Ebola the lens: What do we see?

[This blog was first posted at the great Humanitarian Practice Network.  The research paper is expected this summer and will be co-written by Caitlin Wake.]

Saying goodbye to MSF’s Head of Mission in Liberia and thanking her for hosting me during my research visit. As I leaned in for the double cheek kiss that we Anglophone aid workers are so fond of displaying – a badge of cool and humanitarian familiarity that breaks with the sterility of the brisk American handshake – she leaned back. Her face was slightly horrified, her expression confused. Even as I leaned in further, confused myself and self-conscious of making a mistake, she pulled another step back. And then it clicked: No Touch Policy.

There you have it. One small perversity of the Ebola outbreak. One small particularity in a field of many, and yet also representative of a human crisis where humans are prohibited from touching one another in their blackest moments of need, fear and grief. The sanctioned protocol of bumping elbows – or perhaps fists – just doesn’t allow for the level of human connection that people working in such an unforgiving setting deserve.

A plethora of differences set the humanitarian intervention in West Africa apart from those mounted in response to other major crises, whether in Haiti, Syria or the Central African Republic. Some might find that reason enough to question the wisdom of a research project that aims to draw out lessons for future emergency responses from a black swan of a crisis. I would argue just the opposite – by catching the humanitarian aid system off balance, the Ebola epidemic has thrown the system into high relief, magnifying both strengths and weaknesses that might otherwise have gone unnoticed.

The goal of my research with ODI’s Humanitarian Policy Group (HPG) is to use the international response to the Ebola outbreak in West Africa as a critical lens for scrutinising the ‘humanitarian aid system’ as a whole. We hope to avoid duplicating the multiplicity of other assessments, evaluations and reports by focusing on the big picture, at how the fundamental contours of the aid system result in advantages, as well as shortcomings or gaps. We are interested in the power dynamics which govern the aid system’s architecture, culture and identity, and how these shaped the intervention. Hopefully, this research will contribute to ongoing efforts to improve the system’s response capacity, such as informing HPG’s position towards next year’s World Humanitarian Summit.

For now, though, we must come to terms with the immensity and unprecedented nature of the response, which was not just a colossal humanitarian deployment but also a military and scientific one. To begin with, many viewed this solely as a health emergency, some still do. But when was the last time the aid system confronted a ‘health crisis’ that decapitated local health system systems, shut down schools, postponed elections, gutted economies and shook the stability of nations? Sounds more like a classic complex emergency. Yet beyond MSF and a few specialist NGOs, we consistently hear the same refrain: “We wanted to do something but we didn’t know what to do. We aren’t medical. And we were frightened. Really frightened.” Not the best of starting points for what has become a billion-dollar intervention.

Understanding these dynamics and comprehending how an aid system that was so woefully slow to react has managed to produce such a broad, creative response is part of our task. As is figuring out why some of the mistakes made amount to an almost clichéd repetition of blunders that we have seen over and over again. Do we really need a piece of research to tell us that we are better at identifying lessons learned than implementing them?

The Old Switcheroo

It is difficult to issue a thoughtful mea culpa message and still manage to undermine your credibility. WHO just pulled off that rare double. In short, they posted their message and then replaced it with another, toned-down version. As if the world wouldn’t notice! Sarah Boseley’s blog captures the changes.

The contents should be well-received, in either version. Admitting that it has learned lessons of humility, fragility and (ironically) the need for clear communication – hard to disagree. And it is not the fact of the old switcheroo that bothers me; nor even the innocence in believing that one could slip this by without being caught. No, what I find so depressing is that in all the lessons forced onto the organization by its Ebola response, perhaps the most important has been missed.

I cannot be certain why WHO has toned-down its message, or felt so compelled to do so that it pulled the switcheroo. Somewhere, though, it seems likely that the problem was having rankled some feathers. Some people didn’t like the message, and they weren’t little people. So it had to unrankle them.

And that is the problem. That is precisely what was missing in WHO’s failure to sound the alarm, loudly and early, on this outbreak – the willingness to take the heat for making a call that would have been unpopular with those in power. Humility, fragility, capacity, solidarity… all worthy lessons. But if WHO is to become a force for global epidemic response, it must learn the lesson of rankling feathers. Take a lesson from MSF: It must learn to piss people off.

