Tag Archives: Perceptions

If you’re happy and you know it…

I am not the first humanitarian to owe an apology to the people of Somalia.  Somalia is one of my go-to catastrophes.  Have an audience and need an example? The all-purpose Somalia does the trick: starvation, war, GWOT, counter-terrorism legislation, diversion of aid, refugees, ethnic conflict, climate change, cholera, co-opted aid agencies, murder/kidnapping of  aid workers, displacement etc etc.

Somalia is no longer a nation but an archetype of a certain kind of nation, joining (depending on the day) South Sudan, DRC or CAR in a string cite of intractable, unfathomable brutality, drought, destitution and conflict.  These are the contexts that substantiate the humanitarian case for why delivering compassionate aid to others is a necessary part of our world.  They nourish our system just as we feed theirs. (And by way of confession, I talk about Somalia though I’ve never been there.  Again, I’m not the first humanitarian to take that license.)

I recently did work that involved taking a closer – though geographically removed (Nairobi) – look at the situation in Somalia, now mired in the yet another staggering drought, only five years removed from the 2011/12 crisis (drought, conflict…) that killed upwards of 250,000 Somalis. At first, nothing I saw or heard challenged my narrative of Somalia the profoundly a tragic context. In blunt terms: one of the worst places on Earth.  Think about that: me declaring it one of the worst places on Earth.

In the course of those interviews, though, I began to notice another story – Western aid workers recounting how the ‘mood’ of the people – seems quite different.  Experienced humanitarian hands used the term ‘optimistic’ to describe how many Somalis felt.  Not what I was expecting, and sufficiently weighty to pierce my own confirmation bias.

Further reinforcement?  A recently published set of surveys from (the excellent) Ground Truth shows a full  35 percent of Somali respondents felt that life is improving ‘very much’ for people in Somalia, while another 41 percent said it was ‘mostly’ improving. In fact, only 6 percent answered that it wasn’t.

Not convinced? Back home, I stumbled across the recent National Geographic issue (November 2017) on happiness, including findings from the World Happiness Report.  This scientific study ranks Somalia in 5th place in Africa, quite distant from the other members of my string cite of misery. South Sudan placed 37th, and CAR was 44th – dead last. Here’s a stunner of a finding: Somalia yielded a higher ‘daily happiness’ rating than either the UK or USA. Most of Eastern Europe wasn’t even close.

We need to let that sink in.  We really need to think hard about the looping narratives by which we define Somalia, yet another narrative divide between a the perceptions of an international aid community looking down and a people looking up. For me, our unchallenged authority to problematize Somalia needs to be at the center of the localization agenda (displacing the turf war over funding?).  Note: it is a power that fits well with our proverbial humanitarian hammer’s bias in seeing a world of nails.

Conclusion?  The redistribution of power within the humanitarian system should be judged by percentages of funding flows and by the inability of the external system to reduce a country such as Somalia to conflict, corruption, drought, crisis and death. Absent that shift, we will continue to miss the opportunity to tap into the optimism felt by so many of Somalis, to explore with them more inspired options for international action in times of crisis. And in this, Somalia is not alone.

[This post was updated (a number of small edits) on December 23rd]

Addendum December 27th.   I came across this as I rushed to the supermarket on Christmas Eve, a few recipe-saving purchases for the next day’s big dinner.

Some messages are universal, meaning they resonate at the level of the nation or society and for each and every individual. As the localization agenda evolves, I look forward to the ‘local’ finding different ways to say Here we are!


Headlines of Harvey

Have you heard about the Cajun Navy?  Google it.  644,000 hits. The Cajun Navy is not a one-off story, it is one of the top Hurricane Harvey storylines. If I had to sum it up: ordinary people coming together in the face of extraordinary adversity to save the lives of other people.  Mother with small children stuck in waist deep water? Some bass fisherman on a boat will haul them out.  Elderly man drowning in a car?  A human chain forms and performs the rescue.  The Lt. Governor of Texas likened the civilian effort to the rescue of Dunkirk. If nothing else, this makes for great TV.  But there is more than nothing else.

The accompanying story is that Hurricane Harvey has met its match.  Unprecedented destruction? Sure, but this is Texas, and even a storm like this will not defeat the spirit of the Texans. Is there anyone who has not seen that story?

