Tag Archives: Identity

Health, Our Western Identity

The Hammers and Nails of Ebola

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

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

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

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

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

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

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

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

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

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

Critique of Aid, Politics

The Perils of Blind Faith

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It would be difficult to imagine a person who better combines passion with sanctimony than Bernard Kouchner. He is not self-effacing. Then again, it is his ego and talent that gave birth in part to MSF, and in part to the right to intervene on humanitarian grounds (“droit d’ingerence”), later more or less codified as the Responsibility to Protect (R2P). This entertaining interview on Al Jazeera’s Head to Head program, quite heated in parts, brings out the full Kouchner. He is insufferable and yet also bold, for instance producing an unqualified YES when asked if France should have apologized for its role in the Rwandan genocide. You don’t hear many politicians being as candid.

It’s worth watching just to see the grilling he gets, but also for his unwavering commitment to the idea of humanitarian militarism, of going in to stop the killing. Over and over, Kouchner champions the idea that when people are being killed, doing something is better than doing nothing. His belief seems unshakable, even in the face of examples like the West’s 2011 intervention in Libya, whose humanitarian cloak quickly slipped to reveal an agenda of regime change; an intervention that put Libya on the path to the unqualified violent mess of Libya today and nourished a brutal insurrection in Mali. Humanitarian? More lives lost than saved? Kouchner doesn’t just dodge that question, he seems to view it as irrelevant.

Kouchner accepts no responsibility for the negative outcomes of Western intervention. He deems interfering, even through military means, better than letting people get butchered. Is it good enough, as one of the panelists suggests, to dismiss bad outcomes on the grounds that the intent was pure? That everything else – the messes of the West’s failed state-building in Iraq or Afghanistan – is simply the law of unintended consequences? He seems equally impervious to arguments that the promise of R2P is chimerical, an attractive doctrine that works only in theory because in the real world it has and always will be used to justify self-interested political and military intervention by big powers into the affairs of little powers.

Much of this would be no more than thought-provoking for us humanitarians were it not for the fact of R2P and MSF sharing the same birthplace. Fraternal twins? Once fans of the idea, nowadays most humanitarians I know regard R2P with healthy skepticism. We are quick to recognize the political intent or neo-imperial posturing when the world powers decide to intervene somewhere, especially when based on a humanitarian imperative. And we are quick to note the hypocrisy of so many decisions to look the other way.

Contrast this with our less skeptical approach on calling for more humanitarian aid, as if it were unrelated to the right to interfere politically or militarily. On the level of and connection to power, the similarities of R2P to humanitarian action remain largely invisible to us, despite their sharing (literally, one could argue) the same DNA.

It seems right to me, unshakably right to me, that humans cannot allow other humans to be killed, to die, or to suffer without doing something. Am I as blind as is Kouchner on R2P? Why dismiss military intervention as mistaken given real politik while compassionate aid is necessitated because of real politik? Of course there are negative consequences. They do not shake our faith in the moral imperative to come to the aid of people in crisis; and in the heat of action are easy to ignore or dismiss.

Is it enough to press for more effective anticipation, monitoring and correction of negative consequences: better context analysis, a more piercing focus on the role of aid within the economy of war and openness about mistakes? All good. (Done poorly or half-heartedly, though, these control measures may even serve more to ease our doubts than to correct problems.). What about the deeper level, touching upon the model for humanitarian action, and the web of power relationships in which it rests? We humanitarians possess a profound need to feel good about our work, one that is well-insulated from challenge. What’s hiding in there?

The interview with Kouchner presents a vision of blind belief. For me, it brings these doubts to a head at about the 38 minute mark, leaving me to ponder an exchange between Kouchner and a member of the audience.

Question (from a young Kenyan woman): “…MSF’s actions are often followed by French troops. How would you react when people ask you is MSF just another engine [NGO? The word she uses is unclear] that protects French commercial interests?”

Kouchner: “You are partly right…”.

That is more than a casual sharing of DNA.

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.

Politics

EF Inhumanity

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Let me start off with a good old American colloquialism: It ain’t over till the fat lady sings.  Well, in terms of my career with MSF, the fat lady is warming up her voice.  After 15 years, today is my last day.  Question I am asking myself:  So, Mr. Ex-Director, what words of wisdom after all that time?  What is the big message?  What is the meaning of our MSF/humanitarian life?  Answer I keep coming to: Beats me.

Every time I feel on the verge of grasping it, waves of emails and interruptions tumble me back to the starting line.  More pertinently, waves of challenges from, well, reality.  I cannot understand why MSF was forced to withdraw from Somalia. Why a multi-billion-dollar aid industry struggles to provide a meaningful response to crisis in South Sudan. Or why easily preventable diseases tear through children in so many parts of the world.  Humanitarian action is complex.  No duh.

But there is a message. I have seen the light.  Specifically, I saw the light a few months ago, cycling to work on yet another cold, damp day in London.  I saw a pair of legs.

