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The Prosthetic Breast of Humanitarian Action

SPARKED BY OUTSIDERS 1. Sometimes I am struck by artists and other creators who seemingly grasp humanitarian action better than I. This realization comes with a modicum of envy. They seem to breathe the human condition rather than analyze it. Humanitarian action is a silo, a sectoral silo that shapes and also stunts our perspectives as we engage with the external world.  It thus resembles other fields of action with the critical difference that humanitarianism relates to just about everything because its purpose is humanity, the whole enchilada. This blog is the first in a series where I hope to pass on some of that envy.

The Prosthetic Breast of Humanitarian Action

In 1999 I entered MSF as part of the “bearing witness” industrial complex, translating my civil rights and rural development experience into support of témoignage by MSF project teams. Twenty-five years later, tired of work-related reading, I picked Audre Lorde’s The Cancer Journals from the teetering pile on my wife’s desk.  Lorde’s experience with breast cancer in 1970s America, woven into her experience as a black lesbian feminist, accentuated the gap between bearing witness to the struggles of others and bearing witness to one’s own struggles; and how with a patient’s insight and a poet’s words she was able to produce a piece transcendent enough to offer this humanitarian a lesson or two or ten. Proof, if we needed more of it, of the value of lived experience.

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Choices and options

I’m going to have the mastectomy, knowing there are alternatives, some of which sound very possible in the sense of right thinking, but none of which that satisfy me enough. … Since it is my life that I am gambling with…[1]

There are choices, even if humanitarians feel that so much of their work is driven by a singularity of options, an imperative to move with urgence and exceptionalism’s license to do so. Erasing the choices open to Other societies and Other individuals – a reductionist view of crisis – from our internal narratives helps us to justify these decisions to ourselves. And as our explanations move upwards and outwards towards home society – misinformation in the form of fundraising campaigns[2] – we push responsibility away by foregrounding the necessity of our action, the unique effectiveness of our capacities, and the Other’sdependence upon us.

Lorde’s daring exemplifies how selecting among choices may often be calculated, but a quantitative reckoning replies to an institutional logic while defeating a human one. You can neither remove a breast nor identify the most urgent cases of distress via a process of counting, even if the sector dreams of a joint intersectoral global tool. Worse still, these quantitative reckonings come rooted in the biased mathematics of our capacities and their deficiencies. This is the culture of “needs assessment”, our scrutiny of the stuff that people do not have while remaining unaware of or undervaluing what they do have (their assets, capacities, and well-honed powers of survival). Even there, INGOs often assess the stuff that people don’t have based on the stuff which they possess – so the shelter agency with a warehouse full of tarpaulin, employing staff with heavy financial and emotional stakes in delivering tarpaulin to people in crisis, making an assessment of people’s need for shelter, which it and the institutional funders then redefine as people’s need for this shelter agency to deliver tarps, and completely ignoring the fact that people themselves might see their need differently, not for a tarp but for a job so that they could buy a tarp or rent a home, or for security so that they could return to the home that they own.  Lorde is clear: the mastectomy responds to her need.

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The articulation of the alibi

For as we open ourselves more and more to the genuine conditions of our lives, women become less and less willing to tolerate those conditions unaltered, or to passively accept external and destructive controls over our lives and our identities.  Any short-circuiting of this quest for self-definition and power, however well-meaning and under whatever guise, must been seen as damaging, for it keeps the post-mastectomy woman in a position of perpetual and secret insufficiency, infantilized and dependent for her identity upon an external definition by appearance. (Lorde, p. 50).

Lorde lowers the Boom!  That paragraph should hang as a reminder in the room of every strategic plan workshop, every project team weekly meeting, every community outreach worker morning briefing, and every government and UN office. As Global Truth Solutions summarizes this travesty: it “is indisputable that people should be ‘at the centre’ of humanitarian assistance. It is equally indisputable that they are not.”

Frequently critical in her thinking, Lorde seemingly saves a particular disdain for the ‘saviors’. Not the authors and friends in whom she found wisdom and solace, but in the energetic champion of a prosthetic breast that was so realistic Lorde would “never know the difference”.  Lorde’s rebuke thus fell upon a well-meaning woman from Reach for Recovery, who dispensed useful advice and the idea that through prosthesis, Lorde could be “just as good as [she] was before because [she could] look exactly the same.” (Lorde, p. 34).  This injurious comparison to the accepted standard, the unattainable perfection, pokes a particular spear in the ribs of international aid.  

Today, Lorde’s declaration of empowerment – Every woman has a militant responsibility to involve herself actively with her own health (Lorde, p. 65) – seems ever more distant in humanitarian contexts (and more globally?). Despite increased awareness of the sector’s inequitable power dynamics vis-à-vis people in crisis, the distance to a humanitarian emancipation grows because the root of this humanitarian power lies in its capacity to transform.

First, humanitarian action resembles a response to people’s problems yet more accurately constitutes an alleviation of symptoms (of deeper crisis), a shallowness that manages to elicit both hand-wringing and acceptance for decades on end, along with considerable financial backing. In Lorde’s cancer experience, this humanitarian power is mirrored in the sleight of hand effected by mastectomy as a cosmetic experience: “…the concentration upon breast cancer as a cosmetic problem, one which can be solved by a prosthetic pretense.” (Lorde, p. 47).  I have often talked about this in terms of the humanitarian alibi.  Like a prosthetic breast, humanitarian action forges a humanitarian pause, healing enough global anxiety and stopping enough bleeding for the world to look elsewhere. No breast cancer to see here.

Second, and far less visible in our self-criticism, much can be learned by a community sharing the experience of struggling to overcome the destruction and pain of crisis.  The alternative, to which we’ve born witness over the past five decades of humanitarian action, has helped instill reliance and dependency as a degradation that, once internalized, too often becomes self-perpetuating.  Speaking at the individual level, to these geo-political effects (e.g., the causes and politics of breast cancer) Lorde adds personal politics.