Building Resilience? Turn Crisis into a School

[This is the second in a series of posts aimed at the World Humanitarian Summit.  Along with the previous post (see it at WhyDev as well!), the idea is to suggest how development and humanitarian organizations can work better together.]

Over the past years, the ‘new’ grail of resilience has sparked debate within the aid community (see e.g., here, Dialogue 12). Importantly, few disagree on the ambition of strengthening national and local resilience to crisis, and resilience has been named one of four core themes for the World Humanitarian Summit. The central, somewhat distracting argument seems to pertain to its home.

Is it humanitarian work to build resilience? Or is it development work, with humanitarian content? My pedigree places me squarely in the latter camp. In crude jargon, humanitarian work is about immediate harm reduction, not building for the future. But this sort of dogmatism breeds argument, not progress (and ignores the degree to which funding streams for resilience work determine its home).

Perhaps it is more useful to consider How? rather than Who?. In broad terms, the humanitarian community lacks the skills, experience and, frankly, patience to effectuate transformation. And what humanitarians do possess – technical knowledge – is the relatively easily transferred part of crisis response. Where resilience in terms of government response capacity is most lacking, improving the responsiveness of national authorities requires long-term planning, facilitation rather than implementation, and commitment on the scale of years rather than a reporting cycle.

Let’s take this example: How does one help a district ministry of health develop the capability to deal with a cholera outbreak in a remote cluster of villages? Well, here is how not to do it: run a workshop for a week, hand over pristine copies of the cholera guidelines, and then wait to see what happens. My years working with MSF left me all too familiar with the workshop approach, and the subsequent bout of accusations of incompetence or unwillingness when MSF had to step in because the ministry failed to respond.

This workshop approach creates piles of paper, heavy expectations and, too often, little more than a virtual response capacity. The obstacle is not technical understanding of cholera. You can download that here or here. Faced with actual cholera — with the requirement to scale up exponentially in a short time – the government health service or local NGO (just like many INGOs) are often more seriously impaired by the pre-planning (preparedness), scaling up, management of ongoing services, and the lack of access to emergency funding. Building that will take persistent effort over time, not a specialty of humanitarians; will take hands on experience, rarely available during workshops; and a commitment to learn from failure.

Let’s return to that example of cholera response. A well-placed INGO specializing in development could start by working with the ministry to develop recognized contingency plans, such as for the creation of a temporary Emergency Response Management Team, or a plan for identified ministry staff to be allocated to the emergency response and for how remaining ministry staff will cover the gaps caused by shifting resources to cholera. All of this would require agreed TORs, and new job descriptions, contracts, training, etc. for staff. (It may also require striking a deal with its donors, one that will allow contractual flexibility to engage in rapid onset emergency response).

The development team should then play a bridging function to the experienced humanitarian NGO (i.e., INGOs such as MSF, that have experience running cholera treatment projects), facilitating agreements that come into force during an actual outbreak, allowing the national/local to shadow and then take on progressively greater responsibilities over time. In other words, cholera outbreaks rather than cholera protocols become the driver of resilience. The development team ensures proper ministry presence, and removes the burden from the emergency INGO (the Ebola outbreak is an exception to the rule that humanitarians cannot take on responsibilities for training others during the height of crisis).

With the ministry, an agreed plan for rotating of national/local personnel (secondments) into the emergency response of the humanitarians. This should happen systematically, over years, and build capacity in all areas of intervention, from medical doctors to supply officers and registration desk staff. The development team might also have to bridge between the various government departments that must agree (inter alia) to the division of responsibilities and provision of resources. It probably also needs to broker financial support to the ministry, and work to develop the administrative capacity to manage and report on the funding.

Under various names, the aid community has been talking for decades about improved resilience in the form of improved national operational responsiveness. There have been successes. As well, grand plans have fallen flat. In my years with MSF, there were often requests for training, but I don’t ever remember anyone asking us to engage in the sort of transformational work described above. Nor would we have been wise to say yes – wrong people and bad timing. Being used as a school is different from having to organize oneself into one.

Effective strengthening national and local response capacity requires the particular skillset of the development community. So forget the details of the example above – another humanitarian’s misguided imagination of how a development NGO would do it. What is not imagined is the opportunity for development NGOs to get resilience right by catching humanitarians in the act, and taking the national authorities from understudy to lead.