Exit Harvey and back to the world. When was the last time coverage of a disaster / crisis somewhere in Africa sounded like that?  Or Asia?  These are not occasional human interest stories sunk within the reporting on a major catastrophe, these are top, persistent headlines. The hero is not a brave individual but a brave population. Here’s a sample headline: Spirit of Texas: People pull together to help Storm Harvey victims. I’ve blogged before about the narrative divide, about the power of the narratives that shape our world view. It’s not a new story.

Media and even aid agencies are doing better, but neither the Western public nor aid agency fundraising targets are ready for the courage, resourcefulness and agency of ordinary Sudanese or Bangladeshis as a predominant image of crisis response. We may be able to feel admiration for the fortitude of an IDP mother and rape survivor who has lost a husband plus two children and has now walked 100 miles to find medical care, but that story is of a heroic individual, the victim of a pervasive venality and brutality.

The core humanitarian principle of humanity manifests itself in the compassion to respond to the suffering not of family, neighbours, clan or countrymen, but to anyone, anywhere in the world, simply because they are human beings just like us.  Our hardwiring sometimes works differently, though, and we see and feel attachments or bonds to family, neighbors and fellow citizens that get in the way of us seeing the entire human race through the lens of a dispassionate equality.  Ethnocentrism may even prove biological in origins, which makes humanitarian ideals all the more important, even if ‘unnatural’.

I choke up and find tears on my cheeks when I watch the videos of the Cajun Navy.  I feel pride at the American can-do spirit. There is a special sense of connection because I lived in New Orleans for several years.  I know quite a few actual Cajuns.  Beyond the near-hegemony of a Western worldview, that helps explain why the Western media run with these headlines. Because I will read them and be touched by them.  Of course I am interested and often moved by stories – in the media or the ones I’ve heard in person – of the extraordinary resourcefulness of disaster-affected communities in the so-called global south. But that is different in both degree and quality.

Two conclusions come to mind.  The first is that the depiction of Hurricane Harvey lines up so much better with the reality of humanitarian crisis.  The people of Houston and Beaumont and Port Arthur will rise to the occasion and overcome this catastrophic event. At the same time, they require support from outside to overcome the immediate needs, to support reconstruction, etc.  They do not need to be saved or rescued as they sit there, helpless.  And they do not need the international community to arrive with the intention of solving painful structural issues such as gender/racial inequality, illiteracy, violent crime, drug addiction, undemocratic institutions, environmental degradation…  (Or, at the least, they might very well need that, but it is not how we as humanitarians understand our role.). So why do we humanitarians think so differently about Sudan or Haiti or Bangladesh?

The second is to consider what the people in places like Texas (or Bihar) need most at a time like this.  Water, shelter, food etc come to mind.  Hope and reassurance come to mind.  But perhaps more than these is that spirit, the one Texans reportedly have in spades, the one that sits not in a briefcase or in a convoy full of water bottles but in a bar, shelter or church full of people. It also sits in and is inspired by headlines and stories and Tweets across the media machine. It is a manufactured swell and it is vital to crisis response. Which raises the question, what happens when there is no such inspirational headline, where 99% of the story reinforces a swell of helpless incompetence or the hope that rescue will come in the form of a foreign intervention?

What’s in a name?

Change can happen in the humanitarian sphere. I kid you not. Take TPFKAB. The People Formerly Known As Beneficiaries (also TPFKAAR – The People Formerly Known As Aid Recipients).  Long perceived as problematic – as passive, reductive and patronizing – over the past 18 months or so that nomenclature has been banished, the sector now self-imposing the more (politically) correct “crisis-affected populations” or “people affected by crisis.”

The new(ish) label is more correct in terms of the respect it confers upon TPFKAB. Reducing human beings to a status founded in their relationship to us – “beneficiary” or “aid recipient” or (worse still) “victim” (read: victim in need of saving by us) – placed a rather profound act of dehumanization at the centre of the humanitarian lexicon.  Kudos for recognizing the issue and making the change.  But the new label is sweeping; it too easily counts millions of people who lack a direct relationship to us at all, and whose well-being is heavily defined by that lack.  Why? Moving from TPFKAB to “people affected by crisis” involves swapping out those who actually receive aid with the larger, aspirational category of all those who probably should be receiving aid but often who do not. The new nomenclature obliterates this distinction.

