Tag Archives: Perceptions

Politics

Tony Blair and Global NGOs: Not so strange bedfellows

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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.

Health

Ebola: Three Ideas (continued)

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[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.

aliens

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.

Critique of Aid, Health, Our Western Identity

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

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[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.

Critique of Aid, Our Western Identity

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

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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.

Politics

Secret Agent Man, Redux

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They won’t start talking until we put all our phones in the refrigerator. Dennis McNamara, of the Centre for Humanitarian Dialogue, talking about sensitive negotiations.

A year or so ago I posted a blog about the risks of being infiltrated by spies.  I seem to have missed the point.  True enough, we humanitarians should do more about stopping NGO penetration by the Felix Leiters and Carrie Mathisons of the world. If we want to safeguard trust in our intentions, trust in our essential harmlessness, then we need to keep the spies out.

But that misses the point driven home, driven right into my breast pocket, by Edward Snowden.  The revelations about NSA spying make it clear, the spy is I.  It is no longer a question of keeping spooks-people out, it is a question of the degree to which they have  transformed us into spooks-people in.  The unwittingness of our role is of no relevance. Ditto for our pure hearts.  It is no longer about deliberately passing information back to spy agencies, it is about their routine extraction of sensitive information from our everyday work.

What to do given the lack of convenient refrigerators?  Negotiating access requires daily contact with armed groups, many of whom have so-called terrorist or similar status.  We must talk to them.  We must phone them to ask if it is safe to travel, safe to deliver care, safe to transport a wounded child.  Who needs a mole when our Nokias and Thurayas provide such an effective set of eyes and ears?

Decades ago I thought (briefly, very briefly) about working for the CIA.  I never thought I would be doing it for free.

Critique of Aid, Our Western Identity

Show me the money.

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Go back three decades (or so).  Question to WWF champ Bob Backlund:  What could possibly persuade a man to earn a living by getting his brains beaten out while wearing a Speedo?  Answer:  I make more money than the President of the United States.

Bob has me beat.  The salary of charity execs has been tearing up the media this week.  Here’s Ian Birrell, in an excoriating piece, sending some special love to Save the Children’s CEO: “The fat cat charity chiefs include [Justin] Forsyth, whose £163,000 salary means he earns £20,500-a-year more than David Cameron.”  For the record, this year I will earn less than half that.

The Telegraph broke the story. Numerous takes popped up.  For a balanced argument, try Oxfam’s Duncan Green here.  Here’s another spin.  And another.  Far more revelatory than the stories themselves, take a look at the reams of commentary (the Telegraph piece alone has over 600).  This topic touches a live wire.  The public vents shock and anger at us charity bosses.  I want the public to like me.  And I don’t want to work for peanuts.  So what’s up?

Maybe we should blame ourselves. As far as I can tell, perhaps too many people have been listening to what we charities say.  Unfortunately, what we say doesn’t chime with fat salaries.  Perhaps we’ve told you that every £££/$$$ you send will be used to [fill in blank] and save fly-covered orphan Maria, end the persecution of polar bears, or fix a world of broken smiles.  Never mind that it’s often a whopping fudge, it sets high expectations.  Or perhaps you’ve internalized the subtext of our messages: that we merchants of charity are not like bankers or businessmen; that we are – look at all our sacrifices and good deeds – agents of pure virtue.

Apparently, neither virtue nor efficient use of donations mix well with being paid six digits.  Reading the commentary, lots of you devote time to charity work, and you do it for £184,000 less than the British Red Cross’s CEO’s annual pay.  So you know all about charities, don’t you?  That is one obvious rub.  Public anger betrays a major misunderstanding about the nature, especially, of overseas aid work.  A remarkably idiotic comment from “Normalwoman” sums it up: “it doesn’t take a genius to give money to the poor”.

