a problem, it is important to consider possible solutions. If companies desire to perform research beyond their own borders it is important that some regulatory system is established. As stated in the article What Makes Clinical Research in Developing Countries Ethical? such systems should prioritize participant protection. It should set guidelines to prevent researchers from taking advantage of research subjects. Another possible solution could be achieved through partnership. Although it was not completely perfect, the Leach and Fairhead article demonstrated a relatively effective solution: combining research and direct aid. Health workers provided new mothers with good health care and then performed research on the side (Leach and Fairhead 96). This approach allows beneficial research to done while still maintaining a humanistic element. If implemented correctly the motivation to perform research may even eventually foster more sustainable experimental and medical support systems.

Discussion questions:

  1. What do you think about the research performed after Chernobyl? Even if controversial research produces favorable results is still ethically acceptable? Should medical research guidelines be loosened in a state of emergency or crisis? Who would such an act benefit more: the researchers or the participating individuals?
  2. Not all countries have sustainable systems that can regulate medical research. Who should implement medical research regulations? What research guidelines would be essential in these scenarios?


Petryna, Adriana. 2005. “Ethical Variability: Drug Development and the Globalization of Clinical Trials.” American Ethnologist 32(2): 183-197.

Biehl and Petryna. 2013. “Evidence Based Global Public Health.” When People Come First (Ch. 2).

Emanuel et al. 2004. “What Makes Clinical Research in Developing Countries Ethical? The Benchmarks of Ethical Research.” Perspective.

Leach, Melissa and James Fairhead. 2011. “Being ‘with the Medical Research Council’: Infant Care and the Social Meanings of Cohort Membership in Gambia’s Plural Therapeutic Landscapes.” In Evidence, Ethos and Experiment: The Anthropology and History of Medical Research in Africa. P. Wenzel Geissler and Catherine Molyneux, eds. New York: Berghahn Books.

Humanitarianism: a site of post/colonial tension

In the popular imagination, humanitarianism is an altruistic endeavor to seek and promote human welfare (11).  However, in the execution of humanitarianism, health officials and lawmakers create and arbitrarily follow policies that relegate people on the receiving end to a subhuman existence void of basic rights, such as freedom of mobility, steady employment, and health care (1). There is no universality to humanitarian practices, which are instead contingent on a specific political setting at hand. However, in Doctors, Borders, and Life in Crisis as well as Where Ethics and Politics Meet: The Violence of Humanitarianism in France, both Redfield and Ticktin, respectively, identify a common thread across humanitarianism: aid workers whose practices produce patients with “a limited version of what it means to be human” (2).

As Ticktin illustrates, humanitarianism reinforces colonial subjugation as well as racial and gender hierarchies in what is, arguably, a postcolonial context. The case of Fatima is particularly disturbing because her “suffering body” is a site of common moral ground – between she and the nurses – on which they consciously and inadvertently project tropes of the “oppressed Muslim woman”. Popular French colonial discourse on Algeria informs stereotypes of Algerians that continue to pervade discriminatory employment, education and other policies that privilege white citizens (3). The ability of health care workers to assign political value to lives brings the underlying violence of humanitarianism into sharp relief (2). Philosopher Giorgio Agamben conceptualized that zoë is the minimum level of existence common across all organisms (i.e. bare life). On the other hand, bios describes a life rich with networks and communities unique to humans (2). Unfortunately, the work of humanitarian agencies reinforces life as zoë through temporary and often undignified relief projects (1).

While the nature of humanitarianism is ostensibly apolitical, to either grant or deny an immigrant a permit is a political end in and of itself. According to psychiatrist Jonathan Metzl, “diagnoses can…define, circumscribe, and contain abject populations in ways that harm people in these populations under the guise of helping them” (4). As Ticktin demonstrates, the process of diagnoses is often governed by emotion. Moreover, “fear during particular moments of historical stress” (e.g. immigration and changing demographics of a country) influence how health workers perceive and interact with patients (4). The case of the nurse’s aversion to an Algerian man seeking a renewed permit is situated in France’s political climate that has historically denied and currently withholds citizenship from Arab men for “lack of integration” (5; 6).

