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Critique of Aid, Health, Our Western Identity

What’s a Little Aid Between Friends?

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[Apologies for the gap!  Been too busy.]

Whenever I open the internet the same vital message greets:  “Medical Aid Where it is Needed Most – Independent, Neutral, Impartial.”  That’s the top of MSF-UK’s web page.  Here’s the current headline:  Hurricane Sandy  MSF Teams in New York to Help Those Hardest hit by Sandy.  It has been a top story on the website for over a week.

The last few blogs have looked at the core humanitarian principles.  Not about how they come under attack by those opposed to our brand of goodness – badboy militia groups, depraved dictators and Western leaders who want aid to do their bidding – but how it these lofty values have Savile-ized by us, humanitarians who enshrine these principles in the Ark of their very being.

Impartiality is a particularly directive principle.  It instructs that humanitarian aid doesn’t go to your friends and neighbours just because they are needy; decisions can’t be based on religion, ethnicity or relationship to the country’s finance minister.  That leaves only one legitimate basis for decision-making:  need. And it implies finding those most in need rather than simply needs per se (i.e., go to DRC and everybody has needs, but where are they greatest?).  As Mark Bradbury concludes:  Assistance that is policy-driven, rather than provided on the basis of need, is no longer humanitarian.

In theory, impartiality works pretty easily in a health clinic – take the malnourished infant with malaria before the pregnant woman with a broken finger.  It gets harder as the distance grows.  Behind Door #1 Syria: violence and displacement and war-wounded. Behind Door #2 Chad: pockets of malnutrition, measles and very poor health services or infrastructure.  How do you compare suffering?

It’s no secret (actually, sadly, it is) that the major aid agencies have bent their principles in self interest, or because means were deemed less important than ends (see “Humanitarian Negotiations Revealed” for an MSF compendium of compromise).  Home society operations like those in NYC lie at the crossroads of humanitarian action and institutional needs.  It’s only a few years ago that MSF was running operations in Luxembourg, for chrissake.  GDP is over $106,000 per person. If there, then emergency botox in Beverly Hills makes sense.

Questions have always surrounded the medical impact of these missions, which can appear almost frivolous when juxtaposed against the massive needs in places like DRC or Sudan.  Normally, though, the organization admits a certain degree of self-interest in mounting these missions, a certain acknowledged violation of impartiality.  The rationalization comes later: these activities are, after all, comparatively insignificant.

But what happens when we no longer acknowledge the compromise?  What happens when we claim to be justified in these interventions, on the basis that we have responsibilities as a civil society actor?  No doubt whatsoever that Sandy has provoked health needs in the NY/NJ area (although far greater ones in Haiti, like the increased cholera to which MSF is responding, though in comparative obscurity judging by our own websites).   But if there had been no MSF in the US, would the organization have sent in the troops?  No way.   So what does that mean for impartiality?

As MSF sections in Greece and Spain look in their own back yards, they too find health needs: health systems making drastic cutbacks under economic austerity measures that offer succor to banks and pain to people.  I understand the push in headquarters, the outrage of our Greek staff and donors,  the push from the local community, and the pressure of expectation.  A little compromise is fine, isn’t it?  I mean, it’s just between us.  How to explain to the Greeks who are living this mess that their MSF can’t respond to their crisis?

Well, we do that sort of explanation all the time in countries where there are greater needs though, of course, less affiliation.  There, we are a global actor, magnanimous to offer assistance and hence privileged to deny it.  There, we sometimes go home, as has been done in the face of stunningly bad, though “developmental”, health needs:  closed programs in places like Angola, Liberia or Sierra Leone.

The key point here is that a humanitarian organization must maintain its legitimacy precisely through its refusal to be a civil society actor; through a clarion refusal to privilege localized constituencies over the only constituency that we possess – the whole of humanity. Impartiality operates from the starting point that all human life is inherently (and equally) precious. The idea of preferential treatment should be anathema to humanitarian action, and we must fight the urge to privilege the needs of people who are, literally, close to home.

Why send doctors to Brooklyn?  Well one reason is that there are people there in crisis.  But what level of unmet medical needs in the wealthiest nation on earth?  So it is also because decisions are driven by television, by a social and political proximity to the victims.

As Nick Stockton has put it:  “‘[T]raditional’ humanitarian assistance is concerned first and foremost with the task of saving lives in imminent danger, the notion of a moral or political ‘triage’ that somehow separates the deserving from the undeserving beneficiary, is for many humanitarians ethically repugnant.” Acting upon a supposed responsibility as a civil society actor equals political triage. In the end, there is something fundamentally contrary to humanitarian action and to impartiality if we intervene on the basis that some victims are more deserving than others because of their relationship to us.

Critique of Aid, Our Western Identity, Politics

Working in Humanity

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It’s the whine.  God, I hate that whine.  One mosquito in the room and my ears prick up, straining for a location.  But maybe it’s not the whine that makes me nuts.  Maybe it’s the anticipation, the anxiety of the future bite.

