The COVID-19 pandemic has exposed multiple fault lines in the performances of
health services at every level – from community to national to global
– in ensuring universal, equitable access to preventive and curative
care. Tragically, this has been to the detriment of those who have suffered and
died not only from COVID-19, but also from the myriad other ailments affecting
people around the world. Of those, we wish to highlight here some key categories
of diseases that have caused a greater burden of illness and deaths as a
consequence of the policies and political decisions made in relation to the
COVID-19 pandemic. In our view, these should be considered epidemics or, more
accurately, syndemics – the clustering and interactions of two or more
diseases or health conditions and socio-environmental factors – of
This article explores the actions of Médecins Sans Frontières
during the 2018–20 Ebola outbreak in Nord Kivu, in the Democratic
Republic of Congo. Based on the experiences of practitioners involved in the
response, including the author, and on the public positioning of MSF during the
first year of the epidemic, it argues that although the actions of response
actors were usually well intentioned, they could rarely be described as
lifesaving, may have exacerbated disease transmission as much as limited it and
had the perverse effect of fuelling corruption and violence. The article
documents and analyses contradictions in MSF’s moral and technical
positioning, and the complicated relationship between the organisation and the
international and Congolese institutions leading the response. It argues that
the medical and social failure of the response was the result of an initial
belief in a strategy designed at a time when the only realistically attainable
outcome was to relieve suffering, and of the later inability of the organisation
to convince the authorities in charge of the response to adjust their approach.
It suggests that for future success new protocols must be elaborated and agreed
based on a better social and political comprehension and a better understanding
of the tools now available.
How Can Humanitarian Analysis, Early Warning and Response Be
Aditya Sarkar, Benjamin J. Spatz, Alex de Waal, Christopher Newton, and Daniel Maxwell
In 2017, the UN raised the alarm on famines in North-east Nigeria, Somalia, South
Sudan and Yemen. Starvation has been used as a weapon of war in Syria, and the
Democratic Republic of the Congo currently has among the largest numbers of
severely food-insecure people of any country assessed by the Integrated Food
Security Phase Classification (IPC) system. Each of these sites of mass
starvation or famine can be understood as a ‘political
marketplace’. They are characterised by the dominance of transactional
politics over public institutions, and elite politics is conducted for factional
or personal political advantage, on the basis of monetised patronage. This paper
examines the relationship between these systems of transactional politics and
famine and other forms of mass starvation, and outlines the implications of the
political marketplace framework for humanitarian action. It argues that both
transactional politics and mass starvation emerge from particular
political-economic configurations characterised by economic precarity and
mismanagement, violent forms of peripheral governance and war economies.
Applying the political marketplace framework can help improve humanitarian
information and early warning systems, as well as programme decision-making,
while helping humanitarians think more carefully about the constant trade-offs
they are forced to make.
Debates Surrounding Ebola Vaccine Trials in Eastern Democratic Republic of
Myfanwy James, Joseph Grace Kasereka, and Shelley Lees
Two experimental Ebola vaccines were deployed during the tenth Ebola epidemic
(2018–20) in the Democratic Republic of the Congo (DRC). The first, the
Ervebo vaccine manufactured by Merck, was used as part of a ring vaccination in
the epicentre of the epidemic in North Kivu. In 2019, the prime- (Ad26.ZEBOV)
and boost- (MVA-BN-Filo) vaccine manufactured by Johnson & Johnson
(J&J) became the second vaccine against Ebola, deployed by the DRC-EB-001
vaccine trial in Goma, North Kivu. There was international debate as to the
value and ethics of testing a second vaccine in an epidemic context. This
article examines how this debate unfolded among actual and potential DRC-EB-001
trial participants in Goma. Drawing on ethnographic observation, interviews and
focus groups, it explores how the trial was perceived and contested on the
ground and situated in broader debates about the ethics of clinical trials,
especially during the COVID-19 pandemic. We illustrate how debates around the
ethics of clinical research are not simply centred on bioethical principles but
are inseparable from local political dynamics and broader contests about
governance, inequality and exclusion.
This review essay focuses on two books, Heide Fehrenbach and Davide
Rodogno’s Humanitarian Photography: A History (2015) and
Lasse Heerten’s The Biafran War and Postcolonial Humanitarianism:
Spectacles of Suffering (2017). It situates the books in relation
to broader debates about similarities and differences between humanitarianism
and human rights practice, with a particular focus on the visual cultures of and
ethical debates surrounding representations of suffering.
Chapter 1 contextualizes the book’s analysis in the longue duree history of Uyghur relations with modern China up to 2001. It describes this relationship as having emerged from imperial conquest in the mid-eighteenth century, when the Qing Dynasty conquered the Uyghurs’ homeland, and having developed under the shadow of colonial relations ever since. In particular, it charts the gradual transformation of this relationship as the Uyghur homeland slowly transitioned from being a frontier colony on the edges of Chinese power to the object of Chinese settler colonization. While this history includes moments of accommodation where the relationship between modern China and the Uyghurs appeared headed towards a post-colonial reality, these moments were always temporary and followed by the re-establishment of colonial domination. The chapter ends by suggesting that the Chinese state’s decision to brand Uyghurs as terrorists in the context of GWOT shut off these post-colonial possibilities entirely at a time when they held great potential for the future of relations between Uyghurs and modern China.
Chapter 4 explains that, despite the international claims of a Uyghur terrorist threat established in 2002, very few, if any, Uyghur-led premeditated acts of political violence took place inside the Uyghur homeland during the first decade of GWOT. As a result, China’s policies towards the Uyghurs and their homeland in the early 2000s were more focused on development of the Uyghur region than on combatting its virtually non-existent terrorist threat. This development also fostered a creeping settler colonialism in the Uyghur region, leading to large numbers of Han migrants to the region, facilitating displacement, and promoting Uyghur assimilation into a Han-dominated society. The chapter points to the 2009 Urumqi ethnic violence between Uyghurs and Han as the primary turning point in state policy towards Uyghurs. The state’s primary response to this violence was to expedite its development and colonization of the Uyghur region, but it also included the beginnings of a violent crackdown on pious Uyghurs, particularly in the south of the Uyghur region, initiating a self-perpetuating conflict between rural Uyghur populations and state security forces, which would escalate in coming years.
The conclusion examines the likely future outcomes of the processes of cultural genocide presently taking place in the Uyghur homeland by seeking to answer to three critical questions. How will the present crisis end? What are its ramifications for the future development of GWOT? And what can be done to stem the present processes of cultural genocide in the Uyghur homeland? While the conclusion seeks to hold the Chinese state accountable for its mass atrocities against the Uyghurs, it also places blame on the international community for facilitating this tragedy through its manipulation of GWOT. As such, the conclusion argues, among other things, for the necessity to end this war in order to prevent more genocidal outcomes like that suffered by the Uyghurs. The chapter ends with some thoughts about what the Uyghur cultural genocide tells us about the ominous direction in which the world is headed today.
Chapter 6 explains how the events of 2013–2016 laid the foundations for a campaign of cultural genocide that began in earnest from 2017. The chapter subsequently analyzes the brutality and invasiveness of this campaign itself, which is ongoing, is systematic, brutal, and ultimately aimed at eliminating Uyghur identity as we know it. In particular, the chapter focuses on a complex of policies that have driven this campaign, including the mass internment system, the pervasive surveillance network, and attempts to transform both the landscape of the Uyghur homeland and the lives and culture of Uyghur people. While the chapter highlights the state’s justification for these measures as a counterterrorism effort, it locates the true motivations for them in the state’s increasing settler colonization of the Uyghur homeland.