Humanitarianism ‐ Moving Beyond Medical Rescue to Poverty Reduction, Sustainable Development and Justice?

28 Oct 2011

Presentation at the 13th Berlin Humanitarian Congress, Oct 28th 2011

Dr David McCoy, Peoples Health Movement, NHS London, Centre for International Health and Development, University College London

Good morning

It is a real privilege to be able to address this Congress. And my sincere thanks to the organisers of this conference for inviting me to speak here.

Many of us in this room have multiple identities. I work as a public health doctor in the health system in the UK. I work for an NGO called Aidspan, which was set up to improve the performance of the Global Fund. I am an academic at University College London. I’ve spent ten years living and working in South Africa. I am a Malaysian by birth and nationality. I am a global citizen.

But the identity I will be mainly using today is as a member of the Peoples Health Movement (PHM).

PHM is a loose network of individuals and organisations that works to improve health – it operates from a number of particular perspectives. It is, first and foremost, not an organisation; but is rather a movement with a tiny secretariat and a large network of people, community‐based organisations and NGOs that are coalesced around a vision of health for all. While we are concerned with diseases, health systems, epidemics, vaccines and poverty eradication, much of the contribution made by the PHM is to explain, analyse and act through a political lens; founded on principles of equity, human rights, justice and social solidarity.

So that is where I am coming ‐ and which explains the title of my talk.

In my talk, I want to place humanitarianism ‐ defined simply as the relief of human suffering ‐ within a political and global economic context. I want to extend the concept of humanitarianism beyond the 1 common frame of rescue, relief and aid (often by the rich for the poor; or by those who can for those who can’t; and usually in conflict zones and at the scenes of natural disasters) to a view of humanitarianism that incorporates social and economic justice; and the relief of suffering caused by chronic poverty; chronic food security; chronic violence; chronic unemployment; the massive exploitation of people’s labour; and the theft of their lands.

Put another way, this is a humanitarianism that goes beyond the relief of human suffering to include the prevention of human suffering.

A second introductory point is captured by the photograph below – which, believe it or not, represents a profoundly important question! Is the glass half empty; or half full?

Usually when you are asked this question, you will be labelled either as an optimist or as a pessimist, depending on how you answer the question. But this picture is also a metaphor for how we choose to approach humanitarianism.

For those, who see the glass half full, the world we live in is far from perfect; but may be the best of all possible worlds. Human suffering on the scale we see across the world is inevitable; inequalities are a natural phenomenon; environmental degradation is an unavoidable consequence of development which in turn will produce the technological solutions required to address the problems associated with climate change. And, they would argue, there is much human progress to celebrate – both technologically, but also socially and politically.

For many however, the glass half full justifies and excuses the neoliberal foundations for our political, social and economic relations. Because the implication of a glass half full is that we don’t need radical or revolutionary change ‐ we merely require a humanitarian and welfare industry; and some green regulation to address the problems associated with war; famine; natural disasters; and disease. Such people would say that we can do better at making our world safer, fairer and more sustainable ‐ but the glass is not half empty.

Well, I would argue that the glass is at least half empty. And this is not because I want to celebrate a triumph of pessimism over optimism; nor is it a counsel of despair. In fact it’s the opposite – my expectations for the human race are simply much higher. I expect a much better world. The glass being half empty forms the basis for an understanding that ‘another world’ is not just possible, but is desirable and to be strived for; but that ‘another world’ requires change. Real change. And, as I shall argue, it is change that demands a broadening of our conception of humanitarianism. There is something in all of this that echoes Gramsci’s well‐known (and apparently paradoxical) call for pessimism of the intelligence and an optimism of the will. But here is a practical example of the significance of the glass half‐full and glass half‐empty metaphor.

We frequently hear that the world has made astounding progress in reducing global levels of poverty; and that we may even be on track to reach the MDG poverty targets. Triumphalist rhetoric often accompanies the facts and figures used to describe the absolute and relative reduction of people living on less than $1/day. The glass is at least half full.

But let’s consider a few alternative facts. In spite of three decades of global economic growth, the burning of fuel at a rate greater than at any other time in human history and an explosion of scientific and technological advancement ‐ the number of people living in poverty has actually grown over the last three decades ‐ but only if you use a $2/day measure of income poverty. In this instance, nearly half the world’s population lives in poverty.

Furthermore, we know that the income poverty line of $2/day is a poor and crude measure of poverty and that it uses a methodology that is biased in favour of an under‐counting of people living in poverty (see work of Thomas Pogge and Sanjay Reddy). And if we consider what Peter Edwards has called an ethical poverty line which is defined as “the income level below which further income losses materially shorten life expectancy” and which is calculated to be between $2.80 ‐ $3.90 / day, it would not be unreasonable to argue that the majority of the world’s population lives in poverty. Such a statement could hardly be associated with a glass half‐full view of the state of the world.