The emphasis upon wearing a prosthesis is a way of avoiding having women come to terms with their own pain and loss, and thereby, with their own strength. (Lorde, p. 41). 

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Little or no choice

I think now what was most important was not what I chose to do so much as that I was conscious of being able to choose, and having chosen, was empowered from having made a decision, done a strike for myself, moved. (Lorde, p. 25).

Even in a state of crisis and facing complexity beyond her training, Lorde insisted upon and exercised her agency. Of course, aid is often critical to the survival of people. In practice, we decision-makers, we in the agencies, we often decide for and gamble with the lives of others. We inherited such power, but who gives it to us today? And how is such a hierarchy maintained for years and then decades? We know the answers and yet we resist the solutions. The real task is to think hard about that resistance. How can we resist our institutional and personal resistance?  Can ethics help?

Medical ethical principles, for example, accord a remarkable value to autonomy, creating stringent safeguards that require consent except in very limited circumstances. Even if acting in the best interest of their patients, doctors cannot act without the various options being explained to the patient, who owns and takes the decision. The exception is when the patient is incapacitated (e.g., unconscious), and even there, ethical guidance requires scrutiny to be placed upon the necessity of immediate action and the potential for alternative courses of action. Stripped bare, the logic of charity pales in comparison: the choice – mastectomy or chemotherapy – is taken to be ours (and our donors).

In spite of high-level perennial commitments and policies for accountability to affected people (AAP), the sector remains “stuck in the weeds.” The way out of the weeds is not to create and impose more policies or launch new guidance and conferences. Our path out of the weeds is to recognize and operationalize our existing lodestar principle of humanity. We are stuck not in weeds but in a modern age transgression of that principle. That benefits are delivered does not elude this conclusion.  When necessary, accountable compromises to humanity – properly deliberated and reviewed – may be required in some situations. But pasting the excuse of “emergency” onto years of protracted crisis flunks the humanity test.

There is a progressive cost to ignoring this basic ethic of respect, our own principles, and the consequences of treating communities as societal equivalent to unconscious. A cost to ourselves, as we increasingly become accustomed to unnecessarily harmful ways of working, and they solidify in our processes and our norms. A cost to people, as stunting takes place when this disregard carries on for decades, sequentially divesting people of the opportunity to do “strikes” for themselves. Perhaps one answer to “how much divestment?” lies in the near absence of resistance. The lack of significant resistance from communities themselves suggests prolonged disempowerment; and the lack of resistance from local governments seems self-interested (a discharging or responsibilities).

The alternative is to operationalize faith in people having alternatives. We have alternatives.  This returns us to Lorde, who in the period after the surgery worried about the possibility of a recurrence and how she might deal with her life being shorter than she had expected.  “Would I be able to maintain the control over my life that I had always taken for granted.” (Lorde, p. 48). This control is part of the human experience, and should be part of the humanitarian principle of humanity.


[1] Audre Lorde, The Cancer Journals (1980) London: Sheba Feminist Publishers; p. 27.

[2] Or is it an acceptable form of disinformation, given the good intentions?  I worry that future societies will view it as a form of organized fraud — telling a false story in return for cash!

Resetting our standards

Here is Friday’s Gaza headline: “Israel’s defense chief says military ‘thoroughly planning’ offensive in crowded Gaza border town”.  One might ask: What the hell does that mean?  I don’t know which is more shocking, the idea that it has not been thoroughly planned (aside from those first few days), or that it has. And that is perhaps the point.  We spend an enormous time reading, thinking and arguing about the What.  Is it a genocide? Is it antisemitic? Is it shielding? Was Hamas attack justified? Is this a humanitarian crisis? Has it been sufficiently planned? And so forth.

Moving beyond what is happening

I am more confounded by the Why than the What.  On the Israeli side, at least, the Why seems less mysterious: Netanyahu saving his political career or keeping himself out of jail, or Israel obliterating a proximate threat, or the belief in religious destiny, fear + history + racism + hatred, etc.  What I struggle to understand is why the US government (or the West more generally) is so staunchly entrenched on one side of this conflict given Israel’s arguably genocidal and inarguably targeted campaign to destroy civilian life in Gaza.  It would have been relatively easy to support Israel militarily behind the cloak of much more nuanced public positioning.  Ditto for the UK or Germany.

The US will pay a steep price for this solidarity. Insight from the ever-incisive Nesrine Malik: “When a less safe world becomes an acceptable price to pay for loyalty to allies, the west’s claim to authority as a political and military custodian of law and order looks increasingly tenuous.  Once that authority is gone, the system is rocked from within.”  Certainly, the US position can be explained in negative terms: that these governments are stuck with the fruits of their tortured allegiances, or wedded to the finances of military spending, or that 2024 is a campaign year for embattled President Biden (and PM Sunak), or that the West maintains a double-standard, or that their hypocrisy reveals the inner rot of Western hegemonic power and narcissism.  Certainly these explanations describe influences, but none seems sufficient; none seems reason enough to undermine the West’s own global power and so efficiently gut the very ideals that are so central to wielding this power. Not to mention running the risk of indictments in the genocide cases to come.   

I want to step out of my depth (read: speculation alert!) and ask, what really is at stake for America? Here, let’s postulate some stakes. And if I get it all wrong, please use the comments to enrich the discussion.

An assault on IHL

Violence such as in Gaza today or Mosul in 2016-17 exposes the inherent destructiveness of a military strategy based upon bombardment of densely populated areas, pulverizing alike the people and the social fabric of a people. The mass erasure of the countless details that make us human is not excusable as collateral damage. Is the concussion being delivered to international humanitarian law (IHL) a deliberate strategy to whittle away the safeguards – the rules of war – through which the West has been exercising power, even if also skillfully ignoring these rules when necessary. This time, though, the curtain of hocus pocus surgical strikes has been pulled back. War is messy. That’s why we created rules.

