Duncan McLean Médecins Sans Frontières, Geneva

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Editor’s Introduction

The current issue combines a special section, ‘The Future of Humanitarian Medical Data Studies: Theory and Applications’, edited by Larissa Fast and Darryl Stellmach, and three additional articles. The former draws on the experience of humanitarians, technologists and researchers in examining the advances and risks tied to the rapid inclusion of digital health technologies in humanitarian settings. While the latter papers all broach relations with local actors and communities, a strong ethical aspect ties this issue together. The responsibility of humanitarian organisations to evaluate the impact of their presence, be it through the advent of new technologies, different forms of local engagement, or indeed the reflecting on their impact long after departure, remains ever pressing.

Darryl Stellmach, Margaux Pinaud, Margot Tudor and Larissa Fast contribute the special section’s first paper, a review of the literature. Endeavouring to problematise medical data in humanitarian action, the authors challenge the frequently unquestioned deployment of new technologies and data practices, notably through the ethical dilemmas that can be produced. By juxtaposing the pressure to innovate with sensitivities around biometric and medical data, three central categories of enquiry are highlighted: governance, power and control; justice and equity; and trust. If the dangers of medical data breaches have long been recognised, the instability and inherent inequalities of humanitarian settings hold particular vulnerabilities. The authors provide accessible and clear markers for both practitioners and academics that will prove valuable for future research in this area.

The section’s research paper is provided by Matthew Hunt, Isabel Muñoz Beaulieu and Handreen Mohammed Saeed. From the broad overview of key issues and dilemmas provided in the introductory paper, the second contribution focuses on a specific aspect of the humanitarian project cycle, the closure or handover of activities. The authors point out that the management of medical data during this phase – whether related to sharing, storage, return or destruction – requires careful planning and consultation. They provide an overview of an array of existing guidelines for responsible data management from an ethical perspective before outlining seven questions to facilitate reflection and deliberation when preparing for project closure. These questions provide a highly practical guide, illustrated through a concrete case study, for project teams as they embark on a difficult and potentially fraught phase of a humanitarian project’s lifecycle.

The final contribution to the special section comes in the form of a field report. Jake Leyland, Budhaditya Bhattacharya and Sandrine Tiller explore a darker side of qualitative health data in the form of misinformation in humanitarian programmes. The authors share the experience of Médecins Sans Frontières’ ‘MSF Listen’ project, an internal rumour and misinformation monitoring platform. Likewise aware of the dangers of innovating at all costs, a lucid analysis of the strengths, weaknesses and evolution of an initiative designed to better understand and respond to health misinformation are recounted. From its initial pilots in September 2020, the project was scaled up during the COVID-19 pandemic, facilitating important conclusions, including some of the underlying contextual reasons that contribute to fear, uncertainty and mistrust in health providers.

In a standalone research article, but closely related to the themes of community engagement and particularly the lessons that have emerged from COVID-19, Ellen Goodwin examines the role and influence of international faith-inspired organisations during the pandemic. She notes that local faith actors and their communities are often at the forefront of a crisis, as was belatedly recognised in the response to HIV/AIDS and Ebola. Learning from that experience, and comparatively speaking, the author argues that engagement with local faith actors was generally far more effective in COVID-19-related activities. Whether in terms of speed or the diversity of support provided, this shift holds important lessons for both the faith-based and secular streams of the humanitarian sector.

A more sombre view on the challenges facing local faith actors emerges in Emma Tomalin and Olivia Wilkinson’s research article. Focused on the findings from the project ‘Bridging the Gap: The Role of Local Faith Actors in Humanitarian Response in South Sudan’, they explore the barriers to improving engagement with international humanitarian organisations. The authors likewise recognise the importance of local actors as first responders during a crisis but also note that faith actors are often perceived as both lacking capacity and as less likely to adhere to core humanitarian principles. In attempting to gain legitimacy, and essentially pursue goals that are not necessarily their own, local faith actors risk reinforcing North–South power hierarchies that localisation was intended to counter in addition to alienating their own communities. It is a scathing critique of the localisation agenda and points to the need for more profound reflection and change in the humanitarian system.

A final contribution to this issue comes in the form of a field report from Maelle L’Homme. Humanitarian engagement with South Sudan is also the focus – in this case the disputed Abyei Special Administrative Area – and relations with local communities also comes to the fore. Following an upsurge in violence and the suspension of Médecins Sans Frontières’ medical operations in the town of Agok, the author undertakes a critical reflection on the potential adverse impact of international aid on local power dynamics and intercommunal tensions. Drawing heavily on political economy analyses, conclusions are drawn on some of the unintended effects of humanitarian assistance, along with the challenges and limits of mitigating measures.

The articles in this issue bring together disparate research streams – from the special section’s focus on the present and future of medical humanitarian data studies and reflections on how the humanitarian sector engages with local faith actors and communities, to the potential adverse effects of aid on local patterns of violence. Taken together, they contribute to topical contemporary debates with strong ethical underpinnings, all relevant to exploring the limits and responsibilities of humanitarian organisations both through their presence and the support they attempt to provide.

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