International Relations

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Lessons Learned from an Intervention by Médecins Sans Frontières
Maria Ximena Di Lollo, Elena Estrada Cocina, Francisco De Bartolome Gisbert, Raquel González Juarez, and Ana Garcia Mingo

When the COVID-19 pandemic struck in early 2020, it rapidly became apparent that older individuals were at greater risk of serious illness and death. The risk was even greater for residents in care homes, who live in close proximity and may be suffering other comorbidities. Such facilities also saw a high turnover of staff and visitors, meaning an increased risk of transmission. Data has suggested that care home residents may account for up to a half of all COVID-related deaths in Spain.

As morbidity and mortality for COVID-19 was increasing in March 2020, MSF offered support to Spanish care homes during the first wave of infections. Our intervention included different axes: advocacy, knowledge sharing, training and implementation of measures for a reduction in transmission and for infection prevention and control (IPC).

The situation for care home residents was dire, with many people dying alone, away from loved ones and without access to palliative care. Staff were overwhelmed and ill-equipped to deal with the scale and complexity of this tragedy.

Although technical interventions to reduce transmission were crucial, it became clear that other people-centred activities that supported residents, their families and staff, were of equal importance, including facilitating contact between families, providing emotional support and offering adequate pain management and palliative care.

Residents in care homes have the same rights as everyone else. In the event of future crises, the most vulnerable should not be neglected.

Journal of Humanitarian Affairs
A Realistic Ambition?
Pierre Mendiharat, Elba Rahmouni, and Léon Salumu

Despite a concerted international effort in recent decades that has yielded significant progress in the fight against HIV/AIDS, the disease continues to kill large numbers of people. Although there is still no definitive cure or vaccine, UNAIDS has set an ambitious goal of ending the epidemic by 2030, specifically via its 90-90-90 (‘treatment cascade’) strategy – namely that 90 per cent of those with HIV will know their status, 90 per cent of those who know their status will be on antiretroviral therapy and 90 per cent of those on antiretroviral therapy will have an undetectable viral load. These bold assumptions were put to the test in a five-year pilot project launched in June 2014 by MSF and Kenya’s Ministry of Health in Ndhiwa district, where an initial NHIPS 1 study by Epicentre (MSF’s epidemiology centre) in 2012 revealed some of the world’s highest HIV incidence and prevalence, and a poor treatment cascade. Six years later, a new Epicentre study, NHIPS 2, showed that the 90-90-90 target had been more than met. What explains this ‘success’? And given the still-high incidence, is it truly a success? MSF Deputy Director of Operations Pierre Mendiharat and physician Léon Salumu, Head of MSF France Kenya programmes, discuss the political, scientific and operational challenges of the Ndhiwa project in an interview conducted by Elba Rahmouni.

Journal of Humanitarian Affairs
Open Access (free)
The Politics of Infectious Disease
Duncan McLean and Michaël Neuman
Journal of Humanitarian Affairs
Open Access (free)
Lachlan McIver, Maria Guevara, and Gabriel Alcoba

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 neglect.

Journal of Humanitarian Affairs
Positioning, Politics and Pertinence
Natalie Roberts

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.

Journal of Humanitarian Affairs
How Can Humanitarian Analysis, Early Warning and Response Be Improved?
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.

Journal of Humanitarian Affairs
Debates Surrounding Ebola Vaccine Trials in Eastern Democratic Republic of the Congo
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.

Journal of Humanitarian Affairs
Open Access (free)
Jeffrey Flynn

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.

Journal of Humanitarian Affairs
Four Conversations with Canadian Communications Officers
Dominique Marshall

As the production, content and display of humanitarian images faced the requirements of digital media, humanitarian organizations struggled to keep equitable visual practices. Media specialists reflect on past and current uses of images in four Canadian agencies: the Canadian Red Cross, the Multicultural Council of Saskatchewan, the World University Service of Canada and IMPACT. Historically, the risk to reproduce the global inequalities they seek to remedy has compelled photographers, filmmakers and publicists in these agencies to develop codes of visual practice. In these conversations, they have shared the insights gained in transforming their work to accompany the rise of new digital technologies and social media. From one agency to the other, the lines of concern and of innovation converge. On the technical side, the officers speak of the advantage of telling personal stories, and of using short videos and infographics. On the organizational side, they have updated ways to develop skills in media production and visual literacy among workers, volunteers, partners and recipients, at all levels of their activity. These interviews further reveal that Communications Officers share with historians a wish to collect, preserve and tell past histories that acknowledge the role of all actors in the humanitarian sphere, as well as an immediate need to manage the abundance of visual documents with respect and method. To face these challenges, the five interviewees rely on democratic traditions of image-making: the trusted relationships, both with the Canadian public and with local peoples abroad, which have always informed the production and the content of visual assets. For this reason, humanitarian publicists might be in a privileged position to intervene in larger and urgent debates over the moral economy of the circulation of digital images in a globalized public space.

Journal of Humanitarian Affairs
Open Access (free)
Lewis Hine’s Photographs of Refugees for the American Red Cross, 1918–20
Sonya de Laat

From June 1918 to April 1919, the American social photographer Lewis Hine made photographs of refugees in Europe. Refugees emerged as an unexpectedly humanitarian subject during World War I. Care for them was part of the American Red Cross’ (ARC) overall war relief activities, which Hine was hired to visually record. In this paper, I present the way in which refugees went from being framed in the ARC’s mass-circulated popular Red Cross Magazine as unique, innocent, idealized war-affected civilians to eventually being visually displaced in a shifting humanitarian landscape. For refugees who were, by 1920, making their way across the ocean to North America, visual displacement from the humanitarian visual sphere was tantamount to territorial displacement. Anxieties and negative rhetoric of the unassimilated alien prevailed, resulting in the temporary ‘closure’ of America’s borders and the ARC’s growing American-centric relief activities. Entwined with anti-Bolshevism, American immigration, and isolationist politics of the early twentieth century, Hine’s photographs and the ARC’s role in contributing to humanitarian photography are an early example of a rise and fall in sympathies towards refugees that would continue throughout the century.

Journal of Humanitarian Affairs