{"id":414,"date":"2023-04-04T23:43:12","date_gmt":"2023-04-04T23:43:12","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/chapter\/9-4-anthropological-approaches-to-medical-humanitarianism\/"},"modified":"2023-04-06T21:19:40","modified_gmt":"2023-04-06T21:19:40","slug":"9-4-anthropological-approaches-to-medical-humanitarianism","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/chapter\/9-4-anthropological-approaches-to-medical-humanitarianism\/","title":{"raw":"9.4: ANTHROPOLOGICAL APPROACHES TO MEDICAL HUMANITARIANISM","rendered":"9.4: ANTHROPOLOGICAL APPROACHES TO MEDICAL HUMANITARIANISM"},"content":{"raw":"
\r\n

Abstract<\/h2>\r\n

Despite broadly shared interest in the welfare of \u2018precarious lives\u2019, medical anthropology and medical humanitarianism are too often in tension. In this survey, we sketch a history of the two disciplines, then track three major patterns through which anthropologists approach the analysis of medical humanitarian efforts. Our three patterns frame medical anthropology as: 1) a critique of medical humanitarianism and its ties to colonialism and globalization, 2) a translation of medical humanitarianism and its associated lexicon, 3) and a reform of medical humanitarianism from the inside out. In highlighting the individual strengths of these three approaches, we argue for the value of medical anthropology \u2013 as both a mindset and a method \u2013 in health and humanitarian emergencies.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"650\"]\"Outdoor Figure 9.4<\/strong> Outdoor support clinics, Thaker. Leer, South Sudan, 18 March 2017. Copyright: Siegfried Modola\/MSF; used with permission.[\/caption]\r\n

Introduction<\/h2>\r\n

What possible form and effect does an anthropological presence have on medical humanitarian crises? International medical actors, such as the World Health Organization (WHO) and M\u00e9decins Sans Fronti\u00e8res (MSF), have recognized a role for anthropologists in navigating responses to health emergencies, but this role has yet to be fully defined (Abramowitz et al. 2015, 330; Brown et al. 2015, 1). This is despite broadly shared concerns for engagement with human suffering and the pain of the human condition (Redfield 2013, 5\u20136; Ticktin 2014, 274\u201377), which can be characterized as a convergence of professional sentiments.<\/p>\r\n

Anthropology and medical humanitarianism are both distinguished by internal heterogeneity, making for sometimes-awkward cross-disciplinary encounters; one can never quite be sure whether the other will share or reject one\u2019s own perspectives. The literature on the \u2018anthropological approach\u2019 to medical humanitarian crises is expansive and well theorized, yet for this reason it lacks a common, accessible narrative to pull together a diverse body of work. Such heterogeneity has been problematic for related fields as well. Historians Davey and Scriven (2015, 113), for example, state that \u2018[w]riting on humanitarian history is a booming occupation\u2019 characterized by a \u2018depth, innovation and complexity\u2019 that refuses to cleave to ready patterns or overviews. While the diverse nature of humanitarianism and its scholarship is not easy to encompass with generalities, certain patterns emerge.<\/p>\r\n

In an attempt to summarize anthropological approaches within and in relation to medical humanitarian agencies, this article asks two related questions: how have anthropologists engaged with institutions and action in the context of medical humanitarianism, and how might such engagement look in the future? To develop our analysis, we undertook a survey of relevant materials in medical anthropology. Building on a recent review by Ticktin (2014), which surveys the growing field of the anthropology of humanitarianism, and the conclusions in Fassin\u2019s (2012) Humanitarian Reason: A Moral History of the Present<\/em>, we evaluated works drawing from both anthropological and medical humanitarian sources, including but by no means limited to Anthropological Theory, Annual Review of Anthropology, Medical Anthropology Quarterly, Somatosphere<\/em>, Disasters<\/em>, Health Affairs, Social Science and Medicine, Violence, <\/em>and Politics and Humanitarian Action. <\/em>In doing so, we applied a working definition of \u2018medical humanitarianism\u2019 as proposed by Abramowitz and Panter-Brick (2015, 1) in their recent volume, Medical Humanitarianism: Ethnographies of Practice<\/em>: \u2018the field of biomedical, public health, and epidemiologic initiatives undertaken to save lives and alleviate suffering in the conditions of crises born of conflict, neglect or disaster\u2019. To this definition we added that medical humanitarianism is often a self-attributed label, a personal designation and category of action that responders may invoke, in part, as a moral appeal. In our understanding, humanitarianism places the human, and suffering as a human universal, as core concerns (Fassin 2012, 9; Redfield 2013, 39\u201342; Ticktin 2014, 273). This puts medical humanitarianism in sharp contrast to other forms of international health intervention that may seek, for example, to maximize the productive capacity of a population or buttress a health system against pathogenic threat (Lakoff 2010, 66; Elbe 2011, 849).<\/p>\r\n

This does not prevent a diverse array of actors from invoking humanitarian rhetoric \u2013 in other words, moral concern for human suffering \u2013 to justify actions that have motives quite distinct from saving life and reducing suffering. Thus, as others have noted, the 2003 military intervention in Iraq was characterized, in part, as a humanitarian campaign (Fassin 2012, 189\u2013231; Gilman 2012, 173\u201374). This highlights overlaps in goals and means between medical humanitarianism and the arenas of geopolitics, global economics, global health, disaster management, and international development. Yet, because of the preeminent emphasis on human suffering, humanitarian responses to emergencies are not wholly convergent with other forms of response to health crises, and may differ with regards to timescales, moral stakes, and media visibility (Lakoff 2010, 66\u201370, 74\u201375). (For these reasons, our literature search was confined to \u2018medical humanitarianism\u2019 and excluded material on global health, disaster management, and international development, except where it used \u2018humanitarianism\u2019 as a keyword).<\/p>\r\n

As a moral and political undertaking, humanitarianism recognizes the sanctity and dignity of human life, and the universality of both basic needs and suffering. Emerging in parallel with the rise of industrial capitalism, humanitarian action is the organized, collective practice of compassion. As a concept it began to take shape in the mid-eighteenth century but would come into its own in the nineteenth century (Barnett 2011, 49\u201350). In the rapid social and technological transformation of industrializing Europe, the word came to be associated with a variety of compassionate societies and committees for the relief of human suffering (Barnett 2011, 50\u201360). During these early decades, the International Committee of the Red Cross (founded 1863) provided medical care and supplies to battlefield wounded (Barnett 2011, 76\u201381). For most of the nineteenth century the humanitarian designation was simultaneously applied to issues of prison reform, slavery, and employment conditions; it wasn\u2019t until the Geneva Conventions of 1864, 1929, and 1949 that a humanitarian \u2018sensibility\u2019 would be codified internationally and formally protected (Haskell 1985, 339). International humanitarian law attempted to regulate the conduct of war and provided a protected space \u2013 if imperfectly realized in practice \u2013 for civilian actors to assist those directly affected by conflict. In these spaces of exception, humanitarian actors were attributed political neutrality and immunity from military aggression (Abramowitz and Panter-Brick 2015, 9\u201310; Gordon 2015, 187\u201388).<\/p>\r\n

Humanitarianism in its presently recognized form broadly means relief in times of crisis, particularly as prosecuted through transnational organizations and nongovernmental organizations (NGOs) in particular. For better or worse, medical humanitarianism views human crisis through the clinical gaze, framing human suffering as pathology amenable to medical intervention (Scott-Smith 2014, 23\u201325) and directly imprinted on body and psyche (Fassin 2000, 2005, 372; Ticktin 2011, 254). This has led to an anthropological critique of a tendency towards medicalization, and thus subordination, of lived experiences in the name of biomedicine, a politically fraught expression of compassion (Fassin 2012, 99\u2013101).<\/p>\r\n

There has historically been a breadth of anthropological literature on humanitarian action. In addition to large projects by professional historians (Barnett 2011; Davey and Scriven 2015; see also ODI 2015) and practitioners (Kent 1987; Terry 2002; Magone et al. 2011), anthropologists have written on the origins (both historical and ideational) of medical humanitarian action (de Waal 1997, 65\u201385; Fassin 2012, 1\u201317; Redfield 2013, 35\u201366; Ticktin 2014, 274\u201376). There is much work on the anthropological response to issues of famine, food security, and communicable diseases like HIV\/AIDS, to name a few (see Oliver-Smith 1996, as well as Henry 2005, for comprehensive reviews). In the last decade, however, there has been a rise in the literature focused on the anthropological position, or approach, to the act and rhetoric of intervention itself. It is not what<\/em> anthropology investigates in the humanitarian sphere but how<\/em>. Ticktin (2014, 274, 281\u201382), for example, has broadly framed anthropologists as allies of humanitarian ambitions, critics of unintended consequences, and analysts of an amorphous social phenomenon; Abramowitz, Marten, and Panter-Brick (2015, 3\u20134) have gone even further, undertaking a poll to assess aggregate views of the perspectives of anthropologists working in medical humanitarian contexts. Both studies argue that anthropologists must actively engage individual humanitarian practitioners, agencies, and issues, regardless of whichever conceptual stance they adopt.<\/p>\r\n

Our survey reveals three major strands of discourse on the intersection of anthropology and humanitarian action, which we term \u2018critique\u2019, \u2018translation\u2019, and \u2018reform\u2019. We argue medical anthropology has worked to critique humanitarian action, particularly how the field has become tied to capitalism, colonialism, and globalization. We suggest this approach has sometimes proved isolating, and we examine a second stream of anthropological work that works to translate and reframe medical humanitarian lexicons and ideologies. We finish by describing a third, emerging body of anthropological work that seeks to reform medical humanitarianism from inside out.<\/p>\r\n

These categories are not exhaustive, nor are they discrete: as the survey reveals, they may intersect, cross-pollinate, and flow into one another depending on context and time. In that sense, our analysis offers a spectrum, rather than strict divisions. Our hope is that this discussion challenges a view that oftentimes seems to pit humanitarian practitioners and academic anthropologists against each other (Minn 2007; Ravelo 2015). Indeed, in observing exchanges between these streams, we believe that whatever distinctions remaining between the two are further blurred.<\/p>\r\n\r\n

\r\n

The maturing of medical humanitarianism and medical anthropology<\/h2>\r\n<\/div>\r\n
\r\n\r\nTracing intersections and approaches of medical anthropology to humanitarianism requires knowledge of their complex histories, and how these have given rise to present-day institutional structures and politics. As the above histories reveal, medical humanitarianism, as contemporarily defined, had a violent birth, emerging in the nineteenth century out of military combat, disaster, and war to become an important social force of considerable size and scope (Bass 2008, 11\u201329). Today, the largest humanitarian agencies have annual operating budgets in the billions; for example, Save the Children\u2019s budget in 2015 was more than US$2 billion (Save the Children 2016). Such agencies frequently act as entrenched conglomerates (European Commission 2015, 1). They are fundamental to intra- and inter-country management not only of wars and disasters but also of diverse international crises that emerge, seemingly unanticipated, only to be handled with patterned regularity and predictable rhetoric (Calhoun 2004, 377\u201380). Indeed, the actions of self-declared medical humanitarian agencies cross boundaries of global health, human rights, international development, and political peacekeeping. Naturally, no single agency acts in all these sectors. The mix of activities demonstrates the heterogeneous and fundamentally contested nature of the humanitarian mantle; a wide variety of actors may claim humanitarian motives but undertake action in fundamentally different spheres.\r\n\r\n<\/div>\r\n
\r\n\r\nIn pace with this far-reaching growth, the field has become professionalized, developing frameworks to standardize humanitarian practice, support institution building, and supply scholarship and instruction. In the late 1980s, with the support of the European Commission for LifeLong Learning, European Union member states launched initiatives concerned with the quality and accountability of humanitarian work and established new postgraduate degrees and training in international humanitarian action (Brun and Attanapola 2014, 1; Walker et al. 2010, 2223\u201325). Initiatives like the Code of Conduct for NGOs and the Humanitarian Accountability Project attempted to standardize and professionalize humanitarian work (Walker 2005, 323\u201327). Yet, these developments remain entrenched in a Euro-American schema. According to Abramowitz and Panter-Brick (2015, 7), the professionalization of the medical humanitarian impulse has become a \u2018substantial stand-alone industry\u2019 distinct from volunteerism yet still embedded in a liberal ethic of \u2018giving back\u2019 and \u2018doing good\u2019. What remains to be seen is how this impulse survives its own explosive growth, given concerns that a shallow emphasis on \u2018doing something\u2019 may potentially lead to substandard delivery of care (Abramowitz and Panter-Brick 2015, 7). In the words of Dijkzeul and Wakenge (2010, 1141), the swell in the \u2018role and number of humanitarian actors\u2019 demands \u2018scholarly attention\u2019.\r\n\r\n<\/div>\r\n
\r\n\r\n\u00a0In conjunction with internal challenges to coherence that result from rapid growth, medical humanitarian action also faces external threats. Perhaps most pressing for practitioners is a perceived diminution of respect and recognition for the broad medical and humanitarian mission. While humanitarian \u2018spaces of exception\u2019 have been extensively theorized and often attributed with social and moral force (see, among others, Agier and Bouchet-Saulnier 2004, 303\u201304; Redfield 2005, 340\u201344; Fassin 2012, 151\u201354, 181\u201399), such spaces, when they exist at all, are difficult to establish and maintain in practice (Alli\u00e9 2011, 1\u20135). Because while attacks against humanitarian and medical personnel in wartime are not new \u2013 humanitarian and medical impartiality have never guaranteed immunity despite the dictates of the Geneva Conventions, and the list of targeted attacks against health care facilities in the past century is long \u2013 recent events seem to indicate that humanitarian and health care activities are increasingly under threat as targets of war. From 2011 and onward, there has been a sharp jump in both the frequency and flagrancy of deliberate attacks against medical humanitarian facilities (Baker and Brown 2015, 4\u20137; WHO 2016, 4\u20135, 7). At the present moment, long-standing international norms, both of medical and humanitarian neutrality and the threat of international opprobrium, appear to have lost sway over many state and non-state armed actors.\r\n\r\n<\/div>\r\n
\r\n\r\nThe development of medical anthropology tracks a parallel timeline to medical humanitarianism. In the nineteenth and early twentieth centuries, studies of medicine by anthropologists were typically enveloped within broader studies of cultural and social traditions, at times confining medical anthropology to the study of the ways that the \u2018other\u2019 dealt with issues of sickness and health (Inhorn and Wentzell 2012, 2). But in the latter half of the twentieth century, medical anthropology carved its own niche. Medicine\u2019s intersection with issues of race, gender, and inequality, as well as the increased involvement of anthropologists in international health work and clinical settings in the name of soft diplomacy during the Cold War, energized the discipline (Inhorn and Wentzell 2012, 6\u20137). Anthropologists Strathern and Stewart (1999, 3) track what they call \u2018a circular migration\u2019 \u2013 \u2018from the jungle to the city, and back again\u2019 \u2013 such that medical anthropology became an investigation not only of other cultures and healing practices but also of their own. The development of critical medical anthropology in the 1990s, with its social constructionist understanding of disease and its political economy understanding of power, further popularized the discipline\u2019s approach. However, like medical humanitarianism, the effectiveness of the method posed its own threat: to date, anthropology has been criticized for taking \u2018healthy self-consciousness too far, inadvertently casting itself as a discipline suspicious of collaboration and cross-industry reciprocity\u2019 (Harragin 2012, 4).\r\n\r\n<\/div>\r\n
\r\n\r\nBe that as it may, medical anthropology and humanitarianism continue to intersect. Both emerged from postcolonial concerns in a moment when neoliberalism, human rights, and democratic individualism were ascendant values. Both have thrived in a postnational, post-Cold War era characterized by the privileging of individual enterprise and cultural reductionism of the West. And both have embraced and continue to simultaneously embrace and criticize aspects of these values. Working in similar physical and discursive spaces, medical humanitarianism and anthropology have had interests, goals, and contexts that have at times met at points of complementarity and others at points of tension. Ultimately, it is this historical, material, and ideational relationship that enables, but also complicates, a survey of the literature of the two disciplines.\r\n\r\n<\/div>\r\n
\r\n