The new terminology risks producing a sectoral sleight of hand, as becomes obvious in usage, for example in relation to our humanitarian Waterloo, accountability to those self-same crisis-affected people.  Here is how the Core Humanitarian Standard, the latest elixir for our accountability-challenged sector, proclaims itself: It also facilitates greater accountability to communities and people affected by crisis: knowing what humanitarian organisations have committed to will enable them to hold those organisations to account.  I hate to sound picky (actually, I am rather picky), but the word “some” seems missing: “some (and often small percentage of) people affected by crisis.”  That is who gets our aid.

As Austen Davis wrote 10 years ago, “There are no accountability initiatives that would hold agencies to account for not being somewhere.” That remains true today.  In a smart paper on accountability, James Darcy further elaborated on this blind spot, highlighting the degree to which initiatives to establish humanitarian accountability really mean accountability “for what they do, and how they do it; not for what they fail to do”. Agencies remain unaccountable for their “strategic choices.” These form no small gap: “decisions about whether or not to intervene, the timing of intervention and withdrawal, which areas and communities to prioritise, the choice of programme approach and the ‘mode’ of delivery (how to work, with what types of partner, funding etc.).” (at note 10).

The result? Accountability frameworks that offer no accountability to many of those most profoundly affected by the humanitarian response to crisis – those not receiving aid.  Accountability, of course, is just one problematic area for the use of the new terminology.  What of the very image that comes to mind in a casual expression like “The international humanitarian sector has mobilized in large numbers, with dozens of organizations busy delivering aid to crisis-affected populations in [country].”? If only it were more true.

What of the TPFKABWSBDGA? The People Formerly Known As Beneficiaries Who Should But Don’t Get Aid.  The new nomenclature may not conceal the agency or dignity of TPFKAB, may not wrap TPFAAR within their own victimhood, but it nonetheless manages to exemplify the same old trait of placing our lens onto their world, with something going invisible in the process.  In this case, millions of people affected by crisis yet unaffected by our crisis response.

Thomas Jefferson and the 22nd Century

A New Year and a new baby have sparked my inner Carl Sagan, pondering the next century, musing on the meaning of life. That sort of thinking delivered me rather quickly to Thomas Jefferson.

Speculation about the future remains a dark art. When I was a kid, people imagined life in 2016 would be like The Jetsons (which, btw, takes place in 2062) not Downton Abbey with an internet connection. Extrapolating trends, the pundits prophesied both horrors and nirvanas. We watched 2001, A Space Odyssey and were convinced by its promise. We lamented never seeing a tight-suited Mick Jagger singing about Satisfaction again. Oh, how we were wrong.

Humanitarian crystal balls fare no better than others. When it comes to such predictions, I produced this piece in 2010, looking forward to 2020. Much more serious analysis can be found, for instance, in Randolph Kent’s work with the Humanitarian Futures project (e.g., see here). What about the far future? Not 2020 or 2050. What about a century or two from now? That’s where Jefferson comes in.

It would be difficult to identify a more brilliant politician, philosopher or steadfast champion of democracy, liberty and equality. Enter, stage left, the inconvenient truth that the man who found it “self-evident” that “all men are created equal” also bought and sold men as slaves. Let’s avoid a discussion of the historical and moral context circa 1775. The more pertinent question: When they study the current humanitarian age, what will prove our Jeffersonian blemish? What will leave people in 2116 shaking their heads, outraged at our deep moral and logical flaws? What constitutes our unrecognized racism? One answer: speciesism.

In scores of presentations during my MSF days, I used the slide below (stolen, with thanks, from JAB) to highlight the critical specificity of humanitarian action, distinguishing it from the much broader remit of do-gooderism issuing from a ‘humanitarian’ spirit (development, rights literacy, democracy promotion, gender equality, etc.). As the colored lines appeared, I asked participants whether they thought it a suitable definition of ‘humanitarian.’ Moving left from “doing good for people”, after a few iterations I would then jump out to ‘animal humanitarianism’ for comic relief, perhaps making fun of the (surprisingly successful) organization Donkey Sanctuary. “Has somebody lost the plot?” I would ask. “Is there some confusion over the first five letters of the word ‘humanitarian’?” Hell no doubt reserves a special pitchfork for the sanctimonious.