In a place like Ivory Coast or Congo, that anticipation comes loaded.  An itchy bump is one thing.  Your child’s face, eyes pinched almost shut by malarial swelling, is another.  Now switch to Pakistan.  Mosquitoes are unswatable there.  And they’re present day and night, insistent, watching.  Worse still, they’re loaded not with disease but with the firepower to take out a house.  “Mosquitoes” are the way some Pakistanis refer to the drones that hover in the sky, placing them in a perpetual state of terror.  Children peeing in their pants and grown men tossing from nightmares. This new age of remote warfare is ugly, ugly policy, isn’t it?

Here’s a riddle Frank Gorshin would be proud of: From the perspective of the recipients, what’s the difference between a village being vaccinated by our angelic forces of good (yeah for the humanitarians) and a village being vaccinated by the US military as part of a campaign to win hearts and minds (boo for the commandos)?   Many would answer that there is none; that only we humanitarians would insist on our action as humanitarian and action as perversion of aid.  To justify this arrogance, we fall back on the principle of humanity.  As in:  we have it, they don’t, and that makes us better.    Humanity is our opposable thumb.  It’s what sets us apart.

Oddly, humanity sometimes disappears when we discuss humanitarian principles, but it’s mightier even than impartiality or independence or the right to be driven around in a white Landcruiser.  Humanity is the double-barrelled motivation for our action:  compassion which draws us to aid those who suffer combined with the idea that all people together form one human body, possessing a fundamental and inalienable dignity.  Without humanity, it may be a good thing (think relief assistance, military aid), but it’s not a humanitarian thing (even if it may still be a good thing, like other forms of aid or relief).

Truth is, you can’t really infer humanity because an NGO is constructing a feeding center; and infer self-interested counter-insurgency strategy when the military does the same thing.   Or infer only a profit motive when it’s the private sector delivering the aid.  I’ve met military health personnel who were genuinely motivated by that sense of compassion, even if their superiors ordered the actions for different reasons.  I’ve met plenty of corporates, who do it because they want to help, even if the corporation does it for the PR.  Not unlike, I might add, the situation where one of us self-anointed guardians of humanitarianism intervenes because there’s a fundraising interest.

The commonness of “we’ve got it, they don’t” ideology betrays its importance to humanitarians.  It’s part of our self-identification.   So we bristle with the idea that the military could be doing our good work because we don’t want to be like them.  In fact, we want to oppose our actions to theirs.  I get that.  Our opposition, though, is not directly about the individuals in the military, it’s about the institution.  It’s about the whole shebang. It’s about mosquitoes.

At a certain point, principles and values must pervade an organization, not just lots of the individuals in it.   Can a government killing civilians and terrorizing communities really also claim to embrace the principle of humanity?  Water boarding, Shock and Awe, Cast Lead…   No.  It doesn’t work that way.  When judgment day arrives, the list of good deeds isn’t a get-out-of-hell-free card.

My colleague PM recently returned from a visit to MSF’s field mission in Somaliland.  Usually quite jaded, and certainly not one given over to sentimentality, she writes:  The team here are extraordinary and make me very proud to be part of MSF. They hail from all corners of the globe; there’s a couple of Kenyan Kenyans, a couple of Somali-Kenyans, the obstetrician is from Beijing, the ER doctor from Cuba, the surgeon from Italy. There’s a couple of Danes, and a couple of Belgians, and a very very nice English guy . . .  Many have left their wives, husbands, children at home to do this work. None are motivated by the money; it’s the focus on the patients they like, they tell me. These are not just good people, they are the best kind of people . . .  true ‘humanitarian’ compassion exists here.

What do we make of an organization full of such people, compared to the sort of organization that spends its time deciding how to accomplish its goals through the use of violence?  Or figuring out how to feed people in order to earn a profit?  I don’t work for those organizations.  I work with humanitarians.

Yippee?

Not so fast.  I work with a lot of people who might be surprised by PM’s declaration that staff are in it to help people.  Many don’t believe that our Kenyan or Haitian or Pakistani colleagues are motivated by compassion.  The corridors in our Western HQs grumble with the “unfairness” of our current salary structure, whereby “they” are paid a Western salary, which is a really really high salary for them, rather than the pretty crummy one it is supposed to be for us.  The corridors grumble with the belief that they don’t do it for the same virtuous reasons as us.  It’s our volunteerism versus their best paying job available.  And our corridors don’t grumble at all with the rules which are based on ascribing traits and abilities to people based on their nationality, ethnicity or race.  Did you know that local staff can’t be objective, so you need expats?  Did you know that being Congolese is a mark of corruption?  Or, in reverse, did you know that we expats are all racists?

And then there is the way we treat each other, myself also a part of a directorship full of Alpha males who at times thrive in an atmosphere straight out of a NATO war room, less the holsters.  Or the disappearance of diversity as one climbs the corporate ladder.  Or looking around at the humanitarian circus, where agencies abuse children to raise funds, or launch advocacy campaigns that are every bit as political as, well, politicians.  When ends justify means, humanity becomes a takes a black eye.

We may not shoot people, but we spend a lot of time endorsing an us/them logic, one that, as a rationale, perfectly echoes the root cause of conflict, terrorism,  ethnic cleansing and genocide.

Humanity cannot be occasional or segmented in a humanitarian NGO.  Humanity cannot belong only to the act and actions of the caregiver, logistician or teacher.  It either functions as a principle occupying the very heart of the organization itself, or its absence instructs that we are not humanitarian.

