Tag Archives: Responsibility

Critique of Aid, Health, Politics

Ebola: Three Ideas (continued)

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Ebola 3. A Time To Point Fingers? Yes.

“We can’t dawdle on this one”. That is Barack Obama on September 16, inaugurating a litany of Very Important People sounding clarion calls that the world must act to curtail the scourge of Ebola. David Cameron followed suit. Ban Ki Moon jumped up and down, calling for urgent action, also for nations to give lots of money to the UN and for Bono to organize some sort of Live Aid rerun. To date, the action of calling has greatly dwarfed the action of acting.

There is an undeniable truth to the urgent call for action. But having dawdled for so long – allowing this outbreak to infect and kill so many more people than should have been the case – there is a fundamental deceit in the call as well. In terms of preempting the exponential spread of this disease, the time to act passed four, five, maybe six months ago. Now we must talk of action – action on the ground in West Africa (not to be confused with airport screenings, conferences full of petits fours or throwing money at the problem) – and we must talk of accountability for its opposite.

Ellen Sirleaf Johnson in her recent letter to the world: It is time to stop talking and “send a message that we will not leave millions of West Africans to fend for themselves.” With all due respect, Madam President, that ship sailed. The nations of the world long ago decided that they would do exactly that. They decided to act only when it became a matter of self interest. And I note here that this self interest seems largely electoral, a question of curtailing political damage at home rather than a virus overseas.

Rather than save lives, the response of nations like the US or UK seems designed to save political ass. Through months of inaction, these governments are contributors to Ebola’s explosive spread. And yet they are the best the world has to offer right in terms of response.  We need their boots on ground.  The lone exception to self-interest seems to be Cuba, neither threatened by Ebola nor under pressure to respond, who has pledged hundreds of additional medical doctors on the ground.

Let me be very clear: the urgency of accountability exists because at the nation-state level this is not primarily a question of charity or even humanitarianism. This is not a question of choice or option. This is a question of human rights. This is a question of nations violating their obligation to provide international cooperation and assistance to Liberia, Sierra Leone and Guinea. See for example Physicians for Human Rights or Amnesty International. (Whose voices remain curiously muted. Where is a more strident defense of the human right to health? Where are creative R2P-inspired arguments that there is an international responsibility to protect citizens against a massive violation of their human rights when, as in West Africa, the states themselves are unable to do so?).

And then this is also a question of international security in the form of global outbreak response, which has been entrusted to the most powerful nations on Earth and the UN, who had the money, know-how and responsibility to act much earlier. Finally, there is the question of humanity. These nations, in pursuit of national interest and in a rather self-congratulatory fashion, do such a good job of talking the humanitarian talk; of talking the talk of caring and aiding and helping. But when it came to Ebola, they decided against doing the walk.

Another reason to act right now on accountability is to stop its perversion. We are in danger of accepting a simple story that the World Health Organization is to blame. Well, that is true. But there is a difference between blame for WHO shortcomings and exploiting the WHO as a scapegoat. For starters, there is the impact of WHO funding cuts by governments like Obama’s USA. Or even better, as Dr. Anne Sparrow writes in The Nation, world powers have ensured that the WHO has shifted emphasis to the diseases of the Western World. But more importantly, the WHO was only one of he firemen who sat and watched while this flame spread to a fire and then a blaze and then an outright conflagration.

Will heads roll in the governments of Guinea, Liberia and Sierra Leone? It is a simply wrong to believe that the “basketcase” state of their health systems were either natural or inevitable, like a typhoon. They should have been in a better position to deal with this outbreak. It is true that the scale of the outbreak today, or even back in July, would have swamped all but a well-developed nation. But we must assess matters earlier in time, when the basics of good case management and information flow could have prevented the outbreak from escaping control. What shocked me the most is that so many of their own citizens so distrusted these governments that Ebola was first seen as a ploy to attract and embezzle aid. The abundant health education message of EBOLA IS REAL makes me want to cry. How to stop an outbreak if that is where you begin?