Similar reluctance towards immigrants is felt throughout European governing bodies. In 2014, British Defense Secretary, Michael Fallon, asserted that British towns are “under siege” and “swamped” by immigrants (7). Essentially, his diction equates immigrants to enemy forces. Prior to these insensitive remarks, the Italian navy documented 2,500 accounts of drowned or missing refugees in the Mediterranean (8). Despite Italian operations (termed ‘Mare Nostrum’) that saved 150,000 individuals between 2013 and 2014, officials decided to defund the program (8). This withdrawal of funds, on the grounds that it was “not sustainable”, came as UK Foreign Minister, Lady Anelay, claimed that rescue operations create an “unintended ‘pull’ factor” (9). In other words, humanitarian efforts to save migrants would result in a surge of immigrants to Europe. Both European officials and the French nurse demonstrate that humanitarian efforts regulate the “other” and “become(s) (a) gatekeeper to…‘humanity’ ” (2).

After dismantling Mare Nostrum, the joint European Union initiative created a more passive program called Operation Triton, which has a third of the funding as its predecessor (8). While these rescue efforts are a noble cause that saves lives, heightened xenophobia and racism towards “boat people” pervades not only Sicily and Italy but also former colonizers, such as France (10). As such, Algerian and other individuals who land in Europe will most likely encounter a “postcolonial space created through…politics of humanitarianism (that continue) in the manner of its colonial predecessors, reconfigured for ever-greater forms of exclusion” (2).

In the wake of African and Middle Eastern refugees coming to Europe, it is clear that sentiments of unease characterize France and other country’s humanitarian policies designed to “help” these populations. While one of the aims of humanitarianism is “to build spaces of normalcy in the midst of profoundly abnormal” situations, to what extent is the process of dehumanization a greater source of harm than a health condition in question (1)? How do definitions of “normalcy” and health oppress certain populations?


Discussion Questions:

  1. In my audio response on “Essential Medicines and the Pharmaceutical Fix”, I stated that an “emphasis on drugs doesn’t fix (structural issues) it just makes living under inequality more bearable”. If we understand the ethical implications of humanitarian work, where life is “bearable” but is still “bare life”, what measures can we take to improve its application?
  1. Given the relationship between humanitarianism and colonialism, to what extent is it possible to reform humanitarian such that it no longer maintains hierarchies of difference?


Works Cited:

(1)       Redfield, Peter. “Doctors, Borders, and Life in Crisis.” Cultural Anthropology 20.3 (2005): 328-61. JSTOR. Wiley, Aug. 2005. Web. 11 June 2015.

(2)       Ticktin, Miriam. “Where Ethics and Politics Meeting: The Violence of Humanitarianism in France.” American Ethnologist 33.1 (2006): 33-49. Web.

(3)       Dillender, Amber Nichole. “The Integration of African Muslim Minority: A Critique of French Philosophy and Policy.” Scholar Commons. University of South Florida, 2011. Web.

(4)       Metzl, Jonathan. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon, 2009. Print.

(5)       Fredette, Jennifer. “Are French Muslims Integrated? Depends on What You Mean by Integration.” Washington Post. The Washington Post, 29 July 2014. Web.

(6)       Willsher, Kim. “Algerian-born Man Living in France Is Refused French Nationality.” The Guardian. Guardian News and Media Limited, 9 June 2011. Web.

(7)       Syal, Rajeev. “Michael Fallon Withdraws ‘careless’ Immigration Remark.” The Guardian. Guardian News and Media Limited, 27 Oct. 2014. Web.

(8)       Graham, Georgia. “UK Will Not Support Rescue of Mediterranean Migrants.” The Telegraph. Telegraph Media Group, 28 Oct. 2014. Web. 07 Nov. 2015.

(9)       Bajekal, Naina. “Italy to End Naval Operation That Rescued Thousands of Migrants.” Time. Time, 28 Oct. 2014. Web.

(10)     Scammell, Rosie. “Rising Xenophobia in Sicily at the ‘boat People'” AlJazeera. Al Jazeera Media Network, May 2015. Web. 07 Nov. 2015.

(11)     Webster


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

  1. 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?
  2. 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


Humanitarianism: An End to Suffering or the Destruction of Dignified Humanity?