Critique of Aid, Our Western Identity, Politics

Development vs. Independence

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When a pseudonymous filmmaker put out the laughable, execrable Innocence of the Muslims, did anybody foresee a KFC getting torched?  Not to mention a Hardees.  (Which begs the question:  When was the last time anybody outside of Tennessee even noticed a Hardees?).   Apparently, these heart disease outlets are symbols of the USA, a nation that is being held responsible for Sam Bacile’s vile film.  Just yesterday on BBC, a British military expert referred to it as “the U.S. film,” as if it were an official product of the State Department.  Funny that sort of attribution.  Seems unfair.  Like holding the entire Muslim world responsible for 9/11.

There is no link from bad fast food to American foreign policy (let’s not quibble about U.S. Govt efforts to help U.S. corporations establish overseas markets).  Yet the perceived link is as real to rioters on Lebanon’s “Arab Street” as salt in a Big Mac, isn’t it?

That’s the lesson for independence in humanitarian circles:  we NGOs can’t fully control perceptions; we can only improve our chances.  Independence is factual:  being able to make decisions and then implement programs in such a way as to ensure impartiality trumps political opportunism (i.e., that aid goes to those most in need).  And independence is about what people think.  What does KFC have to do with the American government?  And what does the American government have to do with Bacile’s film (“Sam Bacile” and “Imbecile”:  curiously close!)?  Sometimes, it doesn’t matter.

ALNAP’s recently released State of the Humanitarian System report raises the concern of a growing split between “traditionalist” actors, like MSF and the ICRC, and multi-mandate organizations, like Oxfam or World Vision. (Scroll down on ALNAP’s site if you want to see a video of yours truly in action).  Tellingly, it concludes that “many humanitarian organizations have themselves also willingly compromised a principled approach in their own conduct through close alignment with political and military actors” (SOHS p. 79). Bingo.  That’s your first step to a burned down chicken shack.   But what does this compromise look like up close?

There is the obvious acceptance of funding for programs, especially for work in war zones, from Western governments that are one of the belligerents.  Most international NGOs really struggle with those decisions, attempting an impossible calculation between benefits of the program versus negative consequences for the NGO.  Will “they” shoot at us if we take U.S. Govt money?  Will “they” give us access?

Less obvious for some reason are the ways in which agencies go further than accept government funding.  Responding to the recent Cabinet shuffle in the UK, here’s what Christian Aid had to say about the departing head of Department for International Development (DFID):  “Andrew Mitchell can leave [DFID] with his head held high. He has been a passionate defender of the need for the UK to help people living in poverty around the world.”   That sort of asskissing is so commonplace many NGOs no longer even register its existence.  Here’s Save the Children’s UK CEO, saying that he “completely” trusted David Cameron’s Conservative government on aid and development.

In an astute blog, Jonathan Glennie casually concludes that “Pandering to power is an inevitable part of being a large international charity or research organisation these days; it’s where much of the money comes from.”  Say what?  Inevitable?  Like death and taxes?

The issue goes beyond money.  It goes to achieving organization objectives.  And the relationships go much deeper than offering public praise (which, btw, DFID strongly “encourages” for NGOs receiving funding).   This is not self-promotion, this is partnership.  Many large NGOs must actively cultivate a public, political relationship with a government.  In 2009, Save UK hosted the Conservative Party’s launch of its aid policy.  Right now, Save is preparing to host the Labour Party’s annual conference on int’l development.   Another example:  Islamic Relief co-hosted a Ramadan dinner with the Foreign and Commonwealth Office (that’s not the aid bunch, that’s the politicos).

Beyond partnership, there is the co-mingling of staff.  Lots of NGOs hire directors from the ranks of the political world.  This is a matter of hiring skilled, connected leaders.  Positive impact?  Loads.  Negative impact?  Hard to measure, but a full 30 years after Bernard Kouchner left MSF, the organization still had to issue press releases to distance itself from his actions as French foreign minister.

Let’s get something straight.  I’m not being critical.  Really.  Well, sort of.  This “partnering” has become a policy, not just a practice.  In other words, one NGO’s pandering is another NGO’s advocacy strategy.  Check out journo Peter Gill in his excellent Famine and Foreigners: ‘The intimacy between Oxfam and the Labour government was defended on both sides […] An impressive national consensus was built in Britain around the merits of aid which after decades of [Conservative party] scepticism was endorsed by […]David Cameron.”  (pp. 179 – 180).  Gill was critical of the relationships, but he’s right to realize that they proved an effective vehicle for change.  And lest the sanctimonious pretend they are different, here’s MSF showing some love for none other than the heavyweight champ of drone missile diplomacy, pushing the agenda for HIV/AIDS funding.

The problem lies in the multi-mandate status of most large humanitarian NGOs.  When it comes to development programs and policy campaign objectives, creating a close and public relationship with key governments is crucial to ensuring success (e.g., adequate aid flows, effective policy).  The cosier the better – politics makes for mundane bedfellows as well – even if their new best friends also happen to be shooting up a few war zones.  Put simply, there is little imperative for a development organization to safeguard the perception of independence. The oops factor comes from the fact that development is only half the story of some NGOs.