One major difference here is the absence of that oldest of survival strategies – flight. There is literally nowhere to seek safety, nowhere to shield your children.  Now 134 days too late, even President Biden expresses his concern over the impossibility of evacuating to a place of safety. The strategy of bombardment is thus the airborne equivalent of shooting fish in a barrel; barrel after barrel for months on end, with the additional stipulation that the Israeli military has claimed it is only trying to shoot the sharks, who happen to be shielding in the same barrels. Welcome to urban warfare against an irregular armed enemy. Welcome to the end of IHL’s doctrine of proportionality. Welcome to the wider public watching, reading and talking about it.

The strategy is to normalize this type of warfare, to expand the boundaries of justifiable (i.e., legal) or publicly acceptable combat tactics, because urban warfare is the future of an urbanized world.  It’s not just the shelling of civilians, Gaza marks a rebranding of the tolerable when it comes to civilians, where tactics such as cutting off food and electricity or blocking aid are openly declared.

Shielding – Maintaining the West’s options

Recall the loud condemnation of Hamas’ practice of hiding among civilians – known as “shielding”. And the quieter explanation that while shielding is a forbidden tactic, IHL does not condone using an enemy’s shielding as justification for indiscriminately and indifferently killing lots of civilians.[1] With global access to making and viewing videos, violations of the law become ever more un-deniable and un-explainawayable; hence the need in an age of asymmetric warfare to normalize previously less public and “necessary” transgressions.  

Shielding – Protecting soldiers at the expense of civilians

The heavy reliance on bombardment can also be seen as a strategy of deliberate shielding by the Israelis, as with the US in Iraq. The domestic political imperative in Western democracies now demands sacrificing civilians over there in order to protect military expenditure, popular support, and election votes at home. Israel’s approach in Gaza, like the US’s (and allies) actions in Mosul, shows how this practice forms a more surreptitious form of shielding: one military places “enemy” civilians in the path of violence to protect itself from the enemy military. Bloody and destructive as it might be, invading on foot maintains a much higher level of control over the use of lethal weaponry, reducing civilian casualties/costs but adding steeply to those among the invading soldiers. For Western democracies, this means casualties at the ballot box.

Looking forward

Why such unwavering (and carefully worded criticism) US support to Israel? Is it that the US (or the West) needs and wants Israel to be the dirty cop in the region? Is that enough? Or does it reflect a shift in realpolitik thinking, a belief that law and norms like IHL will prove ever more inadequate in a fast-charging future where inequity, brutality and naked self-interest will be both necessary for the securitization of the West’s idealized societies and widely broadcast (when the West is involved, as with Gaza).  The new world political calculation is that widespread demolition from afar thus becomes “necessary” for the defense of democracy and the rule of law. Perhaps this was always the case, but that was never the ideal presented to the public.

I feel as if I am being prepared to accept tomorrow what constitutes a futurist dystopia of today.  In fact, I think we are being initiated into tolerating it. Seems we as a society are halfway through Niemoller’s poem, and that doesn’t even count our acceptance if not collective ignorance of the war in Sudan, ethnic cleansing in Nagorno Karabakh, mass civilian deaths in Tigray, Rohingya persecution, or the re-education camps in China’s Uighur region (not an exhaustive list). 

I worked for years on the protection (witnessing and advocacy) side of humanitarian action. I preached the idea that if only we could communicate more powerfully what was happening, it would stop (or, at least, slow), or bring justice. Either times have changed, or I have long been too much of an idealist. A less safe world, as Malik says above.  This is the gambit on which we have now more decisively embarked.  Creating a less safe world, and at the same time one where the costs will be inequitably distributed, imposed upon the have nots in order to create and maintain the safety of the haves.


[1] In the US or the UK, nobody would support a SWAT team decision to shoot dozens of pedestrians in order to stop the escape of one murderer. Or claim that in a hostage situation it was OK to lob grenades from afar (killing all) rather than take the risk of losing police in storming the location. We expect and police expect to place civilian safety above their own (within limits). IHL is the same. But the home country politics of US soldiers dying on foreign soil increasingly gives rise to a different weighting of lives, where one American non-civilian trumps [fill in the foreign blank of men, women and children].

Not in Our Name

[I have been drafting and delaying the posting of a number of blogs related to Gaza. In the small points they make they simply don’t seem appropriate given the latest news.  Now over nine weeks in, I’ve lost faith in the idea of waiting for the right time.]

Last Thursday, world humanitarian #1 Martin Griffiths conceded defeat in Gaza: the message that we have been giving – we here being the humanitarian community […] – is that we do not have a humanitarian operation in southern Gaza that can be called by that name anymore.

A praiseworthy defense of the idea and the word behind the idea. We need more.  “Humanitarian” has become a misnomer when used to describe a type of crisis,[1] or mistaken for an “it’s okay, you can focus elsewhere” counterbalance in a hyper-localized Armageddon like Gaza, or applied as an adjective to describe violence (the oxymoronic “humanitarian wars” in the Balkans or Libya), or even a pop culture armada of ships (at 1:34) carrying enough proton torpedoes to detonate a galaxy.  Truth is, our label – humanitarian – carries with it far more capacity to mask, mislead, and divert than we defend against. Maybe that’s because it also bestows such pride and prize.

To pause or not to pause? That is the wrong question

Gaza’s supercharged media environment seems particularly capable of freighting the word with ever greater political liabilities. By way of an example, last month the United Nations Security Council adopted Resolution 2712, calling for “urgent and extended humanitarian pauses” throughout the Gaza Strip to enable humanitarian access in the Gaza Strip. Though immensely more desirable than unrestrained violence, humanitarians should reject the idea of a pause in their name, or any suggestion of a compassionate act by the pausing parties.  Let’s look at the math:

  • A pause in the music = a musical pause. 
  • A pause in the speech = a speech pause.
  • A pause in warfare and atrocities ≠ a humanitarian pause.