What is humanitarian action? JAB chart


The paramount principle of humanity places the fundamental human dignity of all people at the heart of the humanitarian ethos. This amounts to and is part of a larger exceptionalism – granting to humans a set of protections that are denied to other species. It yields a classification, as did race, onto which we graft great significance, including a conviction in our own superiority. There is too much similarity with racism not to wonder whether a future enlightenment will unfold, one holding that all life merits an equal degree of reverence, or at least conceiving of all life as possessing a magic, a magic so singular and astonishing that it renders irrelevant the differences between all of life’s diverse forms.

Right now, there are six boneless chicken thigh filets marinating in my fridge. In other words, I have not yet gone off the animal rights deep end, nor have I adopted dubious New Age philosophies such as Why I Identify as a Mammal. It seems almost inevitable that the proud leaders of humanitarian action today will have their names sandblasted off memorials in the future, with 22nd Century students protesting our virulent speciesism and moral decrepitude (i.e., when we become history, we are not likely to become the heroes we secretly yearn to be).

The import of speciesism to humanitarians is to consider whether the most powerful way to protect humanity would be to stop pushing human exceptionalism. Why does humanitarian action neither embrace nor deploy a reverence for life itself, and does this deficit undercut respect for its central message that family, clan, tribe, race, gender and nationality must be subordinate to the single family of humanity? Perhaps all exceptionalism warrants condemnation because exceptionalism, be it that of Joseph Kony or the US government, inexorably yields atrocity. The Jeffersonian problem, of course, is that we may have to live another hundred years of tomorrows to recognize the atrocities of today.

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.

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.

Tony Blair and Global NGOs: Not so strange bedfellows

The verdict arrived as furiously as in Ferguson: widespread condemnation, both public and internal, for Save the Children’s decision to present Tony Blair with a humanitarian award (see e.g., here). In an act designed to beef up my own award credentials, let me be the first to perform the selfless humanitarian act of extending a hand to STC (John McTernan defended the award, so I’m not the first, but then again he is essentially a Blair protege).

The humanitarian enterprise hardly needs a further injection of public distrust. The criticism focuses primarily on the moral offense of his track record in Iraq – not quite pro-children – or as PR frontman for dictators. Others lament the ugliness of this type of NGO self-promotion rendered naked. To those complaints, let’s add the potential impact in places like Iraq, where armed groups find yet another shining example of the proximity of global NGOs to their political enemies. So much for the perception of neutrality and independence.

Yet it is too easy to mock STC’s self-inflicted wounds. The true humanitarian does not judge the wounded and sick, nor deny assistance, even if it’s all their own bloody fault. The point here is that nobody should be shocked or even surprised that STC gave Blair a big fat and very public award.

The political world requires compromise, and major NGOs, including global aid organizations, labour to make themselves part of that same political world. They do so to be effective. What about Clinton? What about the many NGOs who accept funding from the Clinton foundation? Would it be fair to say that his blind eye to genocide in Rwanda had a negative consequence or two? Or that his almost farcical abuse of power damaged women across the world? What about Obama in the future? Will his legacy of healthcare to poor Americans (or whatever social issues he takes up post-presidency) be permanently tainted by his policy of drone terror? NGOs operate in this same arena, one where compromise is both inevitable and frequent. That is not a justification. That is an explanation.

Many global NGOs establish close relationships with governments and political parties, in order to obtain vital funding and in order to affect policy change (see this 2012 blog). They pepper their offices with the ranks of ex-political figures and their boards with the establishment’s great and the good (hence the blind spot at the top of STC, who did not seeing this coming). STC and Blair have very close ties (see e.g., here).

But even if not directly co-mingling with politicians, global NGOs resemble the Blairs and Clintons of the world – amalgams of brilliant accomplishments with closets of perverse compromises. Being among the elite powers on the planet is no place for unbowed idealism (and make no mistake about the power of the global NGO, be it as a voice of moral conscience, public accuser, or in their dominant relationship to the communities they serve). That reality is a message our publics will understand, if only we stop selling them the myth, and stop selling it to ourselves.