Anthropology as critique<\/h2>\r\n<\/div>\r\n
\r\n\r\nThis bisecting history has helped produce three categories of disciplinary intersection. The dominant form of anthropological discourse on medical humanitarianism at present is that of critique. This approach calls on anthropologists to evaluate, interpret, and analyze NGOs and humanitarian actors as they would any other institution of power and influence. Rather than defer to appeals regarding the sanctity of human life and the moral imperative to aid people in distress (which leads to claims of humanitarian \u2018exceptionalism\u2019), this work approaches these claims face on, problematizing the impact of morally motivated interventionism.\r\n\r\n<\/div>\r\n
\r\n\r\nNumerous case studies track humanitarian missteps, in both practical and ideological arenas. Ticktin (2014, 277\u201381) provides a thorough summary of work in this vein. Anthropologists have critiqued medical humanitarian projects for their unintended consequences, low standards of care, limited local input, weak oversight, and more (see, for example, Harrell-Bond 1986; Escobar 1995; Malkki 1995, 1996; de Waal 1997; Fisher 1997; Macrae 2002; Harragin 2012; Redfield 2013). Anthropologists have also criticized medical humanitarianism in broader swathes, particularly when it is conceptualized as a project with neoliberal, capitalist impulses. In part informed by work on the anthropology of development, which was influenced by Ferguson\u2019s (1990) work on aid in Lesotho, humanitarian action began to be reasoned \u2018in terms of an organized system of power and practice which has formed part of the colonial and neo-colonial domination of poor countries by the West\u2019 (Lewis 2005, 3).\r\n\r\n<\/div>\r\n
\r\n\r\nEarly examples of this framework are perhaps best represented by Pandolfi\u2019s (2000, 2003) work analyzing medical humanitarian agencies in postwar and post communist Albania and Kosovo. In her evaluation of the \u2018right to interfere\u2019 in the name of \u2018emergency\u2019, she describes the disappearing boundaries between medical and military intervention, at times referring to it as a mobile \u2018humanitarian-military apparatus\u2019 (Pandolfi 2003, 496\u201397). She characterizes humanitarianism by its state-like functions, identifying a new form of sovereignty at the intersection of biopolitics and \u2018bare life\u2019, ultimately resulting in the reduction of subjective individuality and the influx of diagnostic and numerical categories based on humanitarian management (Pandolfi 2003, 499).\r\n\r\n<\/div>\r\n
\r\n\r\nIn subsequent years anthropologists published widely read critical studies: Redfield\u2019s (2005, 2013) retrospective ethnographies of MSF, Fassin\u2019s (2012, 1\u20132) critique of the humanitarian epistemology of \u2018moral sentiments\u2019 with regards to the status of immigrants in France, andNguyen\u2019s (2010) commentary against the unintentional making of new markets and economies among both HIV\/AIDS patients and their ART therapies on the part of the humanitarian agency. In these contexts, the logics of what Fassin (2012) calls \u2018humanitarian reason\u2019 expose new vulnerabilities, mark new terrains, and gain control over new bodies.\r\n\r\n<\/div>\r\n
\r\n\r\nMore recently, this work has found itself intertwined with the field and politics of global health. In turn, anthropologists have articulated what they see as the \u2018global health machine\u2019 (Gaines 2011, 87) and an emerging \u2018NGO industrial complex\u2019 (Adams 2013, 76\u201379). Such machinery has been well-documented in a wide variety of phenomena, such as medical volunteerism, which Berry (2014, 347) has criticized for focusing more on the student r\u00e9sum\u00e9 than the provision of medical care; pharmaceutical investment, which Parker and Allen (2014) suggest assumes tyranny over the monitoring and evaluation processes required of most humanitarian projects; the application of the \u2018economic gaze\u2019 to matters of health, wherein \u2018the body is constructed as having little to no value outside of its role in the global economy\u2019 (Sridhar 2011, 1909); and the default to a \u2018one-size-fits-all model\u2019 and erasure of local specificities in the \u2018scale-up\u2019 of global health interventions (Adams et al. 2014, 182\u201383).\r\n\r\n<\/div>\r\n
\r\n\r\nThis \u2018anthropology as critique\u2019 approach has deep historical roots in anthropology\u2019s disciplinary preoccupations, as seen in the overwhelming amount of literature we found dedicated to this thread of discourse. It is well established that anthropological knowledge contributed to European colonial dominance, as is the fact that European power enabled anthropological practice, thoroughly influencing its methods, discourses, and central concerns (Asad 1991, 315). It is this problematic historical relationship with state power that makes many anthropologists justly skeptical of large-scale institutional influence, particularly when deployed among disenfranchised people. Fassin and Pandolfi (2010, 16, 20\u201322) imply that social scientists should resist being used as accomplices in larger humanitarian projects or agendas, especially when any form of intervention is anthropologically understood as a political play or implicit military action. Critical neutrality is both a role and a method in anthropology. But this stance can be taken too far: circumspection can become overwrought; fear of being used can become fear of being useful. This dynamic \u2013 perhaps best reflected in Kleinman\u2019s (1982, 112) mock dilemma of an anthropologist constantly being asked \u2018Whose interest does this professional stranger support?\u2019 \u2013 is bound up in the critique approach to medical humanitarianism.\r\n\r\n<\/div>\r\n
\r\n

Anthropology as translation<\/h2>\r\n<\/div>\r\n
\r\n\r\nAnthropology\u2019s role as external commentator can and has been perceived as isolationist and counterproductive (Abramowitz and Panter-Brick 2015, 8; Ticktin 2014, 283; Tol et al. 2012, 33; Harragin 2012, 3\u20135). Some anthropologists have rejected this viewpoint on the premise that it hampers collaboration and characterizes anthropologists as armchair spectators, trapping them in a \u2018cul-de-sac of critique\u2019 (Ticktin 2014, 283). According to Abramowitz and Panter-Brick (2015, 8), scholarly critiques of medical humanitarian reason are necessary but sometimes \u2018fail to convey the real-time exigencies of humanitarian experience and the range of internal debates within humanitarian networks\u2019. Tol and colleagues (2012, 33) suggest that these criticisms appear to function as fodder for \u2018academic debates without relevance for practice\u2019.\r\n\r\n<\/div>\r\n
\r\n\r\nA second stream of anthropological work has emerged out of this criticism. We argue that anthropology as translation favors an approach that investigates and privileges cross-disciplinary discussion between anthropological and humanitarian actors. With \u2018translation\u2019, we allude to Callon (1986) and Latour (1986), who conceptualize translation as a process through which meanings, claims, and contexts come to occupy new spaces and change foundational ground. Translation is not only interpretation from one language or discipline to another; rather, it is a process by which languages and disciplines are made to cohere, and in the process create new hybrids. In particular, we favor Latour\u2019s (1986, 268) definition, in which translation results in a continuously infinite process of producing \u2018something completely different\u2019. In this definition, anthropological work on medical humanitarianism is not about interpreting the field for lay understanding but about producing a new discourse within which medical humanitarianism can be imagined in critical, creative, and diverse ways.\r\n\r\n<\/div>\r\n
\r\n\r\nFor example, Marcus (2010) argues that anthropology should engage all actors working in a medical crisis. In a nod to Scheper-Hughes\u2019s (1995, 414\u201315) famous rejection of \u2018anthropologists as spectators\u2019, Marcus (2012, 362) calls on anthropologists to \u2018modestly witness\u2019 the conditions they are studying. For Marcus and Scheper-Hughes, anthropologists are not reporters but actors and negotiators. This work places heavy emphasis on issues of communication and articulation. According to this literature, \u2018anthropology as translation\u2019 helps position human suffering in a way that avoids the norms of communication and engagement that \u2018tend to make pain into abstraction\u2019 (Marcus 2010, 371). This is not to evoke what has sometimes been termed and critiqued as the \u2018suffering slot\u2019: which, Robbins argues, situates vulnerability as a \u2018privileged object of attention\u2019 (2013, 450) with \u2018a universalistic quality\u2019 (ibid., 454) that anthropologists can categorize neatly to presume wider understanding. Rather, \u2018anthropology as translation\u2019 forces anthropologists to step out of imagined molds, enabling new forms that bypass norms or universality and instead celebrate distinctions and locality. In the words of Fassin (2012, 245), this work means \u2018straddl[ing] the line between outside and inside \u2026 to be located \u201cat the frontiers\u201d\u2019.\r\n\r\n<\/div>\r\n
\r\n\r\nTranslation work has, in part, been operationalized to reframe the narratives or linguistic and conceptual tropes that humanitarian actors may use. For instance, Redfield (2013, 14, 29\u201334) evaluates shaky underpinnings of the \u2018states of emergency\u2019 that legitimize a \u2018crisis\u2019; Harragin (2012, 3) interrogates the insufficiency of \u2018short-term, humanitarian contracts\u2019 in light of more long-term, existing infrastructural realities; and Feldman and Ticktin (2010, 1\u20135) interpret the practical implications of the humanitarian premise of \u2018humanity\u2019. \u2018Sovereignty\u2019 as a status of independent statehood or actorhood has been similarly unpacked, perhaps most notably by Pandolfi\u2019s (2000) application of Appadurai\u2019s (2003) \u2018mobile sovereignty\u2019 but also more recently by Abramowitz\u2019s (2015) ethnography of MSF\u2019s withdrawal in Liberia, Good and colleagues\u2019 (2015) work on post-tsunami interventions in Indonesia, and Gordon\u2019s (2015) analysis of the complexities and contradictions of medical medicine inherent to Iraq and Afghanistan.\r\n\r\n<\/div>\r\n
\r\n\r\n\u00a0The 2014\u20132016 Ebola outbreak in West Africa may be the most recent foregrounding of anthropology as translation. Ebola\u2019s Ecologies, an interdisciplinary analysis edited by anthropologists Lakoff, Collier, and Kelty (2015), and the introductory chapter of Packard\u2019s (2016) A History of Global Health: Interventions into the Lives of Other Peoples both examine how the Ebola outbreak forged new logics, practices, and rhetorics among its many and diverse actors. In Ebola Ecologies, the Ebola outbreak is seen as a product of failed \u2018administrative imagination\u2019 that neither categorized nor conceptualized of Ebola adequately; to Packard (2016, 2), the global North\u2019s understanding of Ebola \u2018represented examples of cultural modeling\u2019 that \u2018deflected attention from other, more fundamental causes of the event\u2019. But both works acknowledge that the epidemic fostered new formulations in health systems management, pharmaceutical research, and multilateral engagement. Describing the process of Ebola vaccine trials instituted during and after the crisis, Nading (2015) comments on the \u2018contingent, speculative, \u201cchimeric\u201d nature of contemporary global health\u2019; while commenting on the Ebola \u2018watchdog\u2019 groups formed in communities where the infection had spread, Packard (2016, 331) discusses the local and foreign organizing that came together to privilege \u2018capacities for self-help\u2019 and ultimately slow the disease\u2019s progress. Here, it is new imaginations, even some failed ones, that deserve anthropological investigation. As Biruk (2014, 7\u20138) writes, \u2018anthropology [can] take objects in, reframe them, and re-generate knowledge in a new way that excavates the structures and logics that make them\u2019.\r\n\r\n<\/div>\r\n
\r\n

Anthropology as reform<\/h2>\r\n<\/div>\r\n
\r\n\r\nA final stream of anthropological thought seeks not to criticize medical humanitarianism or translate its ideologies but instead to reform the discipline itself. As humanitarian agencies grow in size and complexity and engage with new actors and professionals, anthropologists have pushed for research that acts with, but not within, archetypical frameworks of humanitarian response. While the smallest of the three at present, this discourse promises to grow in the near future, as more anthropologists engage directly and more robustly with humanitarian agencies.\r\n\r\n<\/div>\r\n
\r\n\r\nThis third body of work demands anthropologists assume a more transformative role; in the words of Harragin (2004, 325), an anthropologist working in South Sudan, \u2018It is time it [anthropology] realized that [excessive] introspection risks failing to engage with global forces that will sweep on with or without anthropological insights\u2019. Ultimately, this literature pushes not for criticism nor for hybrid productions but for a \u2018seat at the table\u2019 for anthropologists engaging in humanitarian work (Abramowitz et al. 2015, 330). The focus on participation is key here. As Feierman and colleagues (2010, 123) assert in a piece on medical humanitarian programs, \u2018Anthropologists \u2026 have the potential to play an important role in both mediating and studying flows of knowledge\u2019. Abramowitz (2014) argues, in this same vein, that \u2018many more anthropologists of West Africa are being invited to write commentaries on the current outbreak. But this does not go far enough\u2019 (emphasis in original). This argument for practice is part of a broader demand for engaged anthropology (Fassin 2012; Eriksen 2006).\r\n\r\n<\/div>\r\n
\r\n\r\nAnthropology as reform has the potential to establish a new discursive and professional space, one in which anthropology is not supplementary but a partner in its own right. Here, the focus is on how anthropology might help produce new norms or paradigms within and for humanitarian action. Adding nuance to Abramowitz\u2019s \u2018seat at the table\u2019 offers a productive starting point: anthropology as reform is not a particular kind of temporal or professional role (in other words, follow-up commentary vs. contemporaneous original research) but rather a way of seeing that can alter how humanitarian crises are perceived and addressed. By virtue of method, anthropology works against the essentialism and reductionism that can be pernicious in humanitarian discourse, wherein people can be reduced to biology or statistics. The work of anthropology makes humans coherent within simultaneous contexts of individual, social, and ecological worlds; it unites empirical experience, historical knowledge, and moral subjectivity, and holds these in productive tension (Latour 2014, 13\u201314). When practiced well, anthropology is an \u2018evidence-based field science\u2019 that is simultaneously relational, reflexive, and inclusive (Nyamnjoh 2015, 59\u201360). An anthropological lens on crisis can change the perception of causation, needs, and wants. By extension, this can change the nature of the humanitarian encounter itself.\r\n\r\n<\/div>\r\n
\r\n\r\nWhile some examples of anthropology as reform may already be emerging in medical humanitarian organizations (see, for example, the recent ethnographies of Stellmach 2016 and V\u00e9ran et al. 2017), this phenomenon is perhaps most evident in medical anthropological work on global health. Because anthropologies of global health exhibit considerable disciplinary and practical overlap with medical humanitarianism, a quick summary may indicate how an anthropology of medical humanitarianism can be an anthropology of reform.\r\n\r\n<\/div>\r\n
\r\n\r\nWhile the exact meaning of \u2018global health\u2019 is contested (Koplan et al. 2009; Lakoff 2010; Fassin 2012; Garrett 2013), we use the definition articulated recently by geographer Herrick (2016, 674): global health \u2018involves the transfer of knowledge and resources [and] a variety of efforts to act on and reduce the global burden of disease, and a particular concern for and financial investment in the infectious disease triumvirate of HIV\/AIDS, malaria, and tuberculosis\u2019. Of course, as Herrick (2016, 674) herself acknowledges, this simple definition is complicated by the diverse and complicated assemblage of disciplines, actors, initiatives, and agendas working in the global health sphere.\r\n\r\n<\/div>\r\n
\r\n\r\nAt present, writings on global health seem to be the most conducive to an anthropology of reform. Abramowitz (2014) has taken perhaps the most practical approach, writing of ten tangible actions that anthropology can undertake in public health emergencies, including detecting and identifying latent local capabilities, generating innovative ways of communicating among new and diverse actors, and pushing for funding from government bodies. Emphasized here are the tools and avenues through which anthropology provokes a departure from normalcy. Others (Guyer et al. 2010; Erikson 2012; Sangaramoorthy 2012) recognize the ways that anthropology can participate in traditional approaches to monitoring and evaluation in order to \u2018provide various levels of accountability for activities or policies\u2019 (WHO 2004, 4). According to Biruk (2014, 348), institutionally necessary data, while expected to be \u2018clean, accurate, precise\u2019, and a fixed representation of a problem at hand, is in fact complex, messy, and uncertain \u2013 full of a kind of \u2018noise\u2019 that Abramowitz (2014) argues is uniquely suited for anthropological analysis.\r\n\r\n<\/div>\r\n
\r\n\r\nPerhaps most accessible to the reader is the approach taken by Adams and colleagues (2014, 179\u201380), who borrow from the \u2018slow food movement\u2019 to emphasize the need for \u2018slow research\u2019 in global health. Like the organic slow food movement, Adams and colleagues argue for a combination of long-term anthropological research on local particularities with the \u2018fast\u2019 qualities of emergency relief and information acquisition characteristic of contemporary global health. They urge caution against \u2018anticipatory modes of engagement\u2019 \u2013 the quickening of assumptions and conclusions \u2013 calling instead for a \u2018pause before eating\u2019 and \u2018a moment to contemplate\u2019 what is before or ahead (Adams et al. 2014, 187\u201388). The authors conclude: \u2018Slow research is not necessarily opposed to \u201cfast\u201d research, but it is opposed to what might be identified as a new normal. Slow research is a response, addition, and possible alternative to the newest normative trends\u2019 (Adams et al. 2014, 180). This also suggests how anthropologists might react to the speed and ethical complexity of medical humanitarian crises: not to lose one\u2019s method in the rush of emergency, but rather to double down on method, adapting the technique to the context (Stellmach 2016). Resident in institutions that simultaneously comfort and oppress (as so many institutions of modernity do), anthropologists\u2019 awareness of power dynamics, both institutional and interpersonal, can help us negotiate a path between co-option and refusal to participate for fear of co-option.\r\n\r\n<\/div>\r\n
\r\n\r\nIt is worth reiterating that anthropology as reform is not about fitting anthropology into an existing global health or humanitarian apparatus. As anthropologist and sociologist Pigg (2013, 127) argues, \u2018in the face of intensifying demands on ethnographers to subsume their insights to ever narrower, utilitarian goals \u2026 it is important to recognize \u2026 the unique character of ethnographic praxis\u2019. In other words, anthropology as reform pushes for new sources of evidence that are not constrained by standardized regulations and historical form. Ultimately, as Pigg (2013, 133) argues, the hope is to position anthropology \u2018in the very midst of the making of global health as it \u2013 whatever \u201cit\u201d is \u2013 unfolds\u2019.\r\n\r\n<\/div>\r\n
\r\n