The conduct of war needs no pause to deliver humanitarian aid because the rules of war (International Humanitarian Law) take specific care to protect civilians and their access to lifesaving aid. In this case, a “humanitarian pause in combat” (as used recently by an IDF spokesperson on the BBC) in fact describes a pause in the unlawful blockage of humanitarian aid and a pause in the nine weeks of neglect for IHL’s principles of distinction and proportionality.

Exploitation of the humanitarian luster

Speaking of the conflict, Nesrine Malik called it “a constant”, for “years it can be forgotten.” Humanitarian aid has spent decades expensively ensuring the biological sustenance of Gazans while they stewed in an embittering boil of immiseration and humiliation. A flow of aid that openly assuaged the urgency of Gazan grievances, allowed major powers to withdraw their pressure for change (a two-state solution, now moribund?), and encouraged the world to go about its business while the humanitarians engaged in theirs. Nothing to see here.

This humanitarian alibi has long operated in Gaza, a sleight of hand whereby humanitarian action and objectives mask political inaction.   It is one thing to deliver humanitarian aid to people who need it. It is another to do so a little too silently, a little too deferential to the hands that feed us humanitarians while we feed others. And it is still another matter to accept the terms and conditions of Israel’s effective control over Gaza (if not legal occupation of it), and specifically the Israeli faucet’s drip feed of lifeblood into Gaza. The UN understands, even if it has failed to operationalize this understanding: “There is outrage that humanitarian action is still often used as a substitute for political solutions.” (One Humanity, Shared Responsibility, p. 3).

The situation illustrates an old and difficult ethical tension, where silence is often justified in the name of access to or greater funding for the people most affected by that silence.  Soon we will have to choose. As Dr Sultan Barakat lamented last week (see HPG’s excellent panel discussion on the backlash against human rights – beginning at 58:00), humanitarians will again line up to share in the aid funding to come, suggesting that we have some difficult reckoning ahead over the enduring crises in many places, including Palestine.[2]

The need for humility and honesty about the humanitarian endeavor

Humanitarians have long indulged a deep psychological and professional interest in the public overestimation of our moral and operational greatness: in the public’s confidence in our virtue and overconfidence in our impact in crisis situations like Gaza, or Syria, or Sudan.  The aid is critical. It does save lives and alleviate suffering.  We should neither underestimate nor overestimate it. That’s us – the insiders. 

The bigger issue is the public’s belief in the reach and effectiveness of our work as a solution, and how that contributes to the problem of political disengagement.  Beyond us insiders, the battle behind closed doors and in the media for aid to be delivered in Gaza carries far too many assumptions of the capacity of aid to address (and redress) these wounds.  Large flows of aid will help. But even large flows of aid will be more grossly insufficient than sufficient.  I worry that people need to believe in us, because how else to deal with a world on fire?

What can we do? First, may I suggest consistent use of the term “relief”, which seems a little more accurate by signalling to the public its limited nature.  The sector needs to help the public to understand our insufficiency, let alone that old truth that there are “no humanitarian solutions to humanitarian problems”.  Second, we need to highlight the capacity of people to aid themselves, and to ensure that aid efforts deliberately flow to humanitarian agencies and the society at large. Aid flows – in substance and in name – need to much more deliberately support mutual aid, moving beyond convoys of stuff that humanitarians deliver to resources that leverage Gazans capacity to help themselves.


[1] See Tom Scott-Smith here for a related discussion; or §3.1 of my paper The New Humanitarian Basics. Further critique: at what point does calling violent or even criminal destruction a “humanitarian crisis” become a blend, part euphemism and part neutralizer, akin to Josef Stalin’s famous observation that a million deaths become a statistic?

[2] And within that reckoning, we may want to devote some time to (a) the silence of affected populations in our decision-making processes, which remains stuck in the weeds; and (b) the ethics of accepting funding from governments such as the US, UK, or many others, given their role in the pursuit of this war.

The human need to act

Preface. My friend and colleague Sean Healy died last night and it hurts. Too soon, too unfair, and too painful to so many people.  A great MSFer, humanitarian and person. 

You might think that people working in the humanitarian business would be familiar enough with life and death to be more prepared for when the latter invades the private and organizational space. Perhaps the doctors, nurses and ambulance drivers are. Perhaps not. I’m not medical. So this morning’s sharp sense of Sean’s death catches me off guard. Two thoughts come to mind.

One. We humanitarians spend too much time occupied with relief in terms of the provision of assistance and services. An attention to biological sustenance that we critique on occasion and then slide away from addressing.  Over the past 24 hours, scores of Sean’s friends have been coming together on a WhatsApp group, to offer testament and support and to do something more basic, to be with others as much as such virtual assembly will allow. Similar WhatsApp groups now form spontaneously among many crisis-affected families and communities, yet one has to wonder if the sector could not have set up and scaled up decades ago in order to provide similar services in situations of crisis.  There were certainly some related efforts, such as message services, bulletin boards, and the like, but they remained minimal in their reach.

The point is not about the lack of the services but our inability to grasp or give appropriate weight to the need in the first place.  Its absence does not threaten life. What about suffering? As well, the sharing of pain and seeking community relates to the enduring sectoral blindness to or avoidance of the spiritual, of people’s need to connect with a higher power at a time of natural calamity or armed destruction, and to share this ancient social experience.

Two. With tragedy and pain comes the need to act, to do something, to respond to the external and internal needs. This is com-passion: the need to address the suffering of others as well as our own discomfort at their suffering.  We feel for them. We feel for ourselves. So: do something. Take action.  Even writing a blog. It helps.