Making development work for humanitarian response–and vice versa

[This is the first of a series of posts aimed at the World Humanitarian Summit.  More generally, this post and the next one offer ideas on how development and humanitarian organizations can work better together. Many thanks to WhyDev for their encouragement, editorial help and posting of this blog. Check out their excellent site if you don’t know it. – MD]

How many times have we seen this: a complex emergency with a decade or two of heavy humanitarian intervention (maybe some development organisations and peacekeeping forces as well), scores or even hundreds of millions of dollars spent by aid agencies, legions of expats trafficked through–and yet close to zero planned impact on local economic development or resilience? Sound like Eastern DRC? Haiti? South Sudan?

Foreign aid policy and practice have failed to view humanitarian crisis as an opportunity for development. This gap highlights a missed potential to capitalise on the presence of such a well-resourced foreign enterprise as humanitarian intervention.

A house divided

The aid community has improved its performance these past years by learning that, particularly in complex emergencies, contexts cannot be shoehorned into one end or the other of a false continuum, designated as either “humanitarian” or “development”, with one-size-fits-all implications for the aid response. Nonetheless, this divide is deeply ingrained, reinforced by the two-pronged architecture of the aid system, from funding streams to academic departments to organigrams of agencies and governmental ministries.

This divide has given rise to a fair amount of acrimony, and to a blind spot when it comes to opportunity. It is good–but not good enough–to comprehend that humanitarian crisis and developmental needs lie side by side. We must take the next step and see long-term development opportunities as residing within crisis. It’s time for development agencies to seize the presence of the humanitarian machine, by exploiting its potential as a source for financially sustainable (small) businesses. It’s time to make friends with the enemy.

Mind the gap

We understand almost intuitively how humanitarian crisis, whether conflict, flows of refugees or natural disaster, generates destruction, including damage to the local economy. Yet crisis often means that business is booming for the humanitarian endeavour. Viewed through an entrepreneurial lens, humanitarian response, particularly those stereotypical Western-led interventions in long-standing emergencies, resembles a pretty fat cash cow.

In crisis contexts, INGOs possess relatively massive resources, and they often represent the biggest fish in the pond. In line with these resources, humanitarian NGOs also have needs–many of which could be met locally. Why is it, then, that an organisation like MSF/Doctors without Borders works in Goma for decades, and still expends resources on importing and servicing its own vehicles? Or why in Nyala were there so few restaurants where an expat could go out to eat, even at the height of the Darfur response?

With a large, wealthy and needy humanitarian community present for decades, why do we still find development NGOs teaching women to make soap? Okay, that’s an exaggeration. There is nothing wrong with soap. The point is that many income-generating efforts are not successful, in part because of the lack of people willing or able to buy. But the humanitarian industry and the expats it employs are willing and able – so why aren’t development NGOs helping local people meet this demand?

In places like Port-au-Prince and Goma and Nyala, there are, of course, some local businesses and people who take advantage of the presence of foreign NGOs and expats alike, such as landlords, nightclubs and security services. Typically, though, the untapped demand is much larger, particularly for in-house service at NGOs; and, these businesses are either ad-hoc or pre-existing (especially in the early stages of a humanitarian response). Importantly, they are not the result of development agencies capitalising on opportunity, and so do not by design benefit the community, contribute to self-reliance or help establish an entrepreneurial culture.

The major humanitarian NGOs (and the UN) continue to be the managers and providers of an internal set of non-humanitarian services, which is inefficient. Here, one could talk of NGOs that hire and manage staff to clean their offices or residences, rather than having a development NGO work with a local group to create a cleaning service business. Ditto for vehicle maintenance, transport, catering, many aspects of supply and other functions that typically remain in-house to the INGO. And what of demand for highly-skilled counselling or consulting services (why do Westerners get so many of those contracts?), outsourced not necessarily due to a lack of local expertise, but because the local expertise lacks the know-how to package and market itself effectively?

Closing the gap

There needs to be a convergence of policy and practice aimed at the progressive outsourcing of services from within the foreign humanitarian community to local NGOs and businesses. The first step requires a teaming of development NGOs with their humanitarian cousins to delineate the concept. What services already exist? What services and businesses might comprise “easy wins”? What are the no-go areas (where humanitarian NGOs should retain direct control)? In what contexts would outsourcing be most likely to work? How can the development actors reduce the risks of negative impact when the humanitarians go home?

Next, the development agency must negotiate with national and local authorities, humanitarian NGOs and institutional donors to establish coordinated action and goals. NGOs will need to progressively cede control over important components of their activities. Donors may need to nudge them towards compliance, and national governments may be able to encourage change through regulation.

