Nongovernmental Organizations (NGOs) Research Paper

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NGOs are global actors in today’s world and play a vital role in the provision of goods and services in varied contexts. They have made and continue to make important contributions in serving marginalized, poor people and people in conflict and war areas at the local, national, and international levels. Until recently, the bioethical dimensions to their work had received no special attention. Any discussion of the bioethical issues that arise within NGOs should be viewed with the perspective of the global development theory, international human rights law, against the background of theories of justice within international aid. This entry discusses the development of NGOs, its different forms, varieties of its work, and the bioethical challenges that humanitarian, human rights, and development NGOs encounter in the conduct of their work across the globe.


There is a wide diversity of NGOs and their roles. NGOs have become increasingly important in relation to ideas and debates about “civil society,” globalization, and in the field of international development aid. They have also become central to development theory and practice. Generally, they are nonprofit organizations, and yet there may be exceptions to some operating for profit, engaging in lobbying for profit-driven interests. The category of organizations described as NGOs is extremely diverse. They do a variety of works ranging from humanitarian relief to development and human rights advocacy. Some of them focus on single issue such as gender equality, HIV/AIDS, climate change, health, and education, while some others engage at a larger level of policy goals such as poverty eradication. These organizations have contributed to the development of communities around, and they play a role in protecting and promoting human rights across the globe. They are also important partners of the government in the implementation of activities, projects, and programs designed for community developments. NGOs are regulated by the domestic law of the country in which they are registered and/or operate. They are not bound by international human rights laws. Nevertheless, they are expected to observe the principles and norms contained in these laws rooted in the international Bill of Rights.

It is difficult to understand NGOs properly without reference to government in relation to which they are commonly defined and the international aid system to which many of them are linked through funding and other relationships and of course international human rights law. NGOs have contributed greatly in the area of people-centered development. In this light, the rise of NGOs should also be viewed in relation to the broader understanding of development. Consequently, NGOs are development actors both at the local and at the international levels. For the purpose of this entry, three kinds of NGOs are identified: humanitarian, human rights, and development NGOs.

Different theories of development have been expounded at different times. Each of these theories has related to NGOs in different ways. At the initial stage, these theories or perspectives had in fact little to say about the roles of NGOs. It is the more pragmatic development theories associated with recent trends that have fully engaged NGOs. This of course led to NGOs becoming a vital concept in contemporary concepts of development. It is the gross inequalities in life resulting in massive poverty that is the reason for the demand and supply for NGOs’ services. In this regard, they are concerned with the promotion and protection of the rights of people to the basic necessities of life. This is where NGO path crosses that of global bioethics (Faunce 2014).

The advances in biology, medical research, and technology bring with them bioethical challenges that affect the individual and the protection of the individual’s rights. The primary aim of bioethics is to protect the dignity and fundamental rights of the individual with regard to the application of biology and medicine. It was not until recent times that political philosophers or bioethicists began to address ethical implications arising from the massive scale of global inequalities. In the past, questions of justice were believed to be internal to nation states. Interestingly, over the last decade, there has been an increasing interest in the philosophical issues in global justice. These issues are of course of direct relevance to bioethics. In the past, questions of global health were also separated from questions about distribution of global resources and the institutions governing the world’s social, economic, and political systems.

The central concern of bioethics has been the ethics of individual interaction between physicians and patients and between researchers and research participants. However, since the past decade, the scope of bioethics has expanded. This arises within the context of the knowledge of the importance of the systems within which health-care and research work take place. These systems shape people’s options and the healthcare decisions and determine the resources available to them. All these raise questions as to the justice of the systems. The fact that bioethics relates to basic human rights raises ethical challenges. In our globalized world, bioethics has to also face challenges of global scope. Global bioethics has evolved to embrace issues that relate to biosciences, human rights, and human dignity. This makes bioethics also a social intervention area. There is growing awareness that interactions between NGOs and their beneficiaries take place within the backdrop of global inequality. This inequality is seen as the source of a number of bioethical challenges (Millum 2012). In this light, considerations of global justice are seen to be relevant to global bioethics. We know that different theories of justice diverge in their implication for a number of challenges in global bioethics. What should be then regarded as the ground of fairness of such social relationships that NGOs should have with their beneficiaries? These theories and the challenges in the area of bioethics now intersect.