Conclusion<\/h2>\r\n<\/div>\r\n
\r\n\r\nIn this survey, we have argued that three anthropological approaches \u2013 critique, translation, and reform \u2013 have typically framed the intersection of anthropology and medical humanitarian action. To do so, we detailed the overlapping values and histories of medical anthropology and humanitarianism, highlighting how disciplinary origins feed into contemporary norms of engagement. We have also examined the typologies of anthropological participation, suggesting that ethnography can offer a unique framework by which to understand health and medical issues in the context of humanitarianism.\r\n\r\n<\/div>\r\n
\r\n\r\nWe do not wish to privilege or prioritize one approach over others, but instead to identify and further extrapolate three axes upon which humanitarian action can be evaluated. Each category has an appropriate time and place, and individual anthropologists may switch between each of the three modes as circumstances merit. Medical humanitarianism will continue to shift in direction and purpose, and whether by critique, translation, or reform, anthropologists should take care to purposively entangle \u2013 and disentangle \u2013 these threads of action. Only then will anthropological ways of knowing continue to grow in value.\r\n\r\n<\/div>\r\n
\r\n

About the authors<\/h2>\r\n<\/div>\r\n
\r\n\r\nIsabel Beshar is a medical student at Stanford University School of Medicine. She received her MPhil in medical anthropology from the University of Oxford, where she studied as a 2014 American Rhodes Scholar. She previously worked as a consultant at Global Health Strategies, where she helped coordinate emergency response management of vector-borne diseases and women\u2019s health.\r\n\r\n<\/div>\r\n
\r\n\r\nDarryl Stellmach divides time between academic and applied roles, as a postdoctoral researcher at the University of Sydney and as anthropology implementer for the London office of the aid group M\u00e9decins Sans Fronti\u00e8res (MSF). A former field manager for MSF, Darryl assists with the integration of anthropologists and anthropological research techniques into the agency\u2019s field teams. A Commonwealth doctoral scholar, Darryl\u2019s 2016 dissertation undertook an ethnography that followed MSF aid practitioners in South Sudan as they responded to that country\u2019s emergent civil war and subsequent nutritional crisis.\r\n\r\n<\/div>\r\n
<\/div>\r\n
References\u00a0<\/strong><\/div>\r\n
\r\n

Abramowitz, Sharon. 2014. \u2018Ten Things That Anthropologists Can Do to Fight the West African Ebola Epidemic\u2019. Somatosphere: Science, Medicine, and Anthropology, 26 September. http:\/\/somatosphere.net\/2014\/09\/ten-things-that-anthropologists-can-do-to-fight-the-west-african-ebola-epidemic.html<\/a>.<\/p>\r\n

Abramowitz, Sharon. 2015. \u2018What Happens When MSF Leaves? Humanitarian Departure and Medical Sovereignty in Postconflict Liberia\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 137\u201354. Philadelphia: University of Pennsylvania Press. https:\/\/doi.org\/10.9783\/9780812291698-009<\/a>.<\/p>\r\n

Abramowitz, Sharon, Kevin L. Bardosh, Melissa Leach, Barry Hewlett, Mark Nichter, and Vinh-Kim Nguyen. 2015. \u2018Social Science Intelligence in the Global Ebola Response\u2019. Lancet 385, no. 9965: 330. https:\/\/doi.org\/10.1016\/s0140-6736(15)60119-2<\/a>.<\/p>\r\n

Abramowitz, Sharon, Meredith Marten, and Catherine Panter-Brick. 2015b. \u2018Medical Humanitarianism: Anthropologists Speak Out on Policy and Practice\u2019. Medical Anthropology Quarterly 29, no. 1: 1\u201323. https:\/\/doi.org\/10.1111\/maq.12139<\/a>.<\/p>\r\n

Abramowitz, Sharon, and Catherine Panter-Brick. 2015. \u2018Bringing Life into Relief: Comparative Ethnographies of Humanitarian Practice\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 1\u201320. Philadelphia: University of Pennsylvania Press.<\/p>\r\n

Adams, Vincanne. 2013. \u2018Evidence-Based Global Public Health: Subjects, Profits, Erasures\u2019. In When People Come First: Critical Studies in Global Health, edited by Joao Biehl and Adriana Petryna, 54\u201390. Princeton, NJ: Princeton University Press.<\/p>\r\n

Adams, Vincanne, Nancy J. Burke, and Ian Whitmarsh. 2014. \u2018Slow Research: Thoughts for a Movement in Global Health\u2019. Medical Anthropology 33, no. 3: 179\u201397. https:\/\/doi.org\/10.1080\/01459740.2013.858335<\/a>.<\/p>\r\n

Agier, Michel, and Fran\u00e7oise Bouchet-Saulnier. 2004. \u2018Humanitarian Spaces: Spaces of Exception\u2019. In In the Shadow of \u2018Just Wars\u2019: Violence, Politics, and Humanitarian Action, edited by Fabrice Weissman, 297\u2013313. Ithaca, NY: Cornell University Press.<\/p>\r\n

Alli\u00e9, Marie-Pierre. 2011. \u2018Introduction: Acting at Any Price?\u2019 In Humanitarian Negotiations Revealed: The MSF Experience, edited by Claire Magone, Micha\u00ebl Neuman, and Fabrice Weissman, 1\u201316. London: Hurst & Company.<\/p>\r\n

Appadurai, Arjun. 2003. \u2018Sovereignty Without Territoriality: Notes for a Postnational Geography\u2019. In The Anthropology of Space and Place: Locating Culture, edited by Setha M. Low and Denise Lawrence-Z\u00fa\u00f1iga, 337\u201349. Blackwell Readers in Anthropology. Malden, MA: Wiley-Blackwell.<\/p>\r\n

Asad, Talal. 1991. \u2018Afterword: From the History of Colonial Anthropology to the Anthropology of Western Hegemony\u2019. In Colonial Situations: Essays on the Contextualization of Ethnographic Knowledge, edited by George W. Stocking, Jr., 314\u201324. History of Anthropology 7. Madison: The University of Wisconsin Press.<\/p>\r\n

Baker, Elsie, and Widney Brown. 2015. Doctors in the Crosshairs: Four Years of Attacks on Health Care in Syria. New York: Physicians for Human Rights. https:\/\/s3.amazonaws.com\/PHR_Reports\/doctors-in-the-crosshairs.pdf<\/a>.<\/p>\r\nBarnett, Michael N. 2011. Empire of Humanity: A History of Humanitarianism. Ithaca, NY: Cornell University Press.\r\n\r\nBass, Gary. 2008. Freedom\u2019s Battle: The Origins of Humanitarian Intervention. New York: Alfred A. Knopf.\r\n

Berry, Nicole S. 2014. \u2018Did We Do Good? NGOs, Conflicts of Interest and the Evaluation of Short-Term Medical Missions in Solol\u00e1, Guatemala\u2019. Social Science & Medicine 120: 344\u201351. https:\/\/doi.org\/10.1016\/j.socscimed.2014.05.006<\/a>.<\/p>\r\n

Biruk, Crystal. 2014. \u2018Ebola and Emergency Anthropology: The View from the \u201cGlobal Health Slot\u201d\u2019. Somatosphere: Science, Medicine, and Anthropology, 3 October. http:\/\/somatosphere.net\/2014\/10\/ebola-and-emergency-anthropology-the-view-from-the-global-health-slot.html<\/a>.<\/p>\r\n

Brown, Hannah, Ann H. Kelly, Almudena Mar\u00ed S\u00e1ez, Elisabeth Fichet-Calvet, Rashid Ansumana, Jesse Bonwitt, N\u2019Faly Magassouba, Foday Sahr, and Matthias Borchert. 2015. \u2018Extending the \u201cSocial\u201d: Anthropological Contributions to the Study of Viral Haemorrhagic Fevers\u2019. PLoS Neglected Tropical Diease 9, no. 4: e0003651. https:\/\/doi.org\/10.1371\/journal.pntd.0003775<\/a>.<\/p>\r\n

Brun, Catherine, and Chamila Attanapola. 2014. Professionalisation of Humanitarian Work: The Norwegian Case. European Universities on Professionalization on Humanitarian Action (EUPRHA). http:\/\/hamap.eu\/upload\/2015\/03\/euprha-lcp-norway.pdf<\/a>.<\/p>\r\n

Calhoun, Craig. 2004. \u2018A World of Emergencies: Fear, Intervention, and the Limits of Cosmopolitan Order\u2019. Canadian Review of Sociology\/Revue Canadienne de Sociologie 41, no. 4: 373\u201395. https:\/\/doi.org\/10.1111\/j.1755-618X.2004.tb00783.x<\/a>.<\/p>\r\n

Callon, Michel. 1986. \u2018Some Elements of a Sociology of Translation: Domestication of the Scallops and the Fishermen of St. Brieuc Bay\u2019. Sociological Review 32, no. S1: 196\u2013223. https:\/\/doi.org\/10.1111\/j.1467-954X.1984.tb00113.x<\/a>.<\/p>\r\nDavey, Eleanor, and Kim Scriven. 2015. \u2018Humanitarian Aid in the Archives: Introduction\u2019. Disasters 39, no. s2: s113\u201328. https:\/\/doi.org\/10.1111\/disa.12150<\/a>.\r\n\r\nde Waal, Alex. 1997. Famine Crimes: Politics & the Disaster Relief Industry in Africa. Bloomington: Indiana University Press.\r\n

Dijkzeul, Dennis, and Claude Iguma Wakenge. 2010. \u2018Doing Good, but Looking Bad? Local Perceptions of Two Humanitarian Organisations in Eastern Democratic Republic of the Congo\u2019. Disasters 34, no. 4: 1139\u201370. https:\/\/doi.org\/10.1111\/j.1467-7717.2010.01187.x<\/a>.<\/p>\r\nDunn, Elizabeth Cullen. 2012. The Chaos of Humanitarian Aid: Adhocracy in the Republic of Georgia 3, no. 1: 1\u201323. https:\/\/doi.org\/10.1353\/hum.2012.0005<\/a>.\r\n

Elbe, Stefan. 2011. \u2018Pandemics on the Radar Screen: Health Security, Infectious Disease and the Medicalisation of Insecurity\u2019. Political Studies 59, no. 4: 848\u201366. https:\/\/doi.org\/10.1111\/j.1467-9248.2011.00921.x<\/a><\/p>\r\n

Erikson, Susan. 2012. \u2018Global Health Business: The Production and Performativity of Statistics in Sierra Leone and Germany\u2019. Medical Anthropology 31, no. 4: 367\u201384. https:\/\/doi.org\/10.1080\/01459740.2011.621908<\/a>.<\/p>\r\nEriksen, Thomas Hylland. 2006. Engaging Anthropology: The Case for a Public Presence. Oxford: Berg.\r\n\r\nEscobar, Arturo. 1995. Encountering Development: The Making and Unmaking of the Third World. Princeton, NJ: Princeton University Press.European Commission. 2015.\r\n\r\n\u2018European Commission Press Release: Record EU Humanitarian Budget Adopted for 2016\u2019. News release, 16 December. http:\/\/europa.eu\/rapid\/press-release_IP-15-6336_en.htm<\/a>.\r\n\r\nFassin, Didier. 2000. \u2018Entre politiques du vivant et politiques de la vie: Pour une anthropologie de la sant\u00e9\u2019. Anthropologie et soci\u00e9t\u00e9s 24, no. 1: 95\u2013116. https:\/\/doi.org\/10.7202\/015638ar<\/a>.\r\n\r\nFassin, Didier. 2005. \u2018Compassion and Repression: The Moral Economy of Immigration Policies in France\u2019. Cultural Anthropology 20, no. 3: 362\u201387. https:\/\/doi.org\/10.1525\/can.2005.20.3.362<\/a>\r\n\r\nFassin, Didier. 2012. Humanitarian Reason: A Moral History of the Present. Berkeley: University of California Press.\r\n

Fassin, Didier, and Mariella Pandolfi. 2010. \u2018Introduction: Military and Humanitarian Government in the Age of Intervention\u2019. In Contemporary States of Emergency: The Politics of Military and Humanitarian Interventions, edited by Didier Fassin and Mariella Pandolfi, 9\u201325. New York: Zone Books.<\/p>\r\n

Feierman, Steven, Arthur Kleinman, Kathleen Stewart, Paul Farmer, and Veena Das. 2010. \u2018Anthropology, Knowledge-Flows and Global Health\u2019. Global Public Health 5, no. 2: 122\u201328. https:\/\/doi.org\/10.1080\/17441690903401338<\/a>.<\/p>\r\n

Feldman, Ilana, and Miriam Ticktin. 2010. \u2018Introduction: Government and Humanity\u2019. In In the Name of Humanity: The Government of Threat and Care, edited by Ilana Feldman and Miriam Ticktin, 1\u201326. Durham, NC: Duke University Press.<\/p>\r\nFerguson, James. 1990. The Anti-Politics Machine: \u2018Development\u2019, Depoliticization and Bureaucratic Power in Lesotho. Cambridge: Cambridge University Press.\r\n\r\nFisher, William F. 1997. \u2018Doing Good? The Politics and Antipolitics of NGO Practices\u2019. Annual Review of Anthropology, 439\u201364. https:\/\/doi.org\/10.1146\/annurev.anthro.26.1.439<\/a>.\r\n

Gaines, Atwood D. 2011. \u2018Millennial Medical Anthropology: From There to Here and Beyond, or the Problem of Global Health\u2019. Culture, Medicine, and Psychiatry 35, no. 1: 83\u201389. https:\/\/doi.org\/10.1007\/s11013-010-9203-x<\/a>.<\/p>\r\n

Garrett, Laurie. 2013. Existential Challenges to Global Health. New York: Center on International Cooperation, New York University. http:\/\/www.dphu.org\/uploads\/attachements\/books\/books_1015_0.pdf<\/a><\/p>\r\n

Gilman, Nils. 2012. \u2018Preface: Militarism and Humanitarianism\u2019. Humanity: An International Journal of Human Rights, Humanitarianism, and Development 3, no. 2: 173\u201378. https:\/\/doi.org\/10.1353\/hum.2012.0009<\/a>.<\/p>\r\n

Good, Byron J., Jesse Hession Grayman, and Mary-Jo DelVecchio Good. 2015. \u2018Humanitarianism and \u201cMobile Sovereignty\u201d in Strong State Settings: Reflections on Medical Humanitarianism in Aceh, Indonesia\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 155\u201375. Philadelphia: University of Pennsylvania Press.<\/p>\r\n

Gordon, Stuart. 2015. \u2018The British Military Medical Services and Contested Humanitarianism\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 176\u201390. Philadelphia: University of Pennsylvania Press.<\/p>\r\n

Guyer, Jane I., Naveeda Khan, Juan Obarrio, Caroline Bledsoe, Julie Chu, Souleymane Bachir Diagne, Keith Hart, et al. 2010. \u2018Introduction: Number as Inventive Frontier\u2019. Anthropological Theory 10, no. 1\u20132: 36\u201361. https:\/\/doi.org\/10.1177\/1463499610365388<\/a>.<\/p>\r\n

Harragin, Simon. 2004. \u2018Relief and an Understanding of Local Knowledge: The Case of Southern Sudan\u2019. In Culture and Public Action, edited by Vijayendra Rao and Michael Walton, 281\u2013307. Stanford, CA: Stanford University Press.<\/p>\r\n

Harragin, Simon. 2012. Methodology: Informing L2GP with Insights from Anthropology. Copenhagen: Local to Global Protection. http:\/\/www.local2global.info\/wp-content\/uploads\/Methodolog_paper_final.pdf<\/a>.<\/p>\r\nHarrell-Bond, Barbara E. 1986. Imposing Aid: Emergency Assistance to Refugees. Oxford: Oxford University Press Oxford.\r\n\r\nHaskell, Thomas L. 1985. \u2018Capitalism and the Origins of the Humanitarian Sensibility, Part 1\u2019. The American Historical Review 90, no. 2: 339\u201361. https:\/\/doi.org\/10.1086\/ahr\/90.2.339<\/a>.\r\n

Henry, Doug. 2005. \u2018Anthropological Contributions to the Study of Disasters\u2019. In Disciplines, Disasters and Emergency Management: The Convergence of Concepts, Issues and Trends from the Research Literature, edited by David McEntire. Emittsburg, MD: Federal Emergency Management Agency. https:\/\/training.fema.gov\/hiedu\/aemrc\/booksdownload\/ddemtextbook\/<\/a>.<\/p>\r\n

Herrick, Clare. 2016. \u2018Global Health, Geographical Contingency, and Contingent Geographies\u2019. Annals of the American Association of Geographers 106, no. 3: 672\u201387. https:\/\/doi.org\/10.1080\/24694452.2016.1140017<\/a>.<\/p>\r\n

