Tuesday, December 7, 2010

Interesting, Provocative Article on Humanitarian Aid

So, a friend of mine sent me this super interesting, very provocative article in the New Yorker and I liked it so much I had to share. Here are my thoughts:


So...my response got kind of long-winded...long story short, I think the article is true, but unfair, perhaps in an effort to be provocative. It all comes down to finding a balance between accepting/recognizing the moral imperative to heal the wounded and help the helpless as a reflection of the compassion of human nature, and aiming to be practical in a world with limited resources and less-than-moral individuals. I personally side with the former, but that could change as the world hardens me. haha. optimism vs. practicality, and picking the lesser of two evils--those are biggest and simplest things I took away from the article. Are you willing to sacrifice the lives of the innocent to hurt the guilty by inaction? Or will you save the innocent, while indirectly supporting the guilty?

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But if you want to read my detailed thoughts...haha:

The argument made by homie from RUF who claimed to be rescuing the country by increasing violence and upping the ante, attracting humanitarian aid is an interesting one, but it's kind of like the Machiavellian argument, the ends justifies the means...which is a contentious assertion. I can't really take that argument seriously--it seems to me, to be an excuse for their actions, and one that shouldn't be accepted so easily to relieve them of the obligation to take responsibility for their actions.

The Sierra Leone moral hazard sitch with the bribery for kids and the amputees playing to the media is sad, but true. I mean, it just shows that everything is a business looking for a market...on a lesser scale, and less dramatically, the same thing happens with the parroquia in San Lucas. All these volunteers come down to move rocks around, or a team of docs comes through for two weeks to see a bunch of patients, ignorant to, or perhaps, choosing to ignore, the importance of a continuum of care...What happens to these patients after they leave? Who's there to ensure compliance? So it turns into this thing where the greatest benefit of a lot of the volunteers coming through is that they bring money to spend. The pts get antibiotics, which they might or might not finish, pain meds for chronic arthritis that'll last two weeks, etc. Here, I agree with Polman when she says that many humanitarians are not accountable to anyone or anything. They accept the credit, but not the blame. They wouldn't feel as warm and fuzzy inside if they did--a sentiment echoed by Maren later in the article. (And for some people, it's important to feel that way...it's what inspires people to want to help.) Not to be pessimistic or anything. I appreciate the fact that this trip may be a sacrifice for them, and that they feel their work rewarding. but after the self-righteous glamor has faded from all this humanitarian effort, it's important for volunteers to bring what the community needs, not what the volunteers think the community needs. I think, anyway. But I mean, I'm not an expert nor do I have much experience. It's obviously a complicated issue.

The Nightingale-Dunant argument. Both sides have their own merit...but which is the lesser of two evils? Letting all the wounded be, hoping the war-wagers will have enough compassion to scale back...or accepting the fact that war will happen and taking on the moral imperative to help the innocent, or even not-so-innocent, wounded. That depends entirely on individuals' perspective and experiences, which you can see with Nightingale and Dunant. Nightingale had seen the horrors of war and was hardened by it, whereas Dunant was acting off an overwhelming sense of compassion incited by seeing the multitude of wounded, helpless. With the Nazi/Red Cross thing, for example...you either help the prisoners, indirectly supporting the Nazis, or you help neither. In the case of the former, you're writing off the innocent prisoners, claiming them as casualties of a cold war. Only if the Nazis have a conscience would it bother them to see the prisoners dying without the aid. But the Nazis weren't even torturing the prisoners to attract aid. They were doing it as part of their whole superior race philosophy. Whether or not aid had come, they would have continued carrying out their experiments. In my (humble) opinion, I think the Red Cross did what it had to--carried out the moral imperative to help, as the lesser evil when compared to leaving them to their own devices in the concentration camps.

I do think though, that Polman has a point with the journalists. It's easy to fall into line with the hope-bringing humanitarians--it seems like a black and white issue, a cause for which it's easy to rally. So even "neutral" journalists fall victim to biased reporting, favoring the humanitarian side. But I think that too, reflects a side of human nature...to pick compassion over manipulation or persecution. It's this tendency to side with "compassion" that makes this particular article (which doesn't exactly do that) so provocative.

It makes me a little uncomfortable to read, "Had it not been for the West's charity, the Nigerian civil war surely would have ended much sooner." (I suppose that's the point.) But it's hard to weigh one life against another...you're basically asked to choose between saving the lives of those hurt by the war, or saving the lives of those hurt by extended war (allegedly due to helping those hurt by the war). If you were the daughter or husband or mother of someone hurt by the war, you would unhesitatingly advocate for that patient, regardless of the pain it might bring to however many others. But as unconnected spectators, it's easier to be utilitarian about it and just count the number dead, choosing the smaller number.

As far as the inspiration behind humanitarianism...yes, it does in part, come about because people have lost faith in economic and political avenues to help, but i think you also need to consider the distinct strengths and interests of individuals. Physicians are more likely to advocate for clinical interventions; human rights activists for political change, etc. I can't remember...I think it was with UNICEF that there were the shifts between prioritizing clinical interventions (like ORS and immunizations) or political advocacy to help other countries...when one was prioritized, the players for the other team criticized. There was the whole Carol Bellamy critique in the Lancet and such. When human rights were prioritized, physicians criticized the politicians for ignoring the dying babies as they awaited political change. When clinical interventions were prioritized, the rights activists criticized the physicians for ignoring, and perhaps abetting, the corrupt regime behind the cause for the deaths. Same argument played over and over again.

I think the base argument that's brought up is optimism vs practicality. But you need both, and it's important for there to be individuals fighting for both sides. Imperfect people make imperfect decisions in less-than-ideal situations. As long as people have the conviction to make the tough decisions, someone somewhere will be helped...and inevitably, someone else will be hurt. So. Maybe it comes down to who has the stronger advocates.

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