Actually, Ma’am, we aid NGOs could use a boatload or two more of geniuses. I mean, if I can make it to the job of CEO/director then it is clear the talent pool is thin.  Four decades of development aid to “bongo-bongo land” can hardly be deemed a success.  And in many cases humanitarians haven’t managed better, in spite of our lower ambitions.  Aid is complex, even if our fundraising narratives scrupulously avoid any mention of struggle, ineffectiveness or failure. Now, under attack, the aid agency litany has about-faced: this is a tough job, a really tough job.  So we need talented people, and they don’t work for free.  It’s not just complexity, it’s responsibility:  you can’t ask Saturday volunteers to take life or death decisions (e.g., sending staff into Somalia and Afghanistan), or close programs that are vital to entire communities.

No matter how many ways it is said, though, these defenses sound, well, defensive.  In that vein, Forsythe inked the high-water mark, managing to suggest his salary was somehow related to “the biggest ever fall in child deaths from preventable illnesses such as pneumonia and diarrhoea”.  Oh my.  Defending high salaries by reference to our good work is one step closer to claiming an entitlement. And yet so much of the public backlash aims to trash aid altogether, not high exec salaries.

Besides, who am I to judge? At this stage in my life, I’m not sure if I would not have taken this job for a salary of, say, £40,000 per year. And let’s be clear, that is still a lot of money and there are many people who would be thrilled with such an offer.  You can deliver a lot of vaccines with that kind of money.

Here is the key.  The defensiveness – and I feel it myself – in our voice originates in the same place as the public’s anger.  We both believe that NGO employees, especially leaders, should be agents of virtue.  We should be thankful for the fact that the public still sees a strong moral quality to aid work.  They do not want it to be a business. They do not want their NGO bosses to covet generous salaries.  They do not want a banker’s mentality at the helm of an aid organization.

[Diversion alert! It is perfectly logical to answer that we need capable leaders to perform a tough job, isn’t it?  Worryingly, this response falters under close scrutiny [thanks J for this kernel].  What is the evidence that these high CEO salaries actually enabled organizations to hire talent otherwise unavailable?  In particular, any evidence that it enabled them to hire talent better able to lead an organization to the promised land of effective aid?  Or is it more true that boards look for leaders who are an asset to the balance sheet of the organization, meaning people with the skills, experience and personal qualities to woo major donors and ensure substantial government funding?]

So where will all this end?  Being called a fat cat doesn’t feel good.  The story and keen public reaction seem like another shovel of dirt on the grave of our fundraising ambitions.  I see two lessons.  We aid agencies must counter not with a defense of salaries but by showing what we do.  Public sentiment must more closely align with the reality of aid work, including the warts.

I fear, however, that the real lesson in this story has little to do with our Western publics.  More broadly, this is a story about what people expect from aid workers, and what they find unfair/dishonest.  And like it or not, the societies in which we work also have expectations and a sharp sense of fairness.  If Western publics do not expect their donations to go towards the salary of a CEO, then the people in the countries where we work do not expect those same donations to end up in our large offices, top-flight hardware, homes, restaurant tabs, Landcruisers, televisions, yoghurt, R&R trips etc.

We’ve shut our ears to the critique that we asked people to donate to save, say, the Sudanese, and then we spend it on ourselves right in front of those very Sudanese.  What happens when that gets vented?  In other words, what is the cost of so visibly sabotaging our own position in the battle for moral respect?

Critique of Aid, Politics

Syria: Slippery Slopes for Humanitarian Action

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Syria today is a killing field.  Human bodies stiffen in the rubble and – equally – the lofty ideals of men and women plummet to earth like quail at a shooting party.  Human rights?  Crashing down in the face of sectarian executions and shuttered schools.  Geneva conventions?  There they go, felled by indiscriminate shelling and the withholding of aid to civilians.  Humanitarian principles?  The same. Nose-diving. Full of buckshot and broken trust.

Humanity?  It is probably the only principle still intact. The attention to the Syrian population has been strong.  We humanitarians are aware of and paying attention to the situation inside Syria. There is immense fear, deprivation, disruption, and then the weight of untreated malnutrition, illness and wounds.  Our compassion, however, is starkly contrasted by our absence.  Independent operations inside Syria by the multi-billion pound humanitarian system?  Almost non-existent.