Inhorn, Marcia, and Emily Wentzell. 2012. \u2018Introduction: Medical Anthropology at the Intersections\u2019. In Medical Anthropology at the Intersections: Histories, Activisms and Futures, edited by Marcia Inhorn and Emily Wentzell, 1\u201322. Durham, NC: Duke University Press.<\/p>\r\nKent, Randolph C. 1987. Anatomy of Disaster Relief: The International Network in Action. London: Pinter Publishers.\r\n

Kleinman, Arthur. 1982. \u2018The Teaching of Clinically Applied Medical Anthropology on a Psychiatric Consultation-Liaison Service\u2019. In Clinically Applied Anthropology: Anthropologists in Health Science Settings, edited by Noel J. Chrisman and Thomas W. Maretzki, 83\u2013115. Culture, Illness and Healing series, vol. 5. Dordrecht: Springer.<\/p>\r\n

Koplan, Jeffrey P., T. Christopher Bond, Michael H. Merson, K. Srinath Reddy, Mario Henry Rodriguez, Nelson K. Sewankambo, and Judith N. Wasserheit. 2009. \u2018Towards a Common Definition of Global Health\u2019. Lancet 373, no. 9679: 1993\u201395. https:\/\/doi.org\/10.1016\/S0140-6736(09)60332-9<\/a>.<\/p>\r\n

Lakoff, Andrew. 2010. \u2018Two Regimes of Global Health\u2019. Humanity: An International Journal of Human Rights, Humanitarianism, and Development 1, no. 1: 59\u201379. https:\/\/doi.org\/10.1353\/hum.2010.0001<\/a>.<\/p>\r\nLakoff, Andrew, Stephen J. Collier, and Christopher Kelty. 2015. \u2018Introduction: Ebola\u2019s Ecologies\u2019. Limn, no. 5. http:\/\/limn.it\/introduction-ebolas-ecologies<\/a>.\r\n\r\nLatour, Bruno. 1986. \u2018The Powers of Association\u2019. Sociological Review 32, no. S1: 264\u201380. https:\/\/doi.org\/10.1111\/j.1467-954X.1984.tb00115.x<\/a>.\r\n

Latour, Bruno. 2014. \u2018Anthropology at the Time of the Anthropocene: A Personal View of What Is to Be Studied\u2019. Distinguished Lecture, American Anthropological Association Annual Meeting, Washington, DC, 6 December. http:\/\/sector2337.com\/wp-content\/uploads\/2015\/06\/Latour_Anthropocene.pdf<\/a>.<\/p>\r\nLewis, David. 2005. \u2018Anthropology and Development: The Uneasy Relationship\u2019. In A Handbook of Economic Anthropology, edited by James G. Carrier, 472\u201386. Cheltenham, UK: Edward Elgar.\r\n

Macrae, Joanna. 2002. \u2018Analysis and Synthesis\u2019. In The New Humanitarianisms: A Review of Trends in Global Humanitarian Action, edited by Joanna Macrae, 5\u201318. London: Overseas Development Institute. https:\/\/www.odi.org\/resources\/docs\/293.pdf<\/a>.<\/p>\r\n

Magone, Claire, Michael Neuman, and Fabrice Weissman. 2011. Humanitarian Negotiations Revealed: The MSF Experience. Oxford: Oxford University Press.Malkki, Liisa H. 1995. Purity and Exile: Violence, Memory, and National Cosmology among Hutu Refugees in Tanzania. Chicago: University of Chicago Press.<\/p>\r\nMalkki, Liisa H. 1996. \u2018Speechless Emissaries: Refugees, Humanitarianism, and Dehistoricization\u2019. Cultural Anthropology 11, no. 3: 377\u2013404. https:\/\/doi.org\/10.1525\/can.1996.11.3.02a00050<\/a>.\r\n

Marcus, George. 2010. \u2018Experts, Reporters, Witnesses: The Making of Anthropologists in States of Emergency\u2019. In Contemporary States of Emergency: The Politics of Military and Humanitarian Intervention, edited by Didier Fassin and Mariella Pandolfi, 357\u201377. New York: Zone Books.<\/p>\r\nM\u00e9decins Sans Fronti\u00e8res. 2016. \u2018About Us: We Speak Out\u2019. Updated 31 October. https:\/\/www.msf.org.uk\/advocacy-and-temoignage<\/a>.\r\n\r\nMinn, Pierre. 2007. \u2018Toward an Anthropology of Humanitarianism\u2019. Journal of Humanitarian Assistance, 6 August. https:\/\/sites.tufts.edu\/jha\/archives\/51<\/a>.\r\n\r\nMosse, David. 2013. \u2018The Anthropology of International Development\u2019. Annual Review of Anthropology 42: 227\u201346. https:\/\/doi.org\/10.1146\/annurev-anthro-092412-155553<\/a>.\r\n\r\nNading, Alex. 2015. \u2018Ebola, Chimeras, and Unexpected Speculation\u2019. Limn, no. 5. http:\/\/limn.it\/ebola-chimeras-and-unexpected-speculation\/<\/a>.\r\n\r\nNguyen, Vinh-Kim. 2010. The Republic of Therapy: Triage and Sovereignty in West Africa\u2019s Time of AIDS. Durham, NC: Duke University Press.\r\n

Nyamnjoh, Francis B. 2015. \u2018Beyond an Evangelising Public Anthropology: Science, Theory and Commitment\u2019. Journal of Contemporary African Studies 33, no. 1: 48\u201363. https:\/\/doi.org\/10.1080\/02589001.2015.1021214<\/a>.<\/p>\r\nOliver-Smith, Anthony. 1996. \u2018Anthropological Research on Hazards and Disasters\u2019. Annual Review of Anthropology, 303\u201328. https:\/\/doi.org\/10.1146\/annurev.anthro.25.1.303<\/a>.\r\n

Overseas Development Institute (ODI). 2015. \u2018Global History of Modern Humanitarian Action\u2019. ODI: Shaping Policy for Development. https:\/\/www.odi.org\/projects\/2547-global-history-modern-humanitarian-action<\/a>.<\/p>\r\nPackard, Randall M. 2016. A History of Global Health: Interventions into the Lives of Other Peoples. Baltimore, MD: Johns Hopkins University Press.\r\n

Pandolfi, Mariella. 2003. \u2018Contract of Mutual (In)Difference: Governance and the Humanitarian Apparatus in Contemporary Albania and Kosovo\u2019. Indiana Journal of Global Legal Studies 10, no. 1: 369\u201381. http:\/\/www.repository.law.indiana.edu\/ijgls\/vol10\/iss1\/13<\/a>.<\/p>\r\n

Parker, Melissa, and Tim Allen. 2014. \u2018De-Politicizing Parasites: Reflections on Attempts to Control the Control of Neglected Tropical Diseases\u2019. Medical Anthropology 33, no. 3: 223\u201339. https:\/\/doi.org\/10.1080\/01459740.2013.831414<\/a>.<\/p>\r\nPigg, Stacy Leigh. 2013. \u2018On Sitting and Doing: Ethnography as Action in Global Health\u2019. Social Science & Medicine 99: 127\u201334. https:\/\/doi.org\/10.1016\/j.socscimed.2013.07.018<\/a>.\r\n\r\nRalph Bunche Institute for International Studies. 2011. \u2018United Nations Intellectual History Project\u2019. http:\/\/www.unhistory.org\/<\/a>.\r\n

Ravelo, Jenny Lei. 2015. \u2018Post-Ebola, What Work Awaits Anthropologists?\u2019 Devex: Do Good. Do It Well, 15 September.https:\/\/www.devex.com\/news\/post-ebola-what-work-awaits-anthropologists-86876<\/a>.<\/p>\r\nRedfield, Peter. 2005. \u2018Doctors, Borders and Life in Crisis\u2019. Cultural Anthropology 20, no. 3: 328\u201361. https:\/\/doi.org\/10.1525\/can.2005.20.3.328<\/a>.\r\n

Redfield, Peter. 2013. Life in Crisis: The Ethical Journey of Doctors Without Borders. Berkeley: University of California Press.<\/p>\r\n\r\n<\/div>\r\n

<\/div>\r\n
\r\n\r\nRobbins, Joel. 2013. \u2018Beyond the Suffering Subject: Toward an Anthropology of the Good\u2019. Journal of the Royal Anthropological Institute 19, no. 3: 447\u201362. https:\/\/doi.org\/10.1111\/1467-9655.12044<\/a>.Sangaramoorthy, Thurka. 2012. \u2018Treating the Numbers: HIV\/AIDS Surveillance, Subjectivity, and Risk\u2019. Medical Anthropology 31, no. 4: 292\u2013309. https:\/\/doi.org\/10.1080\/01459740.2011.622322<\/a>.\r\n\r\nSave the Children International. 2016. \u2018Our Finances and Annual Review\u2019. Save the Children International. https:\/\/www.savethechildren.net\/about-us\/our-finances<\/a>.\r\n\r\nScheper-Hughes, Nancy. 1995. \u2018The Primacy of the Ethical: Propositions for a Militant Anthropology\u2019. Current Anthropology 36, no. 3: 409\u201340. https:\/\/doi.org\/10.1086\/204378<\/a>.\r\n

Scott-Smith, T. 2014. \u2018Control and Biopower in Contemporary Humanitarian Aid: The Case of Supplementary Feeding\u2019. Journal of Refugee Studies 28, no. 1: 21\u201337. https:\/\/doi.org\/10.1093\/jrs\/feu018<\/a>.<\/p>\r\nSridhar, Devi. 2011. \u2018Health Policy: From the Clinical to the Economic Gaze\u2019. The Lancet 378, no. 9807: 1909. https:\/\/doi.org\/10.1016\/S0140-6736(11)61829-1<\/a>.\r\n

Stellmach, Darryl. 2016. \u2018Coordination in Crisis: The Practice of Medical Humanitarian Emergency\u2019. DPhil diss., University of Oxford. https:\/\/ora.ox.ac.uk\/objects\/uuid:c81d8b4a-4e73-4bbb-b66f-7c84885ab9b8<\/a>.<\/p>\r\nStrathern, Andrew, and Pamela J. Stewart. 1999. Curing and Healing: Medical Anthropology in Global Perspective. Durham, NC: Carolina Academic Press.\r\n\r\nTerry, Fiona. 2002. Condemmed to Repeat? The Paradox of Humanitarian Action. Ithaca, NY: Cornell University Press.\r\n

Ticktin, Miriam. 2011. \u2018The Gendered Human of Humanitarianism: Medicalising and Politicising Sexual Violence\u2019. Gender & History 23, no. 2: 250\u201365. https:\/\/doi.org\/10.1111\/j.1468-0424.2011.01637.x<\/a>.<\/p>\r\nTicktin, Miriam. 2014. \u2018Transnational Humanitarianism\u2019. Annual Review of Anthropology 43: 273\u201389. https:\/\/doi.org\/10.1146\/annurev-anthro-102313-030403<\/a>.\r\n

Tol, Wietse A., Vikram Patel, Mark Tomlinson, Florence Baingana, Ananda Galappatti, Derrick Silove, Egbert Sondorp, Mark Van Ommeren, Michael G. Wessells, and Catherine Panter-Brick. 2012. \u2018Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings\u2019. Harvard Review of Psychiatry 20, no. 1: 25\u201336. https:\/\/doi.org\/10.3109%2F10673229.2012.649113<\/a>.<\/p>\r\n

Trouillot, Michel-Rolph. (1991) 2003. Global Transformations: Anthropology and the Modern World. New York: Palgrave Macmillan.<\/p>\r\n

Vaux, Tony. 2001. The Selfish Altruist: Relief Work in Famine and War. Abingdon, UK: Earthscan.<\/p>\r\n

V\u00e9ran, Jean-Francois, Beverly Stringer, and Doris Burtscher. 2017. \u2018Anthropology in Humanitarian Situations: An Overview of MSF Experience\u2019. Unpublished manuscript.<\/p>\r\n

Walker, Peter. 2005. \u2018Cracking the Code: The Genesis, Use and Future of the Code of Conduct\u2019. Disasters 29, no. 4: 323\u201336. https:\/\/doi.org\/10.1111\/j.0361-3666.2005.00295.x<\/a>.<\/p>\r\n

Walker, Peter, Karen Hein, Catherine Russ, Greg Bertleff, and Dan Caspersz. 2010. \u2018A Blueprint for Professionalizing Humanitarian Assistance\u2019. Health Affairs 29, no. 12: 2223\u201330. https:\/\/doi.org\/10.1377\/hlthaff.2010.1023<\/a>.<\/p>\r\nWHO (World Health Organization). 2004. \u2018Monitoring and Evaluation Toolkit\u2019. Geneva: World Health Organization. http:\/\/www.who.int\/hiv\/pub\/epidemiology\/en\/me_toolkit_en.pdf?ua=1<\/a>.\r\n\r\nWHO. 2016. \u2018Attacks on Healthcare: Prevent, Protect, Provide\u2019. Geneva: World Health Organization. http:\/\/who.int\/hac\/techguidance\/attacksreport.pdf?ua=1<\/a>.\r\n\r\n<\/div>\r\n

\r\n\r\nEndnotes\r\n\r\n<\/div>\r\n
\r\n\r\n1 Back<\/a>\r\n\r\n<\/div>\r\n
\r\n\r\nPhotographer's note: Three years after the beginning of the conflict, Leer and Mayendit counties are greatly affected by the ongoing violence and the longstanding clashes between governmental and opposition forces. Civilians are on the first line of the conflict and the ongoing violence has a very clear impact on the ability for the population to access basic and secondary medical care and other basic services. The population has been locally displaced multiple times; and many people had fled the area completely.\r\n\r\n<\/div>\r\n
\r\n\r\nIn July, following clashes in Leer County, the population again had to flee and M\u00e9decins Sans Fronti\u00e8res (MSF) had to evacuate international teams from both Leer and Thonyor. In September MSF set up a decentralised basic healthcare programme to continue to reach the population and provide them with primary healthcare in their villages. Through a network of community health workers, community health promoters, and women health promoters, who live as part of the affected population, MSF teams have been able to continue to provide healthcare. These community health workers are trained in treating the most common morbidities, such as respiratory tract infections, malaria, water-borne diseases, etc. They stay with the community and are able to move with the communities if the population need to move, thus continuing to provide healthcare. MSF resupplies them with medical supplies and provides ongoing supervision and training through supporting international teams.\r\n\r\n<\/div>\r\n
\r\n\r\n2 Back<\/a>\r\n\r\n<\/div>\r\n
\r\n\r\nThis is not to say that humanitarian actors and agencies themselves have not engaged in a tradition of self-critique. According to Davey and Scriven (2015, 115), medical humanitarianism \u2018cannot be accused of an unwillingness to reflect on its performance, be it through formal processes of research and evaluation or the collect decompression of a bar-side lament\u2019. Examples can be found in the work of Vaux (2001), Terry (2002), and recent multilateral projects, including the United Nations Intellectual History Project and Global History of Humanitarian Action Project (Ralph Bunche Institute for International Studies 2011; ODI 2015).\r\n\r\n<\/div>\r\n
\r\n\r\n3 Back<\/a>\r\n\r\n<\/div>\r\n
\r\n\r\nAlthough some authors contest this assertion \u2013 such as Dunn (2012, 1\u20132), who argues that the reach and nefarious nature of humanitarian ventures are dangerously overstated \u2013 the notion of humanitarianism as subversion through compassion has had influential effect.\r\n\r\n<\/div>\r\n
\r\n\r\n4 Back<\/a>\r\n\r\n<\/div>\r\n
\r\n\r\nMarcus\u2019s call for anthropologists to \u2018witness\u2019 has clear parallels to the humanitarian commitments of neutrality or t\u00e9moignage (translated as \u2018bearing witness\u2019), as is typically invoked by MSF (2016; see also Redfield 2005 on MSF as \u2018a less modest witness\u2019). This is particularly the case because t\u00e9moignage does not just imply watchful observation, but also the obligation and responsibility to speak on behalf of those in danger. In that sense, humanitarian actors, like anthropologists, are also negotiators: operating in a simultaneous cycle of creating \u2013 and then sacrificing \u2013 \u2018neutral\u2019 humanitarian spaces (Barnett 2011, 224). This interpretation of t\u00e9moignage turns MSF\u2019s own moniker (\u2018without borders\u2019) on its head, positioning humanitarian actors precisely at the borders \u2013 between observation and action, outside and inside \u2013 not \u2018without\u2019 them.\r\n\r\n<\/div>\r\n
\r\n\r\n5 Back<\/a>\r\n\r\n<\/div>\r\n
\r\n\r\nTrouillot ([1991] 2003, 18) was the first to coin the term \u2018slot\u2019 in reference to anthropological tropes, faulting anthropology for choosing as its disciplinary penchant \u2018the savage, the primitive . . . the other\u2019, arguing that the discipline\u2019s survival depended on breaking past this limited niche and narrow object of inquiry.\r\n\r\n<\/div>\r\n
\r\n\r\n6 Back<\/a>\r\n\r\n<\/div>\r\n
\r\n\r\nAnthropologies of global health are one example among many. For example, applied anthropologists and anthropologists of development have also contributed key insights into how anthropologists can work within global institutions. See Mosse 2013.\r\n\r\n<\/div>\r\n
\r\n\r\nCITATION\/ATTRIBUTION\r\n\r\n<\/div>\r\n
\r\n\r\nBeshar, I., & Stellmach, D. (2017). Anthropological approaches to medical humanitarianism. Medicine Anthropology Theory, 4(5). https:\/\/doi.org\/10.17157\/mat.4.5.477\r\n\r\n<\/div>\r\n<\/div>","rendered":"
\n