History And Development

The history of the development of the bioethical challenges in the work of NGOs may be best viewed through the perspective of the development of NGOs as a sector. These NGOs are increasingly involved in monitoring, preventing, alleviating, and even serving as watchdogs for state violations of international humanitarian laws.

As we know, the basis for the existence of NGOs is to assist the needy and disadvantaged. From 1985, there occurred a shift from donors channeling their funds through states to provide humanitarian services to international donors entering into subcontracting arrangements with NGOs. With the establishment of the UN Department of Humanitarian Affairs (DHA) in 1992, NGOs were increasingly subcontracted in negotiation with warring parties and work. Further, NGOs have also become the framework for individual philanthropy. There are thousands of NGOs in form of private or family foundations throughout the world. The fact that NGOs operate in a variety of areas today has led to demand for the reconsideration of the principles that govern them and how they organize and carry out their work. NGOs have at their disposal significant amount of resources; as a result, they are expected to be effective and accountable. The fact that they have become social and political actors having multi-mandates makes their work increasingly complex. In this connection, they are expected to work within the rules of ethics and acceptable international standards. Ethical issues are bound to arise in the relationship that exists between NGOs and their beneficiaries who are mostly people in vulnerable position. The asymmetric power relationship in such an interaction can be a serious matter of ethical concern. This is all the more so as this affects the core of NGOs’ mission and activities. Every NGO has a mission and certain values and ethical and social principles that underline their activities which they must also be held responsible.

The debate about NGO responsibility emerged in the 1990s as a product of many factors. It is among others a product of the astonishing increase in number and size and increased funding and the power of the sector. As early as the 1990s, the humanitarian works of NGOs had come under criticisms for the ways that they failed to cooperate with each other and the way they undermined both government and local groups. NGOs were criticized for observed mismanagement, ineffectiveness, and corruption. Some of the problems revolved around the untenable distinction made between humanitarian aid in the form of emergency relief and development work. In the past, relief was viewed as politically neutral. Today, it is no longer the case because political considerations now limit access to resources and therefore has itself become a political resource. From the 1990s, it was observed that while some governments wanted to contain refugees as matter of policy, there were international NGOs who had other motives, namely, to raise their international status, thereby generate more resources for their operations. There was also the recognition by NGOs working in conflict situations that both warring parties commit atrocities and suffer indignities. Part of this was the awareness that often political opportunists fuel crises rather than disadvantaged people fighting to redress oppressions.

A further important development is the idea of “do no harm” based on the Hippocratic oath which became a watchword of international NGOs following the report by Mary Anderson. This report observed that even the best-intentioned humanitarian or development assistance can inadvertently fuel conflict and produce further damage. She challenged NGOs to sign up like doctors to the principle not to cause harm (Anderson 1996). The humanitarian interventions following the floods in Mozambique in 2000 provided lessons on some of the strengths and weaknesses of NGO interventions particularly the relationship between northern NGOs (NNGOs) and southern NGOs (SNGOs).

In view of this, attempts have been made to self-regulate NGOs through codes of conducts, ethics, good practice standards, etc. Some codes have been tailored to humanitarian work, some to human rights work, and some others to development work. Yet, some others are drafted for a wide range of NGOs. It is to be observed that although all the different kinds of NGOs are not formerly bound by any international law, all the same, international human rights laws and norms create a framework of ethical principles that NGOs are obliged to uphold. Accountability has become a serious issue because of the influence NGOs have on many people including those who do not fall directly under their work. In the history of this self-regulation, it is recognized that the first of these codes in the field of humanitarian aid was the Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief (IFRC 1997). This code was the result of NGOs’ realization of their poor performance in Sudan in the late 1980s. The Caucus of Development NGO Networks (CODE-NGO), the biggest NGO coalition in the Philippines, was probably the first to publish in 1991 a self-regulation initiative code of conduct ratified by more than one thousand NGOs. However, the history of mandatory self-regulation dates back to 1918 with the establishment of the US National Charities Information Bureau (NCIB). The failures observed within the humanitarian sector in regard to the 1994 Rwandan Genocide caused humanitarian NGOs to begin to take accountability more seriously. This led a group of practitioners to create the Sphere Project that in its turn drafted the 2011 Humanitarian Charter and Minimum Standards in Disaster Response (Sphere Project Handbook 2011). This Charter combined general ethical principles with technical standards for the delivery of services, and this has been endorsed by many NGOs. Against this backdrop, the Humanitarian Accountability Project (HAP 2006) was created as a focal point for information on good accountability. In 2008, the University of Nottingham commissioned by the UN Office of the High Commissioner on Human Rights (OHCHR) published the Statement of Ethical Commitments of Human Rights Professionals and the Guiding Principles for Human Rights Officers Working in Conflict and Post-conflict Environments. Thus it became the first organization to publish the first codes that specifically relate to human rights work. There are today multiple of codes and ethics regulations of NGOs. Some of these codes are global in scope such as the WANGO Code of Ethics and Conduct for NGOs (WANGO 2004), while some others target national or individual practitioners. Yet, others apply to particular NGOs, network, or coalition of NGOs.