Crucially, the backlash against STC highlights the gulf between the reality of NGO action and the image of NGOs as noble crusaders. People want to believe in NGOs. And I have a feeling this backlash is particularly dangerous because it involves the choir throwing stones at the priest – nobody can blame the Daily Mail crowd for this storm about aid. What surprises me is the degree to which this gulf lies within the organization as well. STC staff appear to be among the most vocal critics, labeling the award as a “betrayal”. Fair enough to be pissed off at the negative consequences and the hit to trust in STC (or donations), but who did they believe they were working for? Who do any of us humanitarians believe we are working for? And how necessary is it to us to maintain this belief?

Perhaps Toby Denskus says it best, commenting matter-of-factly: We can no longer rely on political activism from large, professional charities. This may not be exactly news, but it is worth a reminder: Large NGOs, charities, ‘civil society organizations’ will not be among those organizations that will rock any domestic political boats.

That is no reason to lose faith. It is a reminder that they work through reform rather than revolution, pushing the establishment to do better, helping to create a better status quo. But to ensconced within that status quo to upend it. Which is why they are part of the world of Tony Blair. If only they wouldn’t broadcast it so brazenly.

Ebola: Three Ideas (continued)

[Originally posted October 2 and lost due to website issues. Apologies to those whose comments have been lost as well.]

Part 2. Ill-suited for outbreak response

And now, for something completely unoriginal: fear of Ebola is doing as much damage as the virus, maybe more. Yes, you knew that. Many have called fear a primary driver, a vector not just of the epidemic but of “collateral” deaths as well. Vox populi across Guinea, Sierra Leone and Liberia confirm a frightening view of humanitarian aid – hospitals are seen as a mixture of deathtrap and house of horrors, the people trained to treat the disease as transmitters or killers. As Jeffrey Stern concludes in his excellent Vanity Fair article, the outbreak would have been contained early on, but people took Ebola underground due to fear and distrust; it later emerged a multi-headed Hydra.

I remember similar issues arising in 2005, when a major outbreak of Marburg haemorrhagic fever had Angolans in the town of Uige running away from – you guessed it – space-suited health workers and afraid to enter hospitals. There too, insensitive burial of the dead sparked anger (so MSF began involving family members in a safe way, allowing them to see the corpses of their loved ones for themselves, stifling wild rumors).

Fast forward to frequent stories of healthcare teams being attacked (e.g., eight Guinea village health workers hacked to death only last week, month nine of the outbreak) that signal an almost primordial reaction. And there should be no comfort in believing such fear only happens in oogabooga land; that these West Africans are depraved, brutal, and primitive. Spielberg, no stranger to scaring us, had space-suited agents invade Elliot’s house to capture ET. Why? Because they breathe like Darth Vader, walk like Frankenstein, and frighten the bejesus out of us (check out the clip). Recall also the hysteria and even violence surrounding HIV/AIDS in the US. Or current scares for Ebola zombies. Or the fact that the discovery of one Ebola patient in the USA wiped billions of $$$ off the value of airline and travel stocks.

From an intellectual perspective, the nature of Ebola has a lot to do with the fear. It’s an exceptional combination of fatal and gruesome. More viscerally, though, the terror of Ebola is epitomized by the protection-suited doctor or nurse. Part hazmat worker, part astronaut, part faceless invader. They walk like robots. Part alien, part monster, part inhuman.


Thus far, the suits seem an unavoidable measure to protect healthcare workers, although some claim such measures are both costly and counterproductive (see here or here). Even if proven that the suits are necessary, we must recognize and combat their perverse impact in driving epidemically dangerous behavior. Hiding from assistance, spreading the disease to family, neighbors. Or maybe the family throws stones to chase away health workers. A fear so strong it permits murder.

But if the suits are necessary, and if they engender such fear, the next question is one I do not see debated: Should treatment and the use of protective suits have commenced so swiftly? Does rapid mobilization cost more lives than it saves in certain outbreak situations? Are there times when the outbreak response – almost universally a model calling for speed in gearing up treatment/vaccination– needs to slow down, at least in terms of the HazMat invasion, to allow populations to be prepared?

Stern: The foreigners [treatment and sensitization teams] had come so fast that they had actually out-run their own messaging. After the Marburg outbreak in Angola, there was even talk of getting the outreach workers and psycho-social experts onto the ground in the first plane, in addition to prioritizing the deployment of infectious disease specialists (see here for old but insightful MSF lessons learned).