The owner of these legs was weaving in and out of the traffic (in this town where last year more cyclists have died than British military personnel in Afghanistan), those boxy black letters his well-inked press release about the power and peril to his left, right and rear.  It was a message for MSF, for all of us.

Let us begin with HUMANITY, since that is the simple imperative where humanitarian action itself should begin.  At once compassion for those who suffer and a declaration of our fundamental sameness.  We are one family, the family of human beings, all so very different at first glance and yet blessed with an identical, universal dignity.  The humanitarian imperative commands a bond with those who do not look or sound like us, believe in what we believe, or watch the same edition of Big Brother that we watch.  The imperative propels us towards those who suffer not out of duty to kin, friends or clan, not out of affinity to those who share our religion or nationality, but because the suffering of one affects the whole and touches us as individuals.  Because in responding to the stranger, we build our own place in the family of humanity.

On top of that, humanity has propelled me to crisis – to this career – because humanity itself is at the root of crisis.  To be sick or injured and have no access to care is bad enough.  All the worse when it is caused by or paired with violence, abuse, exclusion, oppression.  Or greed, power, hatred. Or staggering, structural poverty.  There is something compelling, challenging and sinister about that combination – of responding to crisis because something bad happened to people (e.g., rains didn’t fall) and because something wrong was perpetrated against them (e.g., displaced onto marginal lands).  Compelling because that is where MSF finds those most in need.  Challenging because being humanitarian requires more than therapeutic action.  Sinister because it transforms medical action into an act of protest against the human origins of the harm.  MSF’s very engagement levies an accusation against those who reject humanity.

And that means some people won’t like us.  And that means some won’t let us do our work.  So, MSF (not to mention the rest of the humanitarian system):  What are you going to do?  As the proficiency, ambition and impact of our medical action becomes ever greater, what will become of our commitment and courage as an organization of protest?  As governments around the world become ever more cynical and capable in their manipulation/control of humanitarian aid, as they insist that we shut our neo-colonial mouths, what course will we steer?  What choices will we make?  Establishment aid agency or rebel humanitarian?  Fractious silos of ego and power or collective voice of dissent?  Muted opinion?  Round after round of risk-averse calculation? Or “Fuck Taxis,” because that is the voice of a piece of humanity bearing witness to powerful pieces of its antithesis.  Fuck inhumanity.

Well, MSFers?  I’m leaving.  So what are you going to do? The trend may be clear, but on this key question of humanitarian identity, the fat lady has yet to sing.

[I will leave MSF but Humanicontrarian will live on for a few weeks, then take a break, and then come back fresher than ever.  I hope.]

Critique of Aid, Politics

Friday shorts: Syria, sixpacks and status

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Today, a treat for the reader.  Instead of my meandering approach, I’ll spare you the long-winded digressions and the spectacle of my beating a dead horse.  Here, a few short(er) posts.

1.  In the land of the blind, the one-eyed man is king.  In a land with only one horse, even a lame nag looks like Secretariat.  And so the political leadership of the world piles human hope and diplomatic muscle into a Geneva conference on Syria.  I certainly wish Kerry and Lavrov well.  In the realm of impossibility, even a half-baked solution seems like E=MC2.

The reality is that the Syrian conflict poses an existential threat.  Seems to me that the rush to self-destruction challenges the value of liberty, or freedom or democracy.  Patrick Henry’s “Give me liberty or give me death” makes for a great battle cry.  It sounds profoundly noble.  But at what point should either Assad or the Syrian opposition surrender?  Not militarily defeated but a recognition that the price of victory is too high.  That is not, obviously, a question for me to answer.

Yet I am reminded of King Solomon (in the Koran, Sulayman), a wise man for Jews, Christians and Muslims alike.  When faced with two women each claiming to be the mother of an infant, he threatened to cut the child in two.  The true mother, who loves her child, cries out that she would rather see it pass to the other than perish at the sword.

2.  A lot of magazines dealing with the NGO/charity sector cross my desk.  The recent cover of Charity Times holds the title “Measuring Impact”.  That is the not-for-profit sector’s equivalent of “Twenty Days to Sixpack Abs”.  I mean, is there even one issue of any health journal that does not include an article about how to get better abs?  Is it really possible that there are literally thousands of ways to say exercise regularly and eat less?  Apparently, there are.  I vote for a new research agenda:  Measuring the impact of articles on measuring impact.

3.  NGO. It is as much a title as an acronym; as much a declaration as a status.  What does it mean in a world where those bearing the NGO label are massively funded by governments?  And where governments  dictate so many of the terms of engagement?  I mean, if 75% of your field expenditure is financed by the likes of DFID, ECHO and USAID, the label of NGO seems deceptive.  Ditto where half of your management team used to work for the government.

NGO is an anachronism, a mark of distinction from days gone by, created by the UN to distinguish state actors/bodies from citizen groups.  Those distinctions are now hopelessly blurred.

