THE UNBEARABLE LIGHTNESS OF EX-PATS: Double Binds of Humanitarian Mobility

Abstract

This article addresses legacies of national origin within global forms. Focusing on tensions related to human resources, I consider the case of the humanitarian organization Médecins Sans Frontières (MSF, or Doctors Without Borders). Since 1971, MSF has grown into a large, transnational NGO sponsoring a variety of medical projects worldwide. Amid recent efforts to “decolonize” its human profile, MSF has debated the appropriate role, motivation and remuneration of both international volunteers and local support staff it hires at mission sites. Given the different degrees of ease with which situated persons can travel, the organization's conflicting impulses place it in a classic double bind: to remain mobile it must limit local attachments, while to achieve equality it must embrace them. The figure of the ex‐patriate thus suggests a mundane but precise measure for the threshold of inequality.

Donor data vacuuming

“…These 'outside' advisors, with agendas to serve their home governments, wield considerable power and represent donor interests (Redfield 2012). This power imbalance in what should be country-led processes, has produced, in many cases, the veritable silencing of ministry of health employees when key decisions concerning tools and strategies are made.…”

Stuck in Ruins, or Up and Coming? The Shifting Geography of Urban Public Health Research in Kisumu, Kenya

“…None expressed the desire to work for Kenyan government institutions despite their anxiety associated with short-term contracts, and almost all dreamt instead of employment with international organizations, preferably as expatriates abroad, seeking to escape from what they perceived as a society eroded by lack of resources and opportunity, self-interest and corruption (see also Redfield 2012). One particularly critical study manager summarized issues others had raised in less pointed language:…”

James Bond and Global Health Diplomacy

“…23 Even players such as Medicins sans Frontieres (MSF) and the World Health Organization (WHO), despite their exclusively apolitical manifestoes, cannot hope to avoid some form of non-health influence, partisanship, or even (in the case of MSF) potentially offensive elitism. 24 At the individual level, even non-political global health representatives are frequently presented with opportunities to design and deliver recommendations and programmatic adaptations that address or report on both health and non-health (eg, political, social or economic) goals in concert with each other. 25 Even more fundamentally, such personnel are implicitly responsible for North-South relations in their comportment, behaviours and personal diplomacy when operating overseas.…”

“…Rather than advocating for greater delineation on this basis, fields such as GHD, under certain interpretations, 28 attempt to resolve these tensions by encouraging, leveraging and making explicit such overlaps from the "smart power" perspective, employing altruistic operations to pursue broader non-health goals including international security. 24 GHD can therefore be leveraged to pursue global "goods" unrelated to health programs -a benign force, as long as it is not manipulated into pursuing global "bads" via rapacious foreign policiesand, even then, remains a better route than violent conflict. Is there, then, a "right" way for global health to interact with international politics, intelligence and diplomacy?…”