Humanitarianism has traditionally endeavored to minimize the suffering of individuals through neutral, immediate care in crisis situations in an attempt to reconstruct human dignity (Redfield 328). Medical humanitarian organizations such as Doctors Without Borders, or MSF, whose foundations are based on the alleviation of immediate suffering, however, prioritize mere physical existence, or “bare life”, at the expense of a dignified and satisfying life that extends beyond minimal survival through a refusal to combat the structural violence that is often responsible for the suffering it attempts to treat (Redfield 329-330, 340). Such a “minimal existence” is far from dignified, as there is a sharp distinction between simply living and living well (Redfield 340). One may argue that humanity is defined by recognition of one’s individual capabilities and emotions as well as the needs and desires that are not connected to one’s basic survival; our existence as social, cultivated beings is what fundamentally separates the human race from other living species. MSF’s emphasis on immediate medical treatment thus diminishes the perceived humanity of these individuals, as alleviation of their suffering is evaluated only on the basis of physical necessity and not on their personal experience with poverty, social inequality or other forms of structural violence (Redfield 342).

Individual choice is also vastly limited within MSF’s interventions, as patients are not really given the option of deciding whether to accept treatment (Redfield 337). This raises the question of whether patients are even willing to receive treatment that will essentially prolong the misery and suffering engendered by their social conditions; to what extent can immediate medical aid satisfy victims of structural violence who feel as if they have already lost everything? Humanitarianism may therefore have an extremely limited effect on broken societies in which “temporary relief cannot repair the damage” (Mackreath). Sick individuals will continue to be sick even after momentarily recovering if the underlying social and political factors exacerbating this sickness are ignored; in this sense humanitarianism does little to truly mitigate suffering (Redfield 346; Mackreath).

In France, undocumented immigrants may acquire the legal right to live in France if they possess a life-threatening illness that cannot be treated in their countries of origin (Ticktin 1-2). These immigrants consequently become defined by their illness, as their existence in France is perpetually determined by disease (Ticktin 7). As I mentioned earlier, I believe that humanity extends beyond bare life; how can these individuals therefore be publicly perceived or accepted as part of humanity when their identities are restricted to that of the “apolitical, suffering body” (Ticktin 7)? A disregard for dignified humanity may thus exacerbate the mistreatment of immigrants, who may consequently be perceived as ‘inferior’ within French society and thus undeserving of humane treatment or the maintenance of their basic human rights. These immigrants are not even provided with the foundations of a decent or fulfilling life, as they are prohibited from working and are thus denied any economic, social or political participation in France that is essential for the preservation of a dignified human existence, forced to live “with nothing to wake up to each morning except one’s illness” (Ticktin 9).

The failures of humanitarianism are further exemplified through the experiences of Syrian refugees relocated to the United States to escape the suffering engendered by structural violence and civil war. Although they are relocated on the basis of immediate need, Syrian refugees are provided with virtually no resources to sustain themselves or maintain a sense of dignity amidst their suffering (Davis and Hemish).

One may argue that suffering can only truly be ameliorated by self-determination, meaning an individual’s ability to control his or her own life; self-determination may be perceived as essential for the preservation of dignity (Mackreath). Yet humanitarianism does not bring victims closer to self-determination, as it does not grant them the ability to truly improve their lives or even decide the fundamental conditions of their existence; self-determination is virtually impossible when one’s social status as a dignified human being is compromised. As a consequence of their inability to legally work in France, for example, many immigrants are forced to obtain the means for their survival through degrading and exploitative work in the black market that exacerbates their suffering while simultaneously diminishing recognition of their humanity (Ticktin 7).

Humanitarianism cannot fully alleviate suffering or reaffirm human dignity through a narrow emphasis on immediate care without attention to the maintenance and improvement of patients’ “elaborated human experience” that is essential for a satisfying and happy life (Redfield 330). Who will address structural violence, if not those who have volunteered to help suffering individuals? Humanitarian organizations must strive to promote a dignified existence by actively challenging structural violence and political inequality to enable aid recipients to be publicly perceived and rightfully treated as human beings.