On the other side of the coin, we have the most incredible concentration of private wealth. For example, here are some facts taken from an annual publication produced by MerrylLynch in which you will find a categorisation of human that does not appear in any UN report: “the high net worth individual” and the “ultra high net worth individual”.

According to Merryl Lynch’s World Wealth Report, in 2009 there were 8.6 million ‘high net worth individuals’ identified as having investable (financial) assets over $1 million (excluding primary residence, collectibles, consumables, and consumer durables). Together, they own $32.8 trillion (or 35% of total 3 global wealth). And there were 78,000 ‘ultra‐high net worth individuals’ defined as having investable (financial) assets over $30 million.

It is no wonder that inequality is so high. According to the World Bank, the gini coefficient for income inequality at the global level is higher than for any individual country. And even higher for wealth inequality. 

But this inequality is not produced by accident; or through inevitable or natural processes. For sure, there are certain geographical and natural factors (as emphasised by people like Jared Diamond and Jeffrey Sachs). But much of the inequality, dispossession and deprivation that we see today is produced or sustained through violence; oppression; theft; bio‐piracy; tax evasion; fraud; and corruption. And increasingly, it is being reproduced through the degradation, commodification and destruction of the planet.

The very same processes that result in widespread human suffering existing side by side with immense wealth and over‐ consumption, are the ones that have possibly brought us all to the brink of cataclysmic climate change. The rise in frequency of severe weather events; the projected migration and displacements of peoples as a result of sea‐level rise and failings crops; and the conflict that will be spawned by ecological disruption and collapse threatens to literally drown the humanitarian community with a deluge of human suffering.

Perhaps these inter‐connections between poverty, inequality and climate change and are no better illustrated than in the sad and sorry tale of the oil‐rich Niger Delta. Where multinational oil companies working hand in glove with corrupt politicians and private militias have worked to produce cheap fuel, enrich a small number of people while destroying the living environments of local people.

And so we come to the perpetual need for ‘humanitarian and development aid’; and its perpetual inadequacy. But how does the humanitarian community address this state of affairs? Before I answer this, I think it needs to ask some questions about humanitarian assistance itself. Here are a few questions we might like to consider:

  • To what extent is the current practice of humanitarianism effective?
  • To what extent is humanitarianism an expression of political or moral conviction?
  • To what extent is it an act of solidarity or an extension of the social justice movement?
  • And to what extent might humanitarianism be part of the problem ‐ not so much an extension of social justice; but an extension of the machinery, systems and vested interests that create the crises in the first place?

These are of course rhetorical questions. In any case, there could never be a single answer to these questions. The humanitarian complex – consisting of many different NGOs, as well as the UN, military establishments; donors and governments ‐ is not homogeneous. It consists of different interest groups; different value systems; and different motivations. As with any other complex or epistemic community, there is the good, the bad and the ugly. Many of you in this audience will have witnessed the co‐existence 6 of cynicism; hypocrisy; deception and abuse of power with many and extraordinary examples of solidarity; courage; and generosity within the humanitarian complex.

I’m sure many of you are aware of or have read Linda Polman’s book: War Games ‐ in which she depicts the more murky and dark side of the humanitarian industry; describing how aid and charity can be and is at times captured by ‘un‐humanitarian’ political and military interests; or distorted and corrupted by commercialisation, competition and self‐interest. The book precipitated much debate and criticism; but there was also an acknowledgement that there was much truth in it. Among the challenges described in the book were:

  • Politicised and unequal allocation of aid that fosters unhealthy and unethical competition for funds
  • Co‐option by military / security organs of donor countries
  • Co‐option by commercial companies
  • A proliferation of unqualified and unprofessional agencies that do little good and sometimes harm
  • An accepted, almost legitimised, lack of regulation
  • Foster conflict and encourage atrocities
  • The inadvertent protection of perpretrators of violence
  • Disaster‐affected communities being cast as ‘helpless victims’, elevating the authority and standing of external interveners
  • Individuals and societies being degraded by inappropriate values and cultural norms, while the contributions, needs and interests of local and national stakeholders are ignored or minimised.
  • Local economic development being undermined by high‐wage enclaves

Polman’s book was a conscious and deliberate critique of the humanitarian industry. It was not designed to be a balanced evaluation; but was rather written to bring to the surface a number of difficult issues and tensions. In fact many within the humanitarian community felt that the book recycled problems, dilemmas and difficulties that have been known about for decades.

I suppose the main message is that there is a constant need for critical self‐reflection in what we do as humanitarians ‐ whether it’s in the field of emergency humanitarianism or more long term development.