In the end, the difficulty for big charities to demarcate and safeguard their independence from government blots out the NG in NGO.  In the UK, carrying the Minister’s bag means carrying the bag of the man who said “Using the UK’s aid budget to secure progress in Afghanistan will be my number one priority … Well-spent aid is in our national interest. Nowhere in the world is this case clearer than in Afghanistan.” (UK Minister for Int’l Development Andrew Mitchell, July 2010).

That sort of co-mingling has an effect.  Look, not even people in the same country will trust your motives.  When Save recently highlighted the problem of hunger in Britain, people uncomfortable with that message undermined it by suggesting there was a rat loose.  As reported in the illustrious Daily Mail, “Conservative MP Brian Binley told civilsociety.co.uk he had general concerns as Justin Forsyth […] had worked for the last Labour government”, and suggesting that the report’s alarm over hunger in the UK was part of a “political agenda”.   Turn now to people in foreign lands.  With guns.  Or a sick child.  As I have written before, in the midst of humanitarian crisis, independence goes to the heart of aid, to its integrity.

Which brings us back to KFC.  Bad enough that independent Western NGOs may be targeted as a way of venting anti-American or anti-Western suspicions and anger.  What happens when it turns out that these NGOs actually helped fry the fowl?

Critique of Aid

Where is Development’s Dawn?

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“Being disabled is in the mind, if you don’t accept it, then you can do anything you want.”  That is Ghanaian wheelchair racer Raphael Botsyo Nkegbe.  If you’ve followed the Paralympics, you’ve no doubt heard similar statements. One thing for sure, it is definitely in the mind.  But whose?

Now hundreds of great sporting performances later, many pundits have announced the dawn of a new age for the disabled.  Mainstream media and public sentiment seem to have embraced the plot of sport and competition and achievement over spectacle and pity.  Could it be that we have truly turned a corner in our treatment of people who do not look like the people in magazine ads, even if none of us really look like the people in magazine ads except in so far as limb count?

Or could it be something else, such as the conspicuous, slightly uncomfortable invasion of the ranks of the disabled by strapping veterans of the wars in Afghanistan and Iraq?  These are people we cannot fault for their disability (i.e., not wheelchaired in a gang shooting or drunk driving accident or stupid diving board stunt).  They grew up with us, not ghettoed by disability, not shunned from sight to the same mental closet as those with Down’s syndrome or cerebral palsy.

No, methinks we are not callous enough to place the vet in that closet.  Even opponents of war cannot escape the sense that Paralympic rower Nick Beighton, his two legs blown off by an al Queda IED, is heroic.  Is a normal guy.  Is a casualty of a democracy in which we the people have sent him to that blast.  (For the link to the aid biz, see my blog on how we market to the public a victim who is worthy of their donations, because innocent of his or her suffering.).

There is an idea in Nkegbe’s and Beighton’s and Pistorius’ determined self-definition – wresting control of one’s identity from the judgment of others – that appeals to me on an intuitive level.  Yet I struggle not to see disability.  I get it that Patrick Anderson is a wheelchair basketball scoring machine who could probably knock down 8 out of 10 from the foul line.  Translation:  he possesses a degree of hand-eye coordination that is, in comparison to my own, roughly equivalent to the relative difference (advantage mine) in our mobility.

Yet I don’t feel disabled.  And nobody perceives me as disabled.  Nor do I risk being defined or limited as a person because of what I cannot do as a result of my mediocre athletic coordination.  Ditto for speed or strength or any other physical traits – they define much about me, certainly how successful I might be in sport (or, for that matter, dance) – and yet the skills I don’t have don’t stand out as holes.  My coordination is not missing.  It’s not made of metal.  When I look at Beighton, when I think about his lost legs and what that must mean for his life, I still come to this dreadful word:  disabled.

As a subject of study, the depths of identity are far better plumbed by others.  We all get it that the world creates these categories of dysfunction or “abnormality” by making, at an almost pre-conscious level, judgments against the backdrop of a “normal”.  This normal becomes a standard, and is of course heavily weighted by our common, contemporary set of capacities. In contrast:  the synonym for people like sprinters Oscar Pistorius and Jonnie Peacock:  they are invalids.  Not valid.

Switch now from the fields of sporting endeavours to the fields of sorghum in Burkina Faso.  Switch now to poverty, to the “have nots”.  Switch to the third world, developing countries, lesser developed countries, and the global south.  What makes these labels?  What makes these countries so disabled?  Well, let’s avoid that debate and just agree that it’s something like per capita GNP.  In other words, wealth.  So who decided on that?  Who decided that societies should not be ranked according to the rate of marriage failures, or the number of unwanted teen pregnancies, or levels of drug addiction, or the percentage of old people who spend most of their life separated from family, or the number of adults who follow Rihanna on Twitter?

The real question, though, isn’t who decided the rating system by which nations are placed into the category of disabled.  The real question is this:  how do we launch the dawn of a new age in which these nations, and the billions of people in them, do not define themselves as disabled? How do we arrive at a world where huge chunks of humans do not think of HD TV or paved roads the way we think of Beighton’s missing legs?