Most importantly, NGOs will have to work in the local community to build the actual businesses and services. This requires working in tandem with humanitarian organisations to ensure that needs are met and the quality of services is sufficient. The point is to create sustainable local capacity–businesses, services, NGOs, etc.–that can fill gaps or replace existing services that are owned or managed by humanitarians themselves.

Even to the extent that the activities proposed here already exist, they remain exceptions, haphazard in their genesis and limited in their impact. They do not reflect policy choices aimed at exploiting large-scale, protracted humanitarian interventions for the benefit of local development. Can we not imagine increasing local businesses’ support and service to the humanitarian community, to the point where it becomes a successful core component of development aid?

This opportunity may prove infeasible in some contexts, or it may be counter-productive to become dependent on cash cows whose presence is temporary. But, there is significant potentially successful development work in transforming existing functions into sound, income-generating local businesses.

The Product of Systems

Who is in charge? Part 1.

The richest 1% of the world will soon have a greater share of the world’s wealth than the other 99%. With that eye-catcher of a stat, Oxfam launched a report and a discussion on extreme global inequality. Great stuff. Do not let the quibbling distract you. This is a street child face down on a busy sidewalk in a pool of excrement. Trust your gut: imbalance on this scale is inherently and dramatically wrong. The only debate should be which is worse – what this says about wealth distribution or what this says about power.

But what if I told you that I just read about a place where the richest few control 99.8% of the wealth? Not 48%, as Oxfam’s report denounces, but the whole enchilada? Ninety-nine point eight percent represents an astounding achievement in disparity. Can you guess where? No, not mega-corrupt states like Angola or Equatorial Guinea. No, not the petrol-rich like Qatar or Bahrain. No, not even Mark Zuckerberg’s family. Give up?

The surprise winner of the award for the most inequitable distribution of wealth and control on the planet is none other than us, the ensemble of humanitarian NGOs. Congrats to the likes of MSF and Save and (of course) Oxfam. Here’s Development Initiative’s excellent financial analysis of the humanitarian system (see p. 55ff): National and local NGOs form an essential part of the humanitarian response, but in 2013 only directly received US$49 million – just 0.2% of the total international humanitarian response. That’s US$49M out of about $2.3 billion hitting NGO coffers worldwide.

You can quibble with that figure – it’s not counting indirect flows to national NGOs – but my advice is to trust your gut. Eat your heart out, Donald Trump.

Who is in charge? Part 2

Bill Gates talks solutions. Bill Gates is right. Bill Gates calling for “germ games”. Bill Gates is all over my Twitter feed.

Gates has published an Op-Ed in the New York Times, an article in the New England Medical Journal and done a lot of media work to proclaim that good old human “ingenuity and innovation” can avoid the next Ebola disaster.

Gates makes sense, of course, calling for the development of vaccines, for better surveillance, for a global logistical and medical epidemic response capacity. Gates’ central point, though, is only half correct, and therein lies the flaw in his cunning plan. Gates claims (NYT piece): The problem isn’t so much that the system didn’t work well enough. The problem is that we hardly have a system at all.

Really? Is it that the system doesn’t exist? Or is it that the non-system of epidemic response is the direct product of another system, a highly inequitable international system of interests and power that does not typically place the public good as its paramount ambition? In other words, the very same international system upon whom Gates calls to act.

On one level, Gates forgets what happens to good ideas when their basis for attention and funding is fear and insecurity. What happens when you employ scaremongering to mobilize politicians and Western publics into funding better healthcare systems for the world? My guess: skewed priorities (epidemiological surveillance trumps maternal mortality) and unforeseen consequences, like helping to justify military expansion into global health and humanitarian action. It has not exactly served the lofty goals of international development to have become an integral tool in the global war on terror.

Most importantly, though, Gates seems to be addressing symptoms, not causes. In calling for an international epidemic response system, Gates essentially advocates the same superpower and global institutional approach that helped deliver WHO’s ineffectiveness, Sierra Leone’s woefully inadequate healthcare, or an Ebola response in West Africa that was too late, too slow and too focused on staunching the Westward flow of Ebola rather than healing those who already had it.

Bill Gates outlines a system the world needs to build. Dead right. Now he needs to outline the world that will build it, because he is silent on the need for changes in the way global institutions are conceived, controlled and built in the first place.