Imagine, though, that somebody else wrote this blog for me.  Maybe it just needed to be written, and maybe it would have been of much higher quality, with a description of the aforementioned message services or links to insightful articles on spirituality and aid. What if my need and my agency were ignored? Or consistently ignored, gripped in the iron hand of a dominant foreign doctrine?

This brings us to enormously complex issues such as aid and dependency, localization, disempowerment, and dignity.  Principles and values crisscross our ideology and work – my preferred lens on the aid world – to such an extent that it is easy to lose sight of the basic need of people to do something. A need no weaker than food, shelter, water, or medical care. A need perhaps less urgent, perhaps even less possible in the earliest stages of a crisis; and at the same time a need that could be more deliberately recognized and reflected in our programming as a both a way to conceptualize and deliver vital relief to the recipients of aid, and to the givers.

[Updated: I made some minor changes to this post on 27 November.]

IHL in the Crosshairs

In the wake of my imbalanced reaction to the Ukraine war, I worry that too much of my attention, like this blogpost, is generated by news/social media’s distorted ranking of things in the world. The media also produces a new ordering of anxieties and questions.

How can we better articulate the differences and samenesses between the archetypal deaths of children in the rubble of a bombed house and by the alleged slitting of their throats?

In what ways does our temporal frame of reference also frame our judgment? How far back from October 7th do we need to go in order to see October 7th for what it is, or prepare for what is still to come?

The distinction in the first question seems tangible, and yet such distinctions are becoming warped by ever greater politicization.  I struggle to unpack why throat slitting brings headlines of “sheer evil” and “murder” yet hundreds of deaths in the rubble can be palmed off as collateral damage, or are criticized but in less full-throated terms. Throat-slitting is more of an atrocity. This suggests that harm and damage, such as the accumulation over decades of “non-atrocities”, calls for a more fine-grained vocabulary.

How many people on each side of these divisions hold a deep and lasting conviction in the necessity of violence?  What feeds and maintains this perception?

Is there anything that can be judged wrong (or right) through all eyes? Or is everything, from the blockage of aid to the killing of children, to be contextualized, considered relative or justifiable from a particular point of view?

Some days it seems awfully difficult to be optimistic about us humans. What would it take to reverse the relative invisibility of peace as a form of security? That inquiry seems related to humanitarian protection, and yet there’s a sectoral wall blocking such thinking, a conviction that talking about peace violates neutrality and independence in a way that might jeopardize access.  I tend to agree if we are thinking about peace and neutrality in old terms (read: “rigidly sectorialized”). But we shouldn’t be.

The triple nexus suggests that we humanitarians need to pay attention to peace, specifically to our responsiveness (or not) to peace, to (a) our direct contribution to grievance and conflict or (b) the indirect workings of the humanitarian alibi, where relief assistance becomes the primary vehicle for the international political management of conflicts and crises not named Ukraine-Russia or Israel-Gaza. Perhaps the distinction between ‘Big P’ and ‘little p’ (see here for an explanation) offers a way of engaging at the project level with peace, placing it within the rubric of humanitarian protection and conflict sensitivity. For example, in some contexts, little p – not doing little p but thinking little p while doing humanitarian work – suggests responding to people’s need for protection from conflict simply by bringing different communities together in the implementation of assistance.

Are we being herded into a dominant us-them discourse, one where each side believes that it alone holds and is entitled to act upon the absolute truth? 

The general social trend of the past 20 years seems headed in the direction of powerful us-them divides. Having shied away from neutrality for some good reasons, the public humanitarian voice might need to backtrack towards the posture of neutrality even if individual humanitarians take a side.

Beyond self promotion and fundraising, how can the humanitarian sector capitalize on the intensity and likely duration of the focus on Israel-Gaza (without contributing to it); and how can we diminish the negative consequences?

How might this conflict, so emblematic of the positioning of the West generally, effect on a global scale the trust of people in humanitarian action? Specifically, how might it contribute to a perception of (or render more visible) humanitarian agencies delivering on the direct strategic interests of the West, or being funded by Western governments as force multipliers in the clash of civilizations? What of the perception that humanitarians are blind to their being steeped in/carriers of /attached to a predominantly Western set of principles, policies, ways of working, and culture?

When will Biden fly to Burkina Faso, Yemen, Myanmar, DRC or some other “acceptable” crisis?[1] Would actual engagement even prove effective after decades of bare minimums of humanitarian relief as the primary form of foreign intervention (in other words, is the embeddedness of crisis as big a problem as the original crisis)?

It is quite understandable that aid agencies raise loud demands for access, for all parties to respect international humanitarian law, and for the various authorities to grant safe access into Gaza for relief and other supplies vital to life (e.g., fuel to run the water desalination plants).  But note how much of the political conversation is also centred on this human and political minimum. Obviously, there’s an immediate priority for humanitarian relief. Yet humanitarian work in protracted crises bears witness to how the focus on immediate lifesaving measures means that the important conversations to come (resolution of the crisis) will not come, leaving the same unacceptable human despair that we’ve grown to accept these past decades.

It is quite understandable as well that aid agencies are talking about respect for International Humanitarian Law.  The necessity is to be very clear about how IHL is being misused by politicians to reinforce a distinction between “murderers” on one side and a law-abiding military power on the other. That’s the clash of civilizations that we’re being asked to buy into in much of the US/UK media. Let’s be loud and clear: urban warfare such as in Gaza produces a high-visibility challenge to the law of proportionality.

It is not quite understandable that so many people believe civilian deaths are simply legal within the pursuit of war (including the news presenter on BBC 4 yesterday morning). My concern is that for Western publics, thus politicized discussion risks undermining IHL’s (fragile) integrity, this transforming IHL into a tool of power designed not to place limits on war but to demarcate the line between good and evil, and hence to justify transgressions of those limits. This seems like what is happening right on the front pages of the news. IHL thus becomes one more tool of domination in the eyes of people who experience “evil” differently.