(Digression alert!)  Put differently, our fat compassion is sharply contrasted by our thin skill when it comes to establishing operations inside the wicked (complex), violent contexts of today, as has been the case in Iraq, Afghanistan and Somalia. Over the past year, MSF has been one of just a handful of global humanitarian organizations running direct operations inside rebel-held Syrian territory (as opposed to smaller, diaspora-based interventions). These projects are fragile, geographically limited (predominantly in the north and close to the border), and fall woefully short of the need.  As agencies, we have invested heavily in the capacity to communicate about our actions; increasingly we lack the skills and experience necessary to be active, to be humanitarians where it counts. (End of digression).

Independence?  Neutrality?  The Damascus government has granted the ICRC, several UN agencies, and a few NGOs permission to work in government-held territory.  Those with permission must channel assistance through the Syrian Arab Red Crescent or other government-authorized organizations.  (Read: control). As the New York Times reports, this aid might be doing more for the Syrian regime than for the people.  Here is one rebel’s view: “Food supply is the winning card in the hands of the regime.”  Or one can work through the other side, through groups of Syrians and aid networks aligned with the opposition.  As MSF points out in its recent report, aid is “thereby subject to the political agendas of these actors.”  Bottom line for the “humanitarian effort”?  Neutrality does not exist.  Independence does not exist.

In some ways, that is the “easy” discussion, the obvious-to-everyone compromises on principles.  The debate over the military and political impact of aid moving through Damascus-approved channels or rebel networks is necessary.  It also obscures consideration of damage to that other grand principle, impartiality (aid should go to those most in need, and cannot be based on ethnicity, religion, clan, etc.).  In toxically polarized conflict, local partners or channels are synonymous with ethnic or geographic bias, political agendas and allegiances, co-optation by power brokers and armed groups, and is anything but needs-based.   Syria is but the latest example.  For instance, in the Pakistan flood response, one major evaluation noted that loads of assistance ended up with those who were the “least vulnerable” but who were “close to feudal landlords or connected through certain political affiliations” (p. 36).

A key element to delivering aid according to need means knowing where the aid ends up. Impartiality is not a matter of intent.  It is not the target which counts, but where the arrow lands.  You have to see it reach the individual.  Sadly, even in good times, NGOs tend towards what David Keen (in his book Complex Emergencies, p. 121) sees as dispatching aid towards targets, “usually with relatively few resources allocated to monitoring the fate of relief”.  The resulting situation reinforces local power structures and means that those most in need will fail “to stake a claim to relief for precisely the same reasons that they were exposed to famine and violence in the first place” (Keen again).

That is in good times. In bad times, in bad places where you can’t deliver your aid yourself, aid according to the principle of impartiality (aid based on needs alone) becomes an exercise in blind faith.  At what point, though, does it actually become an exercise in suspending belief?  When does the aid (and hence the organization) shift from being essentially humanitarian in character to solidarity-based or partisan? We humanitarians need to ask and answer those questions, because an exercise in compassion alone is an exercise in peril.

[Big thanks to KW for help with the research].

Our Western Identity

Dog Not Eat Dog

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Dog microchips to be compulsory in England.  Now there’s a headline we’ve all been waiting for.  There’s more:  the chips are made of bio-compatible glass that will not be rejected by the dog’s body.

That story triggered a memory, a tad grainy, of one of those ridiculous toy dogs eating the canine version of beef stroganoff from a porcelain bowl at what looked to be a Michelin starred restaurant.  The image is of some overly precious breed, like a Pomeranian or a miniature poodle.  At the time, I was working in rural Burkina Faso, with the Peace Corps.  It was a period of painful drought across the Sahel, and the people in my community were hurting.

The image came from a news item.  Somewhere in the south of France – one of those caviar communities like Monaco – there was a restaurant catering to the dogs of the wealthy.  Meals were served at Ritz-set tables, full of crystal water bowls and silver candleholders.  Dinner for the pooches cost a ridiculous amount, like $200.  Honestly, that’s my memory of it.

In the pre-web days of the 80s, that story went about as viral as possible in francophone West Africa.  The amount of money to feed one dog one meal equalled the Burkinabé equivalent of, I don’t know, 23 years average GDP, so I guess people were shocked enough to pass it on, like a Youtube video of a fat guy dancing funny.

