A New Medical Mission to El Salvador

Geiger, Jack; Eisenberg, Carola; Gloyd, Stephen; Quiroga, José; Schlenker, Thomas; Scrimshaw, Nevin S.; Devin, Julia

doi:10.1056/nejm198910193211629

Cited by 15 publications

(6 citation statements)

References 3 publications

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“…Our review identified that the primary challenges to neutrality were perceptions that humanitarian assistance was innately political (Fouad et al 2017;Geiger et al 1989;Madhiwalla and Roy 2009) and that the very act of working in conflict settings implied some type of political affiliation (Rieffer-Flanagan 2009). Military and political interventions operating under the guise of humanitarian aid can lead combatants or beneficiaries to doubt the neutrality of humanitarian organizations (Asgary 2015;Clarinval and Biller-Andorno 2014;Cobey et al 1993;Duffield et al 2012;Egeland et al 2011;Gastineau Campos and Farmer 2003).…”

Section: Humanitarian Principles and Challengesmentioning

confidence: 99%

“…Maintaining neutrality can also be difficult for organizations whose workers have experienced violence, threats, or compulsion, or have borne witness to violence or advocated on behalf of victims of atrocities (Blair 1996;Burkle Jr. et al 2017;Civaner et al 2017;Farré 2013;Geiger et al 1989;Slim 1997b). Organizational members' own personal political views could also affect perceptions of organizational neutrality (Jones 2009).…”

Section: Humanitarian Principles and Challengesmentioning

confidence: 99%

“…These pressures could include extortionary negotiations demanding preferential treatment to gain access for combatants (Fennell 1998) and criminalization of providing aid to certain groups (Fouad et al 2017). When threats to impartiality result in aid given to combatants (e.g., when threats of violence force health care workers to provide aid to combatants to prevent worse harm to others), organizations and workers may believe they are complicit in prolonging conflict (Fink 2007) and/or have violated their duty to be impartial (Geiger et al 1989;Madhiwalla and Roy 2009). This can also result in restricting programs to more secure areas regardless of the needs of people living in insecure areas (Haver 2016).…”

Section: Humanitarian Principles and Challengesmentioning

confidence: 99%

“…Societal breakdowns, the loss of normal order, and punitive actions against humanitarian organizations severely limit their ability to fulfill their duty of humanity (Al-Moujahed et al 2017;Fouad et al 2017;Haver 2016;Poffley 2012). Violent threats, abduction, torture, and murder of humanitarian workers; blockade and theft of materials and supplies; and the elimination of access to or destruction of facilities also drastically impede humanitarian missions (Alderslade 1995;Blair 1996;Cobey et al 1993;Fennell 1998;Fouad et al 2017;Geiger et al 1989;Haver 2016;Madhiwalla and Roy 2009;Redwood-Campbell et al 2014). Efforts to avoid violence, such as concentrating operations in safe or comparatively secure areas, preclude access or attention to the most vulnerable and in need (Haver 2016).…”

Section: Humanitarian Principles and Challengesmentioning

confidence: 99%

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Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review

Broussard

Rubenstein

Robinson

et al. 2019

Int J Humanitarian Action

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Background: Humanitarian health care organizations and health workers working in contexts of armed or violent conflict experience challenges in fulfilling ethical obligations and humanitarian principles. To better understand the types of challenges experienced in these contexts, we conducted a systematic literature review. Methods: A broad search strategy was developed for English language publications available in PubMed, Ovid/ EMBASE, and Scopus. The search relied upon three key concept blocks: conflict settings, humanitarian or relief organizations, and non-clinical or non-military ethics. To be included, publications had to (1) refer implicitly or explicitly to ethics and/or humanitarian principle(s), (2) relate to non-military relief work in active conflict or conflictaffected settings, (3) relate to organizational mission and/or delivery of services, and (4) relate to events after 1900. Records were qualitatively analyzed using an emergent thematic analysis approach that mapped challenges onto recognized ethical obligations and humanitarian principles. Results: A total of 66 out of a possible 2077 retrieved records met inclusion criteria. The most frequently noted ethical challenges for organizations working in conflict settings were (1) providing the highest attainable quality of care, (2) protecting workers, and (3) minimizing unintended harms. The humanitarian principle most frequently noted as challenging to uphold was neutrality (the duty that humanitarian actors must not take sides in a conflict). Ethical challenges and humanitarian principles were commonly co-coded. For example, the challenge of providing the highest attainable quality of care frequently intersected with the humanitarian principle of humanity. Conclusions: By categorizing the types of ethical challenges experienced by humanitarian care organizations, this review can help organizations anticipate issues that might arise in conflict settings. The identified relationships between ethical challenges and humanitarian principles suggests that frameworks and guidance for ethical decision-making, if adapted for conflict settings, could support organizational capacity to fulfill ethical and humanitarian commitments.

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