Defining oneself through negation is a tricky business.  (If I had paid better attention at university, I might even remember what Sartre had to say about it).  Lots of organizations are non-governmental.  Technically, the Mara gangs and the International Fan Club of Rihanna would qualify as NGOs (probably more NG than CARE or even MSF).  But for many organizations that are not governmental there is no necessity or identity to be found in distinction from government.  No confusion between the Mara Salvatrucha and a delegation of foreign ministers (I know, I know, between the Mara and typical governments there is an identical imposition of a monopoly of violence to further economic interests, but that’s another blog, one which includes digressions).  So it raises the question of whether times have changed.  Do we now need additional acronymed credentials?

In honor of the tectonic shift towards social entrepreneurship – the transformation of the development NGO into a patron of the free market system – and marking the recently well-promoted “collaboration” between Glaxo SmithKline and Save the Children, I hereby initiate NCO.  Non-corporate organization.  To create distinction from organizations promoting corporate interests.  And for places like Afghanistan, Iraq, Somalia and (soon enough) Syria, how about NMO?  Non-military organizations.  To create distinction from organizations that are directed via belligerent funding to achieve “soft” military targets (talk about a gap re measuring impact!).  A bit clunky on the tongue — “As an NGO/NCO/NMO, we believe…”  — but the distinctions are vital.

Critique of Aid, Our Western Identity, Politics

Corruption in Aid: Meat or Poison?

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Somewhere in the early 80s, hence more or less at the fringes of memory, I was sitting in Benjamin Couilbaly’s dusty courtyard, sharing a meal and some laughs.  His wife served a delicious meat and sauce dish, which we scooped with handfuls of tô, the millet-based paste eaten throughout much of Burkina Faso.  When I asked, he said the meat was “chat sauvage”.  Wild cat.  Fascinating. Some sort of local lynx or bobcat?  I’d figured all manner of wild cats had long been displaced or hunted out.  Then he explained.  A wild cat refers to your neighbor’s cat, when it wanders into your back yard.  Love that logic:  In a community where hunter-gatherer behaviour is still threaded through the cultural norm, it makes little sense to heap as much adulation on domesticated animals as we Westerners do.

Some interesting cyberdiscussion on the issue of corruption.  The big question being asked:  Does corruption undercut development/growth to the extent of warranting such a broken record of Westerners banging on about it?  The provocative Chris Blattman even asks if corruption isn’t an “Anglo-American fetish” (see also some of his posts this week).  ODI research jumps into the analytical fray – What are the effects of corruption, and what are the “inconvenient truths”?

The authors seem to miss an important boat as to why “Third World” corruption sparks such inflamed feelings.  Is it really only a belief that corruption is crippling poor economies?  Or the concerns of a politician like David Cameron, who worries about public backlash against the entire aid budget?

Now, allow me to bang on a bit.  Isn’t it also about the heroic myth we’ve created around aid itself – that it is formed in equal parts out of the virtue and action of us (Western) saviours, delivering the agencyless victims from certain doom?  Hence, theft of aid becomes murder of sorts, with children dying at the hand of the thief; and it becomes an act which blocks aid givers from reaping the rewards of their charitable action (on that, see my previous blog on the selfishness of giving, or in this first person account of overlooking corruption in order to preserve that reward).  Corruption is wrong, but it gets bucked up to the level of immorality incarnate.  And underneath all of that, corruption becomes a convenient, powerful, facile enabler of our own feelings of superiority.

To underline the Us/Them divide, corruption must also become deceptively unambiguous from a moral perspective.  There are probably lots of ways in which the term “corruption” is problematic.  But even thoughtful commentators seem to suggest that “theft is theft”.  Is it?   Is there any reader who doesn’t anger upon reading that some African politician accepted a boatload of cash to grant a political favour?  That’s corruption, right?  Theft.  Clear as day.

In much of the West, of course, being more developed nations, a certain sophistication leads to obfuscation.  Essentially, we’ve created legal or normalized channels to replace many forms of corruption, stripping away the ugliness to allow theft under a different name.  For instance, the web of election contribution rules which transform the immoral/illegal/corrupt purchase of a politician into a perfectly mundane act of election funding, or even free speech.

And in humanitarian circles?   Is theft always theft?  I think we’re back to the cat:  As the saying goes, “One man’s meat is another man’s poison.”  As I’ve posted earlier, an expat using the agency’s white SUV to buy Danone yogurt at the swanky suburban mall is no less an act of aid diversion than when a member of the national staff pinches a bottle of paracetamol.  Guess who gets fired for it?  Guess who returns home to proud parents?

What about when a supersized chunk of the $5.2 billion donated for the Haitian earthquake ends up nowhere near Haitians themselves?  When it disappears into the maw of the saviours?  You know, all that housing, flights, conferences, consultancies and, of course, yogurt?  Into what black hole did that aid money disappear?  Mugabe’s Swiss bank accounts?  Or my British one?

Yes, I do think we have a fetish with the corruption of others.  But that’s really a fetish with self-preservation, because with less biased analysis, humanitarian scrutiny of corruption may not travel so far afield.

[Wanted to react on this topic.  Back to the analysis of humanitarian principles in the next blog]

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

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!”