Abstract<\/h2>\n

Despite broadly shared interest in the welfare of \u2018precarious lives\u2019, medical anthropology and medical humanitarianism are too often in tension. In this survey, we sketch a history of the two disciplines, then track three major patterns through which anthropologists approach the analysis of medical humanitarian efforts. Our three patterns frame medical anthropology as: 1) a critique of medical humanitarianism and its ties to colonialism and globalization, 2) a translation of medical humanitarianism and its associated lexicon, 3) and a reform of medical humanitarianism from the inside out. In highlighting the individual strengths of these three approaches, we argue for the value of medical anthropology \u2013 as both a mindset and a method \u2013 in health and humanitarian emergencies.<\/p>\n

\"Outdoor
Figure 9.4<\/strong> Outdoor support clinics, Thaker. Leer, South Sudan, 18 March 2017. Copyright: Siegfried Modola\/MSF; used with permission.<\/figcaption><\/figure>\n

Introduction<\/h2>\n

What possible form and effect does an anthropological presence have on medical humanitarian crises? International medical actors, such as the World Health Organization (WHO) and M\u00e9decins Sans Fronti\u00e8res (MSF), have recognized a role for anthropologists in navigating responses to health emergencies, but this role has yet to be fully defined (Abramowitz et al. 2015, 330; Brown et al. 2015, 1). This is despite broadly shared concerns for engagement with human suffering and the pain of the human condition (Redfield 2013, 5\u20136; Ticktin 2014, 274\u201377), which can be characterized as a convergence of professional sentiments.<\/p>\n

Anthropology and medical humanitarianism are both distinguished by internal heterogeneity, making for sometimes-awkward cross-disciplinary encounters; one can never quite be sure whether the other will share or reject one\u2019s own perspectives. The literature on the \u2018anthropological approach\u2019 to medical humanitarian crises is expansive and well theorized, yet for this reason it lacks a common, accessible narrative to pull together a diverse body of work. Such heterogeneity has been problematic for related fields as well. Historians Davey and Scriven (2015, 113), for example, state that \u2018[w]riting on humanitarian history is a booming occupation\u2019 characterized by a \u2018depth, innovation and complexity\u2019 that refuses to cleave to ready patterns or overviews. While the diverse nature of humanitarianism and its scholarship is not easy to encompass with generalities, certain patterns emerge.<\/p>\n

In an attempt to summarize anthropological approaches within and in relation to medical humanitarian agencies, this article asks two related questions: how have anthropologists engaged with institutions and action in the context of medical humanitarianism, and how might such engagement look in the future? To develop our analysis, we undertook a survey of relevant materials in medical anthropology. Building on a recent review by Ticktin (2014), which surveys the growing field of the anthropology of humanitarianism, and the conclusions in Fassin\u2019s (2012) Humanitarian Reason: A Moral History of the Present<\/em>, we evaluated works drawing from both anthropological and medical humanitarian sources, including but by no means limited to Anthropological Theory, Annual Review of Anthropology, Medical Anthropology Quarterly, Somatosphere<\/em>, Disasters<\/em>, Health Affairs, Social Science and Medicine, Violence, <\/em>and Politics and Humanitarian Action. <\/em>In doing so, we applied a working definition of \u2018medical humanitarianism\u2019 as proposed by Abramowitz and Panter-Brick (2015, 1) in their recent volume, Medical Humanitarianism: Ethnographies of Practice<\/em>: \u2018the field of biomedical, public health, and epidemiologic initiatives undertaken to save lives and alleviate suffering in the conditions of crises born of conflict, neglect or disaster\u2019. To this definition we added that medical humanitarianism is often a self-attributed label, a personal designation and category of action that responders may invoke, in part, as a moral appeal. In our understanding, humanitarianism places the human, and suffering as a human universal, as core concerns (Fassin 2012, 9; Redfield 2013, 39\u201342; Ticktin 2014, 273). This puts medical humanitarianism in sharp contrast to other forms of international health intervention that may seek, for example, to maximize the productive capacity of a population or buttress a health system against pathogenic threat (Lakoff 2010, 66; Elbe 2011, 849).<\/p>\n

This does not prevent a diverse array of actors from invoking humanitarian rhetoric \u2013 in other words, moral concern for human suffering \u2013 to justify actions that have motives quite distinct from saving life and reducing suffering. Thus, as others have noted, the 2003 military intervention in Iraq was characterized, in part, as a humanitarian campaign (Fassin 2012, 189\u2013231; Gilman 2012, 173\u201374). This highlights overlaps in goals and means between medical humanitarianism and the arenas of geopolitics, global economics, global health, disaster management, and international development. Yet, because of the preeminent emphasis on human suffering, humanitarian responses to emergencies are not wholly convergent with other forms of response to health crises, and may differ with regards to timescales, moral stakes, and media visibility (Lakoff 2010, 66\u201370, 74\u201375). (For these reasons, our literature search was confined to \u2018medical humanitarianism\u2019 and excluded material on global health, disaster management, and international development, except where it used \u2018humanitarianism\u2019 as a keyword).<\/p>\n

As a moral and political undertaking, humanitarianism recognizes the sanctity and dignity of human life, and the universality of both basic needs and suffering. Emerging in parallel with the rise of industrial capitalism, humanitarian action is the organized, collective practice of compassion. As a concept it began to take shape in the mid-eighteenth century but would come into its own in the nineteenth century (Barnett 2011, 49\u201350). In the rapid social and technological transformation of industrializing Europe, the word came to be associated with a variety of compassionate societies and committees for the relief of human suffering (Barnett 2011, 50\u201360). During these early decades, the International Committee of the Red Cross (founded 1863) provided medical care and supplies to battlefield wounded (Barnett 2011, 76\u201381). For most of the nineteenth century the humanitarian designation was simultaneously applied to issues of prison reform, slavery, and employment conditions; it wasn\u2019t until the Geneva Conventions of 1864, 1929, and 1949 that a humanitarian \u2018sensibility\u2019 would be codified internationally and formally protected (Haskell 1985, 339). International humanitarian law attempted to regulate the conduct of war and provided a protected space \u2013 if imperfectly realized in practice \u2013 for civilian actors to assist those directly affected by conflict. In these spaces of exception, humanitarian actors were attributed political neutrality and immunity from military aggression (Abramowitz and Panter-Brick 2015, 9\u201310; Gordon 2015, 187\u201388).<\/p>\n

Humanitarianism in its presently recognized form broadly means relief in times of crisis, particularly as prosecuted through transnational organizations and nongovernmental organizations (NGOs) in particular. For better or worse, medical humanitarianism views human crisis through the clinical gaze, framing human suffering as pathology amenable to medical intervention (Scott-Smith 2014, 23\u201325) and directly imprinted on body and psyche (Fassin 2000, 2005, 372; Ticktin 2011, 254). This has led to an anthropological critique of a tendency towards medicalization, and thus subordination, of lived experiences in the name of biomedicine, a politically fraught expression of compassion (Fassin 2012, 99\u2013101).<\/p>\n

There has historically been a breadth of anthropological literature on humanitarian action. In addition to large projects by professional historians (Barnett 2011; Davey and Scriven 2015; see also ODI 2015) and practitioners (Kent 1987; Terry 2002; Magone et al. 2011), anthropologists have written on the origins (both historical and ideational) of medical humanitarian action (de Waal 1997, 65\u201385; Fassin 2012, 1\u201317; Redfield 2013, 35\u201366; Ticktin 2014, 274\u201376). There is much work on the anthropological response to issues of famine, food security, and communicable diseases like HIV\/AIDS, to name a few (see Oliver-Smith 1996, as well as Henry 2005, for comprehensive reviews). In the last decade, however, there has been a rise in the literature focused on the anthropological position, or approach, to the act and rhetoric of intervention itself. It is not what<\/em> anthropology investigates in the humanitarian sphere but how<\/em>. Ticktin (2014, 274, 281\u201382), for example, has broadly framed anthropologists as allies of humanitarian ambitions, critics of unintended consequences, and analysts of an amorphous social phenomenon; Abramowitz, Marten, and Panter-Brick (2015, 3\u20134) have gone even further, undertaking a poll to assess aggregate views of the perspectives of anthropologists working in medical humanitarian contexts. Both studies argue that anthropologists must actively engage individual humanitarian practitioners, agencies, and issues, regardless of whichever conceptual stance they adopt.<\/p>\n

Our survey reveals three major strands of discourse on the intersection of anthropology and humanitarian action, which we term \u2018critique\u2019, \u2018translation\u2019, and \u2018reform\u2019. We argue medical anthropology has worked to critique humanitarian action, particularly how the field has become tied to capitalism, colonialism, and globalization. We suggest this approach has sometimes proved isolating, and we examine a second stream of anthropological work that works to translate and reframe medical humanitarian lexicons and ideologies. We finish by describing a third, emerging body of anthropological work that seeks to reform medical humanitarianism from inside out.<\/p>\n

These categories are not exhaustive, nor are they discrete: as the survey reveals, they may intersect, cross-pollinate, and flow into one another depending on context and time. In that sense, our analysis offers a spectrum, rather than strict divisions. Our hope is that this discussion challenges a view that oftentimes seems to pit humanitarian practitioners and academic anthropologists against each other (Minn 2007; Ravelo 2015). Indeed, in observing exchanges between these streams, we believe that whatever distinctions remaining between the two are further blurred.<\/p>\n

\n

The maturing of medical humanitarianism and medical anthropology<\/h2>\n<\/div>\n
\n

Tracing intersections and approaches of medical anthropology to humanitarianism requires knowledge of their complex histories, and how these have given rise to present-day institutional structures and politics. As the above histories reveal, medical humanitarianism, as contemporarily defined, had a violent birth, emerging in the nineteenth century out of military combat, disaster, and war to become an important social force of considerable size and scope (Bass 2008, 11\u201329). Today, the largest humanitarian agencies have annual operating budgets in the billions; for example, Save the Children\u2019s budget in 2015 was more than US$2 billion (Save the Children 2016). Such agencies frequently act as entrenched conglomerates (European Commission 2015, 1). They are fundamental to intra- and inter-country management not only of wars and disasters but also of diverse international crises that emerge, seemingly unanticipated, only to be handled with patterned regularity and predictable rhetoric (Calhoun 2004, 377\u201380). Indeed, the actions of self-declared medical humanitarian agencies cross boundaries of global health, human rights, international development, and political peacekeeping. Naturally, no single agency acts in all these sectors. The mix of activities demonstrates the heterogeneous and fundamentally contested nature of the humanitarian mantle; a wide variety of actors may claim humanitarian motives but undertake action in fundamentally different spheres.<\/p>\n<\/div>\n

\n

In pace with this far-reaching growth, the field has become professionalized, developing frameworks to standardize humanitarian practice, support institution building, and supply scholarship and instruction. In the late 1980s, with the support of the European Commission for LifeLong Learning, European Union member states launched initiatives concerned with the quality and accountability of humanitarian work and established new postgraduate degrees and training in international humanitarian action (Brun and Attanapola 2014, 1; Walker et al. 2010, 2223\u201325). Initiatives like the Code of Conduct for NGOs and the Humanitarian Accountability Project attempted to standardize and professionalize humanitarian work (Walker 2005, 323\u201327). Yet, these developments remain entrenched in a Euro-American schema. According to Abramowitz and Panter-Brick (2015, 7), the professionalization of the medical humanitarian impulse has become a \u2018substantial stand-alone industry\u2019 distinct from volunteerism yet still embedded in a liberal ethic of \u2018giving back\u2019 and \u2018doing good\u2019. What remains to be seen is how this impulse survives its own explosive growth, given concerns that a shallow emphasis on \u2018doing something\u2019 may potentially lead to substandard delivery of care (Abramowitz and Panter-Brick 2015, 7). In the words of Dijkzeul and Wakenge (2010, 1141), the swell in the \u2018role and number of humanitarian actors\u2019 demands \u2018scholarly attention\u2019.<\/p>\n<\/div>\n

\n

\u00a0In conjunction with internal challenges to coherence that result from rapid growth, medical humanitarian action also faces external threats. Perhaps most pressing for practitioners is a perceived diminution of respect and recognition for the broad medical and humanitarian mission. While humanitarian \u2018spaces of exception\u2019 have been extensively theorized and often attributed with social and moral force (see, among others, Agier and Bouchet-Saulnier 2004, 303\u201304; Redfield 2005, 340\u201344; Fassin 2012, 151\u201354, 181\u201399), such spaces, when they exist at all, are difficult to establish and maintain in practice (Alli\u00e9 2011, 1\u20135). Because while attacks against humanitarian and medical personnel in wartime are not new \u2013 humanitarian and medical impartiality have never guaranteed immunity despite the dictates of the Geneva Conventions, and the list of targeted attacks against health care facilities in the past century is long \u2013 recent events seem to indicate that humanitarian and health care activities are increasingly under threat as targets of war. From 2011 and onward, there has been a sharp jump in both the frequency and flagrancy of deliberate attacks against medical humanitarian facilities (Baker and Brown 2015, 4\u20137; WHO 2016, 4\u20135, 7). At the present moment, long-standing international norms, both of medical and humanitarian neutrality and the threat of international opprobrium, appear to have lost sway over many state and non-state armed actors.<\/p>\n<\/div>\n

\n

The development of medical anthropology tracks a parallel timeline to medical humanitarianism. In the nineteenth and early twentieth centuries, studies of medicine by anthropologists were typically enveloped within broader studies of cultural and social traditions, at times confining medical anthropology to the study of the ways that the \u2018other\u2019 dealt with issues of sickness and health (Inhorn and Wentzell 2012, 2). But in the latter half of the twentieth century, medical anthropology carved its own niche. Medicine\u2019s intersection with issues of race, gender, and inequality, as well as the increased involvement of anthropologists in international health work and clinical settings in the name of soft diplomacy during the Cold War, energized the discipline (Inhorn and Wentzell 2012, 6\u20137). Anthropologists Strathern and Stewart (1999, 3) track what they call \u2018a circular migration\u2019 \u2013 \u2018from the jungle to the city, and back again\u2019 \u2013 such that medical anthropology became an investigation not only of other cultures and healing practices but also of their own. The development of critical medical anthropology in the 1990s, with its social constructionist understanding of disease and its political economy understanding of power, further popularized the discipline\u2019s approach. However, like medical humanitarianism, the effectiveness of the method posed its own threat: to date, anthropology has been criticized for taking \u2018healthy self-consciousness too far, inadvertently casting itself as a discipline suspicious of collaboration and cross-industry reciprocity\u2019 (Harragin 2012, 4).<\/p>\n<\/div>\n

\n

Be that as it may, medical anthropology and humanitarianism continue to intersect. Both emerged from postcolonial concerns in a moment when neoliberalism, human rights, and democratic individualism were ascendant values. Both have thrived in a postnational, post-Cold War era characterized by the privileging of individual enterprise and cultural reductionism of the West. And both have embraced and continue to simultaneously embrace and criticize aspects of these values. Working in similar physical and discursive spaces, medical humanitarianism and anthropology have had interests, goals, and contexts that have at times met at points of complementarity and others at points of tension. Ultimately, it is this historical, material, and ideational relationship that enables, but also complicates, a survey of the literature of the two disciplines.<\/p>\n<\/div>\n

\n

Anthropology as critique<\/h2>\n<\/div>\n
\n

This bisecting history has helped produce three categories of disciplinary intersection. The dominant form of anthropological discourse on medical humanitarianism at present is that of critique. This approach calls on anthropologists to evaluate, interpret, and analyze NGOs and humanitarian actors as they would any other institution of power and influence. Rather than defer to appeals regarding the sanctity of human life and the moral imperative to aid people in distress (which leads to claims of humanitarian \u2018exceptionalism\u2019), this work approaches these claims face on, problematizing the impact of morally motivated interventionism.<\/p>\n<\/div>\n

\n

Numerous case studies track humanitarian missteps, in both practical and ideological arenas. Ticktin (2014, 277\u201381) provides a thorough summary of work in this vein. Anthropologists have critiqued medical humanitarian projects for their unintended consequences, low standards of care, limited local input, weak oversight, and more (see, for example, Harrell-Bond 1986; Escobar 1995; Malkki 1995, 1996; de Waal 1997; Fisher 1997; Macrae 2002; Harragin 2012; Redfield 2013). Anthropologists have also criticized medical humanitarianism in broader swathes, particularly when it is conceptualized as a project with neoliberal, capitalist impulses. In part informed by work on the anthropology of development, which was influenced by Ferguson\u2019s (1990) work on aid in Lesotho, humanitarian action began to be reasoned \u2018in terms of an organized system of power and practice which has formed part of the colonial and neo-colonial domination of poor countries by the West\u2019 (Lewis 2005, 3).<\/p>\n<\/div>\n