And yet I heard Sirleaf Johnson blame the miserable state of her country’s healthcare system on a war that ended eleven years ago. Perhaps I missed her explanation of what happened to the considerable aid sent to Liberia to rebuild. Ditto for Sierra Leone or Guinea. As Human Rights Watch notes: Endemic corruption, including in health services, has long plagued the governments of all three countries and contributed to years of unrest and lack of development. It is in the first instance not the rich governments of the world who decided to leave millions of West Africans without adequate healthcare or basic outbreak response.

Governmental failure is a matter foremost for civil society. West African voices can already be heard. See, for example, this blog post, questioning poverty in the face of mineral riches and offering judgment on governance: It is not good enough for the Deputy Minister of Foreign Affairs of Sierra Leone Ebun Strasser – King to note that Ebola “took us by surprise and met us when we were ill prepared for it”. Or Abdul Tejan-Cole, speaking eloquently on seeing “civil society step up when government institutions have crumbled or not addressed the crisis”, not because of poverty but because of poor management.

Beyond governments, will heads roll in any aid NGO or agency aside from (presumably) WHO? What of those agencies who have spent years claiming to develop health capacity in West Africa? What of those who have raised money by declaring themselves leaders in global humanitarian emergency health? Where are their beds and nurses and doctors? And where were they when the epidemic could have been controlled? The WHO was silent and even downplayed the gravity of the situation. Did they own the only working phone in West Africa? Aside from MSF, where were the alarm bells from other agencies with health teams already on the ground? Are board members going to resign in disgust? Or is everybody too busy ramping up activities to respond to Ebola the cash cow in addition to Ebola the virus?

There are those who argue that now is the time for action, not recrimination. That is the pragmatic voice of the aid establishment. And that is sweet music for those responsible, who do not in any way fear the hand wringing and promises to do better in the future which have long served to excuse failure and defuse calls for change. To delay accountability now is to reinforce this entrenched pattern of inertia tomorrow.

As did the global political elite know and ignore brewing famine in south central Somalia a few years ago, as did they know and ignore the mounting crisis in Syria, so did they know and ignore the burgeoning Ebola crisis in Guinea, Liberia and Sierra Leone. This is the new world order, in which the most powerful are either unwilling to meet their international obligations, or incapable of doing what is right and what is human until direct self-interest and fear muster the political capacity to act.

Critique of Aid, Politics

World Update: It’s Big and Small

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[Originally posted September 12 and lost due to website issues. Apologies to those whose comments have been lost as well.]

Monday marked six months since I stopped working in the humanitarian field – I left the insulation and employ of MSF and headed off to parts unknown. Actually, I headed off to parts known, the USA, and spent most of the half year with my wife, immersed in the day to day. Road trip. Chilling out. Taking a break. I recommend it.

We passed through spectacular natural scenery, ate sublime meals at diners whose steady disappearance is as tragic as DRC, and interrupted my 15 years living abroad to spend a full month with my aging parents. Even without its day to day excitement, the trip would have been wonderful simply for the fact of spending so many months off the grid. The phone didn’t ring. The email didn’t stack up. Stress seeped into the ether and sleep came in deep doses.

Did I find myself? Discover the meaning of life? Nope and nope. I did manage to attain nirvana in the tiny town of Webb, Mississippi. This perfection came in the unlikely form of neckbone stew at Vera’s café, with sides of cornbread, mac & cheese, and okra. That’s it? The secret of life is high-cholesterol Southern cooking? It may well be. Beyond that, this is the most I can say. First, the world is a really big place. Second, the world is a really small place.

The world got bigger the moment I left MSF. The adrenaline rush of emergency aid causes a narrowing of vision. Aid agencies churn limited ground. Outside, the world is full of joys and marvels and realities like the miserable, inexplicable poverty of many Native American communities. Or take Syria. At the time of my departure it was a daily point of focus. During my first few months in the States I never once heard somebody mention it in conversation.

