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Abstract

Humanitarian action is the active provision of aid designed to save lives, alleviate suffering, and restore and promote human dignity in the wake of disasters and during large-scale emergencies. The humanitarian action that is the focus of this entry is the Dunantist tradition of humanitarianism that adheres to the humanitarian principles of impartiality, neutrality, and independence. In its current form, humanitarian action is enshrined in international humanitarian law and provided by intergovernmental organizations and international nongovernmental organizations. Bioethical issues are numerous and profound. Humanitarian action constantly negotiates between a minimalist and secondary morality, struggling to save lives but also to further human dignity among adversity and animosity. It challenges current arrangements of power and demonstrates an ethic of refusal. The work can be dangerous and aid workers and the populations they aim to serve face resource scarcity, tragic choices, and physical and psychological traumas. Humanitarian organizations struggle to ﬁnd an ethical foothold under neoliberal globalization, so as to fulﬁll humanitarian objectives without reinforcing a global economic system that makes life so precarious for so many. While humanitarian action is context speciﬁc, it remains a coherent and collective expression of compassion.

Introduction

Humanitarian action is the active provision of humanitarian aid: aid designed to save lives, alleviate suffering, and restore and promote human dignity in the wake of disasters and during large-scale emergencies. Beyond this deﬁnition, there is variation in how humanitarian action is framed and understood. It can be perceived as political or nonpolitical, as secular or non-secular, as a movement or an institution, and as short-term emergency response or longer-term development and guided by or apart from humanitarian principles. As Barnett (2011) argues, “[w]e live in a world of humanitarianisms, not humanitarianism” (p. 10). The humanitarian action that is the focus of this entry is the Dunantist tradition of humanitarianism, named after Henri Dunant, a founder of the International Committee of the Red Cross (ICRC) in 1863. The Dunantist tradition of humanitarianism is emblemized by the Red Cross, enshrined in the Geneva Conventions, and protected under international humanitarian law. This humanitarian action is the principled act of saving lives, alleviating suffering, and restoring human dignity; it comes in response to populations in danger and communities in distress and provides tangible succor in the form of materials, services, and medical care. Providing care to groups of people in emergencies requires coordinated, collective responses, calling for workers with a range of skills and from a variety of vocations and professions – aligned with the needs speciﬁc to particular contexts. However, humanitarian action has inherent limits. For at its core, “humanitarianism occurs where the political has failed or is in crisis” (MSF 1999).

This entry deﬁnes humanitarian action with attention to its historical and substantive contexts. It offers relevant background and conceptual clariﬁcations and elaborates on key areas of ethical contention. These include: (1) minimalist versus secondary morality and an ethic of refusal; (2) operational ethical challenges; and (3) functioning under neoliberal globalization. It concludes with a reﬂection of humanitarian action’s essential role and inherent limitations.

History And Development

From The Enlightenment To Dunantist Humanitarianism

Modern humanitarianism stems from the Age of Enlightenment, when critical thinking and discourse challenged conventional boundaries regarding who and what deserved attention and care. The new philanthropists began pursuing social reforms that would make broad improvements in human welfare and began to oppose the suffering resulting from slavery, destitution, inhumane forms of punishment and incarceration, and cruelty to animals. Along this line, cosmopolitanism grew from questioning the moral signiﬁcance of boundaries between nations and states. Cosmopolitans challenged the geographic limits of what was deserving of attention and care and expanded concern to “others” in distant lands. Modern humanitarianism encompasses aspects of both philanthropy and cosmopolitanism. Its cosmopolitan appeal is most acutely felt in times of crisis, when technology relays images of suffering immediately into homes across the world.

Immanuel Kant exempliﬁed cosmopolitanism in his essay Perpetual Peace (1795); Kant’s essay sets a foundation for international distributive justice, collective responsibility, and a common humanity. The more contemporary philosophers Peter Singer and Thomas Pogge build on the cosmopolitan notion of moral obligations to distant others. In Singer’s seminal publication “Famine, afﬂuence and morality,” he argues that those of us who have beneﬁted from economic injustices have a moral obligation to assist those who suffer under them (Singer 1972). Pogge agrees with Singer that we have an obligation to respond to those in destitution and poverty throughout the world, but his conclusion is based on negative duties not to harm others and to provide restitution when we have done so. Examples of such harms are historic and current injustices under colonialism and neocolonialism (Pogge 2008). Humanitarianism is called upon to address large-scale suffering that is often rooted in colonial and neocolonial structures of power.