\n

Early examples of this framework are perhaps best represented by Pandolfi\u2019s (2000, 2003) work analyzing medical humanitarian agencies in postwar and post communist Albania and Kosovo. In her evaluation of the \u2018right to interfere\u2019 in the name of \u2018emergency\u2019, she describes the disappearing boundaries between medical and military intervention, at times referring to it as a mobile \u2018humanitarian-military apparatus\u2019 (Pandolfi 2003, 496\u201397). She characterizes humanitarianism by its state-like functions, identifying a new form of sovereignty at the intersection of biopolitics and \u2018bare life\u2019, ultimately resulting in the reduction of subjective individuality and the influx of diagnostic and numerical categories based on humanitarian management (Pandolfi 2003, 499).<\/p>\n<\/div>\n

\n

In subsequent years anthropologists published widely read critical studies: Redfield\u2019s (2005, 2013) retrospective ethnographies of MSF, Fassin\u2019s (2012, 1\u20132) critique of the humanitarian epistemology of \u2018moral sentiments\u2019 with regards to the status of immigrants in France, andNguyen\u2019s (2010) commentary against the unintentional making of new markets and economies among both HIV\/AIDS patients and their ART therapies on the part of the humanitarian agency. In these contexts, the logics of what Fassin (2012) calls \u2018humanitarian reason\u2019 expose new vulnerabilities, mark new terrains, and gain control over new bodies.<\/p>\n<\/div>\n

\n

More recently, this work has found itself intertwined with the field and politics of global health. In turn, anthropologists have articulated what they see as the \u2018global health machine\u2019 (Gaines 2011, 87) and an emerging \u2018NGO industrial complex\u2019 (Adams 2013, 76\u201379). Such machinery has been well-documented in a wide variety of phenomena, such as medical volunteerism, which Berry (2014, 347) has criticized for focusing more on the student r\u00e9sum\u00e9 than the provision of medical care; pharmaceutical investment, which Parker and Allen (2014) suggest assumes tyranny over the monitoring and evaluation processes required of most humanitarian projects; the application of the \u2018economic gaze\u2019 to matters of health, wherein \u2018the body is constructed as having little to no value outside of its role in the global economy\u2019 (Sridhar 2011, 1909); and the default to a \u2018one-size-fits-all model\u2019 and erasure of local specificities in the \u2018scale-up\u2019 of global health interventions (Adams et al. 2014, 182\u201383).<\/p>\n<\/div>\n

\n

This \u2018anthropology as critique\u2019 approach has deep historical roots in anthropology\u2019s disciplinary preoccupations, as seen in the overwhelming amount of literature we found dedicated to this thread of discourse. It is well established that anthropological knowledge contributed to European colonial dominance, as is the fact that European power enabled anthropological practice, thoroughly influencing its methods, discourses, and central concerns (Asad 1991, 315). It is this problematic historical relationship with state power that makes many anthropologists justly skeptical of large-scale institutional influence, particularly when deployed among disenfranchised people. Fassin and Pandolfi (2010, 16, 20\u201322) imply that social scientists should resist being used as accomplices in larger humanitarian projects or agendas, especially when any form of intervention is anthropologically understood as a political play or implicit military action. Critical neutrality is both a role and a method in anthropology. But this stance can be taken too far: circumspection can become overwrought; fear of being used can become fear of being useful. This dynamic \u2013 perhaps best reflected in Kleinman\u2019s (1982, 112) mock dilemma of an anthropologist constantly being asked \u2018Whose interest does this professional stranger support?\u2019 \u2013 is bound up in the critique approach to medical humanitarianism.<\/p>\n<\/div>\n

\n

Anthropology as translation<\/h2>\n<\/div>\n
\n

Anthropology\u2019s role as external commentator can and has been perceived as isolationist and counterproductive (Abramowitz and Panter-Brick 2015, 8; Ticktin 2014, 283; Tol et al. 2012, 33; Harragin 2012, 3\u20135). Some anthropologists have rejected this viewpoint on the premise that it hampers collaboration and characterizes anthropologists as armchair spectators, trapping them in a \u2018cul-de-sac of critique\u2019 (Ticktin 2014, 283). According to Abramowitz and Panter-Brick (2015, 8), scholarly critiques of medical humanitarian reason are necessary but sometimes \u2018fail to convey the real-time exigencies of humanitarian experience and the range of internal debates within humanitarian networks\u2019. Tol and colleagues (2012, 33) suggest that these criticisms appear to function as fodder for \u2018academic debates without relevance for practice\u2019.<\/p>\n<\/div>\n

\n

A second stream of anthropological work has emerged out of this criticism. We argue that anthropology as translation favors an approach that investigates and privileges cross-disciplinary discussion between anthropological and humanitarian actors. With \u2018translation\u2019, we allude to Callon (1986) and Latour (1986), who conceptualize translation as a process through which meanings, claims, and contexts come to occupy new spaces and change foundational ground. Translation is not only interpretation from one language or discipline to another; rather, it is a process by which languages and disciplines are made to cohere, and in the process create new hybrids. In particular, we favor Latour\u2019s (1986, 268) definition, in which translation results in a continuously infinite process of producing \u2018something completely different\u2019. In this definition, anthropological work on medical humanitarianism is not about interpreting the field for lay understanding but about producing a new discourse within which medical humanitarianism can be imagined in critical, creative, and diverse ways.<\/p>\n<\/div>\n

\n

For example, Marcus (2010) argues that anthropology should engage all actors working in a medical crisis. In a nod to Scheper-Hughes\u2019s (1995, 414\u201315) famous rejection of \u2018anthropologists as spectators\u2019, Marcus (2012, 362) calls on anthropologists to \u2018modestly witness\u2019 the conditions they are studying. For Marcus and Scheper-Hughes, anthropologists are not reporters but actors and negotiators. This work places heavy emphasis on issues of communication and articulation. According to this literature, \u2018anthropology as translation\u2019 helps position human suffering in a way that avoids the norms of communication and engagement that \u2018tend to make pain into abstraction\u2019 (Marcus 2010, 371). This is not to evoke what has sometimes been termed and critiqued as the \u2018suffering slot\u2019: which, Robbins argues, situates vulnerability as a \u2018privileged object of attention\u2019 (2013, 450) with \u2018a universalistic quality\u2019 (ibid., 454) that anthropologists can categorize neatly to presume wider understanding. Rather, \u2018anthropology as translation\u2019 forces anthropologists to step out of imagined molds, enabling new forms that bypass norms or universality and instead celebrate distinctions and locality. In the words of Fassin (2012, 245), this work means \u2018straddl[ing] the line between outside and inside \u2026 to be located \u201cat the frontiers\u201d\u2019.<\/p>\n<\/div>\n

\n

Translation work has, in part, been operationalized to reframe the narratives or linguistic and conceptual tropes that humanitarian actors may use. For instance, Redfield (2013, 14, 29\u201334) evaluates shaky underpinnings of the \u2018states of emergency\u2019 that legitimize a \u2018crisis\u2019; Harragin (2012, 3) interrogates the insufficiency of \u2018short-term, humanitarian contracts\u2019 in light of more long-term, existing infrastructural realities; and Feldman and Ticktin (2010, 1\u20135) interpret the practical implications of the humanitarian premise of \u2018humanity\u2019. \u2018Sovereignty\u2019 as a status of independent statehood or actorhood has been similarly unpacked, perhaps most notably by Pandolfi\u2019s (2000) application of Appadurai\u2019s (2003) \u2018mobile sovereignty\u2019 but also more recently by Abramowitz\u2019s (2015) ethnography of MSF\u2019s withdrawal in Liberia, Good and colleagues\u2019 (2015) work on post-tsunami interventions in Indonesia, and Gordon\u2019s (2015) analysis of the complexities and contradictions of medical medicine inherent to Iraq and Afghanistan.<\/p>\n<\/div>\n

\n

\u00a0The 2014\u20132016 Ebola outbreak in West Africa may be the most recent foregrounding of anthropology as translation. Ebola\u2019s Ecologies, an interdisciplinary analysis edited by anthropologists Lakoff, Collier, and Kelty (2015), and the introductory chapter of Packard\u2019s (2016) A History of Global Health: Interventions into the Lives of Other Peoples both examine how the Ebola outbreak forged new logics, practices, and rhetorics among its many and diverse actors. In Ebola Ecologies, the Ebola outbreak is seen as a product of failed \u2018administrative imagination\u2019 that neither categorized nor conceptualized of Ebola adequately; to Packard (2016, 2), the global North\u2019s understanding of Ebola \u2018represented examples of cultural modeling\u2019 that \u2018deflected attention from other, more fundamental causes of the event\u2019. But both works acknowledge that the epidemic fostered new formulations in health systems management, pharmaceutical research, and multilateral engagement. Describing the process of Ebola vaccine trials instituted during and after the crisis, Nading (2015) comments on the \u2018contingent, speculative, \u201cchimeric\u201d nature of contemporary global health\u2019; while commenting on the Ebola \u2018watchdog\u2019 groups formed in communities where the infection had spread, Packard (2016, 331) discusses the local and foreign organizing that came together to privilege \u2018capacities for self-help\u2019 and ultimately slow the disease\u2019s progress. Here, it is new imaginations, even some failed ones, that deserve anthropological investigation. As Biruk (2014, 7\u20138) writes, \u2018anthropology [can] take objects in, reframe them, and re-generate knowledge in a new way that excavates the structures and logics that make them\u2019.<\/p>\n<\/div>\n

\n

Anthropology as reform<\/h2>\n<\/div>\n
\n

A final stream of anthropological thought seeks not to criticize medical humanitarianism or translate its ideologies but instead to reform the discipline itself. As humanitarian agencies grow in size and complexity and engage with new actors and professionals, anthropologists have pushed for research that acts with, but not within, archetypical frameworks of humanitarian response. While the smallest of the three at present, this discourse promises to grow in the near future, as more anthropologists engage directly and more robustly with humanitarian agencies.<\/p>\n<\/div>\n

\n

This third body of work demands anthropologists assume a more transformative role; in the words of Harragin (2004, 325), an anthropologist working in South Sudan, \u2018It is time it [anthropology] realized that [excessive] introspection risks failing to engage with global forces that will sweep on with or without anthropological insights\u2019. Ultimately, this literature pushes not for criticism nor for hybrid productions but for a \u2018seat at the table\u2019 for anthropologists engaging in humanitarian work (Abramowitz et al. 2015, 330). The focus on participation is key here. As Feierman and colleagues (2010, 123) assert in a piece on medical humanitarian programs, \u2018Anthropologists \u2026 have the potential to play an important role in both mediating and studying flows of knowledge\u2019. Abramowitz (2014) argues, in this same vein, that \u2018many more anthropologists of West Africa are being invited to write commentaries on the current outbreak. But this does not go far enough\u2019 (emphasis in original). This argument for practice is part of a broader demand for engaged anthropology (Fassin 2012; Eriksen 2006).<\/p>\n<\/div>\n

\n

Anthropology as reform has the potential to establish a new discursive and professional space, one in which anthropology is not supplementary but a partner in its own right. Here, the focus is on how anthropology might help produce new norms or paradigms within and for humanitarian action. Adding nuance to Abramowitz\u2019s \u2018seat at the table\u2019 offers a productive starting point: anthropology as reform is not a particular kind of temporal or professional role (in other words, follow-up commentary vs. contemporaneous original research) but rather a way of seeing that can alter how humanitarian crises are perceived and addressed. By virtue of method, anthropology works against the essentialism and reductionism that can be pernicious in humanitarian discourse, wherein people can be reduced to biology or statistics. The work of anthropology makes humans coherent within simultaneous contexts of individual, social, and ecological worlds; it unites empirical experience, historical knowledge, and moral subjectivity, and holds these in productive tension (Latour 2014, 13\u201314). When practiced well, anthropology is an \u2018evidence-based field science\u2019 that is simultaneously relational, reflexive, and inclusive (Nyamnjoh 2015, 59\u201360). An anthropological lens on crisis can change the perception of causation, needs, and wants. By extension, this can change the nature of the humanitarian encounter itself.<\/p>\n<\/div>\n

\n

While some examples of anthropology as reform may already be emerging in medical humanitarian organizations (see, for example, the recent ethnographies of Stellmach 2016 and V\u00e9ran et al. 2017), this phenomenon is perhaps most evident in medical anthropological work on global health. Because anthropologies of global health exhibit considerable disciplinary and practical overlap with medical humanitarianism, a quick summary may indicate how an anthropology of medical humanitarianism can be an anthropology of reform.<\/p>\n<\/div>\n

\n

While the exact meaning of \u2018global health\u2019 is contested (Koplan et al. 2009; Lakoff 2010; Fassin 2012; Garrett 2013), we use the definition articulated recently by geographer Herrick (2016, 674): global health \u2018involves the transfer of knowledge and resources [and] a variety of efforts to act on and reduce the global burden of disease, and a particular concern for and financial investment in the infectious disease triumvirate of HIV\/AIDS, malaria, and tuberculosis\u2019. Of course, as Herrick (2016, 674) herself acknowledges, this simple definition is complicated by the diverse and complicated assemblage of disciplines, actors, initiatives, and agendas working in the global health sphere.<\/p>\n<\/div>\n

\n

At present, writings on global health seem to be the most conducive to an anthropology of reform. Abramowitz (2014) has taken perhaps the most practical approach, writing of ten tangible actions that anthropology can undertake in public health emergencies, including detecting and identifying latent local capabilities, generating innovative ways of communicating among new and diverse actors, and pushing for funding from government bodies. Emphasized here are the tools and avenues through which anthropology provokes a departure from normalcy. Others (Guyer et al. 2010; Erikson 2012; Sangaramoorthy 2012) recognize the ways that anthropology can participate in traditional approaches to monitoring and evaluation in order to \u2018provide various levels of accountability for activities or policies\u2019 (WHO 2004, 4). According to Biruk (2014, 348), institutionally necessary data, while expected to be \u2018clean, accurate, precise\u2019, and a fixed representation of a problem at hand, is in fact complex, messy, and uncertain \u2013 full of a kind of \u2018noise\u2019 that Abramowitz (2014) argues is uniquely suited for anthropological analysis.<\/p>\n<\/div>\n

\n

Perhaps most accessible to the reader is the approach taken by Adams and colleagues (2014, 179\u201380), who borrow from the \u2018slow food movement\u2019 to emphasize the need for \u2018slow research\u2019 in global health. Like the organic slow food movement, Adams and colleagues argue for a combination of long-term anthropological research on local particularities with the \u2018fast\u2019 qualities of emergency relief and information acquisition characteristic of contemporary global health. They urge caution against \u2018anticipatory modes of engagement\u2019 \u2013 the quickening of assumptions and conclusions \u2013 calling instead for a \u2018pause before eating\u2019 and \u2018a moment to contemplate\u2019 what is before or ahead (Adams et al. 2014, 187\u201388). The authors conclude: \u2018Slow research is not necessarily opposed to \u201cfast\u201d research, but it is opposed to what might be identified as a new normal. Slow research is a response, addition, and possible alternative to the newest normative trends\u2019 (Adams et al. 2014, 180). This also suggests how anthropologists might react to the speed and ethical complexity of medical humanitarian crises: not to lose one\u2019s method in the rush of emergency, but rather to double down on method, adapting the technique to the context (Stellmach 2016). Resident in institutions that simultaneously comfort and oppress (as so many institutions of modernity do), anthropologists\u2019 awareness of power dynamics, both institutional and interpersonal, can help us negotiate a path between co-option and refusal to participate for fear of co-option.<\/p>\n<\/div>\n

\n

It is worth reiterating that anthropology as reform is not about fitting anthropology into an existing global health or humanitarian apparatus. As anthropologist and sociologist Pigg (2013, 127) argues, \u2018in the face of intensifying demands on ethnographers to subsume their insights to ever narrower, utilitarian goals \u2026 it is important to recognize \u2026 the unique character of ethnographic praxis\u2019. In other words, anthropology as reform pushes for new sources of evidence that are not constrained by standardized regulations and historical form. Ultimately, as Pigg (2013, 133) argues, the hope is to position anthropology \u2018in the very midst of the making of global health as it \u2013 whatever \u201cit\u201d is \u2013 unfolds\u2019.<\/p>\n<\/div>\n

\n

Conclusion<\/h2>\n<\/div>\n
\n

In this survey, we have argued that three anthropological approaches \u2013 critique, translation, and reform \u2013 have typically framed the intersection of anthropology and medical humanitarian action. To do so, we detailed the overlapping values and histories of medical anthropology and humanitarianism, highlighting how disciplinary origins feed into contemporary norms of engagement. We have also examined the typologies of anthropological participation, suggesting that ethnography can offer a unique framework by which to understand health and medical issues in the context of humanitarianism.<\/p>\n<\/div>\n