Discussion Questions:

  1. How may humanitarian organizations successfully challenge and potentially change conditions of structural violence and political inequality? Do they have the authority or power to do so, or is this far too idealistic?
  2. To what extent does humanitarianism compromise individuality? Can individuality be perceived as essential for human dignity?


Davis, Charles and Mohamed Hemish. “A Refugee’s Story: From War in Syria to Poverty in the US.” teleSUR 4 November 2015. Web. 5 November 2015.

Mackreath, Helen. “The Early Plight of Humanitarianism.” Jadaliyya 26 October 2015. Web. 4 November 2015.

Redfield, Peter. “Doctors, Borders and Life in Crisis.” Cultural Anthropology 20.3 (2008): 328-361.

Ticktin, Miriam. “Where Ethics and Politics Meet: The Violence of Humanitarianism in France.” American Ethnologist 33.1 (2006): 33-49.


The Most “Humane” Organization

Médecins Sans Frontières (MSF), also known as known as Doctors Without Borders, is known across the world as a provider of emergency humanitarian aid in response to war, disease, natural disaster, and exclusion from healthcare (“About MSF”). They push to be ethical, moral, and impartial, but the problem is, there are still people behind the decisions that the organization makes, and it begs the question: who gets to define what is ethical? MSF also treads carefully in order to respond appropriately to crises, but again, what entails a crisis? There is a danger in trying to define these convoluted components of humanitarianism, since the determinant is given the power to ultimately determine the value of a life.

When I search up the definition of “ethical”, the following results show up:

  1. following accepted rules of behavior : morally right and good
  2. involving or expressing moral approval or disapproval
  3. conforming to accepted standards of conduct (“Ethical”)

All of these definitions require ethics being “accepted” or “approved”, but it is virtually impossible to gain 100% approval on anything. Individual people make these decisions, and as seen in the article by Mirian Ticktin Where ethics and politics meet: The violence of humanitarianism in France, there are nurses who read files and meet with people in order to decide if their illnesses warrant citizenship. Like gatekeepers or admissions officers, these nurses are allowed to make a subjective decision, even when their backgrounds and past experiences can easily shape their compassion and who they choose to help (Ticktin). This leaves an incredible amount of room for variability, but can a standard be set on these decisions? Is it truly humane to allow citizenship to one suffering person, while ignoring another?

Similarly, MSF responds to international crises, but there has been uncertaintyeven within the organizationabout what appropriate responses to these issues are.  As with almost all humanitarian aid, there are those two dreaded words: unanticipated consequences. MSF knows that a quick and temporary response to an emergency is crucial, but they have to leave as soon possible since dependence on this aid often hinders a country’s own progress. As said by an MSF administrator of Ugandan projects, “We don’t want to put a foot in the [local] hospital or we’ll be there ten years later” (Redfield).

Unfortunately, that’s exactly what happened in Syria.

In 2011, MSF responded to the Arab Spring in and around Syria by operating medical medical facilities and running field hospitals and clinics. Four years later, MSF is still involved, but is facing an entirely new problem: hospitals largely run by the organization are facing air strikes, and MSF members are being abducted by the Islamic State (IS). Six hospitals have been forced to close, and four ambulances were destroyed (“Syria”). Tens of thousands of people in and around Syria are in desperate need of aid, but MSF and other international organizations are severely restricted in the humanitarian aid and healthcare they can provide. The result is poor and unsafe conditions for refugees who must live in overcrowded spaces, subject to psychological distress. In order to tackle this issue, MSF brought in psychologist and psychiatrists to carry out consultations, but it is clear that problems are compounding onto each other and that thousands of people are still suffering (“Syrian Refugees”).

So then, what is the job of MSF and international organizations? Radfield’s Doctors, Borders, and Life in Crisis distinguishes between two Greek terms for life: zoe and bios. Zoe entails the simple act of living or being alive, while bios represents a life with a narrative, and perhaps in their current state, MSF can only provide refugees the simple act of living. Can it be called humanitarian if the people who are “saved” live in fear, uncertainty, and distress? When is it time to change our mindset from “this is all we can do” to “what we’re doing is not enough”?