In the 1990s, important global bodies like UNESCO and WHO got involved in bioethics. The UNESCO established its Bioethics Programme in 1993 and developed the Universal Declaration on Bioethics and Human Rights (UNESCO 2005). This was adopted by the General Conference on 19 October 2005. This was to be followed by the WHO launch of its Ethics and Health Initiative in October 2002. These Declarations are vital statements NGOs must relate to in their work.

Globally, people have become more sensitive to the issues of poverty, disease, hunger, income inequalities, lack of opportunities, institutional arrangements and management, etc. The high profile status NGOs enjoy on the world stage has brought with it increased scrutiny of work and also the increasing reflection NGOs and their staff have on their work and has brought to focus a number of bioethical questions in their practice. In their capacity as watchdogs for international human rights, they seek violation of bioethical principles in humanitarian and development services. They hold, for instance, health researchers accountable when bioethical principles are breached. In this role, they are expected not just to be responsible, accountable, and objective but must be seen to do so. The rise in the status and power of NGOs entails that important and legitimate questions are raised about their responsibilities. It is equally to be recognized that these organizations may be subjects of ethical appraisal themselves.

Conceptual Clarification

The term nongovernmental organization (NGO) is not an easy word to define as it embraces a wide range of different forms of organizations. A thorough examination of the concept may show that it is a difficult concept to define. We may have to observe from the onset that there is no easy way to reaching a consensus on the conceptual definition of the term NGO. Further, the concept of NGO does not immediately invoke a relationship to bioethics, yet their paths intersect as we have already observed. The diversity of NGOs makes any simple generalization or definition difficult. The World Bank defines NGOs as private organizations aimed at the relief of suffering, promoting the interest of the poor and environment, and providing basic services or undertaking community development (World Bank 1989). In this sense, any kind of organization that is independent of government control can be termed NGO.

There are also other terms that are alternatively used for NGOs. It is viewed as part of the “third sector,” a concept that dates to Etzioni’s (1973) sociological studies of how people become involved in organizations and the different kinds of power relationships that determine three basic organizational forms. In this regard, the third sector is viewed as both a group of organizations and a social space between government and market. Against this background, NGOs may be viewed as a specific subset of this wider family of third-sector organizations. This ideal relates closely to the concept of “civil society.” Yet, NGOs are not simply equated with civil society. Nevertheless, they remain important players in any discussions of it. Civil society as a concept came from political philosophy. In the 1980s, NGOs began to be seen as its center. The ideas of civil society and the third sector help to provide a conceptual framework within which the work of NGOs is understood.

Another definition is provided by USAID that conceives of NGOs as private voluntary organizations. It is not difficult to see that this definition is problematic as many NGOs are state or corporate funded, manage projects, and have professional staff. A more common definition of the term focuses on the idea of NGOs as organizations that dedicate themselves to the promotion of social, political, and economic development. For our purpose, we shall understand NGOs as self-governing, private, not-for-profit organizations devoted to improving the quality of life for marginalized and disadvantaged people (Vakil 1997) ranging from well-known, large international agencies such as Amnesty International and Human Rights Watch to small grassroots and to community-based NGOs. This contrasts it with other third-sector organizations such as town unions, cooperative societies, art and sport groups, and other professional associations. Yet, there are other forms of organizations that combine characteristics from more than one sector. This group of organizations is sometimes referred to as “hybrids” or social enterprises, which are for profit with a social purpose.