“Pound of Cure” Politics

Who hasn’t heard this one: An ounce of prevention is worth a pound of cure. The old adage presents a truism well relevant to the world of international aid. Ebola comes quickly to mind as the latest in a long list of lessons not learned. To wit, at what point – March? May? – would a fairly modest ten million or so have staved off the need for the $1.3B intervention that has been launched to date?

But the proverbial equation generates a false comparison. The “pound of cure” logic dissimulates. That tail of the proverb represents the cost of an intervention at a later stage – the bill for the fix (i.e., action after the problem has materialized). The mistake is to confuse the cost of the fix with the value of the damage. Pound of cure thinking hides ten, twenty or maybe thousands of pounds of loss – 11,000 orphans, schools shuttered, crops unsown or harvests unharvested, businesses bankrupted, national economic growth about-faced. And over 9600 people who are no longer people.

Let’s not be too hard on the proverb. Let’s be hard on ourselves. In the deeply politicized world of international aid and emergency response, the availability of the proverbial ounce of prevention turns out to be part mirage, hence a solid track record of paying for pounds of cure. This study of the 2011 famine in Somalia seems clear enough: Famine early warning systems clearly identified the risk of famine in South Central Somalia in 2010–2011 but timely action to prevent the onset of famine was not taken.

It too often proves more difficult from a political perspective to prevent a problem from arising than to deal later with the consequences of the problem itself. That is because mobilizing preventative action often proves trickier than launching a curative response. Humans seem hardwired to contend with the urgent at the expense of the important. In proverbial terms, that is also because frogs don’t hop out of water brought slowly to boil. And because screeching wheels get the grease before those that merely squeak. Tired yet? How about this? In the aid world, few will pay the early bird to catch the worm.

Enough of the proverbs. Let’s try fairytales. Is it even fair to balance a pound of cure against one sole ounce of prevention? What does the story of the Boy who cried “Wolf!” tell us? If not a boy, then what about the Western NGO? We belong to a business that depends on the production of a veritable smorgasbord of impending disasters; of persistent, strident calls for action (read: squeaky wheels in search of grease). That makes for a fast drip of public alarm, elbow-steered lobbying, and celebrity-endorsed impending doom. Act now! (Or: Send cash!). How many cures – how many actual crises – have actually been averted? Perhaps this is not just a tale of a Boy. Perhaps this is also the work of Chicken Little.

If we flip this around: the emergency aid business is of necessity an industry of alarm. Is there today a cacophony of alarm and media hype that deadens the ear? Have we reached the point where it is actually more efficient and more financially prudent for key donor governments and international institutions to wait and pay for the cure?

And what about the lessons of those fairytales? Cries of “Wolf!” or “The sky is falling” became quite pertinent in the Ebola crisis, where MSF’s early alarm was derided or dismissed in some quarters as yet another NGO fundraising ploy. The NGO cried out that Ebola was real and nobody listened. Real it was. A ton of cure that could have been averted by an ounce of prevention? Seems so. And maybe also a ton of cure that was necessitated by the perception of too many false ounces?


The Hammers and Nails of Ebola

“MSF made a big mistake.” Not a small admission from Claudia Evers, MSF’s Emergency Coordinator in Guinea. Think how much more effective international aid might be if more aid organizations publicized rather than buried such opinion. But that is another blog.

The issue is basic. In its early stages and as the Ebola outbreak mounted, MSF placed almost all its apples in the treatment basket. Fueled by the twinning of high transmission levels and the sloth-paced scaling up of treatment (MSF aside), the virus far outpaced the intervention. Evers concludes: “Instead of asking for more beds we should have been asking for more sensitization activities.”

But did MSF make a mistake? Or is this more of a design flaw in the system? Treatment is what MSF does. Treatment is what MSF is designed to do. When it comes to outbreaks like cholera, or diseases like malaria, or even ‘epidemics’ in some places like maternal mortality, MSF is a hammer of treatment. Nobody, and not even MSF, should be surprised that it sees a world of nails – people who first and foremost need treatment.

To simplify: A good buddy of mine is a cardiologist. His brother is a cardiac surgeon. They disagree bitterly on how best to deal with their aging mother’s heart problems. The former wants to manage it through drugs, diet and exercise. The latter wants to cut. The lesson is that identity determines perception.