Discussion Questions

  1. Compassion currently plays a role in decision making (with France’s Illness Clause and Syrian refugees). Is there any possible way to remove compassion from the equation or ensure decisions are impartial?
  2. In humanitarian work, is it enough to simply keep someone alive? Who holds the responsibility of keeping people physically alive and who holds the responsibility of ensuring these people have human dignity? How do we define dignity?

Works Cited

“About MSF.” Médecins Sans Frontières (MSF) International. N.p., n.d. Web. 05 Nov. 2015.

“Ethical.” Merriam-Webster. Merriam-Webster, n.d. Web. 05 Nov. 2015.

Ticktin, Miriam. “Where Ethics and Politics Meet.” American Ethnologist 33.1 (2006): 33-49. Web. 5 Nov. 2015.

Redfield, Peter. “Doctors, Borders, and Life in Crisis”. Cultural Anthropology 20.3 (2005): 328–361. Web.

“Syria.” Médecins Sans Frontières (MSF) International. N.p., n.d. Web. 05 Nov. 2015.

“Syrian Refugees Need Humanitarian Aid.” Doctors Without Borders Canada/Médecins Sans Frontières (MSF) Canada. N.p., 14 Aug. 2012. Web. 06 Nov. 2015.


Stateless Humanitarianism

As a result of the Arab-Israeli War in 1948, 750,000 Palestinians were displaced to form refugee camps across the country of Palestine and in neighboring countries like Syria, Jordan, and Lebanon. Those refugees didn’t have food, shelter, or even water, and therefore, international support was necessary in order to save them from starvation. The United Nations General Assembly resolution (302) took responsibility of this issue, stating that a new agency named UNRWA (United Nation’s Relief and Works Agency) is established to “Prevent conditions of starvation and distress… and to further conditions of peace and stability.” [1]

The complex political situation that resulted from this conflict limited the support the Palestinian refugees should get from health services and agencies. In his article, Doctors, Borders and Life in Crisis, Redfield quotes the charter of the MSF, “M6decins sans frontiers provides aid to people in need, to victims of natural and man-made disasters, wars and civil wars, irrespective of race, religion, ideology or politics” [2] Yet, this does not seem to be applied in the case of Palestinian refugees. The charter later says, “With regard to humanitarian interventions in the Palestinian territories, MSF faces difficulties when the political stakes of the situation do not easily translate into the language of victims and lives saved.” [3] According to the MSF, politics is rather disregarded when humanitarian support is needed, and at the same time members of MSF rarely suggest that their work will directly build a better social order or achieve a state of justice. “The goal is to agitate, disrupt, and encourage others to alter the world by practicing humanitarian medicine, one person at a time.” [4]

Sadly, the humanitarian support the Palestinian refugees received when they were depopulated was only a reaction to save as many lives as possible, rather than an intention to solve the causation of starvation. Palestinian refugees have been receiving basic food supplies on a monthly basis ever since, but this support is not enough to end the suffering they have to go through. Later on, Palestinians spend years inquiring for humanitarian support world wide, yet because those refugees have been stateless, humanitarianism has failed to take them seriously. In her article, Ticktin argues, “Being thrown out of one’s national community means being thrown out of humanity altogether – being stateless deprives one of the essence of humanity – its political character.” And conversely, she suggests that citizenship, a membership in a polity, conveys full belonging in the category humanity; “ humanitarianism protects individuals by virtue of their membership in humanity.” [5]

It is people who decide what they need, what rights are they missing, and the varieties of violations committed against them. Therefore, humanitarian agencies have no right to use politics, religion, or race as an excuse to reach those in need of help, and it is their responsibility to understand the needs of the victims irrespective of the systems forced upon them. As desperate as those stateless Palestinian refugees are for humanitarian support, the Rwandans are also suffering from scarce humanitarian support due to the political situation surrounding them. Ticktin argues, “The hundreds of thousands of people living and dying in awful conditions in the Rwanda-Zaire borderlands know better than anyone else on the scene what they have done, what has happened to them, why, and what they can hope for if they return to Rwanda.” [6] Yet, when voicing their suffering and struggle, Palestinian and Rwandan refugees are not taken lawfully, both because their representatives are governments that do not represent them as peoples, and also because the counter forces upon them are more powerful than they are, leaving them stateless in humanitarianism.