Ethical Dimension

NGOs And Bioethics

NGOs’ high profile in international development, humanitarian aid, and advocacy as providers of services to people in serious need implies it has to face challenges associated with the activities in which it is engaged. They have a wide range of moral and ethical responsibilities toward all those who are stakeholders in their activities. These stakeholders may be loosely described as all those who may affect or be affected by their work. The primary stakeholders are the people NGOs intend to protect, represent, or assist.

Key Approaches To Ethical Challenges

Worthy of note in this regard is the effect of globalization, technological progress, and rising standard of living in advanced countries and many emerging countries. These have changed the political, social, and economic framework in which NGOs conduct their work. NGOs have in recent times faced increasing bioethical challenges. The first ethical issue is that of justice, which we know to have many meanings. This question of justice seems to cut across all other ethical concerns. Nonetheless, we know that there are different ethical theories, and they diverge in their application on concrete issues. Other ways of looking at NGO accountability have been focused either on performance-based responsibilities or mission-based responsibilities. The former concern the practical workings of an NGO, while the latter address ethical obligations grounded in international human rights laws and standards. Nevertheless, the two also overlap. The fact that respect and protection of human dignity lie at the heart of every kind of NGO does not mean that NGOs automatically respect human dignity in all their engagements. There have been allegations of NGOs discriminating against some people in the delivery of their services, in this way violating their own mission.

In some places, it has been claimed that NGO work causes more harm rather than protect human dignity. A further concern is the allegation that in some countries NGOs’ advocates are not political activists but in the “business of human rights” which of course only serve to advance the interests of the advocates. Indeed, it is important that NGOs respond to these concerns. As the sector expands, self-examination and reflection are necessary. NGO work is now a recognized career path. This is evidenced by the increasing undergraduate and postgraduate courses in human rights, humanitarian, and development works. It is also of strategic importance for NGOs to explore how they can best fulfill their mission, as this may in turn enhance their legitimacy, credibility, and effectiveness.

Perhaps it needs to be pointed out that the bioethical challenges NGOs face and the way they address them are dependent on what kind of NGOs we are dealing with. For example, human rights NGOs argue that they run specific risks in their work that other NGOs do not face. In this connection, they fear that public discussion of their responsibilities may provide excuses needed by some governments to constrain their work and thereby silence or restrict voices for fundamental freedom. Within the human rights community, some are calling for the sector to examine its work more closely. At the same time, some have suggested that NGOs have to be more representative especially on the part of large Western NGOs who dominate the global agenda at the expense of southern NGOs. It should be acknowledged that development NGOs have sought to protect and improve respect for human dignity by applying approaches based on human rights to their work. Human rights NGOs are yet to fully embrace this model (Griffin 2013). NGOs, especially humanitarian NGOs, have developed sector-wide guidelines that address the challenges that arise from their work. There are codes of conduct that aim to promote best practice in specific areas of their work. One may legitimately ask whether these codes of conduct and statement of principles are useful in promoting ethical, accountable, and responsible action by NGOs or should we search for alternative models.

Some of the difficulties when discussing the issues of responsibility of NGOs include the issues concerning the question whether one can sacrifice justice for victims of human rights violations in order to prevent a recurrence of violence and the ethical issues involved with coercive interventions for humanitarian purposes. Others include the question whether the international community has a duty to intervene to end human rights abuses, the risk of imperialism in humanitarian aid, the ethical challenges of global health research, and the challenges associated with working in conflict zones especially in regard to the war against terror. Further, ethical concerns are raised by government funding of NGOs, the limits of NGOs intervention, priority setting and resource allocation in NGOs, and the securitization of humanitarian aid. Yet, further challenges address whether NGOs in fundraising should apply dubious strategies that draw in more funds for them to help the needy or should they employ “appropriate” models that bring in less money and make their work unsustainable.

In engaging these dilemmas that emerge in their work, NGOs may have to employ global bioethical frameworks such as the UNESCO Declaration on Bioethics and other relevant codes of ethics and good practice. What now follows is a brief discussion of a few of these bioethical dilemmas. The idea is not to provide an exhaustive list of bioethical challenges confronting NGOs but some that highlight what forms these dilemmas may take.