Everybody seemed to know about that dog restaurant, as if they represented a standard of sorts in the West.  I think that news item alone built a truth, one I heard over and over again:  “In the West, your dogs eat better than our people.”   There was something quite jarring about that idea – personally jarring to my friends that seemed to increase the distance between us.  And something quite durable.  More than cogent political analysis.  More than economic indicators. More than I could imagine, that idea defined how people understood my world and understood themselves.  Lower than a dog.

Historical anachronism?  A bygone era?  Ten days ago, as my wife and I turned from the main road into the Luxor Airport, a billboard caught our eye.  First of all, there aren’t many billboards in that part of Egypt.  Second of all, there aren’t that many billboards that we could read, anywhere in Egypt. Third, it wasn’t trying to sell us a product.  Rather, it had a picture of a horse and brought me back to my employment.  This was a charity appeal.  Brooke Animal Hospital (they are an international charity, and have been in Egypt since 1934).

The billboard was aimed, literally and directly, at wealthy foreign tourists.  After the airport itself, it may constitute their very first impression of Egypt, or of Africa.  It was about horses and donkeys.  I wonder what Egyptians think.  No shortage of human needs there.  I wonder if Peter Singer would applaud this as progress.

Critique of Aid, Our Western Identity, Politics

Feeding the Fire

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[Apologies for the absence.  Just back from two fascinating weeks — our anniversary! — in Egypt.]

Just last week I was climbing the seriously magnificent Temple of Hatshepsut with my wife.  Its sheer beauty absorbs one’s attention.  Even my peripatetic gaze.  At least until a discordant note in the form of a young Polish woman in a micro sleeveless dress descended the stairs from the first courtyard.  Her dress was day-glo orange.  All of it. And fully radioactive in the noon sun.  In my entire life, I don’t think I’d ever seen clothing that color, save for road crew vests. Not even Dennis Rodman in his lunatic prime.

In the late morning of November 17, 1997 a different sort of scene unfolded on the terrace of that very same temple.  Armed with automatic weapons, six Islamic militants aligned with Al-Gama’a al-Islamyya massacred 62 people, mostly Western tourists.  They unleashed a Breivik-esque melee, for example hacking and dismembering a few honeymooning Japanese couples.  (Tangent alert: Doesn’t it seem less than coincidental that the attack took place at the temple of the first woman pharaoh?).

Those militants understood the enormous value of tourism to Egypt.  It seems they also despised the equally enormous Westernizing impact of tourism on the predominantly Muslim country.  Today, even with an elected President from the Muslim Brotherhood, more stringent Islamic groups in Egypt still take aim at tourism.  The people earning filoos kateer (gobs of money) from Egypt’s tourism, not to mention the people scraping by on its leftovers, simply curse this kind of thinking.  The government, for its part, have put in place greater security.  The question for me:  Why the hell was day glo orange slinking down those steps in the first place?

The point is not at all that women wearing mini-skirts are legit targets for attack.  The point is not to suggest an actual justification for their actions (i.e., women who dress provocatively aren’t “asking for it”).   The point is that some behaviour – disrespectful, abusive, neo-colonial, whatever – creates a justification in their minds.  Gimme a reason! You got one.

The message was consistent in all the tourist books, and in the advice we received:  show respect.  To do that in Egypt, dress and behave conservatively: women and men should cover flesh, don’t walk around the streets snogging, boozing, etc etc.  (In one café that served beer, they asked us not to sit near the door – essentially a tactic of not rubbing the public’s nose in alcohol).  But those with the most to lose in the long run seem the least concerned in the here and now.

The Red Sea resort tour companies offering blitzkriegs of Luxor or the Pyramids seem to be the worst offenders if measured by the sheer volume of people being disgorged from their buses who don’t give a shit.  The scene:  sunburn-glowing Poles, Germans and Brits, dressed for an appearance on Baywatch, mobbing past Egyptian families dressed in galabiyahs.  In close second place were the fat Nile cruise boats, moored along Aswan’s corniche, gleaming white hulls matching the jellified flesh prancing around the pool deck.  In third place, as a matter of unscientific impression, were the French, cloaked as always in the self-assurance of being French.