[1] The world’s crises seem divided into the haves and have-nots – those that have to be fixed (political engagement) and those that do not have to be fixed so long as they do not disrupt Western publics with horrifying images or threaten key strategic interests. 

Maintaining Standards

While the views expressed below may appear critical of localization, this blogsite is an ally: as local as possible; as international as necessary (see here or here).[1]

One particular and necessary strength of the established global humanitarian order has been the production of guidance and standards that govern practice, boost coherence, and safeguard its legendary accountability.  These standards and guidance uphold hard-fought gains in managerialism which ensure humanitarian work contributes vital assistance and protects the safety of people and communities affected by crisis.  Vigilance is necessary.

On a 10-day visit to Ukraine in November 2022 to collect data for an evaluation, I was shocked to find that critical requirements were being ignored in the interest of preserving local ‘culture’, or due to simple ignorance of the standards and risks. Though examples abound, let me draw your attention to what Ukrainians refer to as a hot dog.  It looks like this:

In contrast, and exemplary of the existing global standard, actual hot dogs look like these:

My research into the matter yielded three essential conclusions.

First, categories and standards matter.  Here, there is clear damage at the conceptual level – a significant blurring of the lines. As has a U.S. Supreme Court Justice has declared, a hot dog is a sandwich (see verdict at 2:37). Conclusively, Miram-Webster defines a sandwich as “two or more slices of bread or a split roll having a filling in between” (emphasis added).  With neither two slices of bread nor a split roll, the Ukrainian “hot dog” is not a sandwich. This means it is not a hot dog. It belongs more appropriately in the category of miscellaneous meal products such as the burrito, eggroll, or gyro.

These distinctions have enormous consequences for stakeholders such as beneficiaries and delivery agencies. For example, under U.S. law and reflecting a turf war between agencies, a ham and cheese sandwich on one slice of bread is the responsibility of the U.S. Department of Agriculture, which inspects manufacturers daily. But a ham and cheese sandwich on two slices of bread is the responsibility of the U.S. Food and Drug Administration, which inspects manufacturers about once every five years. And that is just the difference between two sandwiches!  In the aid industry, incentives push in the direction of similar bureaucratic regulation and increased managerial burdens. Obviously, this situation constitutes a threat to the stability and coherence of nutritional guidance. Should UNICEF or FAO have intervened in Ukraine?  Nutritionists or health experts?  We need to avoid this sort of uncertainty.

Second, the Ukrainian “hot dog” presents major health and safety concerns.  Research has shown that choking injury is the fourth leading cause of unintentional death in children under five, hence a risk to the primary target of humanitarian funding. Research produced by the esteemed American Academy of Pediatrics explains that the hot dog is the number one choking hazard due to the size, shape, and consistency of a hot dog chunk, which easily becomes wedged in a child’s windpipe; and is responsible for over 10,000 annual emergency room visits.  This peril is precisely the risk posed by the way the meat protrudes from the breading in a Ukrainian “hot dog”, to be bitten off in choke-friendly chunks by unsuspecting children.  An additional concern, still to be researched, is the risk of germ or bacterial contamination due to the lack of full bun protection for the meat.

Third, this is not good value for money. Claims by advocates of the Ukrainian “hot dog” point to the value and efficiency of the lesser amount of breading, arguing that it will free up financial resources for critically underfunded emergencies such as Yemen, the Horn of Africa, or Haiti. This misdirection ignores the significant reduction in caloric value compared to the standard (American) hot dog bun’s sugar, salt, and ultra-processed carbohydrates. Such a tactical narrowing of the focus also manifests a common evidentiary sleight of hand in the sector: humanitarians cherry-picking one subset of data and ignoring others, such as the disastrous inefficiency of condiment distribution in the Ukrainian “hot dog”.  As the photos reveal, it is a false comparison to substitute a barren cylinder of meat for the more nutritious meat and vegetable (relish, tomato ketchup) sandwiches of a real hot dog.

The target of this post is not the Ukrainian “hot dog” but the importance of safeguarding those components of the international aid system that remain necessary to ensure conceptual clarity of responsibilities and effective programming standards. The author intentionally selected Ukraine to demonstrate that this criticism applies to all local organizations and associations, even ones in a “chosen” crisis because it is local to the West.

[Text updated 14 August 2023]


[1] Disclosure of interest: I benefit from the apparent reimagination of this mantra/policy.  As practice reveals, localization work now includes HQ-level international efforts that are necessary to ensure localization is realized as soon possible (e.g., capacity building, webinars, articles, or even this blog). I note how growth in the formal and ‘water cooler talk’ about localization has blossomed.  This reflects, we must assume, the continued necessity of the international sector, even as the direct funding of assistance to local and national actors reached 1.2 percent of total humanitarian funding for 2022.

The Proportionality of Our Attention

Depending on how you look at it, it was Day 4 or Year 8 of the war in Ukraine when I began drafting this blog.  It is now Day 145. I recall those early days, the emotions stirred as I saw my younger self in the wire-rimmed glasses and quilted winter coat of a young Kyiv professional, or my family in the hand of a child clutching his mother’s luggage strap as the throng surged for the door of a train. There was little in my head that could be labelled dispassionate. In other words, my head held little professional interest in the Ukraine news, even as my unease grew at the white-out erasing all line of sight to any other crisis.