Beyond big picture questions, what about the small-focus, right at the point where doctor meets patient? Or, more accurately, where they don’t meet. Those protective suits do more than spread fear and distrust. They are transformational, diminishing treatment to its therapeutic minimum, leaving doctors dehumanized and detached from the people they are attempting to heal.

Here’s MSF’s Dr. Gabriel Fitzpatrick on not being able to comfort a sick, solitary child: The child was clinging on to the nurse, searching and hoping for comfort in a place which does not allow direct skin-to-skin contact. As a father myself, this image stuck in my mind. Heart wrenching. Here’s Dr. Douglas Lyon: In my spacesuit, I won’t be able to connect and provide reassurance with a smile, body language or a concerned look.

On the flip side, patients remain gravely ill, isolated and terrified. Imagine not knowing what your doctor or nurse looks like. There is a need to insert some human into humanitarian, to enhance the human touch. Design changes in treatment centres are a good step, like using a double line of fences to create a safe distance for viewing and talking. Here’s an idea from Dr. Leslie Snider: How about a book or a doll to show children (adults too!) the person underneath a HazMat suit?

Here’s another idea: What if somebody made transparent protection suits? Until that time, though, what about attaching a big photo of the doctor or nurse to the front of the suit? In other words, pasting a smiling human over the alien invader; allowing the Ebola patient to look his or her doctor in the face.Put a name on it (Dr. Marc!). (How about a flip book with several photos in it? – reassuring, sympathetic, happy, sad, sweaty mess, hugging a cured patient...). One small step towards treatment based on a more human doctor to patient contact. One medium step away from zombie therapeutics.

Ebola: Three Ideas You (hopefully) Haven’t Read

[Originally posted September 26 and lost due to website issues. Apologies to those whose comments have been lost as well.]

Part 1. The Ebola crisis is in part the self-fulfilling prophesy of the way we think about Africa.

The Ebola crisis in Liberia, Sierra Leone and Guinea consumes no shortage of attention in mainstream Western media. Other African crises like CAR, Libya or Sudan, let alone success stories, should be so lucky. Then again, maybe attention isn’t such a good thing after all. Some of it quite responsible, much of it still trades in outworn stereotypes of a continent awash in warlords, loin cloths and killer microbes.

Hooray for resistance to sloppy Ebola storytelling, for example Dionne and Seay’s nailing Newsweek‘s sensationalist cover story. Or earlier this week Sierra Leonean Ishmael Beah skewering the way lopsided Ebola reporting reinforces the role of Africa as a foil, as a continent whose dismal failure reaffirms our superior Western civilization.

But why dump all the blame on the media? NGOs and the UN – the foreign aid establishment – surely merit some credit for perpetuating the popular notion that Africa is a cauldron of tribal brutality, a crucible of scary diseases and a reservoir of primitivism, all rolled into one waiting-for-a-savior basket. (Not to mention the rather stock idea that Africa is a country. On that geographical malapropism, see this great blog.). The point is firstly one of principle: NGOs should be truthful in their communications. Easier said than done. They appear locked into an audience (the home society public) that demands such a stereotype in order to feel compelled to donate (see e.g., my previous blog on this).

We’ve heard criticism of this stereotyping before, often from within the aid and Western media communities. Is there hope? Importantly, Beah published in the Washington Post, bringing his views to Western eyes. If only for a moment, his piece shakes our monopoly over the narrative. As I’ve written before, these stereotypes will come under increasing pressure as internet media expand access to Western debate and discussion. The question: Is the aid industry simply (!) a promoter of the distortion, or an addict as well? But that is for another blog.

The main point here is that the degree to which the monotonous, stereotyped portrayal of Africa gives rise to the conditions in which Ebola outbreaks occur. Persistent underdevelopment, bureaucratic inertia, low foreign investment, unresponsive government, the cycle of waiting for crisis rather than building systems, dependence on the foreign aid community, etc. These ills are all either caused and/or reinforced by the inaccurate portrait of a continent, in this latest episode with a virus as the star in a long line of unabated indigenous catastrophes. NGO action may be vital in combating Ebola, but aid agencies themselves helped weave the very “basketcase” to which they would nowadays respond.