The fact of the world seeming suddenly so much larger says something about the worlds in which we live. The world became quite small as well, at one point not much larger than our campervan. That is partly a function of snugness, the age old feeling of comfort or refuge in our own world. In one way, I had replaced MSF’s porthole with another, but at least stress did not fix my gaze. It felt easy at first to join the big world again.

But beyond my road-tripping, the smallness of the world is partly a new phenomenon, as internet information and social networking shrink rather than expand our understanding of issues, and solidify polarized points of view. See this fascinating piece on data visualization of Twitter action during the Israeli-Palestinian conflict: “We’re most likely to only talk to people like us”.

Since coming back on the grid, the news portrays a world in even worse shape than only a short time before. 2013 was bad enough (see my New Year’s Day send off in Huffington Post). Now add Putin’s Ukraine invasion, Ebola, the atrocities of the Islamic State, Israel’s recent attempt to rubble-ize Gaza, Libyan strife, etc.

The twinned trends of a world getting larger and a world getting smaller are not unrelated to this horrific state of affairs. For example, the more misery that piles up in the world, the more (for example) Sudan, CAR and Haiti gather into a white noise of faceless crisis, meaning these specific realities are rendered invisible from our small worlds. Or this phenomenon: in the face of all that bigness – in the face of seemingly inexorable economic and cultural massification on a global scale — there is a retreat into the local. Self-determination at the atomic level, whether it be the selfie, the slow food movement, or Scottish desire for independence. The discourse of nationalism is on the rise. That can be a good thing – ethnic pride. And that can be the success of the Islamic State or Boko Haram.

This self-determination is not only a longing for freedom or power. It is not only political in nature. It is also the self-determination of right and wrong itself. Reversing 500 years of trending enlightenment, “truth” in the form of political conviction is becoming more localized; naked self-interest more shielded as opposing views no longer enter the fortresses of small world opinion. The internet promised the globe and has in many ways delivered the (isolated) village. Safe in those narrow confines, POW slaughter is justified by religious edict and drone assassinations by self-defense.

Contrary to my hopes, 2014 suggests that 2013 was no aberration (again, see link). Of specific concern to humanitarians should be international law, human rights, and humanitarian action. These have all formed part of the world getting bigger – a concerted effort to globalize respect for certain norms and standards. Now, their meaning and hence their potency has been drained by the steady erosive forces of self-interest, exceptionalism, and realpolitik of the flag bearers.

In the aforementioned Huffington Post piece I wrote there were a “mounting number of places that have reached a critical mass of disrespect for international law and universal ideals, or their outright rejection; and where rudimentary compliance is no longer deemed useful.” My primary concern is not the upsurge of bad actors – there will always be bad actors – it’s the very public destruction of these laws and standards by the good actors, or at least of those who typically advertise themselves as good. In the long game of establishing rules against summary executions or slavery, the act of a jihadi beheading a journalist is a call for strengthening international law; the act of the US government torturing prisoners in Abu Ghraib is a knee-capping of it. What is good for the goose is good (easily justified by) for the gander.

(Diversion alert) The US government should take a lesson from Charles Barkley, who understood there are insidious consequences when the public anchors their beliefs and aspirations in the wrong place (see clip): “I am not a role model”. Sadly, such public self-awareness is not the stuff of nations. Here is Samantha Power a few days ago, banging the drum of international order against Mr. Putin’s Ukraine transgressions: “These rules and principles that have taken generations to build, with unparalleled investment – countless lives have been lost to establish and defend these principles.” Ouch. There falls another brick in the house of international law, crumbled as the world’s biggest pot calls Putin’s (pretty big) kettle black. (Diversion ended)

I do not know what happens to humanitarianism in the face of the world getting bigger and the world getting smaller. Aside from shrill press releases, what course of action to take if we believe that our access to people in crisis (Somalia, Iraq, Syria, Congo…) depends in part upon a strong respect for international law and norms? Where it concerns us, I know that we aid agencies have trumpeted ourselves as flag bearers in the international order. We are the goose too. So I know that we who define the humanitarian project must break from our own growing trends of self-interest and living in too small a world.