So the problem was not MSF calling for a massive, rapid increase in beds and treatment capacity. The problem was that MSF the hammer’s voice stood virtually alone. The problem, in other words, was the absence of other tools in the kit. Where were the wrenches, NGOs that specialize in grassroots mobilization, and who would have seen its potential and pressed for it? Where were the screwdrivers who would have championed decentralized models of care? Where was the diversity of discourse?

Even as sensitization activities scaled up, local communities seem to have been viewed more as targets than as actors. One concern is that the authorities (foreign and international) installed centralized structures for the dissemination of information, rather than capitalizing on local capacities. Another claim is that messages were too simplistic: being told what not to do with a sick child does not provide an actionable solution for a mother with no access to a treatment center. What should she do?

It seems there is an emerging consensus that local communities in Sierra Leone, Liberia and Guinea were sidelined in the rush to contain Ebola, treated more as an obstacle due to their distrust and ‘primitive’ behavior (see, e.g., here). Treated then as a vector for the disease, to be contained rather than sought out as a potential partner in defeating it; not understood to be necessary to generating solutions and disseminating the word. In the end, it seems providential that they did not remain contained, and many communities took the fight against transmission into their own hands (see, e.g., here).

To recap: the Ebola outbreak response reduced communities to a combination of victim, vector, and potential security threat. Otherwise, the aid response and media coverage of it rendered these communities invisible. That invisibility comes because the entire international community – the Western governmental and NGO aid response – is deeply, messianically self-referential. That is the hammer of being a savior, and it blinds us to anything but the nail of victimhood; to the reality that many people, given the shortcomings of international aid, need to know how to save themselves. That is the hammer of being largely Western/foreign, and seeing the nail of disarray, primitivity and ignorance.

One step further: consider this piece from Oxfam CEO Mark Goldring on his recent encounters in Liberia and Sierra Leone. In a few simple paragraphs he conveys the “suffering, bravery and stoicism” of the people. Yet such narratives always fall short. Be it Syrian refugees or civilians in Central African republic or the survivors of Ebola, the sheer scale of grief, social/livelihood devastation and grinding anxiety over life itself evade our comprehension.

For all our efforts, this tremendous suffering remains beyond our ability to fathom with clarity. And it lies beyond our ability to mend. As humanitarian organizations, we find it much easier to be the hammer of crisis response, seeing the nail as the problem called hunger or shelterlessness or, in this case, outbreak. As important as it is to contain and defeat this outbreak, I wonder if we are preconditioned to see the virus, sick people to be mended, and not the millions of people who need something altogether different than the hammers of Western pity, charity, or aid.

When the Pendulum Swings

Be careful what you wish for. That is what I would tell Thomas Frieden, if ever I had an opportunity to talk to the distinguished director of the US Government’s Centers for Disease Control (CDC). While the failures which led to the Ebola epidemic must be addressed and most certainly require difficult changes, we should avoid launching the pendulum too far in the opposite direction. Over-correction can be just as dangerous as doing nothing. (Perhaps even worse if, in the long run, failed change undermines the very case for change itself.).

Speaking as the executive board of the World Health Organization voted to overhaul the organization, here is what Frieden said: “Too many times the technical is overruled by the political in W.H.O. We have to reverse that.” His comments follow the generally accepted observation that the bungled response to the outbreak was in part due to the poor quality of WHO staff in West Africa. Political appointees rather than officials with proper qualifications.

I’ll start with the obvious: Frieden appears to be right. But there is a mistaken underlying assumption – that health, disease, pandemic response constitute primarily technical challenges. This overlooks the degree to which these issues are profoundly political. So: true enough that political savvy can neither replace nor overcome a deficit of technical understanding. Even worse, what of situations where the so-called political appointees lack political savvy, meaning where they are appointed for reasons of political loyalty and ties rather than political acumen? That’s a lose – lose situation.

But Frieden’s comment ignores the opposite risk. All the technical savvy in the world may amount to very little when it hits the political wall. Better qualified WHO appointees in West Africa may have recognized much earlier the threat posed by rising Ebola cases, and may have been less concerned with offending local political sensitivities, but there would have been plenty more hurdles to cross, some of them sadly and resolutely political. Remember, before they felt the threat themselves, the greatest powers in the world chose not to respond to Ebola in this strategic backwater of a region.

