The New Yorker has a thoroughly well written piece on the downside of aid. It traces the emergence of humanitarian aid as an international industry, starting with the Biafran war and following a course through Sierra Leone and Rwanda. The central theme of the article is that aid often causes as much suffering as it aims to alleviate, and that potential client regimes know that to see aid dollars they must simply ratchet up the scale of the conflict. The author, Philip Gourevitch, cites Ethiopian and Somalian famine, attracting food aid that allowed the governments to feed their own armies and persecute marginalized populations. Yet perhaps the most disturbing example she gives is of Sierra Leoneian rebels amputating victims as a means of attracting aid.
“It was only when you saw ever more amputees that you started paying attention to our fate,” a rebel leader told her. “Without the amputee factor, you people wouldn’t have come.”
And then there’s what happened in Sierra Leone after the amputations brought the peace, which brought the U.N., which brought the money, which brought the N.G.O.s. All of them, as Polman tells it, wanted a piece of the amputee action. It got to the point where the armless and legless had piles of extra prosthetics in their huts and still went around with their stubs exposed to satisfy the demands of press and N.G.O. photographers, who brought yet more money and more aid. In the obscene circus of self-regarding charity that Polman sketches, vacationing American doctors turned up, sponsored by their churches, and performed life-threatening (sometimes life-taking) operations without proper aftercare, while other Americans persuaded amputee parents to give up amputee children for adoption in a manner that seemed to combine aspects of bribery and kidnapping. Officers of the new Sierra Leone government had only to put out a hand to catch some of the cascading aid money.
For me, this article resonates hauntingly. As someone who is working to get into poverty-related medicine, and who has an attraction to dangerous situations, I have to constantly wonder what the right course of action is in conflict doctoring and aid. If this article resonates with you, I would highly recommend William Easterly’s White Man’s Burdern (reviewed elsewhere on this site), which approaches aid from the same skeptical, evidence-based viewpoint.
As the article is close to wrapping up, Gourevitch quotes a top UN officer, “Yes, mistakes were made, but we are not responsible.” Linda Polman* tells the author, “As far as I’m aware no aid worker or aid organization has ever been dragged before the courts for failures or mistakes, let alone for complicity in crimes committed by rebels and regimes.”
I had a chance to ask professor Joel Ngugi (of UW School of Law), who practices in humanitarian law, last February about the situation that was then taking place in Haiti. US troops had taken over the airport, were deciding which planes would land and which wouldn’t (diverting Doctors Without Borders planes and closing the airport for hours at a time for photo ops). Meanwhile, hundreds of thousands of bodies were being extricated hastily from rubble, and dumped into mass graves — unlabeled, unphotographed, unidentified — in a manner contrary to how I’d seen it done during the 2004 tsunami, and contrary to WHO recommendations**. I asked him if there would be any legal basis for accountability to potential mistakes that might be made during the ‘humanitarianism at the end of a gun barrel’ we were seeing unfold in Haiti. His answer to me was that no, he knew of no precedent for accountability by aid organizations or for governments coming to render aid.
**The priority is to care for survivors. There is no significant public health risk associated with the presence of bodies. Nevertheless, bodies should be collected as soon as possible and taken away for identification.” WHO 2006 Management of Dead Bodies after Disasters
*This article is largely based on her research and quotes her heavily throughout. I will review two of her books in the near future. For now, here’s an appearance she made on The Daily Show, in support of her latest book.