BMJ 321:101105. CR made substantial contributions to the conception and design of the study; the analysis and interpretation of the data; and revised the manuscript critically for important intellectual content. . Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Distilling relevant experiences and insights from both public health ethics and clinical ethics and adjusting them to the context of humanitarian aid may allow the young field of ethics of humanitarian action to advance in an efficient way, while benefitting from achievements in neighboring fields. The increased emphasis in MSF on research led to the creation of an ethics review board (ERB) in 2001. General Assembly resolution 58/114 (2004) Strengthening of the coordination of emergency humanitarian assistance of the United Nations. 2017). Hugo Slim is a senior research fellow at the Las Casas Institute for Social Justice, Blackfriars Hall, University of Oxford. The precise ways in which ethical obligations are in tension or are mutually supportive are context dependent. The decision to undertake research in a crisis warrants scrutiny. Provides an opportunity for participants to consider the practical implications of humanitarian principles & ethics on their work. Ethics and Humanitarian Intervention - YouTube The UN Charter states that human rights is the responsibility of international society. ABSTRACT. Within these categories, nodes were created to accommodate specific obligations and principles; within these nodes, subnodes were created to capture specific challenges to fulfilling the obligations and principles. At a few organizations, I was the first person to bring up the need for visual ethics guidelines. If it could be delayed until the acuity of the crisis diminishes, it ought to be. Annex 3 The Humanitarian Charter . About this course. Dev World Bioeth 2:109130, O'Callaghan S, Leach L (2014) The relevance of the fundamental principles to operations: learning from Lebanon. It is possible that a different research team would produce different findings or come to different conclusions from these data. 2017; Haver 2016; Weiss 2016); and tensions arising between organizational, individual, and local beliefs and norms (Civaner et al. WM made substantial contributions to the interpretation of the data and revised the manuscript critically for important intellectual content. Company reg. In these workshops, for example, attendees viewed humanitarian principles more as motivating ideals, whereas ethical obligations were viewed as more specifically action-guiding. Humanitarian Health Ethics Research Group. In some instances, this intersection was found to represent apparent tension between fulfilling humanitarian principles and ethical obligations. Our only hope for intervention in civil war. Practicing honesty and transparency in communications was an important theme in our review. This is a qualitative study drawing on Grounded. Efforts to avoid violence, such as concentrating operations in safe or comparatively secure areas, preclude access or attention to the most vulnerable and in need (Haver 2016). Political PrinciplesNeutrality and Independence Part 1: The ethics of doing good and working internationally Before going to another country (or even to another part of the same country) to help people, you should carefully consider the value and skills you have to offer as well as the impact you could have - and will be aware that you could do harm as well as doing good. Lack of training for workers (especially in disaster- or conflict-specific competencies) was cited as leading to inadequate or inappropriate care for vulnerable populations and forcing workers to make ad hoc decisions about triage and prioritization of patients and treatmentsresulting in suboptimal care (Civaner et al. African Rights 5, Pictet J (1979) The fundamental principles of the Red Cross. Humanitarianism: A Dictionary of Concepts is intended as a user's guide for practitioners and students involved in the humanitarian sector. Finally, as a qualitative study, our findings involve subjectivity. This is despite ethical elements being ever-present in humanitarian work, especially in high-risk, insecure conflict settings. In: Cahill KM (ed) The pulse of humanitarian assistance. Researchers will need to use judgment in responding to situations of ethical uncertainty. 