Modern humanitarianism is reactionary and has evolved and adapted to new forms of suffering. Barnett (2011) identiﬁes three ages of humanitarianism: imperial humanitarianism (1800–1945), neo-humanitarianism (1945–1989), and liberal humanitarianism (1989 to present). The current liberal humanitarianism is marked by globalization and international responses to diverse forms of crisis and disaster. Humanitarianism as a vocation is rooted in three traditions: the religious, the Wilsonian, and the Dunantist (Stoddard 2003). Religious humanitarianism is the oldest form of humanitarianism, evolving out of overseas missionary work. Wilsonian humanitarianism is named after US President Woodrow Wilson, who felt that American NGOs could best help the world by providing both humanitarian aid and furthering American aspirations and values (America’s “manifest destiny”), particularly during the Marshall Plan after the Second World War. Dunantist humanitarianism, named after the Red Cross founder Henri Dunant, adopts the humanitarian principles deﬁned below. The liberal Dunantist humanitarianism is the dominant form within the international humanitarian enterprise and is the focus of this entry.

Humanitarian Principles And The International Humanitarian Enterprise

Humanitarian action is founded on the principle of humanity that all human beings are entitled to be treated humanely and to receive lifesaving assistance simply by virtue of being human and on the humanitarian imperative that people have a right to receive humanitarian assistance and humanitarian actors have a right to provide assistance wherever it is needed. Humanitarian action observes three additional guiding principles: neutrality, impartiality, and independence. Neutrality refers to abstaining from engaging in military operations or taking sides in hostilities or controversies of a political, religious, or ideological nature. Impartiality means providing assistance based on need alone and without discrimination, with priority given to the most urgent cases of distress. The principle of independence stipulates that humanitarian organizations should not have links to parties in the conﬂict nor have a stake in its outcome. Principled humanitarian action thus serves the interests of beneﬁciaries rather than political, religious, or other agendas. It is not to serve as cover for military operations, religious proselytism, or commercial enterprise, nor is it to be manipulated by economic or geopolitical strategic interests. Terms and conditions of humanitarian action guided by these principles are enshrined in the Geneva Conventions and protected under international humanitarian law.

Humanitarianism originated in the battleﬁeld but has since broadened its ambition. While it still responds to the devastating and far-reaching effects of war and political/sectarian violence, it also responds to other assaults on human life such as natural disasters, famines, disease outbreaks, population displacement, and systemic social injustices relating to poverty, inequality, and neglect. Such problems of human suffering, or crises of humanity, overwhelm local capacities to respond and thereby demand external assistance. Emergencies are not humanitarian emergencies per se, but social, political, economic, and/or environmental emergencies demanding a humanitarian response. The notion of the humanitarian emergency is therefore contentious in that the label may have a sanitizing effect, obscuring the root causes of crisis and delimiting the response to the humanitarian sector.

Many actors such as governments, militaries, religious organizations, and charitable organizations, as well as family, friends, and neighbors, provide immediate and longer-term assistance to victims of crisis and disaster. However, these responders are typically considered to be part of local resiliency – the social safety net – and are not considered part of the humanitarian enterprise. In usual parlance, humanitarian aid refers to emergency assistance provided by intergovernmental organizations and international nongovernmental organizations (NGOs): these organizations are generally based in the Global North and have satellite ofﬁces around the world. They typically mobilize in response to crises and disasters in resource-poor settings in the Global South. Examples of humanitarian organizations include United Nations organizations such as the United Nations Refugee Agency (UNHCR), the United Nations Children’s Fund (UNICEF), and the World Food Programme (WFP), as well as the International Committee of the Red Cross (ICRC) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and private international NGOs such as CARE, Oxfam, Save the Children, and Médecins Sans Frontières (MSF). Humanitarian action is context speciﬁc, but typically includes the provision of primary healthcare, water and sanitation, food and nutrition, shelter and site planning, public health surveillance, vaccination campaigns, and disease outbreak response. The UN Ofﬁce for the Coordination of Humanitarian Affairs (OCHA) has a mandate to coordinate the many large and small organizations that make up the international humanitarian response. High-proﬁle emergencies (the donor darlings) typically elicit well-funded responses from multiple organizations, whereas low-proﬁle, protracted emergencies in less geopolitically strategic areas (the donor orphans) may expect little or no response.