I have no idea whatsoever.  But I have a feeling it is that very internalization of the identity of being disabled which is the true disabler.  And I have a feeling that this is the overarching challenge to development.  It slaps a giant “PART OF THE PROBLEM” sticker on the back of the aid industry. There, it is a matter of mind, a matter of definition that the Third World should see disabled when they look in the mirror.

Health, Our Western Identity

Baby Helmets for the World

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Yummy!  There’s a Whole Foods Market in Stoke Newington.  That consumed an hour yesterday afternoon.  And about 50 quid.  The excitement mounted as I meandered through that bastion of American food and health branding.  Dare I admit to titillation at the prospect of real pretzels and something besides mayo-based sauce to put on a salad?  Or Mexican style salsas that aren’t made by Old El Paso, which seems to be the only brand sold in Britain, which is like having 65 million people who think the Ford Fiesta is the only car in the world.

Part of the WFM experience involved discovering Kallo Low Fat Rice Cakes.  Think about that for a moment.  Low fat rice cake.  That’s not exactly the same thing as a low fat English breakfast.  The label boasted 0.2g of fat.  What do you figure, that’s down from 0.3 grams?  Maybe 0.4g?  (Just for comparison sake, a rather basic version of a Full English boasts about 400 times more fat).  Oh, and a pack of Kallo’s Low Fat Rice Cakes costs £7.64, which is only slightly less than the price of platinum on the basis of weight.  People are willing to pay for health.

Our visit to Whole Foods Market came just after getting lost in Abney Park Cemetery, a hidden gem that’s part graveyard and part medieval forest.  Reading the 19th C gravestones there, it’s hard not to remark the ordinariness of children or young adults dying.  Cut to 20 years ago:  walking through Lafayette Cemetery in New Orleans, digesting the significance of family headstones with three or four children perished within a stretch of three weeks.  Makes you realize how far removed many of us have become from the reality of the human condition being nasty, brutish and short.

In the chasm between “haves” and “have nots”, we can conjure many dividing lines:  The digital divide, the education divide, the life expectancy divide.  Yet I find it hard to imagine a deeper division than the one in which the “haves” side includes a chunk of people suffering panic attacks over the fat content of a rice cake.  The luxury of that effort, the obsessive nature of that fear, the idiosyncrasy of that market all point to a rarefied environment, to say the least.

So we must ask:  How many of us shoppers at Whole Foods think of ourselves as rarefied (read: nutters) as opposed to normal arbiters of healthy living?  How close is that luxury/obsession/idiosyncrasy to those who hold power in the humanitarian business?  And how far removed is it from the world of the beneficiary?  What does this gap say about the values underlying aid programs dealing with health?  We must ask these questions because the removal – the distance – is not so easily contained to the many absurd disparities between a society in which hunger is a permanent and defining ache and one in which people study the labels of organic yoghurt as if reading the instructions to defuse a bomb.

No, the distance here is generated by the value assigned to health and, perhaps, to life itself.  It is that value – the hyperinflation of health – which underpins our worrying about the fat content of aerated rice flour.  We come from societies “evolving” to the point where the minute risk of ill health or injury prompts such overly protective behaviour as the baby helmet or the craze for umbilical cord banking.  Here lies a fundamental disjunction between medical humanitarian and beneficiary, one largely invisible to us.  How else to describe our obsession with their health; with our overweening valuation of their health more than their own valuation of it?

OK.  We live in a different world. I guess my question is the degree to which we unwittingly export our world, or impose it; to which we remain blind to our way not being the only way.

When Somali elders prefer a cataract surgery clinic to primary healthcare for their community, do we listen to their request or overrule their unenlightened undervaluation of the health of a two-year-old?  When a Sudanese woman runs a risk by not bringing her child to the clinic, what is our reaction?  Do we question our own alarm at that minimal risk?  Or do we construct an entire narrative of victimhood, where she is forced to make such a “bad” choice in order to collect firewood or care for her other children?  Or do we construct a narrative of her ignorance, where she doesn’t understand the consequences of her own actions?  We export, in other words, our valuation of risk.  Will the humanitarians of the future insist she walk three hours to pick up her baby helmet?

When a Zimbabwean man refuses to wear condoms or stop visiting prostitutes, what is our reaction to his running the risk of catching/spreading AIDS?  Do we accept his choice or, again, construct an idea of his ignorance?  More importantly, do we even register our imposition and increasingly commercial marketing of biological longevity as some sort of universal right?  Do we recognize in ourselves the front men of a pharmaceutical industry whose wet dream is a world population sucking down as many pills as we do?  What of his response to our attempts at steering him on the right path; at our incessant moral hectoring and ever-so-repetitive educational demand that he change his behaviour?  Some days, I think we miss his response altogether:  “Hey, you, loosen up.  Chill out.  Eat some deep-fried food.  Live a little!”

Politics

No Mo’ Waste

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Just returned to work from two weeks of holiday.  Did the staycation in London, including a trip to the Olympics to watch the USA basketball team annihilate a surprisingly good Nigerian team, and then a few days in the charming English countryside of Devon, which was full of last-minute deals on cottages because the predicted tourist hordes frightened so many people away.

So you’ll have to excuse this rather quick post, as my inbox appears to have been consuming too much product from proud Games sponsors like McD’s, Coke and Cadbury (two thumbs up to sleb chef Jamie Oliver for calling out God, in the earthly form of David Beckham, for endorsing the junk food industry).