My instinct tells me that Frieden comprehends this quite well, and he may be one of those rare individuals who blends technical qualifications with a significant level of political interest and ability. That is not a common combination. A case in point: the bi-annual meetings of the Executive Directors of the various MSF sections. For the six years I was ED, there was never a time when more than one of the nineteen EDs was a doctor (though we often had a number of ex-lawyers), or more than one of the operational directors, and very few of the heads of mission. Throughout the executive level of MSF, from project coordinator to director, one finds few medically qualified personnel sitting in the hierarchy of decision-makers.

This is not the place for an analysis. Suffice it to say that (1) from security management to human resource management to negotiated access, running effective emergency medical missions in places like Sudan or Haiti requires more than medical know-how and expertise; and (2) the organization has built substantial in-house medical expertise across the spectrum of its areas of intervention.  But the problem highlighted by Frieden’s quote is easier to describe than solve. In terms of the political and the technical, integrating those two bodies of knowledge, experience and focus posed a consistent challenge within MSF, and we struggled with various policies aimed at improving organizational structure and culture.

The Executive Board of WHO proposes what we sometimes termed “remedicalization” in MSF. The goal is clear: ensuring that Frieden’s “technical” sufficiently nourishes WHO analysis, decision and action. Sticking technical people into what are often politically charged jobs, though, may simply create the next crisis, the one where the pendulum has swung too far.

Lessons From Charlie Hebdo

What do David Cameron, Angela Merkel, Benjamin Netanyahu and Mahmoud Abbas have in common? Well, probably lots of things. Here’s one you weren’t thinking of: All of them attended Sunday’s massive Charlie Hebdo rallies in Paris, and did not make any such powerful protest when the Taliban murdered 132 children in Peshawar. A number of articles (see here or here), comments and tweets have contrasted the West’s reaction to the murder of twelve satirists with the case of those Pakistani children, or Boko Haram’s abduction and enslavement of 276 Nigerian schoolgirls.

There is a sad futility in making such comparisons. First, it is not a comparison of like to like. Would the Charlie Hebdo attack have created such a global outpouring without the video footage of the gunmen making their escape? Are the Taliban not the old story, half as sexy as the Islamic State? Bottom line: lots of factors explain Sunday’s extraordinary political and emotional outpouring as 3.6 million people pinned Je Suis Charlie to their hearts.

Beyond that, though, is the misplaced anger of these accusations. It is OK to feel a greater kinship to those closer to us than to those far away. This form of tribalism may even be hardwired into us as human beings. We can still exercise the core humanitarian principle that we share an equal kinship with all humanity. So I can admit to feeling closer to editor Stephane Charbonnier or cartoonist Jean Cabut than to teacher Sofia Amjad or pupil Asad Aziz (even while imagining the school children to be ‘more innocent’ – apologies for that, but you get what I mean). The mistake is not in experiencing the bias of our own very human emotions. The mistake is to allow that bias to go unrecognized, so that it fails to be overruled.

The even larger mistake is in failing to see that the source of those biased feelings is not solely kinship. These biases – our different reactions to Charlie Hebdo versus Peshawar’s massacre – are produced by the same relations of power and privilege that nourish the Western NGO and produce biased approaches, strategies and activities. These prejudicial factors range widely, from the North-South bias in media coverage to the effective valuation of some human lives over others to the difference between the West’s position towards the right to free speech versus the right to an education. Sadly, recognition of these biases will remain spotty without genuinely more global decision makers at the top of our nominally-global aid agencies.

Lesson 2: The sense of senseless

Do not succumb to the reactive view that these killings are senseless, outbursts of psychotic madness, the work of a purely bloodthirsty fanaticism. On display are undoubtedly a purpose and a logic and the capacity of this attack to advance the personal and strategic interests of the murderers. There is a cruel win-win at play – do nothing and the Kouachi brothers’ actions will look heroic, having cowed the West into a fearful submission. Have a mass rally and, well, their actions will look heroic. After all, we were not the message audience. We are more likely its vector in the quest to “sharpen contradictions.”

I wish I were in France myself. I would have marched. But I would have known that the rally plays into the hands of the militants – adding glory to the deeds in the same way an arsonist purrs as his blaze nets a five-alarm response. And my concerns would have been with my colleagues around the world, because international NGOs continue to be seen by many as symbols of Western blasphemy. Targets.

Lesson 3: Who are we kidding?

