Aid workers should talk to the Taliban about health care

by Paul Harvey | Humanitarian Outcomes
Friday, 7 March 2014 14:44 GMT

An Afghan woman waits to receive aid as she stands behind the door of the Afghanistan Chamber of Commerce and Industries during Ramadan in Kabul, Aug. 1, 2013. REUTERS/Mohammad Ismail

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

To meet the needs of citizens in crises, we must engage with those causing the problems

There’s nothing like being insulting to kick off a really good discussion. So, having been rude to Medicins Sans Frontieres (MSF), I now need to respond to their comeback and to the contribution by Simon Levine of the Overseas Development Institute to a burgeoning debate.

I think I should start with an explanation of why I talked about MSF’s original blog being an example of ‘sanctimonious polemic’. This wasn’t just me being snarky and trying to drum up interest - there were some serious points behind it.

I feel that MSF does in some of its communications (both written and in tedious coordination meetings) have a tendency to holier-than-thou infallibility. This matters because it risks undermining some of the important things they are often saying about the failures of humanitarian response.

No one likes being told off by someone who thinks they are always right, and this approach fails to acknowledge the difficult dilemmas that are core to humanitarian debates. It’s also frustrating because MSF is famous for the fierceness of its internal debates about these issues, and bringing more of that into the open would be welcome.

But back to the substance of the arguments. At the core of MSF’s concerns about resilience is their feeling that the humanitarian capacity of other organisations is shrinking. The trouble here is that MSF end up in something of an evidence-free fire zone. 

Resilience, multi-mandate distractions and value for money all end up being blamed for a perceived erosion of capacity. The first problem with this is that it’s far from clear that capacity is shrinking. At the global level both the numbers of humanitarian personnel and the overall humanitarian spend have been consistently growing.

MSF might respond that there are growing numbers of people doing the wrong thing in the wrong places, but the evidence is definitely thin. We hope that a DFID-funded, Humanitarian Outcomes-led research programme just starting on aid in insecure environments will provide more evidence.

The second problem is that it’s far from clear that, where there are failures in response, MSF are right to blame resilience et al. For starters many agencies have always been multi-mandate and have spent 20 years trying to link relief and development, so it’s not clear what has changed that would have eroded capacity.

I’d argue that the failures of response in particular places at particular times, and shifting resources and capacities in particular organisations and sectors, need to be interrogated on their own terms rather than blamed on convenient scapegoats. So rather than pointing the finger at resilience, we need to look at what led to failures in Central African Republic or what’s happened to capacities in the water and sanitation (WASH) sector.


Much of MSF’s response claims that thinking long-term risks being a distraction from the immediacy of critical short-term needs. More fundamentally, a focus on resilience and engagement with the state risks undermining access by putting perceived neutrality at risk.

They note: “We have not heard anyone talking about 'resilience building' in Taliban-controlled parts of Afghanistan or Al Shabaab parts of Somalia.” It would certainly be difficult to engage Al Shabaab or the Taliban around their responsibility to deliver health services in the areas they control, not least in the context of Western donor terrorism designations. But I’d argue that, difficult as it is, that’s precisely what part of humanitarian action should be about.

It’s the long, difficult and often fruitless haul of arguing with warring parties to respect international humanitarian law and human rights, pointing to their responsibilities to assist and protect civilians, and reminding Western donors that humanitarian action fundamentally relies on being able to talk to all sides in a conflict.

Otherwise, we’re letting warring parties off the hook and effectively saying, “Fight as nastily as you like, with no concern for civilians and we’ll pick up the pieces”.

As Simon notes, there’s a tendency in these debates to fall back into false binary choices and frame things in either/or terms. Either you’re a pure humanitarian or multi-mandate; either you work with the state or you don’t; and either you embrace resilience or reject it.

MSF’s argument is that humanitarian and more developmental approaches should be entirely separate and that any focus on the longer term risks eroding capacity for meeting immediate needs.

I’d argue that the long haul of principled engagement with states and other parties to conflicts about their responsibilities in the conduct of war and the needs of civilians must remain a core part of humanitarian action. And that this, in some contexts, might include approaches that attempt to developmentally build the resilience of local systems for service delivery, both state and non-state.