Critique of Aid, Politics

Depoliomacy

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Having swapped his political fez for the humanitarian beret of the International Rescue Committee, David Miliband is calling world attention to the spectre of polio outbreak in Syria. He has seized on a tragic development.  Rising polio numbers play out like a dead canary in a coal mine. At once powerfully symbolic of the calamity of Syria today and a frightening omen of Syria tomorrow.

Coincidentally, polio confirmation comes just as chemical weapons inspectors have declared that equipment for producing, mixing and filling chemical weapons has been destroyed.  Cut to fist-pumping Western nations?  I mean, progress on CWs is relatively good news, no?

In an astute exchange on BBC Radio 4’s Today programme (yesterday, around the 2:10 mark), Miliband and John Humphries aired the rather stunning conclusion that the world has breathed a sigh of relief since the chemical weapons deal has been made.  Guard down.  Attention elsewhere.  Result:  in the hoo-hah around chemical weapons – well-deserved though it may have been – Assad found a “licence to carry on what he was doing – slaughtering an awfully lot of people” (Humphries).  This analysis, shared by many others, makes for a cautionary tale.

The only law left standing in Syria today may be the law of perverse consequences.  MSF played an instrumental role in sparking attention/reaction to the chemical attacks (see my previous blog).  As if Western governments justifying potential retaliatory strikes were not enough of an unintended consequence, there is also the sidelining of a truly unprecedented humanitarian crisis.  As Christopher Stokes eloquently explains:  Syrian people are now presented with the absurd situation of chemical weapons inspectors freely driving through areas in desperate need, while the ambulances, food and drug supplies organised by humanitarian organisations are blocked.

Absurd?  Yes.  Predictable?  Why not?  What chunk of this hindsight should not have been foresight? We all knew that U.S. or French militaries would twist the outcry against chemical weapons to suit their own ends.  We should also consider it no surprise that Western governments, desperate for a chance to demonstrate action/resolve/victory will jump on any issue that masks their protracted, utter inability to do something about the horrors of Syria.  Action is generic in that regard.  Action acts as a pressure release.  Action is solution.  No need for further attention.  Chemical weapons?  Sleep easy. Mission accomplished.  You could airlift 2 million ab-tronic exercise devices to Syria and the US public would coo in the comfort at good being done.

And it is not just governments. It is no surprise that the media needed a new angle to this Syria tale, that NGOs needed to show success, that we were all emotionally drained by trying to think of the ever-worsening big fat disaster.  In other words, did we not know enough to understand that one major risk of speaking out against chemical weapon attacks was that the international effort would be diverted away from the millions of starving, abused, sick, wounded and frightened people? Absurd = perverse, does it not?

Now: what of polio? In one breath, Miliband laments the negative impact of chemical weapons as distraction and then raises the issue of polio.  Obviously, it may turn out differently.  And obviously, dealing with polio is a good thing.  But this is Syria 2013.  We ignore the law at our peril.

In the end, it is quite sad that ten cases of polio are able to generate more attention, and perhaps more momentum for change, than massacre after massacre, month after month, million after million.  A new outcry:   Stop the killing! Humanitarian ceasefire! We need to stop the polio!

Miliband is shrewd.  He comprehends the symbolic value in a polio outbreak.  He trumpets the potential for a polio campaign to give rise to a new “humanitarian bridgehead” inside Syria.  Polio vaccinations as a silver bullet?  That makes for a nice soundbite, but it ignores the governing law of the land.  The risk is that depoliomacy produces a great campaign and an even greater distraction.