Been asked to throw away a pot of yogurt by airport security lately? Plenty of brave talk. Lots of people tweeting Voltaire. But who are we trying to fool? Much of the West is particularly and increasingly risk-averse (see e.g. this blog or this one), and we have seen the degree to which even remote threats of harm have elicited ineffective or expensive overreactions. The Ebola panic comes to mind. So let us not be surprised if standing up for free speech quickly gives way to risk management, threat aversion, and a substantial chilling of the exercise of the right to say whatever the fuck one wants.

Lesson 4: The humanitarian culture of offense

The right to offend. The right to talk back to a parent, denounce a President, or criticize a government. The right to “speak truth to power” as so many have suggested. Freedom of speech is one of the core universal human rights. And it is one of the rights that runs most contrary to the common sense, laws, limits of accepted behavior or culture of many societies.

We know that many challenge this absolutist approach to freedom of speech. We need to look no further than our universities, where academics have found themselves policed for advancing unpopular ideas, or the growth of political correctness as muzzle. And that is in the West, the supposed champion of free speech. How does it play in the corners of the world that do not believe in such public airing of opinions or insults? Where maintaining ‘face’ holds enormous cultural currency? Where the values and needs of society trump those of the individual?

Nothing justifies murder. But what of the many places in the world where nothing justifies offensive speech? We fall easily into the rationale that it is a universal right. That is elsewhere a legal technicality, not a shared ideal. More specifically to humanitarian work, what of the many places where we regularly assert this right to offend through our public reports, our exposure of the violence and abuse of civilians in a place like Darfur or Congo?

I remember a Japanese MSF doctor, thoroughly opposed to our advocacy campaign. He had no disagreement with the facts of it, yet he felt ashamed by the public airing. Neither our insistence on universality, nor our conviction that public advocacy forms a necessary component of humanitarian action, obviate the offense of our speech. And causing offense will strike many as un-humanitarian, an act of aggression and an exercise of power no different from inking a blasphemous cartoon.

Cyber Warfare: Think about who might be next

International cyber warfare did not begin with somebody stealing the launch codes to the nuclear arsenal on a U.S. Navy Triton submarine. It did not begin with a cabal of MIT geeksquad eco-terrorists shutting down oil production in the Arctic Circle. No, those are Hollywood story lines. In the end, international cyber warfare began with the revelation that Angelina Jolie is a “spoiled brat.” It began, funnily enough, with Hollywood itself; with a powerful movie studio pulling the release of its $42 million movie, shamed by outings of internal secrets, hurt by stolen scripts, threatened with violence. So much for The Interview.

Have you followed this story (e.g., here, here or here)? Did you feel a bit catty early on, as I did, a little too elated to see Tinseltown’s top brass squirm as their personal emails became Gawker headlines? Be careful. Here’s a test. Aside from a Hollywood studio about to poke fun at the oddball ruler of a pariah country, can you think of another Western entity, or body of entities, who might occasionally humiliate the leaders of relatively powerless countries? Who might ritually indulge in the arrogance of airing someone else’s dirty underwear? Who might just irritate some nation enough, or threaten enough reputational damage, that the allure of socking one of these self-appointed voices of global conscience in the gut might appear both justified and quite delicious?

On the surface, the Sony saga has some appeal to those of us who root for the underdog: marginalized basketcase government jumps corporate behemoth and beats them into surrender. There is glory in that. And power. We NGOs in particular should understand the apparatus at play. The North Korean government (allegedly) has rode the vehicle of celebrity to guarantee viral coverage for its story, in the process shaming the would-be shamers. I can think of a few other governments who might be interested in that kind of power, and instead of a second rate comedy being canned it might be a documentary about rape in Darfur, or a report on the deliberate destruction of health facilities in Syria.

Let’s face it, in terms of our cyber security large Western NGOs have erected far less of a fortress than a company like Sony Pictures. We are exposed. Crucially, we are easily more vulnerable than the movie biz to blackmail when public perception and trust are at stake. It wasn’t pretty, but those Sony emails certainly didn’t say anything we didn’t already think about Scott Rudin, Amy Pascal or that entire industry. The public is titillated, not abhorred, by their sneering. In contrast, what do aid execs write when nobody is looking? I’m guessing that donors contributing a million a year would not appreciate email musings refering to them as, say, egomaniacal , dandruffy pains in the ass. Not to mention direct orders to strengthen the facade that the agency is working through local partners, or the truth about bloated HQ staff travel budgets and long-running projects with little impact.

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