Challenges Of Ethical Imperialism

One of the bioethical areas of interest is the allegation of imperialism against Western NGOs. A major challenge that has been recognized in relation to this is the propensity of Western beliefs, values, and practices to undermine traditional ways of life and distinctive religious and cultural belief systems of others (Fuller 2012). They have been accused of being “Trojan horses” which transfer Western capitalist values into communities, undermining host communities and cultural values. This is more pronounced in NGOs delivering health services. The problem is that there is the risk of NGOs unduly influencing recipients to abandoning their own beliefs in an effort to secure material benefits. The recently emerging trend where former leaders and politicians are getting involved in humanitarian services especially in conflict areas serves to further complicate issues and seems to confirm the view that the West is simply using aid as a foreign policy tool.

The challenge is for NGOs not to structure aid in a way that violates beneficiaries’ central, moral, and religious beliefs. This arises from the nature of the offer and the context in which it is made. It is a matter of experience that a person living in poverty may not have viable choices between accessing essential health care and respecting society’s normative values.

Attempts have been made by some NGOs to address the inequality between NNGOs and SNGOs, for example, the British Overseas NGOs for Development (BOND) has sought to address this challenge and states that cooperation should be based on shared values and vision. Within the field of human rights, the 2008 Guiding Principles for Human Rights Field Officers (HRFO), developed by the UN Office of the High Commissioner for Human Rights, has directly addressed the issue of local custom and universality. This requires human rights workers to work closely with local partners to ensure the spirit of international law is applied while at the same time respecting local cultural norms consistent with this law.

Global Resource Allocation

A further area of interest is the issue of global resource allocation. NGOs deliver billions of dollars worth of humanitarian and development assistance every year. This makes them an important source of basic goods and services especially for many of the world’s poor population. In the face of scarcity of resources, they must prioritize what interventions to engage with and in which places. It is expected that their priority setting is made using moral criteria since they are involved in a moral enterprise and therefore moral agents. An increasing number of faith-based NGOs provide health services in many poor, disaster, and conflict areas. Some of them have been criticized for mixing up humanitarian aid with proselytism. Such actions undermine the autonomy of recipients, violate their rights to informed consent, and exploit their vulnerability.

In this regard, the Code developed by the Red Cross provides that the humanitarian imperative comes first and that humanitarian aid should be given according to the needs of individuals, families, and communities. Different models have been proposed to address the dilemma of resource allocation in the face of scarcity. There have been arguments that allocation should be governed by processes that ensure the maximization of cost-effectiveness and efficiency-based view (Pogge 2007). This entails that these allocations are made according to the principles of justice based on the principles of public accountability and decisions being made in transparent manner.

Global Health Research

Global health research is accepted as a vital element for development. NGOs are valued partners in global health research. Global health research addresses the health of global population. It may be seen as part of the preceding resource allocation challenges. For the sake of clarity, it is treated as a separate dilemma in this entry. Research involving human subjects has posed serious ethical challenges to researchers since the 1960s. Individual researchers could no longer cope with the dilemmas in research with the involvement of human subjects. This led to the development of measures to regulate different types of human research by the Council of International Organizations of Medical Sciences. Ethics committees have also come to birth as an answer to some of the problems. Today, health research is carried out in multiple places. It is also common knowledge that research resources are inequitably distributed especially with regard to resources directed toward research in diseases that affect mostly the poor bearing the greatest global health burden. One of the main bioethical challenges in this area is the question of how Western researchers conducting research in poor countries should treat their participants during and after research trials.

Another issue for research NGOs is how they relate to the health of individuals and societies in poor-resourced countries. This deals with the issue of inequitable distributions of research resources dedicated to the poor, the challenge of the 10/90 gap. This is the situation where only 10 % of the world’s resources are being used to address the health problems of 90 % of the world’s population shouldering the greatest burden of disease. In the design, implementation, and evaluation of research, NGOs have a bioethical responsibility to ensure that ethical issues are adequately addressed in both design and conduct of research (Delisle et al. 2005). This challenge entails fulfilling the moral duties of justice and respect in the face of widespread poverty. This responsibility also extends to playing an effective role in priority setting in research to help in reducing the disease burden of the world’s most poor people. Informed consent of recipients has been required as applied in hospitals and clinics, yet it is agreed today that even with full informed consent, the work of NGO can still be morally objectionable. The reason is that the economic situation of recipients is likely to constrain whatever choice they made. At the same time, NGOs need to avoid the situation where they permit the cultural and value judgments of recipients to govern project when such values conflict with the deeply held convictions of NGOs.