[2] Redfield P. 330

[3] Redfield P. 354

[4] Redfield P. 334

[5] Ticktin P. 44

[6] Ticktin P.392

European Humanitarianism and the Refugee Crisis

Stories about the “refugee crisis” in Europe are dominating the media lately, as tens of thousands of people continue to pour into Eastern Europe, most of whom are fleeing the conflict in Syria and Iraq. This has caused fracturing of the EU along ideological lines, as some states see it as their “humanitarian duty” under international law to accept refugees, while others fear “Islamization” and economic stress caused by the influx of so many people.

The framing of this as a “humanitarian crisis” is relatively recent, although thousands of people have been desperately attempting to reach Europe over the last several years. Before 2015, people trying to “illegally” enter Europe were mostly referred to as “migrants”, undeserving of asylum or refugee status. Most of these people were fleeing endemic poverty and violence in various parts of Sub-Saharan Africa, and their most common path to Europe was a treacherous journey across the Mediterranean from Libya to Italy. While thousands drowned at sea, the EU scrambled to ensure better control of its “sea borders”. [1]

This year has seen massive amounts of people crossing from Turkey into Greece and the Balkans, both by land and sea. Most of these people are Syrians fleeing the civil war, and now the term “refugee crisis” has come into use, overshadowing the issue of “migrants” arriving from Africa. Europe is again scrambling to figure out a solution. [2] Some Eastern European states such as Hungary, citing economic and security concerns, have begun building fences and enacting strict border controls, in an attempt to keep refugees out. The EU as a whole has begun questioning the future of the Schengen zone, which allows for free movement between EU member states, without requiring a visa. Germany, initially the most accepting of the refugees, is now hinting at expedited EU membership for Turkey if it is able to seal its borders. [3]

This huge influx of people has sparked debate over who is “deserving” of asylum or protected refugee status. Clearly, the EU has decided, “migrants” fleeing endemic poverty and violence in Sub-Saharan Africa are not. Here I draw parallels to Ticktin’s study of the “illness” clause in French immigration law. In both cases, the logic of humanitarianism privileges some kinds of suffering over others: “illness (or war-related trauma) can cross borders, but poverty cannot” (Ticktin 39).  To obtain the special designation of “refugee” under international law, and thus permission to stay in Europe, refugees must “prove” their status in some way, by somehow providing documentation of their persecution, or medical proof of their suffering. [4] In this way, as Ticktin describes, people are reduced to their bare life by the state, creating a “meritocracy of suffering” (Ticktin 34). Among those who are considered “legitimate” refugees, there is a general tendency for Europe to be more sympathetic to those escaping IS, rather than those fleeing conflict in Somalia and Eritrea, “failed” states whose violence is so routine it receives little media attention.

Additionally, the terming of this a refugee “crisis” has interesting implications. As Redfield writes, a “crisis” is a “rupture from the normal that demands a decisive response” (Redfield 336). In this case that involves both providing for basic biological needs and creating a long-term solution for resettlement. Humanitarian groups providing aid to these refugees (in Europe as well as in Turkey) tend to reduce these people to their “zoë”: they provide food, shelter, and basic medical care. However, in most places, refugees are denied the right to work, and are not granted equal citizenship status, even if they are residing in their host countries indefinitely. This is best illustrated by the camps in Turkey and Jordan, which resemble cities and have housed some of the same Syrian families for up to 4 years: refugees are kept alive, but given no social, economic, or political rights. [5] As Redfield suggests, humanitarian groups, in their effort to stay “neutral” or “apolitical”, tend towards providing for basic needs rather than intervening in the conflicts that cause the displacement in the first place. Europeans and Americans are able to fulfill their “humanitarian duty” by taking in refugees displaced by the Syrian war, while also maintaining the guise of neutrality in the conflict. However, is was arguably Europe and America’s refusal to intervene meaningfully early in the Syrian conflict to push out Assad that has led to such a protracted, fragmented conflict. As Ticktin notes, the “crisis” of migration does not happen in a vacuum: immigration to France is a result of colonialism, and the displacement of millions of Syrians is partly due to Western complicity in a brutal war.