\n

We do not wish to privilege or prioritize one approach over others, but instead to identify and further extrapolate three axes upon which humanitarian action can be evaluated. Each category has an appropriate time and place, and individual anthropologists may switch between each of the three modes as circumstances merit. Medical humanitarianism will continue to shift in direction and purpose, and whether by critique, translation, or reform, anthropologists should take care to purposively entangle \u2013 and disentangle \u2013 these threads of action. Only then will anthropological ways of knowing continue to grow in value.<\/p>\n<\/div>\n

\n

About the authors<\/h2>\n<\/div>\n
\n

Isabel Beshar is a medical student at Stanford University School of Medicine. She received her MPhil in medical anthropology from the University of Oxford, where she studied as a 2014 American Rhodes Scholar. She previously worked as a consultant at Global Health Strategies, where she helped coordinate emergency response management of vector-borne diseases and women\u2019s health.<\/p>\n<\/div>\n

\n

Darryl Stellmach divides time between academic and applied roles, as a postdoctoral researcher at the University of Sydney and as anthropology implementer for the London office of the aid group M\u00e9decins Sans Fronti\u00e8res (MSF). A former field manager for MSF, Darryl assists with the integration of anthropologists and anthropological research techniques into the agency\u2019s field teams. A Commonwealth doctoral scholar, Darryl\u2019s 2016 dissertation undertook an ethnography that followed MSF aid practitioners in South Sudan as they responded to that country\u2019s emergent civil war and subsequent nutritional crisis.<\/p>\n<\/div>\n

<\/div>\n
References\u00a0<\/strong><\/div>\n
\n

Abramowitz, Sharon. 2014. \u2018Ten Things That Anthropologists Can Do to Fight the West African Ebola Epidemic\u2019. Somatosphere: Science, Medicine, and Anthropology, 26 September. http:\/\/somatosphere.net\/2014\/09\/ten-things-that-anthropologists-can-do-to-fight-the-west-african-ebola-epidemic.html<\/a>.<\/p>\n

Abramowitz, Sharon. 2015. \u2018What Happens When MSF Leaves? Humanitarian Departure and Medical Sovereignty in Postconflict Liberia\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 137\u201354. Philadelphia: University of Pennsylvania Press. https:\/\/doi.org\/10.9783\/9780812291698-009<\/a>.<\/p>\n

Abramowitz, Sharon, Kevin L. Bardosh, Melissa Leach, Barry Hewlett, Mark Nichter, and Vinh-Kim Nguyen. 2015. \u2018Social Science Intelligence in the Global Ebola Response\u2019. Lancet 385, no. 9965: 330. https:\/\/doi.org\/10.1016\/s0140-6736(15)60119-2<\/a>.<\/p>\n

Abramowitz, Sharon, Meredith Marten, and Catherine Panter-Brick. 2015b. \u2018Medical Humanitarianism: Anthropologists Speak Out on Policy and Practice\u2019. Medical Anthropology Quarterly 29, no. 1: 1\u201323. https:\/\/doi.org\/10.1111\/maq.12139<\/a>.<\/p>\n

Abramowitz, Sharon, and Catherine Panter-Brick. 2015. \u2018Bringing Life into Relief: Comparative Ethnographies of Humanitarian Practice\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 1\u201320. Philadelphia: University of Pennsylvania Press.<\/p>\n

Adams, Vincanne. 2013. \u2018Evidence-Based Global Public Health: Subjects, Profits, Erasures\u2019. In When People Come First: Critical Studies in Global Health, edited by Joao Biehl and Adriana Petryna, 54\u201390. Princeton, NJ: Princeton University Press.<\/p>\n

Adams, Vincanne, Nancy J. Burke, and Ian Whitmarsh. 2014. \u2018Slow Research: Thoughts for a Movement in Global Health\u2019. Medical Anthropology 33, no. 3: 179\u201397. https:\/\/doi.org\/10.1080\/01459740.2013.858335<\/a>.<\/p>\n

Agier, Michel, and Fran\u00e7oise Bouchet-Saulnier. 2004. \u2018Humanitarian Spaces: Spaces of Exception\u2019. In In the Shadow of \u2018Just Wars\u2019: Violence, Politics, and Humanitarian Action, edited by Fabrice Weissman, 297\u2013313. Ithaca, NY: Cornell University Press.<\/p>\n

Alli\u00e9, Marie-Pierre. 2011. \u2018Introduction: Acting at Any Price?\u2019 In Humanitarian Negotiations Revealed: The MSF Experience, edited by Claire Magone, Micha\u00ebl Neuman, and Fabrice Weissman, 1\u201316. London: Hurst & Company.<\/p>\n

Appadurai, Arjun. 2003. \u2018Sovereignty Without Territoriality: Notes for a Postnational Geography\u2019. In The Anthropology of Space and Place: Locating Culture, edited by Setha M. Low and Denise Lawrence-Z\u00fa\u00f1iga, 337\u201349. Blackwell Readers in Anthropology. Malden, MA: Wiley-Blackwell.<\/p>\n

Asad, Talal. 1991. \u2018Afterword: From the History of Colonial Anthropology to the Anthropology of Western Hegemony\u2019. In Colonial Situations: Essays on the Contextualization of Ethnographic Knowledge, edited by George W. Stocking, Jr., 314\u201324. History of Anthropology 7. Madison: The University of Wisconsin Press.<\/p>\n

Baker, Elsie, and Widney Brown. 2015. Doctors in the Crosshairs: Four Years of Attacks on Health Care in Syria. New York: Physicians for Human Rights. https:\/\/s3.amazonaws.com\/PHR_Reports\/doctors-in-the-crosshairs.pdf<\/a>.<\/p>\n

Barnett, Michael N. 2011. Empire of Humanity: A History of Humanitarianism. Ithaca, NY: Cornell University Press.<\/p>\n

Bass, Gary. 2008. Freedom\u2019s Battle: The Origins of Humanitarian Intervention. New York: Alfred A. Knopf.<\/p>\n

Berry, Nicole S. 2014. \u2018Did We Do Good? NGOs, Conflicts of Interest and the Evaluation of Short-Term Medical Missions in Solol\u00e1, Guatemala\u2019. Social Science & Medicine 120: 344\u201351. https:\/\/doi.org\/10.1016\/j.socscimed.2014.05.006<\/a>.<\/p>\n

Biruk, Crystal. 2014. \u2018Ebola and Emergency Anthropology: The View from the \u201cGlobal Health Slot\u201d\u2019. Somatosphere: Science, Medicine, and Anthropology, 3 October. http:\/\/somatosphere.net\/2014\/10\/ebola-and-emergency-anthropology-the-view-from-the-global-health-slot.html<\/a>.<\/p>\n

Brown, Hannah, Ann H. Kelly, Almudena Mar\u00ed S\u00e1ez, Elisabeth Fichet-Calvet, Rashid Ansumana, Jesse Bonwitt, N\u2019Faly Magassouba, Foday Sahr, and Matthias Borchert. 2015. \u2018Extending the \u201cSocial\u201d: Anthropological Contributions to the Study of Viral Haemorrhagic Fevers\u2019. PLoS Neglected Tropical Diease 9, no. 4: e0003651. https:\/\/doi.org\/10.1371\/journal.pntd.0003775<\/a>.<\/p>\n

Brun, Catherine, and Chamila Attanapola. 2014. Professionalisation of Humanitarian Work: The Norwegian Case. European Universities on Professionalization on Humanitarian Action (EUPRHA). http:\/\/hamap.eu\/upload\/2015\/03\/euprha-lcp-norway.pdf<\/a>.<\/p>\n

Calhoun, Craig. 2004. \u2018A World of Emergencies: Fear, Intervention, and the Limits of Cosmopolitan Order\u2019. Canadian Review of Sociology\/Revue Canadienne de Sociologie 41, no. 4: 373\u201395. https:\/\/doi.org\/10.1111\/j.1755-618X.2004.tb00783.x<\/a>.<\/p>\n

Callon, Michel. 1986. \u2018Some Elements of a Sociology of Translation: Domestication of the Scallops and the Fishermen of St. Brieuc Bay\u2019. Sociological Review 32, no. S1: 196\u2013223. https:\/\/doi.org\/10.1111\/j.1467-954X.1984.tb00113.x<\/a>.<\/p>\n

Davey, Eleanor, and Kim Scriven. 2015. \u2018Humanitarian Aid in the Archives: Introduction\u2019. Disasters 39, no. s2: s113\u201328. https:\/\/doi.org\/10.1111\/disa.12150<\/a>.<\/p>\n

de Waal, Alex. 1997. Famine Crimes: Politics & the Disaster Relief Industry in Africa. Bloomington: Indiana University Press.<\/p>\n

Dijkzeul, Dennis, and Claude Iguma Wakenge. 2010. \u2018Doing Good, but Looking Bad? Local Perceptions of Two Humanitarian Organisations in Eastern Democratic Republic of the Congo\u2019. Disasters 34, no. 4: 1139\u201370. https:\/\/doi.org\/10.1111\/j.1467-7717.2010.01187.x<\/a>.<\/p>\n

Dunn, Elizabeth Cullen. 2012. The Chaos of Humanitarian Aid: Adhocracy in the Republic of Georgia 3, no. 1: 1\u201323. https:\/\/doi.org\/10.1353\/hum.2012.0005<\/a>.<\/p>\n

Elbe, Stefan. 2011. \u2018Pandemics on the Radar Screen: Health Security, Infectious Disease and the Medicalisation of Insecurity\u2019. Political Studies 59, no. 4: 848\u201366. https:\/\/doi.org\/10.1111\/j.1467-9248.2011.00921.x<\/a><\/p>\n

Erikson, Susan. 2012. \u2018Global Health Business: The Production and Performativity of Statistics in Sierra Leone and Germany\u2019. Medical Anthropology 31, no. 4: 367\u201384. https:\/\/doi.org\/10.1080\/01459740.2011.621908<\/a>.<\/p>\n

Eriksen, Thomas Hylland. 2006. Engaging Anthropology: The Case for a Public Presence. Oxford: Berg.<\/p>\n

Escobar, Arturo. 1995. Encountering Development: The Making and Unmaking of the Third World. Princeton, NJ: Princeton University Press.European Commission. 2015.<\/p>\n

\u2018European Commission Press Release: Record EU Humanitarian Budget Adopted for 2016\u2019. News release, 16 December. http:\/\/europa.eu\/rapid\/press-release_IP-15-6336_en.htm<\/a>.<\/p>\n

Fassin, Didier. 2000. \u2018Entre politiques du vivant et politiques de la vie: Pour une anthropologie de la sant\u00e9\u2019. Anthropologie et soci\u00e9t\u00e9s 24, no. 1: 95\u2013116. https:\/\/doi.org\/10.7202\/015638ar<\/a>.<\/p>\n

Fassin, Didier. 2005. \u2018Compassion and Repression: The Moral Economy of Immigration Policies in France\u2019. Cultural Anthropology 20, no. 3: 362\u201387. https:\/\/doi.org\/10.1525\/can.2005.20.3.362<\/a><\/p>\n

Fassin, Didier. 2012. Humanitarian Reason: A Moral History of the Present. Berkeley: University of California Press.<\/p>\n

Fassin, Didier, and Mariella Pandolfi. 2010. \u2018Introduction: Military and Humanitarian Government in the Age of Intervention\u2019. In Contemporary States of Emergency: The Politics of Military and Humanitarian Interventions, edited by Didier Fassin and Mariella Pandolfi, 9\u201325. New York: Zone Books.<\/p>\n

Feierman, Steven, Arthur Kleinman, Kathleen Stewart, Paul Farmer, and Veena Das. 2010. \u2018Anthropology, Knowledge-Flows and Global Health\u2019. Global Public Health 5, no. 2: 122\u201328. https:\/\/doi.org\/10.1080\/17441690903401338<\/a>.<\/p>\n

Feldman, Ilana, and Miriam Ticktin. 2010. \u2018Introduction: Government and Humanity\u2019. In In the Name of Humanity: The Government of Threat and Care, edited by Ilana Feldman and Miriam Ticktin, 1\u201326. Durham, NC: Duke University Press.<\/p>\n

Ferguson, James. 1990. The Anti-Politics Machine: \u2018Development\u2019, Depoliticization and Bureaucratic Power in Lesotho. Cambridge: Cambridge University Press.<\/p>\n

Fisher, William F. 1997. \u2018Doing Good? The Politics and Antipolitics of NGO Practices\u2019. Annual Review of Anthropology, 439\u201364. https:\/\/doi.org\/10.1146\/annurev.anthro.26.1.439<\/a>.<\/p>\n

Gaines, Atwood D. 2011. \u2018Millennial Medical Anthropology: From There to Here and Beyond, or the Problem of Global Health\u2019. Culture, Medicine, and Psychiatry 35, no. 1: 83\u201389. https:\/\/doi.org\/10.1007\/s11013-010-9203-x<\/a>.<\/p>\n

Garrett, Laurie. 2013. Existential Challenges to Global Health. New York: Center on International Cooperation, New York University. http:\/\/www.dphu.org\/uploads\/attachements\/books\/books_1015_0.pdf<\/a><\/p>\n

Gilman, Nils. 2012. \u2018Preface: Militarism and Humanitarianism\u2019. Humanity: An International Journal of Human Rights, Humanitarianism, and Development 3, no. 2: 173\u201378. https:\/\/doi.org\/10.1353\/hum.2012.0009<\/a>.<\/p>\n

Good, Byron J., Jesse Hession Grayman, and Mary-Jo DelVecchio Good. 2015. \u2018Humanitarianism and \u201cMobile Sovereignty\u201d in Strong State Settings: Reflections on Medical Humanitarianism in Aceh, Indonesia\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 155\u201375. Philadelphia: University of Pennsylvania Press.<\/p>\n

Gordon, Stuart. 2015. \u2018The British Military Medical Services and Contested Humanitarianism\u2019. In Medical Humanitarianism: Ethnographies of Practice, edited by Sharon Abramowitz and Catherine Panter-Brick, 176\u201390. Philadelphia: University of Pennsylvania Press.<\/p>\n

Guyer, Jane I., Naveeda Khan, Juan Obarrio, Caroline Bledsoe, Julie Chu, Souleymane Bachir Diagne, Keith Hart, et al. 2010. \u2018Introduction: Number as Inventive Frontier\u2019. Anthropological Theory 10, no. 1\u20132: 36\u201361. https:\/\/doi.org\/10.1177\/1463499610365388<\/a>.<\/p>\n

Harragin, Simon. 2004. \u2018Relief and an Understanding of Local Knowledge: The Case of Southern Sudan\u2019. In Culture and Public Action, edited by Vijayendra Rao and Michael Walton, 281\u2013307. Stanford, CA: Stanford University Press.<\/p>\n

Harragin, Simon. 2012. Methodology: Informing L2GP with Insights from Anthropology. Copenhagen: Local to Global Protection. http:\/\/www.local2global.info\/wp-content\/uploads\/Methodolog_paper_final.pdf<\/a>.<\/p>\n

Harrell-Bond, Barbara E. 1986. Imposing Aid: Emergency Assistance to Refugees. Oxford: Oxford University Press Oxford.<\/p>\n

Haskell, Thomas L. 1985. \u2018Capitalism and the Origins of the Humanitarian Sensibility, Part 1\u2019. The American Historical Review 90, no. 2: 339\u201361. https:\/\/doi.org\/10.1086\/ahr\/90.2.339<\/a>.<\/p>\n

Henry, Doug. 2005. \u2018Anthropological Contributions to the Study of Disasters\u2019. In Disciplines, Disasters and Emergency Management: The Convergence of Concepts, Issues and Trends from the Research Literature, edited by David McEntire. Emittsburg, MD: Federal Emergency Management Agency. https:\/\/training.fema.gov\/hiedu\/aemrc\/booksdownload\/ddemtextbook\/<\/a>.<\/p>\n

Herrick, Clare. 2016. \u2018Global Health, Geographical Contingency, and Contingent Geographies\u2019. Annals of the American Association of Geographers 106, no. 3: 672\u201387. https:\/\/doi.org\/10.1080\/24694452.2016.1140017<\/a>.<\/p>\n

Inhorn, Marcia, and Emily Wentzell. 2012. \u2018Introduction: Medical Anthropology at the Intersections\u2019. In Medical Anthropology at the Intersections: Histories, Activisms and Futures, edited by Marcia Inhorn and Emily Wentzell, 1\u201322. Durham, NC: Duke University Press.<\/p>\n

Kent, Randolph C. 1987. Anatomy of Disaster Relief: The International Network in Action. London: Pinter Publishers.<\/p>\n

Kleinman, Arthur. 1982. \u2018The Teaching of Clinically Applied Medical Anthropology on a Psychiatric Consultation-Liaison Service\u2019. In Clinically Applied Anthropology: Anthropologists in Health Science Settings, edited by Noel J. Chrisman and Thomas W. Maretzki, 83\u2013115. Culture, Illness and Healing series, vol. 5. Dordrecht: Springer.<\/p>\n