Sure am glad Mitch Romney didn’t pick Mo Farah for veep.  He could run for prime minister and win about now.  Taking gold in both the 5K and 10K had to be a top-3 highlight of this Olympics.  Heart.  It reminded me of Lasse Virén, one of those pieces of trivia that has stuck in my head for an inexplicably long time.  He did the same thing in 1972.  And then again in ’76.

Anyway, the issue here is Mo.  He’s from Somalia.  He moved to the UK and managed to clock one of the great sporting accomplishments of this young century.  The question:  what if he hadn’t left Somalia?  The answer is pretty clear.  Remember “A mind is a terrible thing to waste”?  Remember those ads?  I think they somehow played a role in my choosing this career.

Is “terrible” enough of a term to describe the waste of human potential in places like Somalia?  What is the world missing?  What are the equivalent achievements in the sciences to Mo Farah’s double gold?  A vaccine for TB?  Maybe even we could dream bigger, like a formula for cold fusion, or an end to Jersey Shore (and Geordie Shore, because somebody over here thought the original was simply too good not to spin off)?   Don’t we undermine the very idea of human dignity when the leaders in places like Somalia or Congo are thought of as nothing more than ineffective, tribal or corrupt?

To answer that question, I’ll quote from a recent essay on Congo posted by a buddy of mine, Ed  Rackley:  The loss of human lives and potential in the Congos, Haitis and Afghanistans of the world amount to much more than the personal and political failings of national leaders; they are calculated criminal acts. Crimes against humanity of a lesser degree than genocide, yes, but surely the act of trapping entire populations in cages of illiteracy, hunger and constant insecurity for decades, even generations, should be punishable.

Critique of Aid, Health, Politics

Bugged Out Over Haiti Cholera

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Somewhere, somebody should start a blog on how to make yourself unpopular in humanitarian NGO circles.  Here’s one sure-fire formula:  praise the UN.  Or don’t even praise them, just defend the UN.  Or don’t even go that far.  Just mention the UN without also blaming them for everything that’s wrong in humanitarian action (there is an exception to UN-bashing if, at the time, blame is being heaped on government donors in an effort to obtain funding).  So I am wary of violating the NGO ethic of cool, as well as damaging my self-image promotion, by saying what could be construed in some quarters as a sycophantic devotion to the aid world’s paragon of bureaucratic inertia.

Yesterday I came across this posting on the cholera situation in Haiti.  Voilà the House of Representatives of the United States of America, that tireless defender of the downtrodden, harvesting political hay from the fact that UN peacekeepers introduced the cholera bug into the water system of Haiti (or did they?).  Haiti was, of course, a country that effortlessly fit into one of those overused “perfect storm” analogies looking at factors conducive to cholera killing a shitload of people (estimates are 4500 – 7000).  Low population awareness?  Check.  Zero natural immunity?  Check.  Poor to zero emergency healthcare capacity?  Check.  Widespread mingling of drinking water with bodily effluent?  Double check.  Voodoo.  Check.

America’s top politicians have made their bold call:  because UN troops introduced cholera into Haiti, they are the “proximate cause” of the epidemic.  Read the letter.  Strong stuff!  You’d think they were condemning North Korea or one of those single-named dictators like Mugabe, Gadddafy, or the newly anointed (to the single-name club) Assad.  Congress continues:  “As cholera was brought to Haiti due to the actions of the UN, we believe that it is imperative” for the UN to deal with it.  Put simply:  you are the cause of this mess, so you have clean it up.

Is there one person paid to run the US possessing even a small appreciation of irony?  Let’s look at that accusation on causality for two secs.  OK.  One sec.  Because it is quite remarkable, isn’t it, when the US government endorses the idea that a powerful global actor has to clean up the messes it makes on foreign soil.  Forget Iraq.  Forget Afghanistan.  Forget Viet Nam, Cambodia or Laos.  Forget the Arctic ice pack melting away like all those pledges to build a better Haiti.  Forget, even, a drone missile or two being an uninvited guest at a Pakistani wedding.  Forget all the messes where the US govt wears the label of proximate cause like Gilligan wears a cap.

Forget them and focus on Haiti.   After four decades or so of propping up a series of Olympic medalists in the decathlon of brutal, corrupt, incompetent, venal (but anti-communist!) political leadership – not to mention that sordid little CIA relationship with local paramilitary butchers and other political interference – you would think the USG might shy away from the promoting an idea that proximate cause engenders political and moral responsibility in the poorest place in the Western hemisphere.

In the end, though, perhaps the bigger danger comes not from the US’s lack of introspection, but from peddling the idea that bacteria can be the cause of so much destruction.  (More on that next post). The cholera disaster in Haiti is caused by the interaction of vibrio cholera with a dysfunctional sanitation system, with paradigmatic urban slums, with an almost unprecedented level of abject poverty.

And on the proximate causes of that mess, both US and Haitian politicians seem unsurprisingly silent.  Ditto for the Center for Disease Control, who managed to predict that the risk of cholera introduction into Haiti was low, presumably because they naively assumed the thousands and thousands of people making up the relief armada were well-wiped westerners who did their business in the plush Hotel Karibe.  Ditto for most of the relief effort, who seem uninterested in answerability for Haiti’s mess despite its longstanding moniker as the “Republic of NGOs”.