It is OK to identify with people because we find something of ourselves in them.  These paths of affinity trace paths of identity such as race and gender as well as less obvious similarities.  In March 2002, in the back of an MSF Landcruiser, I sat opposite an Angolan man who had already lost four children, cradling a last, limp daughter on his lap. My next several nights brought terrible imagery, and in the mornings came panic attacks at the thought of going to work.  Weeks later, debriefing with a psycho-social care counsellor in Amsterdam, I came to understand why I’d experienced such a reaction on this occasion, and not on others.  I’d become a father in 1999 and was struggling with a new kind of performance anxiety. This man and his little girl were no longer ‘simply’ a pair of humans in extreme distress.  I saw a dad, unable to protect his child, and to this day it seems like the most terrifying feeling in the world. 

It is even OK for the countries of Europe to devote far more attention and aid to the crisis in their back yard, just as we would expect the African Union to be far more involved in a crisis in the Sahel than the OAS or ASEAN nations.  But…

It is not OK to ignore the structure of the aid system to the point that our affinities undermine our common humanity; to ignore the significantly skewed concentration of ‘certain’ affinities in the decision-making clubhouses across major donors, UN agencies, and the large INGOs. Voting on the Christmas dinner menu is not a problem until we in the clubhouses ‘discover’ that turkeys own the bulk of the votes. Neither human affinities nor the AU nor the OAS create a global distortion in aid resources.  The formal humanitarian sector does. Notably, in 2022 this distortion has been noted. Witness the mainstream critique being raised re the proportionality of aid going to the Ukraine versus other crises, such as Somalia, Yemen, or Ethiopia. (see here or here).  And yet our fixation on Ukraine has endured these past months, only beginning to wane in June and only fleetingly interrupted by an earthquake in Afghanistan.

Bias in the ignoring of bias.  Following the previous point, perhaps more revealing and yet less revealed is the double-standard; the non-response to partiality’s contamination of the principled ‘purity’ of aid.  For years now, ‘local’ actors have been forced to swallow the bitter pill that they cannot be neutral because of their local identity, and hence were disqualified from ascending to the penthouse suites in the global humanitarian club. Their ‘natural’ bias of being in their home context, full of affinities, has been judged as threat to principled aid. The system assigns consequences to such bias. So where was the call in the Ukraine crisis for humanitarian decision-makers to step aside given their bias; given their conflicted interest and powerful affinities?  Where was the challenge to the neutrality of their agencies and the appropriateness of having authority over their work given the undivided support for Ukraine among their home country governments and citizens?

Humanitarians need to be particularly mindful of impartiality in this regard, because this is the substantive ethical principle that operationalizes our affinity-laced humanity.  Impartiality instructs humanitarian aid be delivered on a non-discriminatory basis and therefore in proportion to the urgency of need.  We may forgive media corporations for following the cash and clicks even as we might hope for a more equitable distribution of news content.  If it bleeds, it leads – that is their credo?[1] But it is a problem for humanitarians when not all bleeding is of equal media value because humanitarians have a different obligation. Where is the assessment of the sector’s principled performance? As the Ukraine crisis produced and engulfed resources, how did impartiality fare at the global level of distribution?  Where is the concern over agencies pulling staff/resources away from other crises to manage the well-funded expansion of operations in the Ukraine war context? Tellingly, the Ukraine response suggests a pathogen in the system at the level of impartiality, which as an ethical rather than operational principle should raise far greater discussion than the neutrality of local organizations. 

Is institutional attention a critical resource, like healthcare, food, or cash? What does it mean when GD (General Director) after GD heads to Ukraine for a photo op and website home pages greet the visitor with the faces of Ukrainian children in March, April, May, and often still in June? Given the causal linkage of attention to the provision of assistance, asylum, refuge, and compassion, shouldn’t impartiality guide the institutional use of humanitarian media resources, such as an agency’s home pages or its Twitter feed? Perhaps this would have been the perfect time to counter the prominent bias in media attention by devoting prime website real estate to other crises, or sending GDs to other contexts, to interrupt the frozen gaze on Ukraine. To some extent this discussion is taking place. Good. But is the issue being framed as a matter of obligation and principle? Is this discussion alive in board rooms as an issue of accountability? Or are some humanitarians simply feeling uncomfortable with their in-house disproportions?

Privilege is the power of an agency to assume it can determine right from wrong for itself, especially in a system so weak in accountability. The entitlement of the formal Western sector is well illustrated in deciding for itself when it must play by its own rules, when compromising them is ok for itself or not OK for others.

Power is the privilege of not even being conscious of this assumption.


[1] Actually, when you think figuratively about it, If it bleeds, it leads wouldn’t be such a bad standard to guide impartiality.  Certain better than If they’re white, the aid shall take flight.

Don’t Just Do It

The leader of the UK’s Labour Party just took action. “I would, of course, do the right thing and step down.”  This is, of course, politics. Kier Starmer’s catchy response to accusations he broke Covid lockdown rules was delivered in order to contrast his integrity with the Prime Minister’s refusal to hold himself to account. 

Forget about the recent plan to send single male migrants to Rwanda, or even Brexit, the British government’s most dangerous manoeuvring comes in the form of a single, innocuous word: “job”.  As in “But I think the best thing I can do now is, having settled the fine, is focus on the job in hand.” Faced with a police fine for having broken Covid rules (see “Partygate” for those lucky enough not to follow British politics), the party line was clear: the Prime Minister wanted to “deliver on the priorities of the British people”, he was “keen to get back to the job”, and the British people wanted to see the Tory party “getting on with the job”. 

This line of argument recalls the well-worn path of politicians, corporations, the Catholic church and, sometimes, just about all of us:  the good I do buys me some space for the bad.  It’s like carbon offsetting for sins.