2017; Civaner et al. Article at www.fernandoalmansa.com 12. Appendix 1. A full summary table of qualitative findings with representative quotations can be found in Additional file 1: Appendix 4. Independence demands that humanitarian actors retain their autonomy and remain independent of political or military objectives of other actors. Violent threats, abduction, torture, and murder of humanitarian workers; blockade and theft of materials and supplies; and the elimination of access to or destruction of facilities also drastically impede humanitarian missions (Alderslade 1995; Blair 1996; Cobey et al. Health professionals have wrestled with their ethical guiding principles for millennia, and in some cases there is no longer an oath, but a booklet or manual to guide the practitioner. It is now time to open the discussion about ethics and humanitarian-based principles regarding the work being done in countries affected by conflict and other disasters. Humanitarian health organizations and health workers frequently work in conflict settings where they are subject to direct attack and where active armed conflict disrupts basic institutions and provision of services. Similarly, the ethical obligation to provide honest and transparent communication could be in tension with the principle of independence, for example, if distributing communication relies upon state-owned media. We . International Humanitarian Affairs. Google Scholar, Asgary R (2015) Direct killing of patients in humanitarian situations and armed conflicts: the profession of medicine is losing its meaning. Third, in practice humanitarian organizations and workers may view and use humanitarian principles and ethical obligations differently; this assumption was later borne out in workshops we conducted as part of the larger project. While pursuing this goal, careful attention to both the ethics OF and ethics IN these research activities is a key responsibility for researchers, partnering organizations, RECs and funders. 8. Supporting a locally-led response is an obligation based on the idea of fair decision-making processes. An important starting place for humanitarian research ethics is to inquire about expected ends: What knowledge is likely to be gained by a study and who will benefit from that knowledge? In a field where theory and practice are too seldom aligned Hugo Slim has pulled off a rare feat a book that is as useful to the thoughtful aid practitioner as it is to the applied scholar. https://doi.org/10.1371/journal.pone.0174162, Clarinval C, Biller-Andorno N (2014) Challenging operations: an ethical framework to assist humanitarian aid workers in their decision-making processes. Am J Disaster Med 4:261271, Hunt MR, Schwartz L, Sinding C, Elit L (2014) The ethics of engaged presence: a framework for health professionals in humanitarian assistance and development work. The Humanitarian GoalHumanity and Impartiality (DOCX 54 kb). Advancements in operational security (Egeland et al. Dignity PrinciplesParticipation, Empowerment and Respect 5. Humanitarian Action (Cornell University Press, Ithaca, NY, and London, 2002). 28 View 3 excerpts, cites background and methods Annex 4 Principles of Good Humanitarian Donorship, Slim writes in a very engaging manner that is both erudite and easy to read, professional and personal at the same time, as humanitarianism must be. https://doi.org/10.1016/S0140-6736(17)30741-9, Fraser V, Hunt MR, de Laat S, Schwartz L (2015) The development of a humanitarian health ethics analysis tool. In the ethical obligations category, the obligation of appropriate acquisition and management of assets (including financial, material, and human assets) was added as a node (Civaner et al. This is a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance. 2011; Gastineau Campos and Farmer 2003; Haver 2016; Mak 2014; Slim 1995; Sunga et al. Disasters 22:96108, Fink S (2007) Protection of civilians in armed conflict: a decade of promises. 2009; Rubenstein 2015), there has yet to be a comprehensive review focusing on ethics and humanitarian project closure. To be sure, the obligation to protect workers is not the humanitarian organizations alone; the international community, via international humanitarian law, also plays a role in protecting humanitarian health workers (Burkle Jr. et al. Somerset House Similarly, we excluded military ethics as not germane to humanitarian practice. 2017; Clarinval and Biller-Andorno 2014; Fouad et al. 2012; Egeland et al. These studies explore issues of relevance to humanitarian . Quality of care and resource management intersected the ability of organizations to realize an equitable distribution of benefits and burdens, an obligation of justice or fairness, and minimizing harms of a response. The comparison revealed differences related to length of text coded and frequency of coding, but not the presence or absence of nodes. The Structure of Moral Choices For instance, a lack of interorganizational information sharing (Haver 2016) or an inability to attain necessary information due to operational restrictions (Bernthal et al. The ethical framework of the International Association of Professionals in Humanitarian Assistance and Protection (PHAP) begins with recognition of the value of all human life. A total of 66 out of a possible 2077 retrieved records met inclusion criteria. For example, because solidarity implies both suffering with and consulting community members, lack of coordination between organizations could lead to disorder, duplicative efforts, or blind spots in identifying community needs. (Humanitarian ethics : a guide to the morality of aid in war and disaster) The Different Levels of Humanitarian Ethics Humanitarian ethics engages at three very different levels of practice: the intimate, the operational and the strategic. When we interviewed disaster researchers and members of Research Ethics Committees (RECs) who had reviewed disaster research protocols, we were struck by the following tension: interviewees identified community engagement as especially important, even essential, in disaster settings, yet they also consistently described it as very difficult to achieve. 