But this critical self‐reflection requires a political analysis and a clear moral framework. The solutions to the problems described within the humanitarian complex is only partly about creating new structures and systems; or better accountability frameworks; or more effective performance management indicators.

More fundamental solutions include speaking the truth to power; drawing lines in the sand beyond which you will not compromise even if it means reducing your chances of funding or being kicked out of a country; recognising that noble and well‐meaning intentions can have harmful and unintended consequences; and truly considering how we can give the dispossessed and deprived not just relief, but also power and agency. This means not using charity as a means to reinforce hierarchies and dependency; but rather replacing it altogether with solidarity and real development.

But critical self‐reflection in the way we deliver relief and humanitarian aid needs to be linked to a broader effort at addressing the causes of human suffering. Here again, there is no political, managerial or technological blueprint for addressing the problems we face. But there are, I think, a few signposts – so that even if we don’t have a detailed map, we can push forward in the right direction. What might these signposts say? I think there are three over‐arching signposts.

The first signpost says “Develop a clear and coherent intellectual framework”. This relates to the earlier arguments about a critical (and pessimistic) assessment of the state of the world that would incorporate:

  • A political economy of human suffering
  • Clear lines being drawn between poverty and wealth – so that, for example, every time there is a famine, we don’t just label and symbolise that famine with a picture of a starving fly‐ridden child – but also include a picture of a high net worth individual; or a picture of a local warlord together with his London‐based arms dealer, and his Swiss accountant and or Cayman Island bank manager
  • A critique of capitalism and its inherently irrational and destructive nature: it’s time we make more explicit the link between neoliberalism, capitalism and humanitarian crises; and in doing so, analyse how ethnic, religious, gender and geographic identities are manipulated to mask economic exploitation.

Another world is possible. Another world is needed. But we need to describe that world clearly and intellectually; and to then define the multiple strategies and approaches required to get there.

The second signpost says “reinvigorate the moral discourse”. I don’t need to preach to any of you about values and principles. But I think there is a need to challenge the way in which human suffering is so often formulated as a technical problem; or the result of a gap in science that requires more research; or as a problem to do with organisation, management and coordination.But there is no scientific, technocratic or charitable solution to injustice – and there is a constant need to speak out this truth within and beyond the humanitarian sector.

The final signpost says: Build a political strategy. This is perhaps the most important of the three signposts. Here, among the things we need to examine is the relationship between NGOs and politics. For example, are NGOs political? Or have they become a substitute for politics; or a substitution for popular mobilisation and struggle?

I am often struck by the sense of how, for vast numbers of the western public, we have out‐sourced our global politics to the NGO sector. It seems to me that we need to reconceptualise the role, place and function of professional NGOs; and to see how they relate to civil society more generally. We need a revolution of thought; new ways of doing politics; a redistribution of power, wealth and property. It is so often said that the revolution will not be funded. But the professional NGOs that are funded, have an important role to play in the popular struggles that are going on all around the world today.

A second element of a political strategy must be to build horizontal linkages between the progressive elements of the NGO community and civil society. Break out of our silos. Those of us working in global health and humanitarian relief need to forge links with those political struggles designed to reform global governance institutions; the banking and credit system; tax evasion; the utterly discredited regime of intellectual property rights; the corporate media; and so on and so forth.

And at the same time we need to build the global community; strengthening our cross‐border and trans‐ national allegiances. Last week Asmaa Mahfouz, the young Egyptian woman who precipitated the protests in Tahrir Square in Egypt through a you tube video – visited the occupation of Wall Street in New York – bringing support and lessons learnt from the so‐called Arab Spring ‐ clearly recognising that the struggle of ordinary people in Egypt is the same struggle of ordinary people in the United States. And if we look closely enough, it is also the same struggle of millions of people living in refugee camps across the world. Independence, neutrality and impartiality – these are the cardinal principles of humanitarian relief.

I fully appreciate the principle of neutrality and impartiality on the battlefield and in the conflict zone; but in most other instances, humanitarianism involves taking a side. Being neutral and impartial is far too often used as an excuse for not taking sides; or worse still, used to camouflage the reality that sides have been taken either unconsciously, inadvertently or covertly.

We can and we must find ways to combine rescue, relief, charity and aid (some of which may be provided neutrally and with impartiality) with a political agenda that is NOT neutral but which sides firmly with the interests of the oppressed; the exploited; the poor. Perhaps this needs to be another element of the political strategy – how do we do both; without one compromising the other.

The unique role and position of the humanitarian community – operating at the coal face of human suffering – whether it is in the refugee camps of Somalia; or the sweatshops of Cambodia; or the violent shanty towns of Mexico; or the shattered remains of Haiti – means that your voice and actions may be more important than most. Not just in providing relief to human suffering. But also in preventing human suffering and acting upon its root causes.

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