Critique of Aid, Politics

The “New” Humanitarian Fig Leaf

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You can’t stop a genocide with pills, food and blankets.  That simple truth can, however, become camouflaged by those very same pills, food and blankets.  In short, that old humanitarian bugbear, the fig leaf problem:  governments toss the hustle and bustle of relief efforts at a situation as a mask for political inaction.  In the churn of that virtuous activity, we all sleep in the comfort of our well-publicized “doing something about it”.  In the face of complex issues and hard decisions, politicians find an easy out.

It’s not a useless “out”, of course, but helps only in a limited way because the real problem isn’t displacement, hunger or illness, those are the symptoms.  Remember, humanitarians aren’t supposed to fix war or poverty, but we should cut the fig leaf effect by being loud about the need for a fix by those with the power to do so.

But is that the end of our fig leafiness?  In terms of its goodness, when you think of Switzerland, what do you think of?  I think of it as one of those relatively congenial nations, mostly full of fairness, benevolence and good chocolate.  The political neutrality of the Swiss probably goes a long way to this relatively benign impression of a state.  Thinking harder, the role of Swiss banking darkens the picture – wealth on the back of drug cartel and dictator loot.  But somehow an image of peace and tranquillity – literally, of bucolic mountain vistas – prevails.

A recent editorial in The Guardian commented on the seedy side, even of Swiss chocolate.  Child labor, dirty dealings in commodities like oil and sugar, and even noting that Darth Vader’s helmet has Swiss origins.  Then again, there’s always the Red Cross, one of the great, good things in the world.  The picture brightens.

I am used to the idea that our organizational activities might act as a fig leaf, veiling the real story behind staggering inaction to such diverse crises as the genocide in Rwanda, the earthquake in Haiti and AIDS (yes, even there, throwing medicines at a socio-political disease).  I am not as used to or comfortable with the notion that we agencies ourselves function as a fig leaf for the venal politics of nations.  It’s a fig leaf not so much as mask but as counterweight; PEPFAR funding as a balance against drone assassinations.  Does the former enable the latter, the way a mafia boss buys acceptance through a host of charitable donations?

Now we have China, Kuwait, Turkey and India all trying to join the humanitarian system.  I thought such “Western-style” charity functioned as a Louis Vuitton bag of statehood and success.  Conspicuous consumption of “have” status.  Now I wonder if they coveted something more than arrivée cred.  Now I wonder if they seek to be humanitarians as ballast for dirty deeds and bloody hands that come with BRIC power.

So now I wonder about we agencies, proud emissaries and flagbearers for the generosity of our patron states.  Who in this business thinks of Oxfam and Save as the Swiss chocolate of the British?  Ditto for CARE and World vision in the US and MSF in France or Belgium.  Who knew that humanitarian action wasn’t simply a fig leaf for the inaction of politicians – it’s a fig leaf for action as well.

[So much for originality.  I already published a paper by more or less the same title as this blog, looking at how “humanitarian protection” acts as a fig leaf.]

Ready for some viewing?  Here are two humorous (and old) takes on aid, plus two links to some great work by BBC Four that aired last week.

1.  The Onion’s send off of the Save Darfur movement.

2. Ricky Gervais’ Africa appeal. Hilarious.

3.  The Trouble With Aid.   Piercing documentary by BBC Four on the limits of aid in a messy world.  And then the panel dabate featuring yours truly afterwards.  For now, unfortunately, they’re s only available if you’re in the UK.

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, 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.

Politics

The Bad Colonel

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A throng of gunmen haul a 69-year-old man through the dusty street. His chest lays bare, face bloodied. He is beaten and sodomized and shot.

What kind of person does not feel compassion? Well, me, the kind who understood the victim was Saddam Osama Gaddafy.

For an humanitarian, compassion isn’t just a nice thing, like a day without dust in Khartoum or stroopwafels in a care package. Stripped to its essential principles, compassion is humanitarianism’s driver. Not money and not adventurism and not do gooderism or altruism or charity and certainly not the twin devils of winning hearts and minds or building the legitimacy of the state. Compassion is what moves us to address the suffering of others, no matter that they are foreign to your family, village, clan, or nation. They are humans.  Compassion is also that common ground between the Christian ethos of Western missionaries and the humanist ethos of Western INGO staff on mission. Jesus would have felt compassion for the Colonel, no?