2017; Fennell 1998; Fouad et al. Working with a research librarian, we developed a broad search strategy utilizing three core concept blocks: (1) conflict, (2) humanitarian or relief organizations, and (3) non-clinical or non-military ethics. MD made substantial contributions to the conception and design of the study; the analysis and interpretation of the data; and the drafting of the manuscript. Strand Full searches as executed in each of the three databases (Ovid/EMBASE, Scopus, and PubMed) on May 17, 2017 (at 1:00, 1:08, and 1:15 PM EST, respectively). We chose search terms for each concept block using controlled vocabulary and key terms with iterative search yield analyses. Int J Humanitarian Action 4, 15 (2019). 2008). Among these, four have come to represent the core principles of humanitarian action: humanity, impartiality, neutrality and independence. Areas of ethical tension will almost certainly include the allocation of scarce resources, discontinuing care or closing to new admissions (both for covid-19 cases and those with other morbidities), "complicity" in coercive measures, care for staff amidst (PPE) supply shortages, and prioritisation vis--vis pre-existing crisis needs. For example, the ethical obligation of ensuring a fair distribution of the benefits and burdens of aid supports fulfilling the humanitarian principle of impartiality. Lancet 375:329340. Fourth, we did not assess the quality of included publications. . It can be hard living up to these principles when others do not share them, while persuading political and military authorities and non-state actors to let an agency assist on the ground requires savvy ethical skills. Findings related to expatriate healthcare professionals' experiences of resources and constraints for addressing ethical issues in humanitarian crises illuminate the complex nature of ethical reflection, deliberation, and decision-making in humanitarian healthcare practice. While not the focus of our review, coders did make note of strategies organizations used to attempt to manage identified challenges. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Regarding humanitarian principles, for instance, some organizations have maintained independence by refusing to accept funds conditional upon particular program changes or by investing and developing their own asset management strategies to avoid reliance upon, or sharing assets with, partisan groups. Moreover, there were concerns that humanitarian aid could destabilize established in-country health and other support systems and create unsustainable programs that result in support gaps when aid programs depart (Hunt 2009; Jaspars and O'Callaghan 2010; Rieffer-Flanagan 2009). What does it take to be an ethical humanitarian worker? Organizations can inadvertently or unwittingly become affiliated with other political objectives, for example, if they capitalize upon access gained by other, partisan groups, or use security services (e.g., formal military support) (Black 2003; Clarinval and Biller-Andorno 2014; Egeland et al. https://doi.org/10.1111/dewb.12013, Hurst SA, Mezger N, Mauron A (2009) Allocating resources in humanitarian medicine. Copy the code below and paste it into your web site. https://doi.org/10.1080/13623699.2012.678059, Redwood-Campbell LJ, Sekhar SN, Persaud CR (2014) Health care workers in danger zones: a special report on safety and security in a changing environment. The top challenge ranked by the group was disagreement between patients/families and health care professionals about treatment decisions, and several steps are proposed that can be taken to help address this key challenge. The study draws on data from 70 humanitarian organizations and makes use of multiple regression models to deduce the relationship. Calls for action and outrage are examples of distinct moral values which can justify humanitarian imagery. Do humanitarian agencies inadvertently encourage ethnic cleansing by always being ready to mop-up the consequences of scorched earth warfare? The multi-faceted field of global ethics (which includes international ethics, global justice, and international political theory), on the other hand, has examined at length the specific issue of armed humanitarian intervention and the 'responsibility to protect' (Wheeler, 2000; Holzgrefe and Keohane, 2003; Bellamy, 2009). The authors choose not to provide this information. Respect is not limited to data collection. Considerations included how to develop trust, identify community representatives, partner with local organizations, and establish parameters for effective collaboration. Given these realities, the justificatory bar for research is high: If a study could be conducted in a non-crisis situation and still answer its research question, it should be. PART THREE ETHICAL PRACTICE IN HUMANITARIAN ACTION, 7. 