Under the system currently in place in Europe, this huge movement of people unfortunately necessitates some kind of “triage” in determining who is allowed to stay. However, the EU should look into the causes of these mass displacements and migrations (economic as well as war-related) and attempt to address them, rather than blocking out people who haven’t suffered “enough” to justify entry. Europe and the West have long been complicit in the conflicts and economic crises that lead to mass migration.


  1. How should wealthy countries decide whom to let across their borders? Is there any kind of ethical way to do this?
  2. How might the ability to enact “humanitarianism” in itself be a privilege? What are the power dynamics at play here?






Redfield, Peter. 2008. “Doctors, Borders, and Life in Crisis.” Cultural Anthropology 20(3): 328-361.

Ticktin, Miriam. 2006. “Where Ethics and Politics Meet: The Violence of Humanitarianism in France.” American Ethnologist 33(1): 33-49.

Bring out the Human in Humanitarianism

The context of global humanitarianism has been growing throughout the years. Peter Redfield’s Doctors, Boarders, and Life in Crisis, along with Miriam Ticktin’s The Violence of Humanitarianism in France, really paint a picture of major consequences that are associated with humanitarianism. The first are the consequences associated with this transition of humanitarianism to politics. The second is the possible dehumanization of those who are being helped. After reading the examples provided by both authors, it is clear that there has been a shift in what humanitarianism is and that sometimes it creates a limited version of what it means to be human.

This shift of humanitarianism to politics is illustrated with the “illness clause” in French law. This clause gives people with serious illness the right to stay in France regardless of if they are an undocumented immigrant. This clause was created as an alternative to human rights discourse and for those who did not obtain rights based on the states interests (Ticktin, 5). Due to this, the illness clause made sickness a primary way for undocumented citizens to get papers to stay in France. People would even go as far as infecting themselves with an illness such as HIV/ AIDs just so they could stay in France and “live more fully.” In this case, humanitarianism, seen with the illness clause, shifting to politics resulted in a consequence where the undocumented were giving up bodily integrity for human dignity. These immigrants would rather live a fuller life infected with HIV/AIDS than be completely healthy and deported. Some citizens even took up identities of friends who had died of HIV/AIDS just to stay in the country (Ticktin, 8). In essence, this clause is allowing undocumented immigrants to place less value on their lives and create a limited version of what it means to be human. In France these people are giving up an opportunity to a healthy life just to be considered a citizen.

The dehumanization that can be associated with humanitarianism can be seen in the refugee camps mentioned in Doctors, Boarders and Life in Crisis. Even though these camps foster the possibility of mass survival, the figure of a human still emerges from behind that of a citizen (Redfield, 341). The goal of these refugee camps may be to aid those who have suffered from severe political and ecological instability, however, it is important to note that they do play a role of devaluing human life. In these camps, the refugee’s dignity and citizenship are put into question. Here the only things that matter are calorie intake, hydration and shelter (Redfield, 342). Yes these are very important aspects of life that need to be protected. However, because these aspects are the biggest and only concerns of the camp, individuals loose their ability to voice their opinions and perform acts of civil virtue. In this sense, the person is being seen not as a person but just as another body in the camp.

This is again seen in the worlds second largest refugee camp in Jordan. This camp holds more that 80,000 people whose lives are on hold and going nowhere (Swan, BBC). For some of these refugees, life in the camp holds such little value and hope that they would rather return home to Syria. On one hand obviously these refugee camps are providing safety and life to those who were in danger, but on the other hand these people are losing what it means to be alive. An important question must be asked: what, if anything, should we do to help these people who are already suffering maintain the feeling of what it means to be alive?


Discussion questions:

  1. How do humanitarians ensure that in providing necessary materials for living, that they are also providing what is essential to feel human?
  2. Is there a way to stop or at least limit this shift of    humanitarianism to politics?


Work Cited:

Redfield, Peter. 2008. “Doctors, Borders, and Life in Crisis.” Cultural Anthropology 20(3): 328-361

Ticktin, Miriam. 2006. “Where Ethics and Politics Meet: The Violence of Humanitarianism in France.” American Ethnologist 33(1): 33-49.

“Lives on Hold: The Scots Helping Syrians in a Refugee Camp – BBC News.” BBC News. N.p., n.d. Web. 05 Nov. 2015.