Compassion became a second victim of October 20th, Gaddafy’s final bad hair day. Like that sentence’s finish, an ambivalence allows acceptance of the inappropriate (Hillary’s laugh), the uncivil (meat locker visitation hour) and the illegal (his killing). It later struck me that I didn’t feel compassion, my heart too easily counterweighted the final half hour of abuse with his forty years of torture, violence and egomania.

While an individual manages to excuse himself for such an emotional, vengeful reaction, I find the official silence of the humanitarian community rather loud. Maybe not on Gaddafy’s death, because we don’t usually report on such singular events, but on the entire Arab Spring. We portray ourselves as defenders of law and of what is right and of fairness. Yet in these historic times we show the lack of compass so evidently present in our cousins, the human rights organizations. They’ve had this right all along. They’ve steadfastly and no doubt unpopularly and no doubt unlucratively documented and denounced the violations committed by the West’s very champions.  Maybe it is easier for them: their mandates force them look at what the law says and look at what the actors are doing.  For us, compassion and pragmatism often dictate when we exercise that part of our mandates to raise our voice.

Here, our compassion, like our neutrality, follows rather a rather lopsided set of mainstream Western mores.  In Tunisia, Egypt, Bahrain and Libya we humanitarians have seen victor’s justice; the treatment accorded to those on the side of the dictators by those who have raised their fists for freedom and democracy. We have seen the violent abuse of black Africans trapped inside Libya, condemned by the color of their skin to the accusation of mercenary. We’ve seen doctors not wanting to treat “them”. And we’ve seen those jumpy mobile phone videos of a wretched man dragged out of a drainage ditch. We’ve seen a great deal. We haven’t said much.

Critique of Aid

The Corporate Responsibility

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I came across this blog/forum at Tales from the Hood and thought I’d contribute:

In terms of the for-profit sector – those massive corporate-states we love to demonize – how many are naïve enough to believe that CSR is primarily motivated by a desire to do good, rather than an idea that doing good is useful.  CSR is a tool to build public image, morale and maybe even business itself.  Plenty of blogs and commentary out there testify to the rather cynical regard in which CSR is held. 

That cynicism might be well-earned (and not without its parallels in the government funding to which so many NGOs are addicted).  A corporation with a fiduciary responsibility towards its shareholders to create profit should not lightly engage in activities contrary to the banker’s bottom line.  Of course, CSR can be a way for considerable resources to be placed in the service of humanitarian goals. The world would be a better place if Big Pharma, for instance, would dedicate more resources to developing unprofitable lines of drugs for neglected diseases like kala azar and chagas. 

That said, it would probably be an even better place if Big Pharma wouldn’t spend so much effort in fortifying the protective walls around their products (read: profits) when effective generic drugs could help healthcare providers reach millions more people.  Now that would be an actual exercise in CSR.  In other words, CSR should cease to be a subset of activities/projects within the larger corporate mission, and should become instead a guiding principle of the corporation in the exercise of its mission.   In current practice, then, CSR is a figleaf, providing a get-out-of-unethical-behavior-free card.  What would stop a landmine manufacturer or a torture rendition firm from having CSR?  In short, the SR of CSR should cover the entire C, not just some part of it.

But let’s not stop at the C of CSR.  Why shouldn’t NGOs, especially aid INGOs, be scrutinized with the same level of cynicism?  The big ones are as corporate (though non-profit) as BP.  Well, almost.  Doesn’t our application of CSR to “them” betray an assumption about the motives behind our actions?  That when we do good, it is for the sake of the good itself.  Hence our blindness towards any sense of social responsility as a discrete element of our action, because we equate it with all our activity; we believe the SR ethos permeates the entirety of our organizations.  Of course, within an INGO it’s not the interest in profit driving aid activities, but one cannot deny the extent to which institutional interests drive INGO behavior, in particular the survival of the organization or of the jobs and way of life of its staff.  So what about NGOSR?  To what extent can we think of field activities – the building of a school, distribution of food, vaccination campaign – as SR?  To what extent are those activities a form of SR for the institution of the NGO?  They improve public perception, build morale, and generate the income which pays for offices and salaries and SUVs and an occasional booze up on an exotic beach.