2017; O'Callaghan and Leach 2014). This paper reviews current approaches found in the engineering education literature to assess ethics instruction outcomes. 2017). Funding sources can compromise independence by taking decision-making authority away from organizations if funding is conditional, e.g., specifying services offered or populations served (Clarinval and Biller-Andorno 2014; Harding-Pink 2004; MacCormack 2007; Slim 1997b). At the same time, this must be done carefully, to preserve the humanitarian commitment to independence. Neutrality was coded most frequently. Ethical review processes need to be sensitive to this reality, and reviewers require adequate understanding of the ethical implications of methodological decisions. Int Rev Psychiatry 10:239247. Humanities Courses / Philosophy 103: Ethics - Theory & Practice Course . Photo: Sumaya Agha for Mercy Corps. Regarding tensions, for example, the duty to provide the highest quality care (which could require significant resources) could be in tension with the duty to humanity, i.e., to relieve suffering wherever it was found (which could require devoting fewer resources but to more individuals in need). The paper describes an ongoing . This research was funded by Elrhas Research for Health in Humanitarian Crises (R2HC) programme, funded equally by the Wellcome Trust and DFID, with Elrha overseeing the programmes execution and management. The Centre recommends three areas to support ethical data practice: Establish clear codes of conduct for ethical data management. In the literature, solidarity has been defined in different ways to include concepts of political advocacy, human rights, shared suffering, and consultation with those affected (Hunt et al. I agree to have my email address transferred to Mailchimp. Disasters 21:244257, Slim H (1997b) Relief agencies and moral standing in war: principles of humanity, neutrality, impartiality and solidarity. Violent attacks against humanitarian health organizations and workers have many negative consequences. In light of solidarity being a more recently emergent principle lacking a single standard definition in the literature, for the purposes of coding, we employed a broad conception of solidarity that encompassed all of these possible uses. Results Social structures, including governments, exist to foster the common good. Articles included in the review (N=66). A particular challenge related to this obligation was concern over risk transfers, or situations where organizations might seek to mitigate their own risks or risks to their workers by transferring them to others (e.g., by assigning certain tasks to local individuals). The identified relationships between ethical challenges and humanitarian principles suggests that frameworks and guidance for ethical decision-making, if adapted for conflict settings, could support organizational capacity to fulfill ethical and humanitarian commitments. 2017; de Waal 2010). Humanitarian Data Exchange (HDX) (2019) SHCC attacks on health care. To be included, publications had to (1) refer implicitly or explicitly to ethics and/or humanitarian principle(s), (2) relate to non-military relief work in active conflict or conflict-affected settings, (3) relate to organizational mission and/or delivery of services, and (4) relate to events after 1900. Humanitarian Deliberation JAMA 270:632634. - (Please find the details in UKRANIAN BELOW).The Humanitarian Ethics and Principles in Practice module is run as two 60 minute sessions. The Ethical Origins of Humanitarian Action, PART TWO THE MODERN ELABORATION OF HUMANITARIAN PRINCIPLES. https://doi.org/10.1017/s1816383113000489, Fegley R (2009) Local needs and agency conflict: a case study of Kajo Keji County, Sudan. Public Health Ethics. Impartiality stipulates that humanitarian actors must not discriminate or give preference to any nationality, race, religious belief, class, affiliation, or political opinion. 1989; Madhiwalla and Roy 2009). Am J Trop Med Hyg 92:678680. Through this module, students will collectively develop a set of . 2017). 2017; Rieffer-Flanagan 2009; Slim 1995). Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, Department of Epidemiology, Florida International University, Miami, USA, Syrian American Medical Society, Washington DC, USA, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA, Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University, Baltimore, USA, Current affiliation: Center for Bioethics and Humanities and Division of General Internal Medicine, University of Colorado, Mailstop B137, 13080 E. 19th Avenue, Aurora, CO, 80045, USA, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA, You can also search for this author in https://doi.org/10.20529/IJME.2009.023, Michael M, Zwi AB (2002) Oceans of need in the desert: ethical issues identified while researching humanitarian agency response in Afghanistan. Dev