Unlike development aid, humanitarian aid is generally intended to be short term in nature and in response to immediate needs. After mounting an emergency response, humanitarian organizations will formulate an exit strategy and withdraw when the crisis is over or when they can hand over to a partner organization such as the local ministry of health or another NGO. While humanitarian projects may be intended to be short term in nature, reality is often different. Humanitarian organizations ﬁnd themselves locked into complex situations of extreme deprivation, serial natural disasters, chronic low-intensity conﬂict with recurrent spikes of violence, and deliberate abuse or neglect of vulnerable populations. In such situations, there is seldom a feasible exit strategy. Humanitarian aid organizations may ﬁnd themselves working for decades in a single locale.

Humanitarian aid is independent from but sometimes coordinated with aid and services provided by governments and militaries, although humanitarian aid excludes the use of military force and is not synonymous with the term “humanitarian intervention,” a euphemism for a military intervention on supposedly humanitarian grounds such as the United Nations responsibility to protect (R2P) initiative. During armed conﬂict, humanitarian actors negotiate for humanitarian space, a space of both conceptual and geographic importance where humanitarian action can occur unhindered. The term “humanitarian space” was popularized in the 1990s when the former president of MSF used the phrase espace humanitaire to refer to an environment in which humanitarian agencies could operate independent of external political agendas. Should civilians be trapped by ﬁghting, humanitarian actors will negotiate a humanitarian corridor allowing safe passage to humanitarian space. While the delivery of humanitarian aid is apolitical, it can have profound and far-reaching political effects. For example, the call for humanitarian healthcare and vaccination campaigns has facilitated ceaseﬁres in what has been described as health-for-peace initiatives.

Ethical Dimensions: Humanitarian Action And Bioethics

Minimalist Versus Secondary Morality And An Ethic Of Refusal

Merely keeping people alive versus doing more in the interest of human dignity (serving bios versus biography) is a running and largely unresolvable tension within humanitarianism. The tension lies in humanitarianism’s foundation in battleﬁeld ethics, as well as in conventional interpretations of the principle of neutrality that view humanitarianism as strictly apolitical. When humanitarian actors engage in political discourse or action – however compelling or seemingly justiﬁed the reason – they move into the domain of the ideological and surrender their neutrality. Organizations can be perceived as non-neutral for engaging in develop mentalism, peace activism, nation building, or human rights advocacy and for advocating for the use of force to protect populations in danger (as with the R2P initiative). Should humanitarian organizations be viewed by governments or belligerents as non-neutral, access to civilian populations can be obstructed or denied.

Perhaps as an unintended consequence, humanitarian aid tends to preserve current arrangements of power and reinforce the status quo; humanitarian organizations are reluctant to speak out against harmful policies or to advocate for marginalized populations for fear of losing their neutral status. This reduces humanitarianism to a minimalist morality:

Humanitarianism has replaced the imperialist and ideological discourses to become a substitute for politics and justice. The palliative ideology, the morality of urgency, the ambulance politics are supported by a morally indolent constituency that loves cheering its humanitarian heroes and sanctifying the victims.. . Contemporary humanitarianism is a shelter value, a minimalist morality not based in a categorical imperative but in emotions over circumstances. (Raich 2002, p. 4).

Proponents of a more vocal or activist humanitarianism argue that the minimalist-morality humanitarianism is at best mere charity and at worst complicity in atrocities and gross violations of human rights. In serving humanity, humanitarian action demands a secondary morality:

[D]oing anything to, with or for people always incurs a secondary morality. Humanitarian action is no exception. It would be wrong simply to save and protect people in any way. There are good and bad ways to save people that are determined by wider moral goods around their personal, social and economic dignity. You can’t just save and leave. You can’t just save by cruelly concentrating people in camps. You can’t just focus on a few survivalist priorities while driving up local rents and salaries in a way that impoverishes others and starts a brain-drain. You can’t just save people without an eye to their continued protection or their future livelihood. .. . As any humanitarian worker will tell you, real relationships between people means that you cannot just stop helping because they are alive and have not died. Being alive brings with it wider needs and wider moral goods. (Slim 2003, p. 3).