Health

A Fat Tax on HIV+

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How many others missed this early April news gem?  Arizona Governor Janet Brewer proposed socking obese Arizonans who are enrolled in Medicaid or Medicare with a $50 surcharge unless they adopt a supervised weight-loss program prescribed by their doctor.  (Smokers will get nailed as well.). 

Congratulations to the Gov for the world’s first “Fat tax”.   

The Gov’s arguments run pretty simple along the surface:  unhealthy lifestyle choices and behavior eat up the healthcare budget, so let’s make these miscreants and self-indulgers pay.  After all, why should the public subsidize bad behavior?  Looked at differently:  If some guy like me wants to bicycle the streets of London without a helmet, running the lights, why take money away from cancer research to pay for his brain surgery? (It’s a slippery slope:  skiers and joggers are always breaking ankles, and that costs a lot of money, but taxing them would bring us right back to the obesity risk of blogging from the couch all day.).

If the Arizona governor sounds confused on the workings of blame here, as if people choose to be obese the same way our guy chooses to cycle recklessly, it’s because any debate on the merits or not of the fat tax as a public health policy is misplaced.  This is about trimming budgets, not waistlines.  Ha ha. From a health policy standpoint, blaming the sick sounds perverted, though I guiltily admit somewhat less so in light of estimates that the cost of obesity is the US range from $150 to $270 billion.  Isn’t that more than the continental budget for healthcare in Africa?  Anyway, from a financial standpoint, the fat tax is the sort of decision that will be increasingly more common as politicians and health officials scramble to save cash.

 Now flip to HIV/AIDS.  I recently visited MSF’s HIV/AIDS project based in Khayelitsha township, on the outskirts of Cape Town.  It’s an impressive programme, one that has led to a great deal of innovation on the treatment/delivery side of things and, more importantly, to a sizeable scaling up of HIV+ people receiving anti-retroviral therapy.  Depressingly, I found the decade of advances in HIV treatment have been unmatched by advances in preventing transmission.  It’s simple:  too many men refuse to wear condoms and they certainly aren’t interested in abstinence. 

During my visit I listened as young outreach and community education workers exhorted others on the need to do education in the taxi stands and drinking places, or called for opening hours in the evening, etc. etc.  Essentially, the same hopeful exhortations I heard 10 years ago.  As if a “new” or “improved” community messaging will actually produce a sufficient enough change of behavior to reign in this epidemic.  Aside from the fact that it doesn’t work well enough or fast enough in a context like South Africa, I’m still a fan of this sort of health education.  But limits need to be recognized.  The problem isn’t solvable through education because it’s not caused by ignorance.  That is a topic, though, for a later blog.

For now, back to Arizona.  How long before the logic of the fat tax will be applied to men and prostitutes in South Africa?  There, masses of people knowingly engage in high risk behaviour – becoming infected and (quite different from obesity) infecting others – and then fall ill.  They then assert a right to treatment.  So how long before the “no condom tax” or a “surcharge on unprotected sex”?  How long before money is switched out of HIV treatment into other health priorities at the ministry level, as is already happening on the global stage?  In the end, the Arizona fat tax heralds the coming day when budgetary pressure on the state forces a false distinction between “good” sick people and “bad” sick people.  After the obese, after the smokers, will come the reckless, be it the helmetless riders or rubberless fuckers.