Let’s skip back five years.  Not long after the World Humanitarian Summit, I was talking to a leader in our sector, a vocal proponent of transferring power to local non-governmental organizations (LNGOs).  “Kevin” was an enthusiastic supporter of the Grand Bargain, especially the commitment to deliver a fat chunk of funding directly to local organizations.  Turns out, Kevin’s commitment involved a commitment to the idea of localization rather than to an actual substantial shift of responsibility and financial resources.  Turns out, his views spoke for much of the sector.  Turns out, there was a caveat.  The sector’s inequitably powerful and overly Western contingent can bask in the noble glow of being champions of localization while effectively blocking it.

The INGO Kevin worked for – a major player – was committed to the Grand Bargain. Yet, its uppermost commitment is understood as being to people, not the Bargain.  Fair enough. But this ‘higher’ commitment has been interpreted to mean that Kevin’s INGO should operationalize localization only if it did not diminish the quality or quantity of aid, and that Kevin’s INGO should be the judge of this potential diminishment. 

This was the Grand Bargain’s ideological equivalent of fine print. So much for the slogan says humanitarian work should be “as local as possible and as international as necessary”. There’s a lot of ‘devil’ in the detail of that last bit.” But let’s not enter the “INGO vs LNGO: who can do it better?” debate. The more critical issue is that the arguments of both sides – the pros and cons of local action – share the same underlying logic. This is the logic of effectiveness. Is aid really only about who can do the job better?

Back to the British PM. The danger in Boris Johnson’s declaration recalls the danger we as leaders perpetrate and perpetuate upon our own humanitarian sector.  We remove annoying obstacles to our business by rendering ethical principles invisible.  The Kevins of our sector can talk endlessly about doing things the right way, about one day doing things in a ‘righter’ way (new evidence-based guidelines are being developed by our global task force!), and about doing things in a ‘righter’ way than local organizations (after all, we must build their capacity on the new evidence-based guidelines).

What the Kevins do not want to talk about is doing the right thing.

Johnson’s apology for transgressions effectively shreds the uppermost responsibility of leadership – to champion the ideals, aspirations, and ethical principles which guide actions, and which unite societies even where there are strong disagreements on the ‘how’ level. Neither British politics nor humanitarian action would be well-served by moral purity, yet the power of both are gutted by excluding ethics from deliberation and decision. We need to think about the politics that has girded decades of constant, directive paternalism; and the presumption this status quo can be justified on the basis of effectiveness and actions.  The ethical cost is too high, for instance to the principle of humanity.

People matter because they are not static vessels of need to be filled by our action. Human solidarity is impossible without recognition of the other’s human sovereignty. Being more capable than local NGOs sounds like a logic we tossed out 60 years ago (and it’s an assumption of dubious accuracy as well).  Would it have been OK for Britain to maintain rule over Kenya or Sierra Leone on the basis of Her Majesty’s greater technical and economic capacity?  That sounds offensive. Why?  Because there are principles more important than doing a good job.

Two new posts (elsewhere)

Last week ODI/HPG launched a new (and excellent) report on what we can learn from the response to DRC Ebola outbreak #10. Having led HPG’s 2015 review of the Ebola response in West Africa, I was asked to contribute to the discussion. Twice. That led to a joint blog with Kerrie Holloway, one of the authors of the new report. To nobody’s surprise the authors found issues such as community engagement and embedding the international response in the context of the outbreak remain points of weakness.

This led to my solo blog post, where I ask whether or not it is time to shoot the messenger. Meaning, whether or not in addition to our finger-pointing at operational agencies and donors, it is we who deliver evaluations and reviews turn to accept some responsibility for sectoral intransigence and bad practice. Why do evaluation and review miss the forest for the trees, or dive into program performance with politics and systemic dysfunction being placed oh-so-conventiently outside the scope? What is the cost of this misdirection?

It’s past time the sector pays more attention to the messenger. The opening of the blog…

=============================================

As the Humanitarian Policy Group (HPG) launches its new research on the 2018–2020 Ebola outbreak in the DRC, global news of new outbreaks in the Republic of Guinea and again in DRC gives pause to reflect. By way of grasping for a silver lining, this frequency offers the opportunity to improve global health and humanitarian operational responses by learning from them. A second opportunity is to improve by learning from how we learn.

Our sector publishes no shortage of evaluations, reviews and reports that traffic in ‘lessons learned’. Yet contrary to the cosy idea of having learned lessons, this new HPG report from Crawford, Holloway, et al highlights a repetition of shortcomings, such as the quintessential agency turf battle that manifests in debates over how the crisis was framed and thus responded to (in this case whether Ebola Virus Disease (EVD) was primarily a vertical health crisis or had fused with and fuelled the longstanding conflict and multi-dimensional political and economic crisis in Nord Kivu); and the failed imperative for such extraordinary expenditure (in this case, an estimated $1 billion) to leave behind permanent infrastructure and capacity. These issues are anything but unfamiliar. They were unambiguously signposted by many reports on the 2014-16 outbreak in West Africa, including a previous HPG study (which I led), and in the evaluation reports of too many crises before that…

[To continue (to get to the fun part), here’s the link.]

The Politics of Humanitarian Uncertainty

[What began as a conversation about uncertainty with HERE-Geneva’s Marzia Montemurro ended up finding its way to an article, now published by the good folks at Global Dashboard. The thrust of our argument is that humanitarians have “failed to engage with the bias in its attention and the political content of how uncertainty is interpreted, ignored, unseen, and suppressed.”

Our catchy tiitle? Uncertainty and Humanitarian Action: What Donald Rumsfeld can teach us. The article:

Since its onset, one striking feature of the coronavirus pandemic (COVID-19) has been the narrative power of its novelty. This global narrative depicts COVID-19 pushing humanity towards a ‘historical divide’ of BC and AC (before and after COVID-19), where unknown, unpredictable futures await.  Within the humanitarian sector, we reveal this same preoccupation with the post-COVID future in a plethora of reports and webinars. While the virus itself may be the antihero of this narrative, we believe uncertainty should be recognised as the second, less visible protagonist.

Keep reading here.