Because humanitarian action incurs a secondary morality, there is a need for a revisioning of the principle of neutrality, one that does not equate with complicity in the face of gross violations of human rights, but that allows humanitarian aid workers to speak out and condemn actions, policies, and individuals that breach human rights or humanitarian law. An important distinction is that such criticisms are directed against people or groups based on what they do, not on who they are.

Témoignage is an example of this form of advocacy as practiced by the medical humanitarian organization MSF. The word “témoignage” comes from the French verb, “temoigner,” which literally translates as “to witness.” Témoignage means sharing experiences and raising public awareness about intolerable situations as a pillar of humanitarian action. Decisions to speak out are balanced according to the interests of aid recipients, the risk of retaliation against aid recipients and humanitarian aid workers, and the risk that the organization will be expelled from a region or country. When organizations are not speaking out publicly, they may be operating behind closed doors within the corridors of power, using nuanced or strategic approaches to advocacy. Quiet diplomacy sometimes produces better results (Magone et al. 2011).

Inherent in humanitarianism is the ethic of refusal. The ethic of refusal “directly challenges any logic that justiﬁes the premature and avoidable death of a part of humanity in the name of a hypothetical collective good” (Hofman and Delaunay 2010). It rejects notions of disposable and surplus populations. It refuses to believe that human suffering and preventable deaths are acceptable trade-offs for any political order or economic system. The ethic of refusal demands that people not be sacriﬁced today for the promises of a better tomorrow. Inevitably, because of the ethic of refusal, humanitarian action clashes with the established order. The term “ethic of refusal” has also been used to express the duty of humanitarian organizations to refuse to participate when humanitarian aid is co-opted, misappropriated, fuelling and prolonging conﬂict, or in some other way exacerbating human suffering.

Operational Ethical Challenges

Humanitarian action has no assurances within shifting geopolitics. It struggles to respond and adapt within contexts of asymmetrical and unconventional warfare, the targeting of civilian populations, the use of rape as a weapon of war, the co-optation of humanitarian aid within counter-insurgency operations, and the calculated destruction of healthcare facilities. Operating under austere conditions amidst often extreme levels of violence, humanitarian aid is subject to abuse, manipulation, and direct attack. Belligerents can be ignorant of or indifferent to international humanitarian law and perceive no difference between invading Western forces, intrusive Western corporate culture, and the corresponding wave of Western NGOs. Belligerents often target the beneﬁciaries of humanitarian aid as a method of intimidation and control. Preventing people from receiving humanitarian aid is a way to demonstrate the power of an otherwise peripheral or insigniﬁcant militia group. Punishing recipients of aid is a way to prevent local populations from associating foreign actors with benevolent aid that wins hearts and minds.

Aid work is a dangerous occupation. Every year, aid workers are murdered, kidnapped, raped, or beaten. Crimes against aid workers can be politically motivated, but aid workers are also subject to common criminality. Where there is severe deprivation and a breakdown of social cohesion, aid workers may make easy targets. Humanitarian aid workers also fall victim to more mundane hazards such as diseases and motor vehicle accidents. And importantly, they are subjected to psychological trauma from witnessing or experiencing extreme levels of violence and suffering and from having to “play god”: making impossible life-and-death decisions in the line of their work. (To be sure, however, much aid work can be without incident and even routine or boring.)

At a macro level, humanitarian organizations have to make difﬁcult decisions regarding which crises they will respond to – what sorts of disasters and in what parts of the world. These decisions are made according to organizational mandate, ability to respond, measures of added value, prioritization in relation to other emergencies, and the participation of other actors. While such decisions may seem operational in nature, they invoke deeper ethical questions: How many people must die before a situation is deemed an emergency? What if allocating resources to a new emergency means cutting back in another? Is it ethical to address a singular issue (e.g., cholera or measles) when there are dire broader needs? Should the organization have a certain level of competency and commitment before initiating a response? Is the organization responding because the emergency is highly publicized and well-funded (a donor darling) at the expense of other crises that are hidden and neglected? Should the organization initiate a project if there is no conceivable exit plan? Will the humanitarian response be used to justify government inaction and the redirection of resources? Will the project create a “pull factor” and put people at greater risk? Is the situation too dangerous for aid workers? Could the team be quickly evacuated to a safe location? Obviously there are many questions with no easy answers and little time or reliable information on which to base them.