Pract 7:342352, Slim H (2015) Humanitarian ethics: a guide to the morality of aid in war and disaster. Even without this type of overt pressure, humanitarian health organizations could sometimes be compelled to concentrate aid work in safe or more easily accessible areas. As described in our methods, coding of humanitarian principles and ethical obligations was not mutually exclusive. Int Rev Psychiatry 26:558565. In addition, humanitarian workers themselves may struggle to feel they are in solidarity with local populations. J Int Humanit Action 4. https://doi.org/10.1186/s41018-019-0055-x, Civaner MM, Vatansever K, Pala K (2017) Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey. Violence against humanitarian health workers, which may result in death, is a persistent and pervasive contemporary problem (Humanitarian Data Exchange (HDX) 2019; Safeguarding Health in Conflict Coalition (SHCC) 2018). Table 2 summarizes findings related to humanitarian principles evident in the literature reviewed. This systematic review is part of a larger project examining (via interviews and workshops) the organizational- and individual-level ethical challenges that humanitarian organizations have faced during the Syrian conflict. First, a preliminary codebook was developed based on an informal review of the literature (Additional file 1: Appendix 2), the research teams experience and knowledge of the field, and consultation with experts in related areas of humanitarian ethics research, such as ethical issues that emerged in responding to the 20142015 Ebola epidemic. At this stage, two major additions were made to the codebook. https://doi.org/10.1017/S1049023X14000934, Rieffer-Flanagan BA (2009) Is neutral humanitarianism dead? Broussard, G., Rubenstein, L.S., Robinson, C. et al. How to find ways in which community participation can be ensured and enhanced while being realistic about time and resource constraints has been described as a key ethical challenge for humanitarian research. Provided by the Springer Nature SharedIt content-sharing initiative. Read more stories by Ajoma Christopher, Katie Drew & Peter Batali. 2012; Fink 2007; Gardemann 2002; Hunt 2008; Michael and Zwi 2002; Poffley 2012; Slim 1997a, b). Societal breakdowns, the loss of normal order, and punitive actions against humanitarian organizations severely limit their ability to fulfill their duty of humanity (Al-Moujahed et al. Compiling experiences of effective community engagement in humanitarian research would be an important service for shared learning in this area. Arabic For Specific Purpose (ASP)- Humanitarian. This funding source had no role in the design of this study, the analysis or interpretation of data and results, or the decision to write and submit the manuscript. 2014). Threats to the emergent humanitarian principle of solidarity were experienced in several ways. 1 for the study flow diagram and Additional file 1: Appendix 3 for the list of 66 included articles). work Perpetual Peace he attempted to articulate principles to guide the heads of states towards a more peaceful world and . "You end up working and working and bond with like-minded people with the same experience. This in turn can undermine organizations capacity for solidarity (MacCormack 2007). Little analysis has been made of ethical challenges encountered by health care professionals (HCPs) participating in humanitarian aid work. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. What Kind of Ethics is Humanitarian Ethics? Examination is initially based on the four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. Harding-Pink D (2004) Humanitarian medicine: up the garden path and down the slippery slope. Article at www.fernandoalmansa.com 10. Although ethical obligations of humanitarian health organizations and health workers may overlap, the focus of the codebook was the organizational level. 2011; Poffley 2012). Social workers have a responsibility to promote and work to the Code of Ethics in carrying out their obligations to people who use social work services, to one another, to their employers, to colleagues in other disciplines and to society. Humanitarians are required to be impartial,independent, professionally competent andfocused only on preventing and alleviatinghuman suffering. 2011;5(1):91-9. PubMedGoogle Scholar. Fordham University Press and The Center for International Humanitarian Cooperation, New York, pp 243262, Madhiwalla N, Roy N (2009) Bombing medical facilities: a violation of international humanitarian law. SG made substantial contributions to the acquisition of the data and revising the work critically for important intellectual content. The Ethical Origins of Humanitarian Action -- PART TWO THE MODERN ELABORATION OF HUMANITARIAN PRINCIPLES 2. It is comprehensive, passionate and has the special gift of lucidly exploring moral complexities. Alex de Waal, Executive Director, World Peace Foundation at the Fletcher School, Tufts University, Humanitarian workers confront desperately difficult ethicalchoices every day as they struggle to provide aid in war and disasters. 