Special kudos, though, for the lawyers suing the UN over cholera.  Such a nice example of the little guy taking a pop at power.  But if you want to introduce some accountability for the woes of Haiti, maybe the brave lawyers should leave blue-helmeted Nepalese peasants alone and go after those champions of justice on Capitol Hill.

Critique of Aid, Uncategorized

The Race to the Bottom

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At the risk of diminishing the heroic status of all those who work in humanitarian organizations – of all those who toil hour upon hour in an effort to save every last life possible on this Kurtz-ridden planet – let me confess that on occasion, right in the middle of the work day even, my computer screen begins to show articles about the Philadelphia Eagles football team.  Once in a while, articles about the fascinating life of celebrities also pop up.  My computer tends to do this more often during the football season, but also during the approach to the NFL draft, training camp, and, well, on just about every day I’m in the office and hence tiring myself to the bone to save the world or, on days when that seems too tall an order, reading over the 12th draft of the office annual plan, sorting the pens in my desk drawer by color, etc.

For those who regularly read humanitarian agency reports, you probably understand.  The brain needs a break.  It needs regular refuge from the horror.  I unwind with dose of the Eagles, the greatest team never to win a SuperBowl.  Since about two weeks ago, though, my respite has been effectively cancelled by Amina and her nameless invaders.  Surrounding an article about the contract extension of a promising young running back, peeking from the banner, the blitzkrieg begins.  Starving babies.  Grotesquely contorted, ribcage-clad babies.  The enlarged skulls of the emaciated.  Faces in pain, eyes set right on mine.

This isn’t just disaster porn twanging my heartstrings. This is disaster porn combined with new technology, meaning I can’t just turn the page because some big aid agency, let’s call them HAL, has its hooks into my cookies.  Click to a new story.  There’s Amina. Click again.  Here’s that misery-distended face and the floating caption: “No child should be this hungry.” Click again, and one of these kids rolls up from below my screen, like horror-movie fog seeping under a door, asking for £10 now.

Such is the brave new world of Google.  I must have looked at HAL’s website recently, and they know it, so now they are hitting me up with a retargeting campaign.  Where are the ethical limits on exploiting the privacy of web users?  I don’t know.  All major agencies use this technology to enhance fundraising results.  It’s called prospecting.   And like prospecting, one tries to pick a spot that looks good.

In other words, it makes sense to show your appeals to somebody who has recently read stories about aid, or articles about the places we work, or visited our websites.  Note that the NGO also purchases the target audience and the frequency with which its ads appear.  Once per week?  Every two days?  Fairly often?  Where does one draw the line?  Again, I can’t say exactly where the line should be, but surely it should be drawn before creating the appearance of stalking me, and long before any sane person would prefer to set fire to his cash, stocks and bonds rather than allowing even once cent to end up in HAL’s pocket.

Of course, this isn’t just about new technology.  It’s an old one as well.  There are standards.  There have been papers and conferences and workshops and all manner of effort to ensure that photographs and imagery used by humanitarian agencies is respectful of our beneficiaries.  There’s even a code of conduct that is designed to eliminate the merchandizing of starving babies.

I can hear one potential response:  Mind your own business.  Nobody elected you the moral police of UK’s humanitarian aid community.   Is it good enough to leave this up to the market?  Do we leave it up to the public?  Is stalking and exploitation OK because it has proven results?  The cash flows (even if I doubt HAL ever bothers to calculate the cost of pissing so many people off).

But what about my God given right to self-righteous moralizing?  After all, one might expect humanitarians to be slightly less mercenary than bloodsucking automated telephone sales companies.  [Insert fist thumping].  One might expect them not to exploit children!  [Insert more strident fist thumping]. And this campaign might poison the well of public generosity for all of us.    No wait, it’s worse than that. [Insert preachy voice].  This cynically mawkish and manipulative appeal might spark the end of humanitarian assistance as we know it.

Or, it may also be true that none of us are any better; that we simply cling to our own set of arbitrary distinctions that allow us to feel that we’re different.

Politics

Happy Independence Day South Sudan

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You have to admire a Prime Minister whose jobs strategy is, essentially, telling people to go and look for work overseas.  That was Portugal’s PM, refreshing for a politician in his apparent disregard for popularity, not to mention his honesty about not having one shred of a plan.

It reminded me of the recent declaration by Salva Kiir – the leader of the world’s youngest nation and easily the President with the most intriguing taste in hats – that South Sudan would introduce stern austerity measures.  Say what?  That’s like, well, I can’t really think of an analogy.  Victoria Beckham announcing she’s going to start dressing up when she appears in public?

One might have thought the very concept of austerity included limits; theoretical boundaries beyond which the term becomes inapplicable.  Austerity:  official action by a government to reduce the amount of money it spends, or the amount of money that people in a country spend.

See what I mean?  The concept seems to imply that government actually spends money on services, and that people aren’t foraging for bugs and leaves for dinner.  Other definitions suggest a particular inappropriateness:  austerity = reduced availability of luxuries and consumer goods, esp when brought about by government policy.