Once projects are initiated, there are a slew of ethical challenges and dilemmas relating to the day-to-day experience of humanitarian action. Many, often harrowing, accounts have been written from the perspectives of expatriate (expat) humanitarian aid workers. Such accounts speak of experiences in providing humanitarian aid in times of war, sectarian violence, population displacement, complex emergencies, disease outbreaks, and within an inadequate international humanitarian complex. Ethical challenges can lead to psychological trauma. Psychological trauma results from having to perform tasks beyond one’s competency level, working within complex historical, social, political, and commercial structures and having to bend to aid agency policies and agendas (Schwartz et al. 2010). Aid workers, after having made disturbing ethical compromises and impossible decisions, may have trouble reintegrating after returning home.

Many see humanitarian aid work as a higher calling, and aid workers are often celebrated as heroes. Their adventures and exploits are popularized in books and movies, where the humanitarian persona (drawing on gender stereotypes) ranges from cowboy doctor to saintly nurse. The persona ﬁts the white savior narrative, a racist trope in which a white character comes to the rescue of people of color. Along this line, victims of disaster are faceless, infantilized, and wholly dependent. Of course this narrative is simply untrue on all fronts. Expatriate (or expat, foreign) humanitarian aid workers are far outnumbered by their national counterparts. As an illustration of this, MSF’s national staff make up around 90 % of all its ﬁeld workers. Simply put, most humanitarian aid is provided by national staff: local professionals and skilled workers who are well versed in the regional languages, customs, and contexts.

National staff are particularly vulnerable to violence and attack. National aid workers serve as health professionals, ﬁeld managers, security guards, and drivers. In highly volatile contexts, NGOs often run projects remotely; rather than sending in expats, organizations will depend on their national staff for the running of day-to-day operations. Because of this, national staff are subject to greater security risks. Therefore, international organizations have a moral responsibility to support and protect national staff, and national staff should be consistently consulted regarding security.

Humanitarian Action Under Neoliberal Globalization

The main challenge for bioethics today is the impact of neoliberal market ideology worldwide. (ten Have 2013)

State governments have moral and legal obligations to ensure conditions for their citizens to be healthy, an inherent responsibility to advance their population’s health and well-being. Humanitarian organizations may inadvertently absolve states of these obligations when leading the charge in public health emergencies. The involvement of international humanitarian organizations is not benign. When international humanitarian aid organizations “come to the rescue,” they not only appropriate government responsibilities but also validate private foreign involvement, medicalize social injustices, and undermine local forms of resilience. Given that healthcare services are viewed as commodities under the prevailing neoliberal ideology, the international humanitarian response to crises can be viewed as the contracting out of essential health services to private transnational NGOs. Within this logic, beneﬁciaries of aid are referred to as clients in a bid to harmonize aid with contemporary policy frameworks.

The transitioning of health services from government to NGO has been called philanthrocapitalism, the NGO-ization of global health, voluntourism, and the charitable-industrial complex. Rather than challenging the root causes of crises, attentions turn to issues of professionalism and cost-effectiveness. Through this process, the effects of social injustice are depoliticized, fragmented, and compartmentalized into NGO issues and projects (Choudry and Kapoor 2013).

In this perspective, international NGOs can be viewed as Trojan horses for neoliberalism:

Current ways of working in northern NGOs, adopted because of pressures to become more professional, to make complex development realities manageable, and to obtain funding – all donor requirements – increasingly follow agendas set by the multi-and bi-lateral organizations. They often appear to be only infrequently offering an alternative voice or a source of alternative values, ideology and thinking; they more often appear as extensions of the dominant aid agenda. (Wallace 2004, p. 216).