See No Fogeys. Hear No Fogeys. Help No Fogeys?

Ten years ago I visited our projects in Pool Province in Congo-Brazzaville.  It was during Pasteur Ntumi’s armed, mystical insurrection; a time when military groups chose videogame names like the “Cobras” or “Ninjas”.  I heard more than once that Ntumi could levitate. But that is a different story.

We lurched down the ersatz road, passing many villages. They looked quiet. They looked abandoned.  Empty, I kept being told. Empty. But they were not empty. Everyone under 45 had long bolted for the IDP camps, but the elderly hadn’t left.  Occasionally I would see a skinny man, somewhat dishevelled and gray, carrying a bundle of wood or wandering the dusty alleys between houses.

If terms of vulnerability, those community guardians must have registered off the charts.  And we weren’t touching them.  We were driving by without seeing them, or seeing their absence in our busy health clinics.

This is not uncommon.  A “neglected generation”, as HelpAge research shows. Or see here. MSF has concluded that aid programmes miss the elderly even though we all intuit their vulnerability.

It shouldn’t be that way.  Impartiality dictates to humanitarians that we make decisions based solely on the needs of people, not their life expectancy after treatment or value to society.  Attaching value to human life is inimical to humanitarian action. Ditto for medical ethics. We don’t value people based on age. Grannies are absolutely equal in value to toddlers. We don’t try to justify differentiation by arguing cost effectiveness in terms of life value.  That kind of thinking will lead you down the path to hell, to saving the owner of the factory over the workers, the teacher over the vagrant, the NGO expat over the NGO local staff.

Impartiality implies that you have done a proper assessment to identify, in this population and in this crisis, those most in need. In a place where the needs overwhelm resources, it implies choices will be made.  As the research shows, though, we don’t do a good enough job of assessing needs when it comes to the elderly.

The problem is not one of mere choices, but of the underlying subconscious preferences; of blinkers. Some of these blindspots have evolved within our work.  For example, we use shorthands to target people/areas of greatest need:  “under fives,” “IDPs,” “pregnant and lactating women” are typical proxy indicators of greatest need.  And with good reason. It is true that you will find higher burdens of needs among these target groups, or overlapping needs (e.g., sick child plus no shelter or clean water), or greater severity of needs (e.g., on average, a toddler with malaria is more at risk than an adult with malaria).  But has looking for proxies meant not seeing others?

The way our brains work, it seems that if you are focused on one thing you will not see something else.  (Here is a great test of selective attention). The elderly have different needs from those of children, and you need to look in a different way. For example, as a starting place, you need to make sure that your assessment tools are able to ‘see’ elderly people. Much of MSF data collection puts people into boxes: < 6 months, 6 months to five years, 5 – 14 years, and > 14 years. We literally lump teenagers in with octogenarians. Where else would that happen except in wedding photos?

With data like that – with the conceptualization of our target population underlying those numbers – busy teams miss those who do not arrive.  That gap in spite of understanding that elderly have special access issues. It’s sometimes really simple. If you’re sick and seventy, trekking 10 km to find healthcare is not ideal.

Research leads to calls for paying attention; for systematic consideration of the elderly in humanitarian response.  But why are the decks stacked against impartiality in the first place? One reason is the way we think about children in our own societies, and in particular the way we think about their well-being. There’s a certain tragic disposability of children in places where birth and mortality rates are high.  And in the West, a tragic overvaluation, with children raised in porcelain towers.  (See my blog on baby helmets).  Apologies, this is the slippery turf of sweeping cultural generalization, but you get what I mean.

In the end, it is not accidental that the humanitarian project prioritises children. What is the UNICEF equivalent for the elderly? There is none. Why is Save the Children so much larger than HelpAge? The quantity of Western NGO resources essentially devoted to children in other parts of the world reflects a very Western valuation of children. That institutionalization of our value system produces a certain set of programme activities, the organisations that deliver them and, ultimately, that thing we call the humanitarian system.

Inherent in those values is the feminisation and infantilisation of victimhood. Powerlessness plus victimhood equates innocence, and that underpins why people give money to a cause. You can sell starving babies – we do it all the time. Try geriatrising it.  Pause the camera on the face of an old man.  You won’t run a billion-per-year NGO on that face.