Koplan, Jeffrey P., T. Christopher Bond, Michael H. Merson, K. Srinath Reddy, Mario Henry Rodriguez, Nelson K. Sewankambo, and Judith N. Wasserheit. 2009. \u2018Towards a Common Definition of Global Health\u2019. Lancet 373, no. 9679: 1993\u201395. https:\/\/doi.org\/10.1016\/S0140-6736(09)60332-9<\/a>.<\/p>\n

Lakoff, Andrew. 2010. \u2018Two Regimes of Global Health\u2019. Humanity: An International Journal of Human Rights, Humanitarianism, and Development 1, no. 1: 59\u201379. https:\/\/doi.org\/10.1353\/hum.2010.0001<\/a>.<\/p>\n

Lakoff, Andrew, Stephen J. Collier, and Christopher Kelty. 2015. \u2018Introduction: Ebola\u2019s Ecologies\u2019. Limn, no. 5. http:\/\/limn.it\/introduction-ebolas-ecologies<\/a>.<\/p>\n

Latour, Bruno. 1986. \u2018The Powers of Association\u2019. Sociological Review 32, no. S1: 264\u201380. https:\/\/doi.org\/10.1111\/j.1467-954X.1984.tb00115.x<\/a>.<\/p>\n

Latour, Bruno. 2014. \u2018Anthropology at the Time of the Anthropocene: A Personal View of What Is to Be Studied\u2019. Distinguished Lecture, American Anthropological Association Annual Meeting, Washington, DC, 6 December. http:\/\/sector2337.com\/wp-content\/uploads\/2015\/06\/Latour_Anthropocene.pdf<\/a>.<\/p>\n

Lewis, David. 2005. \u2018Anthropology and Development: The Uneasy Relationship\u2019. In A Handbook of Economic Anthropology, edited by James G. Carrier, 472\u201386. Cheltenham, UK: Edward Elgar.<\/p>\n

Macrae, Joanna. 2002. \u2018Analysis and Synthesis\u2019. In The New Humanitarianisms: A Review of Trends in Global Humanitarian Action, edited by Joanna Macrae, 5\u201318. London: Overseas Development Institute. https:\/\/www.odi.org\/resources\/docs\/293.pdf<\/a>.<\/p>\n

Magone, Claire, Michael Neuman, and Fabrice Weissman. 2011. Humanitarian Negotiations Revealed: The MSF Experience. Oxford: Oxford University Press.Malkki, Liisa H. 1995. Purity and Exile: Violence, Memory, and National Cosmology among Hutu Refugees in Tanzania. Chicago: University of Chicago Press.<\/p>\n

Malkki, Liisa H. 1996. \u2018Speechless Emissaries: Refugees, Humanitarianism, and Dehistoricization\u2019. Cultural Anthropology 11, no. 3: 377\u2013404. https:\/\/doi.org\/10.1525\/can.1996.11.3.02a00050<\/a>.<\/p>\n

Marcus, George. 2010. \u2018Experts, Reporters, Witnesses: The Making of Anthropologists in States of Emergency\u2019. In Contemporary States of Emergency: The Politics of Military and Humanitarian Intervention, edited by Didier Fassin and Mariella Pandolfi, 357\u201377. New York: Zone Books.<\/p>\n

M\u00e9decins Sans Fronti\u00e8res. 2016. \u2018About Us: We Speak Out\u2019. Updated 31 October. https:\/\/www.msf.org.uk\/advocacy-and-temoignage<\/a>.<\/p>\n

Minn, Pierre. 2007. \u2018Toward an Anthropology of Humanitarianism\u2019. Journal of Humanitarian Assistance, 6 August. https:\/\/sites.tufts.edu\/jha\/archives\/51<\/a>.<\/p>\n

Mosse, David. 2013. \u2018The Anthropology of International Development\u2019. Annual Review of Anthropology 42: 227\u201346. https:\/\/doi.org\/10.1146\/annurev-anthro-092412-155553<\/a>.<\/p>\n

Nading, Alex. 2015. \u2018Ebola, Chimeras, and Unexpected Speculation\u2019. Limn, no. 5. http:\/\/limn.it\/ebola-chimeras-and-unexpected-speculation\/<\/a>.<\/p>\n

Nguyen, Vinh-Kim. 2010. The Republic of Therapy: Triage and Sovereignty in West Africa\u2019s Time of AIDS. Durham, NC: Duke University Press.<\/p>\n

Nyamnjoh, Francis B. 2015. \u2018Beyond an Evangelising Public Anthropology: Science, Theory and Commitment\u2019. Journal of Contemporary African Studies 33, no. 1: 48\u201363. https:\/\/doi.org\/10.1080\/02589001.2015.1021214<\/a>.<\/p>\n

Oliver-Smith, Anthony. 1996. \u2018Anthropological Research on Hazards and Disasters\u2019. Annual Review of Anthropology, 303\u201328. https:\/\/doi.org\/10.1146\/annurev.anthro.25.1.303<\/a>.<\/p>\n

Overseas Development Institute (ODI). 2015. \u2018Global History of Modern Humanitarian Action\u2019. ODI: Shaping Policy for Development. https:\/\/www.odi.org\/projects\/2547-global-history-modern-humanitarian-action<\/a>.<\/p>\n

Packard, Randall M. 2016. A History of Global Health: Interventions into the Lives of Other Peoples. Baltimore, MD: Johns Hopkins University Press.<\/p>\n

Pandolfi, Mariella. 2003. \u2018Contract of Mutual (In)Difference: Governance and the Humanitarian Apparatus in Contemporary Albania and Kosovo\u2019. Indiana Journal of Global Legal Studies 10, no. 1: 369\u201381. http:\/\/www.repository.law.indiana.edu\/ijgls\/vol10\/iss1\/13<\/a>.<\/p>\n

Parker, Melissa, and Tim Allen. 2014. \u2018De-Politicizing Parasites: Reflections on Attempts to Control the Control of Neglected Tropical Diseases\u2019. Medical Anthropology 33, no. 3: 223\u201339. https:\/\/doi.org\/10.1080\/01459740.2013.831414<\/a>.<\/p>\n

Pigg, Stacy Leigh. 2013. \u2018On Sitting and Doing: Ethnography as Action in Global Health\u2019. Social Science & Medicine 99: 127\u201334. https:\/\/doi.org\/10.1016\/j.socscimed.2013.07.018<\/a>.<\/p>\n

Ralph Bunche Institute for International Studies. 2011. \u2018United Nations Intellectual History Project\u2019. http:\/\/www.unhistory.org\/<\/a>.<\/p>\n

Ravelo, Jenny Lei. 2015. \u2018Post-Ebola, What Work Awaits Anthropologists?\u2019 Devex: Do Good. Do It Well, 15 September.https:\/\/www.devex.com\/news\/post-ebola-what-work-awaits-anthropologists-86876<\/a>.<\/p>\n

Redfield, Peter. 2005. \u2018Doctors, Borders and Life in Crisis\u2019. Cultural Anthropology 20, no. 3: 328\u201361. https:\/\/doi.org\/10.1525\/can.2005.20.3.328<\/a>.<\/p>\n

Redfield, Peter. 2013. Life in Crisis: The Ethical Journey of Doctors Without Borders. Berkeley: University of California Press.<\/p>\n<\/div>\n

<\/div>\n
\n

Robbins, Joel. 2013. \u2018Beyond the Suffering Subject: Toward an Anthropology of the Good\u2019. Journal of the Royal Anthropological Institute 19, no. 3: 447\u201362. https:\/\/doi.org\/10.1111\/1467-9655.12044<\/a>.Sangaramoorthy, Thurka. 2012. \u2018Treating the Numbers: HIV\/AIDS Surveillance, Subjectivity, and Risk\u2019. Medical Anthropology 31, no. 4: 292\u2013309. https:\/\/doi.org\/10.1080\/01459740.2011.622322<\/a>.<\/p>\n

Save the Children International. 2016. \u2018Our Finances and Annual Review\u2019. Save the Children International. https:\/\/www.savethechildren.net\/about-us\/our-finances<\/a>.<\/p>\n

Scheper-Hughes, Nancy. 1995. \u2018The Primacy of the Ethical: Propositions for a Militant Anthropology\u2019. Current Anthropology 36, no. 3: 409\u201340. https:\/\/doi.org\/10.1086\/204378<\/a>.<\/p>\n

Scott-Smith, T. 2014. \u2018Control and Biopower in Contemporary Humanitarian Aid: The Case of Supplementary Feeding\u2019. Journal of Refugee Studies 28, no. 1: 21\u201337. https:\/\/doi.org\/10.1093\/jrs\/feu018<\/a>.<\/p>\n

Sridhar, Devi. 2011. \u2018Health Policy: From the Clinical to the Economic Gaze\u2019. The Lancet 378, no. 9807: 1909. https:\/\/doi.org\/10.1016\/S0140-6736(11)61829-1<\/a>.<\/p>\n

Stellmach, Darryl. 2016. \u2018Coordination in Crisis: The Practice of Medical Humanitarian Emergency\u2019. DPhil diss., University of Oxford. https:\/\/ora.ox.ac.uk\/objects\/uuid:c81d8b4a-4e73-4bbb-b66f-7c84885ab9b8<\/a>.<\/p>\n

Strathern, Andrew, and Pamela J. Stewart. 1999. Curing and Healing: Medical Anthropology in Global Perspective. Durham, NC: Carolina Academic Press.<\/p>\n

Terry, Fiona. 2002. Condemmed to Repeat? The Paradox of Humanitarian Action. Ithaca, NY: Cornell University Press.<\/p>\n

Ticktin, Miriam. 2011. \u2018The Gendered Human of Humanitarianism: Medicalising and Politicising Sexual Violence\u2019. Gender & History 23, no. 2: 250\u201365. https:\/\/doi.org\/10.1111\/j.1468-0424.2011.01637.x<\/a>.<\/p>\n

Ticktin, Miriam. 2014. \u2018Transnational Humanitarianism\u2019. Annual Review of Anthropology 43: 273\u201389. https:\/\/doi.org\/10.1146\/annurev-anthro-102313-030403<\/a>.<\/p>\n

Tol, Wietse A., Vikram Patel, Mark Tomlinson, Florence Baingana, Ananda Galappatti, Derrick Silove, Egbert Sondorp, Mark Van Ommeren, Michael G. Wessells, and Catherine Panter-Brick. 2012. \u2018Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings\u2019. Harvard Review of Psychiatry 20, no. 1: 25\u201336. https:\/\/doi.org\/10.3109%2F10673229.2012.649113<\/a>.<\/p>\n

Trouillot, Michel-Rolph. (1991) 2003. Global Transformations: Anthropology and the Modern World. New York: Palgrave Macmillan.<\/p>\n

Vaux, Tony. 2001. The Selfish Altruist: Relief Work in Famine and War. Abingdon, UK: Earthscan.<\/p>\n

V\u00e9ran, Jean-Francois, Beverly Stringer, and Doris Burtscher. 2017. \u2018Anthropology in Humanitarian Situations: An Overview of MSF Experience\u2019. Unpublished manuscript.<\/p>\n

Walker, Peter. 2005. \u2018Cracking the Code: The Genesis, Use and Future of the Code of Conduct\u2019. Disasters 29, no. 4: 323\u201336. https:\/\/doi.org\/10.1111\/j.0361-3666.2005.00295.x<\/a>.<\/p>\n

Walker, Peter, Karen Hein, Catherine Russ, Greg Bertleff, and Dan Caspersz. 2010. \u2018A Blueprint for Professionalizing Humanitarian Assistance\u2019. Health Affairs 29, no. 12: 2223\u201330. https:\/\/doi.org\/10.1377\/hlthaff.2010.1023<\/a>.<\/p>\n

WHO (World Health Organization). 2004. \u2018Monitoring and Evaluation Toolkit\u2019. Geneva: World Health Organization. http:\/\/www.who.int\/hiv\/pub\/epidemiology\/en\/me_toolkit_en.pdf?ua=1<\/a>.<\/p>\n

WHO. 2016. \u2018Attacks on Healthcare: Prevent, Protect, Provide\u2019. Geneva: World Health Organization. http:\/\/who.int\/hac\/techguidance\/attacksreport.pdf?ua=1<\/a>.<\/p>\n<\/div>\n

\n

Endnotes<\/p>\n<\/div>\n

\n

1 Back<\/a><\/p>\n<\/div>\n

\n

Photographer’s note: Three years after the beginning of the conflict, Leer and Mayendit counties are greatly affected by the ongoing violence and the longstanding clashes between governmental and opposition forces. Civilians are on the first line of the conflict and the ongoing violence has a very clear impact on the ability for the population to access basic and secondary medical care and other basic services. The population has been locally displaced multiple times; and many people had fled the area completely.<\/p>\n<\/div>\n

\n

In July, following clashes in Leer County, the population again had to flee and M\u00e9decins Sans Fronti\u00e8res (MSF) had to evacuate international teams from both Leer and Thonyor. In September MSF set up a decentralised basic healthcare programme to continue to reach the population and provide them with primary healthcare in their villages. Through a network of community health workers, community health promoters, and women health promoters, who live as part of the affected population, MSF teams have been able to continue to provide healthcare. These community health workers are trained in treating the most common morbidities, such as respiratory tract infections, malaria, water-borne diseases, etc. They stay with the community and are able to move with the communities if the population need to move, thus continuing to provide healthcare. MSF resupplies them with medical supplies and provides ongoing supervision and training through supporting international teams.<\/p>\n<\/div>\n

\n

2 Back<\/a><\/p>\n<\/div>\n

\n

This is not to say that humanitarian actors and agencies themselves have not engaged in a tradition of self-critique. According to Davey and Scriven (2015, 115), medical humanitarianism \u2018cannot be accused of an unwillingness to reflect on its performance, be it through formal processes of research and evaluation or the collect decompression of a bar-side lament\u2019. Examples can be found in the work of Vaux (2001), Terry (2002), and recent multilateral projects, including the United Nations Intellectual History Project and Global History of Humanitarian Action Project (Ralph Bunche Institute for International Studies 2011; ODI 2015).<\/p>\n<\/div>\n

\n

3 Back<\/a><\/p>\n<\/div>\n

\n

Although some authors contest this assertion \u2013 such as Dunn (2012, 1\u20132), who argues that the reach and nefarious nature of humanitarian ventures are dangerously overstated \u2013 the notion of humanitarianism as subversion through compassion has had influential effect.<\/p>\n<\/div>\n

\n

4 Back<\/a><\/p>\n<\/div>\n

\n

Marcus\u2019s call for anthropologists to \u2018witness\u2019 has clear parallels to the humanitarian commitments of neutrality or t\u00e9moignage (translated as \u2018bearing witness\u2019), as is typically invoked by MSF (2016; see also Redfield 2005 on MSF as \u2018a less modest witness\u2019). This is particularly the case because t\u00e9moignage does not just imply watchful observation, but also the obligation and responsibility to speak on behalf of those in danger. In that sense, humanitarian actors, like anthropologists, are also negotiators: operating in a simultaneous cycle of creating \u2013 and then sacrificing \u2013 \u2018neutral\u2019 humanitarian spaces (Barnett 2011, 224). This interpretation of t\u00e9moignage turns MSF\u2019s own moniker (\u2018without borders\u2019) on its head, positioning humanitarian actors precisely at the borders \u2013 between observation and action, outside and inside \u2013 not \u2018without\u2019 them.<\/p>\n<\/div>\n

\n

5 Back<\/a><\/p>\n<\/div>\n

\n

Trouillot ([1991] 2003, 18) was the first to coin the term \u2018slot\u2019 in reference to anthropological tropes, faulting anthropology for choosing as its disciplinary penchant \u2018the savage, the primitive . . . the other\u2019, arguing that the discipline\u2019s survival depended on breaking past this limited niche and narrow object of inquiry.<\/p>\n<\/div>\n

\n

6 Back<\/a><\/p>\n<\/div>\n

\n

Anthropologies of global health are one example among many. For example, applied anthropologists and anthropologists of development have also contributed key insights into how anthropologists can work within global institutions. See Mosse 2013.<\/p>\n<\/div>\n

\n

CITATION\/ATTRIBUTION<\/p>\n<\/div>\n

\n

Beshar, I., & Stellmach, D. (2017). Anthropological approaches to medical humanitarianism. Medicine Anthropology Theory, 4(5). https:\/\/doi.org\/10.17157\/mat.4.5.477<\/p>\n<\/div>\n<\/div>\n","protected":false},"author":101,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-414","chapter","type-chapter","status-publish","hentry"],"part":368,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/chapters\/414","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/wp\/v2\/users\/101"}],"version-history":[{"count":7,"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/chapters\/414\/revisions"}],"predecessor-version":[{"id":580,"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/chapters\/414\/revisions\/580"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/parts\/368"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/chapters\/414\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/wp\/v2\/media?parent=414"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/pressbooks\/v2\/chapter-type?post=414"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/wp\/v2\/contributor?post=414"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/ppscant2550medicalanthropology\/wp-json\/wp\/v2\/license?post=414"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}