Well, one country’s healthcare, education and roads are another country’s caviar, Gucci and Maserati.   Happy Birthday South Sudan!

Of course, we must recognize the difference between government budget and spending on services.  South Sudan may be the first place on Earth, and certainly the first democracy, with an absence of functioning services on which to impose austerity measures even though there has been fairly whopping government expenditure.  That’s because $4 billion sent to the various ministries ended up in Swiss bank accounts.  That’s not me being cynical, that’s the President himself, in a May letter promising amnesty and anonymity to his government officials if they would please please return the missing cash.

In fairness, though, it is hard to disagree with the need for some sort of financial austerity, so I should get off my high horse.  I mean, South Sudan has been getting reamed by the mothership of Bashir’s Sudan, so it’s perfectly logical that President Kiir would announce the cessation of all oil shipments for the next few years (the only way for the oil to get to market is through Sudan).  True, that declaration of independence has caused some side effects for the economy, perhaps because oil exports amount to every penny the government owns (98% of state revenue)?  Sort of like collateral damage,  no? Or cutting off your face to spite your nose.

So austerity is the price the government will pay for independence.  Here:  watch this 30 sec clip and sub in the word “austerity” every time you hear the word “probation”.  Makes you wonder if governments don’t have limits to what they are allowed to do in the name of independence.  At what point does one have to accept a little reaming?

You could argue humanitarian organizations should ask themselves the same question every time the principle of independence blocks the provision of aid.  Shouldn’t we swallow a small dose of Marsellus Wallace?  Of course, neither government nor NGO will pay the price at all.  Perhaps our moralizations amount to this: a modern twist on Patrick Henry:  “Give me liberty or give you death”.

Politics

Secret Agent Man

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Anyone out there remember James Bond’s funeral?  Yes, Bond died.  Sort of.

The burial at sea of MI6 ace spy comes early in “You Only Live Twice”.  Seems the cloak of having died was necessary for 007 to foil SPECTRE’s capturing of US and USSR spaceships, which threatens British high tea with the unsavoury effects of nuclear war.  Key to the plot is Bond going undercover, becoming a Japanese fisherman in a small island village (near the fake volcano island being used by Blofeld as a secret rocket launch station and underground base).  He marries a Japanese secret agent (named, as they are, Kissy Suzuki) and settles into village life with neither fanfare nor, apparently, the notice of any of the other villagers.

Are you following this picture?  Sean Connery circa-1967 disguises himself as a Japanese fisherman after a wee bit of surgery to make his eyes look slanted.  In fact, it looked like somebody put scotch tape on his eyebrows.  That’s the same Connery who emerged bare-chested from the surf in “Dr. No” and looked no less unlike a Japanese villager than Lassie.  That stretch of the imagination is called Hollywood.  See also, John Wayne playing Genghis Kahn.

Out here in the real world, though, spies probably don’t stick out quite so sore thumbly, as it’s bad for business; worse for health.  Spies in the real world probably look like people on TV, even reality shows.  They probably look like well, you or me (even if we would never agree to be on a reality show).  That means they probably look like NGO workers.  Recent news suggests that they may in fact be NGO workers.

First it was the Norwegian government admitting that its secret service had agents inside Pakistan, which was widely understood to mean NGO workers.  Then, last week, the Dutch government saying that it used journalists to spy on the Chinese.  Ouch!  Those are the good governments; the ones with actual moral scruples.

Well, that news fits the times.  I blogged on the CIA’s recent use of a fake vaccination campaign to identify and kill OBL.  Here’s how that myopic action is playing out right now, in Northwest Pakistan, where military commander Hafiz Gul Bahadur refuses to permit polio vaccination, because “spies could enter the region under the cover of vaccination teams to get information”.

Add on top of that the way we here in the West usually view NGOs as organizations where the NG means something, but NGOs in many parts of the world are very G, amply and expressly tied to the interests of the rulers or the State itself.  So it would be perfectly normal for people in the countries where we work to be suspicious of our self-proclaimed neutrality and independence to begin with.

What now?  It’s not like humanitarian agencies have policies on what to do with spies in the house.  Presumably, we’d strap them to a table with a laser beam inching its way towards their groin.  In the absence of a laser, we could terminate their contracts, although that’s not really the same thing as having a policy on the issue.  (Interestingly, we sometimes “know” that one of our national staff is a spy for the host country.  And what do we do?  Nothing.  It’s not a bad thing – helps create transparency (i.e., the security goons in the government can see what we’re up to)).

Do NGOs have responsibility to do a better job of protecting their integrity and neutrality against infiltration?  Do we have a duty to vet more robustly our employees?  NGOs typically perform a criminal records check, but I’m relatively certain there’s no website to verify if somebody isn’t a CIA assassin.  Random lie detector tests?  Push governments to publicly disavow this abuse?  Make it a criminal offense for a government to do this?  Ignore the issue until it becomes “common knowledge” that there are spies in the house?  Ignore it until our beneficiaries have suspicions about us?  Until they fear talking to us?  Until people warn them against talking to us?

Kind of makes you wonder, doesn’t it?  Why would anybody with my background and training do this job for so little pay?  Well, I’m exposing this issue in a blog, so it couldn’t possibly be me.