The point is that Little Miss Day Glo wasn’t just an insensitive tourist. She became a recruitment poster, fiery sermon topic and a rallying cry all rolled into one.  To anybody with an anti-Western agenda, she’s ammo.  So if I were those tour operators, I’d be making sure people who got on the bus weren’t dressed to insult.  Not because it will matter to the militant.  You can’t stop the militant.  But you can stop ordinary people from listening to the militant.  You can stop people from joining the militant, or having sympathy for his cause.  You can stop making the militant’s job easy.  In the end, there is something fundamentally wrong with the everyday Egyptian left cringing, clutching the family closer, one hand across their children’s eyes.

But I’m not a tour operator.  I work for a humanitarian organization.  And yet I ask the same questions and reach the same answer:  What about our behaviour as aid workers?  We need to stop wearing the day glo orange.  We need to stop making it easy.

Health, Our Western Identity, Politics

Apocalypse Now (and Again)

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The world did not end yesterday.  At least, not for you.  Not for me.  Yet in places like Syria, Pakistan, and South Africa, individual worlds = came to an end.  The culprits?  Not the dreaded riders of the Apocalypse, but well familiar stalwarts like hatred, greed and violence.

Earlier this week the United Nations launched its largest appeal ever, for nearly £1 billion, to address the crisis caused by the war in Syria. The months of fighting have provoked supply shortages, mass migrations and huge numbers of wounded against a background of intensifying cold, grief and devastation. And what will the UN do with that money?  The multi-billion dollar international humanitarian industry is virtually locked out of Syria.  It simply does possess the skills and capacity to work effectively in what can only be described as a very modern humanitarian crisis:  security risks, lack of authorisation from the government, and an insufficient ability to negotiate and maintain access in such circumstances.

Even MSF has struggled enormously to open hospitals inside Syria, vitally important to those reached and yet insignificant compared to the larger needs. Put simply, in the midst of such epic crisis, and despite Herculean efforts of Syrian doctors and nurses, ordinary Syrians have preciously poor access to drugs or medical care.

It’s not the obvious cases of civilians in war – old people, women, children, and even babies –wounded in bombings and shrapnel injuries. Or the psychological trauma.  It’s the slow fade that shocks me, the banality of chronic conditions: diabetics who run out of medication, children with asthma, and women who need caesareans.  Where would I get my resupply of statins in a place like that?  I’d have to give up sausages.

Earlier this week in Pakistan, polio immunisation campaigners were assassinated in a series of targeted attacks. No medical work can be carried out effectively in the atmosphere of mistrust caused by years of deliberate misinformation, rumours, or such a blatant abuse of the medical act as having spies pose as doctors (see my earlier blog on the good doctor Afridi or humanitarians as spies).

Humanitarians can’t shoot their way into town.  If you headed an NGO, would you be able to ask people to go out and vaccinate?  Where a nurse “armed” with nothing more than a syringe might end up between the crosshairs of a weapon? The pursuit of political and military objectives erodes trust in healthcare itself, and children fall ill and die of diseases – diseases for which prevention is simple in theory, but dangerous in practice.

And far from the week’s headlines, in places like Uzbekistan, Swaziland and South Africa, highly virulent strains of tuberculosis (TB) spread. Increasingly resistant to treatment, TB causes people pain, suffering and debilitation until death liberates them. Those who are “lucky” enough to access treatment are administered a highly toxic drug regimen that lags on for years – and given an only per cent chance of cure.

Syria, Pakistan and South Africa lie far apart on the map.  The common denominator of much suffering in these nations, as in so many others, is the space between people who need care and people who can provide it.  This lack of access – and the deaths that result – is as preventable as polio; it is not the doing of cosmic forces beyond human control.  No, I’m afraid the world does not end in one big bang – it blinks out in the bits and pieces of human lives.

[I drafted the original version of this blog as a letter to the editor but it didn’t get picked up.  P and S from the office contributed a great deal to the editing.  Thanks]