Our Western Identity

Opening Salvo: Ask the poorest for funding

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How does one inaugurate a blog?  If I wait for that deep inspiration, some 3 paragraph reflection that cuts to the bone of the humanitarian aid industry … Well, now you understand why I didn’t get this going last year.  The other strategy is to opt for a more simple debut by just starting.  

Forget DFID (oops: UKaid).  Forget USAID.  Forget even CIDA and SIDA.  Humanitarian aid agencies should start seeking funds from the foreign offices in the countries where they work.  Need money for a cholera treatment centre in Zimbabwe?  Why not ask Botswana, Congo and Ivory Coast for funding?  Need to mount a measles vaccination campaign in Nigeria?  Why not ask the government in Sudan for funding. 

Well, one rather obvious answer would be the unlikelihood of actually getting any money.  And we all know it’s all about the money.   One can only imagine the confused faces of Zambian bureaucrats when a billion per year INGO rep asks for money to run its projects in Bangladesh.   But one other answer, and the answer you’ll likely receive from these governments and INGO HQs themselves, is fundamentally wrong.   The poorest in the world will have turned an important corner when we all get rid of the answer:  “Because we are poor.”

Did anyone notice the news last week that South Africa will launch its own development aid agency?  (See the IRIN article here:   http://www.irinnews.org/report.aspx?ReportID=91651).  South Africa joins emerging powerhouses such as India, China and Brazil as recipients of aid who are now entering the hallowed ranks of the aid business.  Whether a ploy to boost the standing of the country, part of a strategic investment in foreign relations, or, contrary to that rash of cynicism, the governmental embodiment of compassion for those in need, I think it deserves a couple of thumbs up.

In other blogs, I’d like to examine this as part of salutary trend towards ending the Western hegemony of what we refer to as aid.  The Western donor-INGO duet could use a little competition.  But I’d like to focus on something else.  The act of standing up.  In the IRIN article, Ivor Jenkins, of the non-profit Democracy for Africa (IDASA), has this to say about the SA announcement:  “I do think it’s important for us as a country to start to have a sense of responsibility, and giving and not only receiving as we have for many years.’”  

Sense of responsibility.  That just about nails it on the head.  Western aid agencies have been taking increasingly damaging and certainly well-earned straight rights to the chin on their neo-colonial and/or neo-imperial attitude.  {I’ll be writing about that in future blogs).  We swagger through other people’s homelands, delivering the aid to the victims of the state’s own failure towards its people.  States don’t mind the aid, but aren’t quite as keen on the swagger.  Imagine that.  But some governments have had an easy time of playing it both ways, finger-pointing at neo-colonialism while hiding too easily behind neo-colonyism, the international relations equivalent of a Stepin Fetchit routine.  Poor countries as beggars who must shuffle through the corridors of the rich nations, whose economic and historic superiority impose an expectation of  moral duty to ship their money South.

The stereotype creates an existential split.  Not between wealthy countries and poor countries, as if those categories determined who should and should not give aid.  Certainly not between nations actually capable of sending aid to other nations and those incapable (Should Ireland be sending its cash anywhere?).  No, this is a split between those nations assuming the role of beggars or victims and those who assume the position of lord and savior.  More than acknowledging a sense of responsibility, SA’s move is a declaration that poverty is no excuse for the incapacity to help nations, just as wealth is hardly a guarantee for either compassion or generosity.

So future kudos to the first aid agencies that stop reinforcing the existential victimhood of governments in the developing world.  Let’s treat every government as sharing in the responsibility to come to the aid of people in crisis, both within and without their territory.  Let’s stop acting neo-colonial and ask governments to stop acting like neo-colonies. 

And kudos to the government of South Africa for embracing a lesson already being taught by poor people the world over.  If you look closely in places like Haiti, Darfur and Eastern DRC, you’ll find not places where the Western aid enterprise has saved helpless masses of people, but where the WFP convoy-sized gap in aid (2200 kcals per day!) is filled by the countless invisible acts of kindness between families, neighbours and strangers, all part of the same community of the abject poor.