Under neoliberal globalization, humanitarian organizations compete for donations on the open market and are forced to overstate their own importance in the pursuit of private donations, while governmental and intergovernmental health institutions are locked in a downward spiral of being underfunded and undermined. The effect is destabilizing for global health, but the tragic consequences are hidden in the triumphalism surrounding the humanitarian response. Triumphalism is the the illusion of moral victory and neutrality in the face of global health injustice (Raich 2002). Humanitarian philanthropy creates illusion that the global economic system is benevolent, compassionate, and eager to “give back” to those in need. It applies technocratic expertise in transcending the failings of marginalized state institutions, justifying parallel systems and foreign intervention (Levich 2014). As was demonstrated in the international humanitarian response to the West Africa Ebola crisis: “Popular portrayals [in the mainstream media] continue to solely blame Africans for their weak governments and healthcare systems, while elevating former colonial powers – which were erected through black suffering – as generous benefactors” (Harvard African Students Association Political Action Committee 2015).

Ideologically, the neoliberal marketplace favors private charitable organizations – the third sector – over democratically accountable governmental and intergovernmental organizations, since it can mean reduced tax spending and smaller government. Private humanitarian organizations can prove more efﬁcient under competitive market conditions by relying on donations, volunteers, and temporary workers. Hence, contemporary humanitarian discourse is less about social justice and solidarity and more about ideological views of competitive efﬁciency and professionalization. A pointed concern is that the humanitarian enterprise can amount to little more than an ad hoc system to mobilize foreign health workers. When humanitarian responses come to an end and when projects close, expatriate staff return home, national staff are laid off, and the preexisting conditions persist: not just the material conditions, but the social and economic policies that resulted in the initial high mortality and suffering (Polman 2011).

Not all humanitarian organizations acquiesce. Many have taken additional actions to address injustices and intolerable situations. For example, there are now broader humanitarian appeals demanding that lifesaving medicines should not be a luxury (the Campaign for Access to Essential Medicines), that economic trade agreements should not sacriﬁce public health (campaigns against the Trans-Paciﬁc Partnership Agreement), and that people ﬂeeing intolerable situations should not be maltreated and persecuted (the Health for Undocumented Migrants and Asylum Seekers Network). On the surface, these broad appeals may seem more closely aligned with the human rights movement. However, motivations stem from the realpolitik of humanitarian action and the ethic of refusal, illustrating humanitarianism’s inevitable clash with the established order.

Conclusion

Humanitarian action could be deﬁned as aid provided by volunteers, at great personal risk, in distant lands, in contexts of disaster, government incompetence, abuse or neglect, and typically during armed conﬂict. However, these features describe its conditions rather than its essence. Many humanitarian aid workers are paid competitive wages, humanitarian projects are undertaken in collaboration with local and national ministries of health, and humanitarian action extends well beyond warzones. Therefore, humanitarian action has some broad deﬁning characteristics but is ﬁercely context speciﬁc. It varies in terms of sociopolitical context, population in need, mandate and capacity of the organization, nature of the response, and intended and unintended consequence.

Humanitarian action conjures notions of an active and activist humanitarianism, one that eschews the passivity associated with conventional, inadequate, or inappropriate aid and suggests a deﬁant, unbound, and creative response to large-scale human need in tragic circumstances. Humanitarian action intends not only to address novel sources of human suffering but also to address vehement criticisms of the humanitarian enterprise itself. In so doing, it strives for more than a minimalist morality, simply keeping people alive, but also to further autonomy, self-determination, and dignity. However, despite its best efforts, humanitarianism can be nothing more than “the least bad of awful alternatives” (Barnett 2011, p. 6). Others expressions of the limits of humanitarian action are “there are no humanitarian solutions to humanitarian problems” and “you can’t stop a genocide with doctors.”

Humanitarian action continues to expand in response to diverse and complex forms of crises and human suffering. Contemporary humanitarian action is directed toward groups ranging from refugees and internally displaced persons (IDPs) to prison inmates and sex workers. Aid has come to include “more than Band-Aids,” from sophisticated surgeries and treatments for HIV/AIDS and drug-resistant TB to counseling for survivors of rape and torture. Sophisticated assessment tools and international supply chains facilitate nuanced and context-speciﬁc responses that incorporate cutting-edge technologies and a wide range of skilled workers and professionals. It is expanding to include the rescue of migrants at sea and healthcare for asylum seekers in European capitals. It involves emergency planning for the specter of failed states and for the disastrous and emerging consequences of global climate change. The future of humanitarian action is dependent on a barrage of forces and counter-forces within the prevailing geopolitical and economic order. Mostly, though, its future is dependent on collective expressions of compassion.

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