The Limits Of Humanitarian Assistance

The recent Ebola epidemic in Liberia and neighboring countries has highlighted another perspective hitherto not taken seriously in humanitarian action. Humanitarian and development work are often contrasted. The former is simply viewed as immediate response to natural or human-made disasters. Today, this distinction is being questioned by recent developments such as the experience with HIV/AIDS, Ebola epidemics, and Syrian refugees in Jordan and Lebanon. Many of these refugees face uncertain future in foreign countries involving chronic, long-term situations, and their rehabilitation requires many years of continued intervention as they face ongoing health and welfare challenges. In this situation, the bioethical issue concerns what the proper bioethical response should be and its limit. The process of defining the limits raises ethical challenges.

Securitization Of Aid Assistance

The work NGOs do is now appropriated for different use by diverse actors on the global stage. There has been an increasing tendency to relate humanitarian assistance to security over the past decade such as the dilemmas faced by NGOs in coalition-occupied Iraq. This development may be traced to the 9/11 terrorist attack on the World Trade Center in the USA with the resultant declaration of “war on terror.” Today the work of aid workers is challenged by military operations, which often claim to serve humanitarian purpose. This effectively blurs the line between the military and civil society.

Humanitarian aid in this post-cold war era is therefore increasingly being used by the West as part of the effort to contain disorder, in the form of migration, conflicts, and terrorism that threaten to destabilize the West. The challenge in this area is that NGOs may begin to be seen as part of the effort by the West to “contain” disorder which threatens rich countries. This has led to the undermining of the principles of neutrality, impartiality, and independence of NGOs. Recently, the USAID introduced a new federal screening program aimed at uncovering terrorists. This partner vetting process requires NGOs to collect detailed personal data including biographical information and bank account numbers of each officer, board member, and critical employees associated with the aid project funded by the USA. This vetting process has drawn criticisms from NGOs who allege that the new system is overly intrusive, undermines NGO mission, and is potentially capable of endangering the lives of their employees.

Bioethics In Wartimes

Humanitarian actions especially in conflict zones are varied. A key issue in this regard is the question about whether bioethics in times of conflict is identical with bioethics in times of peace. These activities raise bioethical challenges for NGOs such as the ethics of assisting combatant soldiers and discrimination based on religion and ethnic background. One of the dilemma concerns military necessity, that is, physicians trying to save lives during an action geared to taking the same life. There are equally the problems of informed consent, confidentiality, and dual use of new medical technologies. Other issues concern what rights soldiers have as patients, especially if they might return to battle or are enemy combatants. It has been argued that military necessity plays havoc with patient’s rights to life, medical care, informed consent, confidentiality, and the right to die. It is observed that the current war on terrorism challenges the traditional concept of neutrality of physicians as many are called upon to assist in interrogational torture or to develop biological or chemical weapons. NGOs are sometimes alleged to be helping people from the “wrong” side of a conflict. Such issues connect global justice to global bioethics. NGOs involved in research are confronted with the question about sacrificing life science research and technology as an effort to prepare against possible acts of bioterrorism. These are at the heart of the bioethical challenges in NGO work. The recognition for the need of adherence to bioethical principles and norms has led to the UNESCO’s development and codification of bioethical principles and norms onto the global normative stage with its UNESCO’s Declaration on Bioethics and Human Rights (UDBHR 2008) and reports from the International Bioethics Committee (IBC).


It is a matter of observation that bioethical challenges that can be resolved only by attention to questions of international justice arise whenever organizations such as international NGOs with global reach attempt to provide services. NGOs’ high profile in the global community in its involvement in the provisions of various services such as humanitarian aid, development, and advocacy services especially within the setting of poverty has highlighted many bioethical challenges. These difficulties have become more pronounced with the war on terror. Yet, as moral agents and vital players on the world stage, NGOs have a responsibility to conduct their work within the international human rights laws, and the various declarations of important international institutions as well remain faithful to their mission. NGOs have an obligation to reflect on their role in humanitarian aid, development, and advocacy practices. Bioethics path intersects with NGOs’ work, both of which have to be done under international human rights law.

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