12. Understanding that range is essential for developing strategies to better manage them, but existing systematic reviews have not focused on ethical issues specifically (Chaudhri et al. For example, when an aid organization works closely with a local population, that association could be perceived as compromising neutrality if the local population is perceived to be on one side of the conflict. 2014). 2017; Haver 2016; Poffley 2012). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Elrha or the r2hc. The humanitarian principles category drew upon the four widely accepted humanitarian principles: neutrality, impartiality, humanity, and independence (General Assembly resolution 46/182 1991; General Assembly resolution 58/114 2004; Pictet 1979; Sphere Project 2011). Public health and humanitarian interventions: developing the evidence base. Unanticipated ethical challenges often arise, however, during implementation of humanitarian research due to the unpredictability and shifting nature of crises. Disasters 34(Suppl 2):S130S137. Humanitarian and development aid in the times of economic crisis; times of great need and reduced resources. You can read our privacy policy here. Though I think people have written about their experience, but not in systematic ways or in the mainstream medical journals," Dr. Asgary said. Julian Sheather rightly notes that researchers must treat participants with respect, and not just as grist for the research mill. 2011). Safeguarding Health in Conflict Coalition (SHCC) (2018) Violence on the front lines: attacks on health care in 2017. 3. 2017; Civaner et al. Second, our findings have identified common ways in which ethical obligations and humanitarian principles can be mutually challenged in conflict settings. Our site uses cookies. BMJ 329:398399. Introduce ethical audits as part of standard practice. Careful attention is needed toward both the ethics OF research in humanitarian settings, that is the justification for launching a particular study and whether it is designed in an ethically robust manner, and ethics IN research, including attention to ethical considerations arising in the course of carrying out a study. 1993; Fennell 1998; Fouad et al. 2017; Farr 2013; Geiger et al. Humanitarian Ethics - Socialist Worker News & Analysis About the SWP SWP TV Donate Join the SWP SWP Meetings Subscribe Contact us Shop We use cookies on our website to give you the most. Ethics of Humanitarian Field Work Featuring Dr. Chiara Lepora Date Tue May 2nd 2017, 12:00 - 1:30pm Event Sponsor McCoy Family Center for Ethics in Society, WSD Handa Center for Human Rights & Int'l Justice Location Encina Hall, 616 Serra St., CISAC Central Conference Room (2nd Floor) Please RSVP here. Featuring contributions from humanitarian practitioners, health professionals, and social and political scientists, this book explores the question of ethics in modern humanitarian work,. 2017; Gardemann 2002; Haver 2016), it is nearly impossible to treat all potential beneficiaries equitably or reach those most in need. https://doi.org/10.1017/S1049023X1500480X, Gardemann J (2002) Primary health care in complex humanitarian emergencies: Rwanda and Kosovo experiences and their implications for public health training. Second, the intersection between ethics and humanitarianism in conflict settings creates the potential for using ethical decision-making to support and improve humanitarian action. The ethical analysis begins with the commonly used Principlist approach of Beauchamp and Childress, 15 which relies on the four principles, that is autonomy or respect for persons, beneficence, non-maleficence, and justice. Appropriate acquisition and management of assets (i.e., informational, financial, and human assets) was an ethical obligation that emerged in the analysis. Public health ethics frameworks An indispensable guide to the moral quandaries confronting those engaged in humanitarian action. Based on theoretical grounds, we believe that existing approaches are incomplete for use in an ethical framework appropriate for humanitarian engineering, i.e., one that includes not only an ethics of justice, but also an ethics of care. These frameworks share a commitment to creating decision processes that help identify the ethical issues at stake in a particular situation and make better decisions around them. 2011). First, observing this connection brings additional clarity to the nature of the challenges humanitarian organizations may face when operating in conflict settings. After 451 duplicates were removed, and 1537 records were excluded during abstract and title review, 89 articles were selected for full-text review. https://doi.org/10.4103/ajm.AJM_173_16, Article Matthew Hunt, PT, PhD, is an Associate Professor at the School of Physical and Occupational Therapy of McGill University, and co-lead of the Humanitarian Health Ethics Research Group. Yet the ethical appropriateness of this practice has been to date underexplored. The purpose of this study is to establish the relationship between ethics and procurement performance of humanitarian organizations in Kenya. Dev World Bioeth 8:5969. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy. 2011; Fegley 2009; Fraser et al. The humanitarian principle most frequently noted as challenging to uphold was neutrality (the duty that humanitarian actors must not take sides in a conflict). Syria, in particular, has been called the most dangerous place on earth for health-care providers (Fouad et al. His book should be required reading for all frontline aid workers and even more so for their bosses. Cambridge Review of International Affairs, Few fields of human enterprise are as morally challenging as humanitarian aid, especially in wartime. https://doi.org/10.1111/1758-5899.12315. Although there has been a discussion of ethical issues related to closing humanitarian projects (Fuller 2006; Hunt and Miao 2018; Hurst et al. General Assembly resolution 46/182 (1991) Strengthening of the coordination of humanitarian emergency assistance of the United Nations. Stewardship PrinciplesSustainability and Accountability 6. this edited volume from ayesha ahmad and james smith offers an expansive tour across the difficult landscape of ethical conundrums in humanitarian action, traversing issues related to "moral distress," triage and treatment of mental health and ebola patients, cross-border health provision, humanitarian failures, and humanitarianism's place in the https://doi.org/10.3310/hta15430, Chaudhri S, Cordes K, Miller N (2019) Humanitarian health programming and monitoring in inaccessible conflict settings: a literature review. Hum Rights Q 31:888915. In total, 66 articles met inclusion criteria and were included in the analysis (see Fig. This can be done in the form of rescuing and providing safety . Conflict settings present substantial barriers to humanitarian health response efforts. Int Rev Red Cross 95:287307. Demonstrating respect for individuals and communities affected by crisis. We collected the stories of ethical challenges reported by expatriate HCPs who participated in humanitarian and development work. Highlights Images of victims displayed by medical humanitarian organisations are often problematic from the standpoint of biomedical ethics. Passages that were difficult to interpret were discussed and coding was reconciled through discussion among the entire study team. 2019]), in conducting research on sexual violence in emergency situations, and other areas (see Additional file 1: Appendix 2). This is a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance. 2017; Michael and Zwi 2002), and policies restricting the administration of care to select populations and blocking access to certain locations (Al-Moujahed et al. https://data.humdata.org/dataset/shcchealthcare-dataset. Getting aid to vulnerable populations in armed conflicts and disasters is only the first step in responsible humanitarian action. These considerations are particularly salient in humanitarian research where vulnerabilities are amplified and resources are scarce. Below, we present key summary findings. London WC2R 1LA. In addition, whether existing frameworks for ethical decision-making in humanitarian action (Clarinval and Biller-Andorno 2014; Fraser et al. Philosophy, ethics, and humanities in medicine : PEHM. Humanitarian health care organizations and health workers working in contexts of armed or violent conflict experience challenges in fulfilling ethical obligations and humanitarian principles. Confl Health 5:6. https://doi.org/10.1186/1752-1505-5-6, Mak K (2014) Principles of neutrality and impartiality of humanitarian action in the aftermath of the 2011 Libyan conflict. Hard ethics in humanitarian work. Careful attention is needed toward both the ethics OF research in humanitarian settings, that is the justification for launching a particular study and whether it is designed in an ethically robust manner, and ethics IN research, including attention to ethical considerations arising in the course of carrying out a study. While humanitarian work has always presented unique ethical challenges, such efforts are now further complicated by the impact of globalization, the escalating refugee crisis, and mounting criticisms of established . PLoS Curr 6. https://doi.org/10.1371/currents.dis.96bec99f13800a8059bb5b5a82028bbf, Cobey JC, Flanagin A, Foege WH (1993) Effective humanitarian aid. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. A notable challenge to honest communication was the perception that open communications could subject organizational assets to additional risks (e.g., by subjecting them to further attacks) (Redwood-Campbell et al. The article focuses on the moral skills required by today's humanitarian practitioners if they are to work out a new model of humanitarian identity and positioning which supersedes the traditional but devalued notion of neutrality. masterful . https://doi.org/10.1111/j.1467-7717.2010.01149.x, Domres B, Koch M, Manger A, Becker HD (2012) Ethics and triage. 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